Pharm CH 11 (1)

Which information should you document after vaccinating a patient with the seasonal influenza vaccine? a. Age of the patient b. Color of the vaccine c. Condition of the site d. Expiration date on the vaccine vial e. Insurance type f. Name of the patient g. Needle length and diameter h. Site of vaccination

A, C, D, F, H The information required to be documented in the patient's medical record or permanent log for vaccination includes the age and name of the patient; name of the vaccine; manufacturer, lot number, and expiration date of the vaccine; dosage of the vaccine; site of the vaccination; and condition of the side.

Which are types of vaccines? (select all that apply) a. Activated vaccines b. Attenuated vaccines c. Immunological vaccines d. Toxoid vaccines e. Naturally formed vaccines f. Biosynthetic vaccines

B, D, F The four types of vaccines currently available are inactivated vaccines, attenuated vaccines, toxoids, and biosynthetic vaccines.

The nurse knows that lymphocytes contained in white blood cells (WBCs) provide true immunity but require the assistance of what process? a) Inflammation b) B-cell sensitization c) Acquired immunity d) Antibiotic production

a) Inflammation Lymphocytes in WBCs establish true immunity but need the assistance of inflammation to do so. Sensitizing B cells against a specific antigen happens when the T lymphocyte (T cell) helps the B lymphocyte (B cell) learn exactly how the invading antigen's code is different from the person's code. The sensitized B cell starts making and releasing antibodies that will bind only to cells or products that carry that specific invader's code. Acquired immunity is a learned internal protection and results in long-term resistance to the effects of invading microorganisms. Antibody production is an adaptive process performed by B lymphocytes (B cells) after they learn to recognize a specific invader

Which patient is most likely to be taking azathioprine (Imuran) as a single agent daily instead of combination selective immunosuppressant therapy? a. 30-year-old with rheumatoid arthritis b. 35-year-old experiencing an acute rejection episode after a heart transplant c. 50-year-old who received a donated kidney in a transplant 3 years ago d. 70-year-old who has colon cancer that has metastasized to the liver

a. 30-year-old with rheumatoid arthritis Therapy for transplant maintenance and antirejection drug therapy requires a combination of at least three different types of antirejection drugs. Metastatic colon cancer is not treated with azathioprine. Depending on the type and severity of an autoimmune disorder, it is most often treated or managed with single agent therapy.

The nurse is caring for a patient with an organ transplant. What statement regarding acute rejection after solid organ transplantation is correct? a. A combination of drug therapy is used to prevent it. b. Drug therapy to prevent solid organ rejection is temporary. c. One episode of acute rejection means that the patient will lose the new organ. d. Drug management of immune responses can repair the damage to the organ.

a. A combination of drug therapy is used to prevent it. A combination of drug therapy is administered to prevent rejection. Drug therapy to prevent solid organ rejection is lifelong and not temporary. An episode of acute rejection does not automatically mean that the patient will lose the new organ. Drug management of the immune responses may limit the damage to the organ and allow it to continue to function, but does not repair the damage.

A patient whose foot was cut deeply by a rusty tin can last received a tetanus toxoid vaccination 8 years ago. He is prescribed to now receive a tetanus toxoid injection. What type of immunity does this vaccination help provide? a. Boosting of artificially acquired active immunity b. Initiation of artificially acquired active immunity c. Boosting of naturally acquired active immunity d. Initiation of naturally acquired active immunity

a. Boosting of artificially acquired active immunity This patient has received tetanus toxoid vaccinations in the past. Any vaccination is an artificial delivery of a substance that can trigger immunity. The fact that it is a toxoid and not an antibody means that the patient's body has actively produced antibodies in the past. By giving the patient more of the toxoid, the patient's own immunity to tetanus is being "boosted."

Which statement regarding artificially acquired active immunity is true? a. It requires "boosting" on a regular schedule. b. It is present in only children and not in adults. c. It can be used for vaccinations but not for immunizations. d. It has the shortest duration of effectiveness of any type of immunity.

a. It requires "boosting" on a regular schedule. Artificially acquired active immunity is long-lasting but requires boosting on a specific schedule to remain effective. This type of immunity can develop in adults as well as in children.

The nurse is performing an admission history assessment on a patient who admits to having had chicken pox as a child. What type of immunity does this provide to the patient? a. True immunity b. Innate immunity c. Artificially acquired active immunity d. Artificially acquired passive immunity

a. True immunity True immunity or antibody-mediated immunity is the ability of the body to recognize a specific organism when it reinvades (reexposes itself to the body's internal environment) and takes steps to remove, inactivate, or destroy the invading organism before illness can occur. So for most types of diseases caused by infectious organisms, the person actually has the disease only once.

