Chapter 68: Childhood Immunization

An otherwise healthy child receives a varicella virus vaccine. Three weeks later the parent calls to report that the child has a mild case of chickenpox and wonders how this could happen after the vaccination. What will the nurse tell the parent? a. "A varicella-like rash can occur after the vaccine is given." b. "The vaccine was probably ineffective." c. "This represents a serious vaccine side effect." d. "Give the child aspirin to treat any fever that may occur."

"A varicella-like rash can occur after the vaccine is given."

The parent of a 2-month-old infant who has just received the first dose of DTaP asks the nurse about expected reactions to the vaccine. The nurse will respond by saying that: a. "Mild reactions, including a low-grade fever, are common." b. "Most children do not experience any reaction." c. "Seizures are common and may require anticonvulsant medication." d. "The most common reaction is a rash that develops into itchy vesicles."

"Mild reactions, including a low-grade fever, are common."

A 1-year-old child is scheduled to receive the MMR vaccine, pneumococcal vaccine (PCV), Varivax, and hepatitis A vaccine. The child's parents request that the MMR vaccine not be given, saying that, even though there is no demonstrated link with autism, they are still concerned about toxic levels of mercury in the vaccine. Which response by the nurse is correct? a. "Most U.S.-made vaccines have zero to low amounts of mercury." b. "Other vaccine preparations contain mercury as well." c. "Thimerosal is a nontoxic form of mercury." d. "You can get more mercury from breast milk and many foods on the market."

"Most U.S.-made vaccines have zero to low amounts of mercury."

The parents of an infant who will be attending day care tell the nurse that they do not want their child vaccinated against rotavirus because an older cousin developed intussusception after receiving this vaccine. Which response by the nurse is correct? a. "Intussusception is much less serious than getting the disease." b. "It was probably just a coincidental reaction to the vaccine." c. "The newer vaccines for rotavirus are not associated with intussusception." d. "Your child will have herd immunity and won't need the vaccine."

"The newer vaccines for rotavirus are not associated with intussusception."

An immigrant child is in the clinic for MMR vaccination. The nurse learns that the child has recently received an immune globulin injection for a viral infection, currently has an upper respiratory infection with a temperature of 100° F, and has a recent history of thrombocytopenia, which has resolved. What does the nurse tell the child's parents? a. "The vaccine is contraindicated in this child because of the history of thrombocytopenia." b. "The child should be brought back for the vaccine when the temperature is back to normal." c. "The child is at increased risk of developing autism from this vaccine." d. "The vaccine must be postponed for 3 months after administration of the immune globulin."

"The vaccine must be postponed for 3 months after administration of the immune globulin."

The parent of a child who attends day care questions the need for Varivax. What will the nurse tell the parent? a. "Chickenpox is not as contagious as other communicable diseases." b. "The child will be protected by herd immunity and does not need the vaccine." c. "Varicella is an uncomfortable disease, but it is not that serious." d. "Varicella in adults can have serious consequences."

"Varicella in adults can have serious consequences."

A nurse is preparing to administer vaccines to a 1-year-old child. The parents ask the nurse to give the child acetaminophen before administering the vaccine to reduce the pain. Which response by the nurse is correct? a. "Children don't remember pain, so it isn't necessary to give acetaminophen." b. "The small needles used to inject the vaccines cause hardly any discomfort." c. "You can apply a topical anesthetic when you get home to reduce pain from the injection." d. "Your child's response to the vaccine may not be as effective if I give acetaminophen."

"Your child's response to the vaccine may not be as effective if I give acetaminophen."

Which are recommended measures to help minimize pain associated with vaccine administration? (Select all that apply.) a. Administer acetaminophen or ibuprofen before the vaccine is given. b. Apply a topical anesthetic to the injection site before the vaccine is given. c. Give intramuscular vaccines rapidly without aspiration. d. Have the child lie down while the vaccine is given. e. Provide tactile stimulation as a diversion.

Apply a topical anesthetic to the injection site before the vaccine is given. Give intramuscular vaccines rapidly without aspiration. Provide tactile stimulation as a diversion.

A 4 -year-old child who has been receiving high-dose systemic glucocorticoids for several months comes to a clinic for school immunizations, which usually include the DTaP vaccine; varicella virus vaccine (Varivax); the measles, mumps, and rubella virus (MMR) vaccine; and the inactivated poliovirus vaccine (IPV). The clinic nurse will expect to administer which vaccines to this child? a. All four school immunizations b. DTaP and IPV only c. DTaP, OPV, and Varivax only d. DTaP and IPV, along with immunoglobulins

DTaP and IPV only

The public health nurse is teaching a group of parents about immunizations. The nurse tells the parents that after receiving the varicella virus vaccine, children should temporarily avoid close contact with whom? (Select all that apply.) a. Neonates b. Siblings c. Relatives older than 65 years d. Pregnant women e. Individuals infected with HIV

Neonates Pregnant women Individuals infected with HIV

A 1-year-old child receives the MMR vaccine. The next day the child's parent calls the nurse to report that the child has a temperature of 103° F. What will the nurse do? a. File an adverse event report with the Vaccine Adverse Event Reporting System (VAERS). b. Notify the child's provider that thrombocytopenia is likely to occur. c. Reassure the parent that fever can occur with the MMR vaccine. d. Tell the parent to take the child to the emergency department.

Reassure the parent that fever can occur with the MMR vaccine.

An 11-year-old boy received all childhood immunizations before attending school as a kindergartner. Which vaccines are recommended for this child at his current age? a. DTaP, MCV4, Varivax b. PCV-23, Td, MMR c. Tdap, MCV4, HPV d. Tdap, Varivax, hepatitis B

Tdap, MCV4, HPV

A nurse at an immunization clinic is providing vaccines to children. The parent of a child waiting to receive vaccines tells the nurse that the child has an immune deficiency disorder. The nurse understands that which vaccine should not be administered to this child? a. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine b. Haemophilus influenzae type b (Hib) vaccine c. Polio injection d. Varicella virus vaccine

Varicella virus vaccine

A clinic nurse receives a phone call from a parent who states that a 2-month-old infant has a severe cough, a low-grade fever, and a runny nose that have lasted over a week. What will the nurse ask the parent? a. Whether the infant has had the first set of vaccines b. Whether the infant received a hepatitis B vaccine as a newborn c. Whether the infant attends day care d. Whether there is a family history of respiratory disorders

Whether the infant has had the first set of vaccines

The nurse at a public health infant immunization clinic is acting as a preceptor for a nursing student. To assess the student's understanding of vaccinations, the nurse asks the student where the hepatitis B vaccine (HepB) should be administered. The student would be correct to respond that the hepatitis B vaccine should be administered in the: a. dorsogluteal muscle in an adult. b. anterolateral thigh in infants. c. ventrogluteal muscle in adolescents. d. deltoid of toddlers.

anterolateral thigh in infants.

The parent of a child receiving the polio vaccine wants to know why the oral polio vaccine (OPV) is not given. The nurse will explain to this parent that the oral preparation: a. can cause paralytic poliomyelitis. b. contains antigens that increase allergic reactions. c. is less effective than the IPV. d. is more expensive to administer.

can cause paralytic poliomyelitis.