Immunization--Zerweck

A nurse has stuck herself with a needle while starting an IV. What prophylactic medication would the nurse anticipate receiving from the employee health department? 1. Hepatitis antitoxin 2. Immune gamma globulin 3. Hepatitis B immune globulin 4. Haemophilus influenzae type B (Hib) vaccine

3 Rationale: Hepatitis B immune globulin would be the appropriate prophylactic medication. Immune gamma globulin could be prescribed but is not as specific. The Hib vaccine is for infants to prevent Haemophilus influenzae. (Lewis, et al, 8 ed., p. 1069.)

Which statement is correct regarding administering tetanus immunization to adults if they did not complete their primary series, or if it was undocumented? 1. Administer three doses; the first two doses are administered at least 4 weeks apart, and the third dose is given 6 to 12 months after the last dose. 2. Administer a tetanus booster if it has been 2 years since the adult received a previous dose. 3. Administer a tetanus booster to all clients who have wounds. 4. Administer a single tetanus booster at age 65 for persons who have completed the full pediatric series.

1 Rationale: According to the Centers for Disease Control and Prevention (CDC) guidelines for adult immunization (2011), adults, including pregnant women with uncertain history of a complete primary vaccination series, should receive a primary series of tetanus boosters. A primary series for adults is three doses; administer the first two doses at least 4 weeks apart and the third dose 6 to 12 months after the second. A single tetanus booster is recommended at age 50 years for persons who have completed the full pediatric series, including the teenage/young adult booster. (Immunization Action Coalition, http://www.immunize.org/catg.d/p2011.pdf)

The nurse is assessing an 8-month-old infant in an immunization clinic. The nurse knows that by 8 months, the child should have had which immunizations? 1. Hepatitis B first and second doses, all of the initial diphtheria-tetanus-pertussis (DTaP) series, two doses of IPV, pneumococcal vaccine, and rotavirus (RV) series 2. All of the DTaP and polio series, measles-mumps-rubella (MMR), and pneumococcal vaccine 3. DTaP first and second doses, MMR first dose, all of the hepatitis B series 4. Varicella, DTaP first dose, and hepatitis B first dose

1 Rationale: Standard immunizations are two doses of hepatitis B series, all of the initial DTaP series, two doses of IPV (inactivated poliovirus), the rotavirus series (Rota), and pneumococcal vaccine series. MMR and varicella vaccines are not given until 12 to 15 months of age. (Hockenberry, Wilson, 9 ed., p. 497. Centers for Disease Control and Prevention, http://www.cdc.gov)

The nurse is screening clients waiting to receive an influenza vaccine. Which client would the nurse question receiving the vaccination? 1. A 48-year-old woman with a fever of 102° F orally 2. A 30-year-old man who has cholelithiasis 3. A 65-year-old man with congestive heart failure 4. A 70-year-old woman who has type 2 diabetes

1 Rationale: The nurse would question giving the influenza vaccine to the client with a moderate illness, with a fever. Clients with chronic pulmonary and cardiac problems should receive the vaccine when they are in a healthy state, not when they are compromised. The options contain no indication that any of the clients are compromised with their chronic conditions. Do not make the clients any sicker than the question is presenting them. (Centers for Disease Control and Prevention, http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm)

A mother comes to the clinic with her 4-month-old for routine immunizations. The nurse anticipates which of the following immunizations will be administered during this visit? Select all that apply. 1. IPV (poliovirus) 2. Rotavirus (RV) 3. DTaP (diphtheria, tetanus, pertussis) 4. MMR (measles, mumps, rubella) 5. Hib (Haemophilus influenzae, type B) 6. Varicella 7. PCV (pneumococcal conjugate vaccine)

1,2,3,5,7 Rationale: The IPV (inactivated polio vaccine), rotavirus (RV), DTaP (diphtheria, tetanus, and acellular pertussis), Hib (Haemophilus influenzaevaccine), PCV (pneumococcal vaccination) are administered at 4 months. The MMR (measles, mumps, and rubella) and varicella vaccine are administered at 12 to 15 months. (Hockenberry, Wilson, 9 ed., p. 499. Centers for Disease Control and Prevention, http://www.cdc.gov)

The nurse understands that which of the following immunizations leads to long-lasting immunity? 1. Immune gamma globulin 2. Inactivated polio virus (IPV) 3. Rho(D) immune gamma globulin 4. Antivenom for black widow

2 Rationale: The advantage of an inactivated poliomyelitis vaccine (IPV) is its long-lasting immunity. The other three—immune gamma globulin, Rho(D) immune gamma globulin, and black widow antivenom—are all temporary means of immunity. (Lewis, et al, 8 ed., pp. 211-212.)

What is important information that a nurse should know about administration of a measles-mumps-rubella (MMR) vaccine to an adult? Select all that apply. 1. It should never be administered to an adult, because most adults are immune to the diseases. 2. Adults born during or after 1957 should receive one or possibly two doses of MMR vaccine unless they have a medical contraindication, or laboratory evidence of immunity. 3. A second dose of MMR vaccine is never recommended for adults, because it is recommended only for children. 4. Administer one dose of MMR vaccine to women whose rubella vaccination history is unreliable or who lack laboratory evidence of immunity. 5. Pregnant women who do not have evidence of rubella immunity should be vaccinated on completion of the pregnancy. 6. Administer a booster dose of MMR vaccine if the adult was born before 1957.