The nurse is caring for a patient who has antibody-mediated immunity to chicken pox. What statement is correct about this type of immunity? a) Antibodies are made by T cells. b )Immunity can be transferred from one person to another. c) With every re-exposure to the chicken pox virus, the body becomes less immune to it. d) Antibodies are not concentrated but dispersed evenly throughout the body.

b )Immunity can be transferred from one person to another. Antibody-mediated immunity can be transferred from one person to another. A special feature about antibody-mediated immunity is the antibodies made by B cells, and not T cells. With every re-exposure to the chicken pox virus, the body becomes more and not less immune to it. These antibodies are released into the blood and other body fluids and can go to where they are needed most in the body, such as sites of invasion. Antibodies are not dispersed evenly throughout the body, but are heavily concentrated in the spleen, parts of lymph nodes, tonsils, and the mucosa of the intestinal tract.

A 75-year-old patient tells you he is not planning to receive a "flu shot" this year because he had one just a year ago. What is your best response? a. "Because you are older and your immune system is more fragile, you should have one this year too as a booster." b. "The virus causing influenza often changes each year and a new influenza vaccination is needed every flu season." c. "The "flu shot" you had last year should still protect you for seasonal influenza, but you still need a vaccination for H1N1." d. "The fact that you have been vaccinated by injection just last year makes you a candidate to use the nasal vaccination this year."

b. "The virus causing influenza often changes each year and a new influenza vaccination is needed every flu season." The seasonal influenza vaccine is composed of three or four different types of viral antigens that are thought by the Centers for Disease Control and Prevention to be the ones most likely to be prevalent during the year's influenza season. Because this composition changes every year, last year's vaccine may not contain the right viral antigens for this year and the person would be unprotected.

What is definition of a toxoid that can be used for vaccination? a. A vaccine containing antibodies that were produced by other animals in response to the administration of human white blood cells. b. A vaccine that contains a modified toxin that an organism produces or a small part of the actual organism. c. A vaccine designed to be toxic to or inhibit the excessive functioning of the immune system. d. A vaccine that contains artificially created antibodies that will generate passive immunity.

b. A vaccine that contains a modified toxin that an organism produces or a small part of the actual organism. A toxoid is a vaccine, not an antibody, that contains either a modified toxin an organism produces or a small part of the actual organism. It does not contain any type of antibodies and does not inhibit immune functioning.

A child is receiving a seasonal influenza vaccination administered by nasal inhalation. What type of immunity is expected to develop as a result of this vaccination method? a. Artificially acquired passive immunity b. Artificially acquired active immunity c. Naturally acquired passive immunity d. Naturally acquired active immunity

b. Artificially acquired active immunity Although most vaccines are injected, some are swallowed orally (such as the oral polio vaccine) and others are inhaled nasally. Regardless of how the vaccine is delivered, it is artificial rather than natural because it is deliberately placed in a person's body with the intent of triggering immunity. Because it is a vaccine rather than preformed antibodies, the person's own immune system must take an active part in generating sufficient antibodies to provide full immunity.

What is the most important question to ask a 68-year-old adult who requests to receive the shingles vaccination? a. Is there any possibility you might be pregnant? b. Did you have chickenpox as a child or an adult? c. Do you have either type 1 diabetes or type 2 diabetes? d. Did you receive a seasonal influenza vaccination last year?

b. Did you have chickenpox as a child or an adult? The shingles vaccination is actually a booster injection to help a person who already has learned to make antibodies to the virus that causes chickenpox (varicella zoster) to make more of them to attack the residual virus in his or her body to prevent an outbreak of shingles. If a person has never had chickenpox, he or she is not at risk for shingles and the vaccination would be useless. Having diabetes or having received a seasonal influenza vaccination a year ago is not a contraindication for vaccination. A 68-year-old is out of the childbearing range.

9. Which antirejection drug works by inhibiting the mTOR pathway? a. Azathioprine (Imuran) b. Everolimus (Zortress) c. Tacrolimus (Prograf) d. Daclizumab (Zenapax)

b. Everolimus (Zortress) Everlolimus is a drug from the antiproliferative class that interferes with T lymphocytes being able to complete the cell cycle for cell division by blocking the mTOR signal transduction pathways.