2,4,5 Rationale: According to CDC guidelines for adults, the following are the recommendations for MMR vaccination. Measles component: Adults born before 1957 can be considered immune to measles. Adults born during or after 1957 should receive more than one dose of MMR vaccine unless they have a medical contraindication, documentation of more than one dose, or other acceptable evidence of immunity. A second dose of MMR vaccine is recommended for adults who (1) were recently exposed to measles or in an outbreak setting, (2) were previously vaccinated with killed measles vaccine, (3) were vaccinated with an unknown vaccine from 1963 to 1967, (4) are students in postsecondary educational institutions, (5) work in health care facilities, or (6) plan to travel internationally. Women who are pregnant and susceptible should be vaccinated as early in the postpartum period as possible. (Immunization Action Coalition, http://www.immunize.org/catg.d/p2011.pdf)

Unless contraindicated by chronic illnesses, what immunizations are recommended for all clients over 50-years-old who have had the recommended series of childhood vaccinations? 1. Measles, mumps, and rubella (MMR) boosters 2. Oral polio (inactivated poliomyelitis vaccine [IPV]) booster every 10 years 3. Influenza every year and tetanus booster every 10 years 4. Hepatitis A and B boosters every 10 years

3 Rationale: Recommendations from the Centers for Disease Control and Prevention (CDC) are for an influenza vaccine annually and a tetanus booster every 10 years. Pneumococcal vaccine also is recommended for clients between the ages of 19 and 65 years. For persons older than 65 years, a one-time revaccination of pneumococcal vaccine is advised if they were vaccinated more than 5 years previously and were less than 65 years old at the time of the primary vaccination. The other vaccinations are not appropriate for the adult who has had the series of childhood immunizations. A one-time dose of Tdap is recommended for all adults to reduce transmission of pertussis to infants. (Centers for Disease Control and Prevention, http://www.cdc.gov)

A mother expresses concerns about the 4-month immunizations, stating that her infant's leg was warm to the touch, slightly swollen, and red. What should the nurse explain before administering the next set of immunizations? 1. Because of the response the last time, the diphtheria, tetanus, and pertussis (DTaP) booster will not be administered at this time. 2. Only half of the prescribed dose will be given, which will prevent the postimmunization reaction. 3. It will be necessary to wait for 6 months before administering the next set in the series. 4. These are expected results; apply a cool pack to the affected area.

4 Rationale: After an immunization, an infant typically has local inflammatory changes at the site, along with a mild temperature elevation. The mother also may note that the child is cranky and irritable. Immunizations would never be given in a half dose. If anything is given separately, it would be the pertussis, which can cause more side effects than the diphtheria and tetanus. (Centers for Disease Control and Prevention, http://www.cdc.gov/vaccinesafety/Vaccines/Common_questions.html)

The nurse is assisting in the discharge preparation of a new mother and her infant. The mother asks when the immunizations will begin for her infant. What is the best nursing response? 1. The first series of the DTaP vaccine will be given before her discharge. 2. DTaP and varicella vaccines will be administered around 3 months of age. 3. The series of infant immunizations will begin around 6 months of age. 4. Immunizations are recommended to begin at 2 months old.

4 Rationale: Immunizations are started as early as 1 month (first dose of hepatitis B vaccine is recommended to be given before discharge from the hospital). The diphtheria, tetanus, and pertussis (DTaP) vaccine and inactivated poliovirus vaccine (IPV) series, pneumococcal vaccine (PCV), Haemophilus influenzae (Hib) series are started at 2 months. (Hockenberry, Wilson, 9 ed., p. 495.)

The measles, mumps, and rubella (MMR) vaccine is not administered to infants younger than 12 months. Why is this vaccination not recommended for this group of children? 1. Children younger than 12 months have a greater risk for an adverse reaction. 2. This group of children is not at high risk for contact with diseases. 3. There is greater risk of cardiac involvement in younger infants. 4. The immune system of the child will not respond effectively to the vaccination.

4 Rationale: The child younger 12 months still has some circulating maternal antibodies that could affect the child's response to the immunization. The child's immune system may not be adequately mature, but the correct answer is more specific to the situation. This group of children is at high risk for contact with the diseases, but they do not have an increased risk for an adverse reaction. (Hockenberry, Wilson, 9 ed., pp. 501-502.)

What immunizations may be recommended for the 11- to 18-year-old client? 1. Measles, mumps, and rubella (MMR) and varicella 2. Pneumococcal conjugate vaccine (PCV) and tetanus boosters 3. None, if the teenager is current with childhood immunizations 4. Tetanus, diphtheria, and pertussis booster (Tdap) and meningococcal (MCV4)

4 Rationale: The recommendation for this age range is a Tdap booster and a meningococcal vaccination. The childhood immunization schedule is for a DTaP booster to be given to school-age children (4 to 6 years) and the Tdap again at 11 to 12 years. The meningococcal vaccine should be given at 11 to 12 years, and/or a catch-up immunization by age 18 years. The pneumococcal childhood vaccination series should have been given from age 2 months through age 23 months. The MMR series already should be completed by this age. HPV vaccine is recommended for females age 11 to 26 years old and males ages 9 to 18 years old. (Hockenberry, Wilson, 9 ed., p. 498. Centers for Disease Control and Prevention, http://www.cdc.gov)