Which condition would be a contraindication for giving RhoGam to an Rh-negative mother? a. Having an allergy to peanuts and penicillin b. Giving birth to an Rh-negative infant c. Receiving a blood transfusion after delivery d. Giving birth to twins

b. Giving birth to an Rh-negative infant RhoGam allows any antiRh antibodies produced by an Rh-negative mother against an Rh-positive fetus/infant's blood to be eliminated from her body. An Rh-negative fetus/infant would not trigger the mother to synthesize antiRh antibodies. Because RhoGam is not made from peanuts or penicillin, an allergy to these substances is not a contraindication to its use. Blood transfusions are not a contraindication for RhoGam and neither is the birth of twins (unless they both are Rh-negative).

With which disorder or organism is a killed vaccine used to trigger immunity? a. Tetanus b. Influenza c. Hepatitis B d. Human papilloma virus

b. influenza The vaccines for tetanus, hepatitis B, and human papilloma virus are all toxoids. Only the vaccine for influenza has been inactivated and is considered a "killed" vaccine.

For which patient should vaccination with an attenuated vaccine be avoided? a. 18-month-old child who has asthma b. 36-year-old woman who has taken insulin by injection for 25 years c. 48-year-old man who has severe immunosuppression as a result of a stem cell transplant 1 month ago d. 66-year-old woman who takes the anti-inflammatory drug meloxicam (Mobic) daily for severe arthritis

c. 48-year-old man who has severe immunosuppression as a result of a stem cell transplant 1 month ago. An attenuated vaccine contains live viruses that have been modified and should not be able to reproduce. When given to a person whose immune system is profoundly suppressed, such as those who have recently received a stem cell transplant, it can cause the person to actually develop the disease

What would be the expected response in an Rh-positive infant who was accidentally injected with RhoGAM? a. The infant would rapidly develop antibodies to Rh-positive red blood cells. b. The infant would rapidly develop antibodies to Rh-negative red blood cells. c. Some of the infant's Rh-positive red blood cells would be destroyed. d. The infant's blood type would change from Rh-positive to Rh-negative.

c. Some of the infant's Rh-positive red blood cells would be destroyed. RhoGAM is a collection of antiRh-positive antibodies. They would bind to some of the infant's Rh-positive red blood cells and destroy them. Because the infant has many more red blood cells than there are antibodies in RhoGAM, the accidental injection could not destroy all or even most the infant's red blood cells. The infant may develop a few antibodies against RhoGAM but will not make them against red blood cells that are either Rh-positive or Rh-negative. The infant's blood type for Rh will not be affected.

How are vaccination and immunization related? a. They are actually the same thing. b. They are completely unrelated to each other. c. The outcome of successful vaccination is immunization. d. The outcome of successful immunization is vaccination.

c. The outcome of successful vaccination is immunization. Although many people use these two terms interchangeably, they actually are different. Vaccination is the process of administering a vaccine to a person in the hope that the person will respond by making antibodies against the substance in the vaccine and thus develop immunity to it. Thus successful vaccination results in immunization against the substance in the vaccine. Not every vaccination results in full immunization.

The clinic nurse is caring for a pair of identical twins. The nurse knows that all cells in a person's body have a universal product code (or tissue type) specific to that person (and any identical siblings). What is the official name for this code? a. DNA b. Family set c. Tissue type d. Genetic pattern

c. tissue type Tissue type is the official name for a person's universal product code or tissue type. Along with human leukocyte antigens (HLAs), it is genetically determined by the genes inherited from one's parents. So the codes are similar among family members but only exactly the same in identical siblings (e.g., identical twins and triplets). DNA, family set, and genetic pattern are not used officially to describe a person's universal product code.

What is the role of the T lymphocyte (T cell) in the development of long-lasting antibody-mediated immunity? a. Enhancing the sensitized B lymphocyte's production of antibodies on second and subsequent exposure to the same antigen b. Preventing general immune responses from becoming excessive and leading to autoimmunity c. Distinguishing sensitized B lymphocytes from unsensitized B lymphocytes d. Assisting unsensitized B lymphocyte to recognize new antigens

d. Assisting unsensitized B lymphocyte to recognize new antigens The T lymphocyte has many roles in cell-mediated immunity. Its major role in antibody-mediated immunity is helping unsensitized B lymphocytes to recognize foreign invaders (antigens) and learn to make antibodies against them. T lymphocytes do not prevent autoimmunity and do not promote the memory function of increased antibody production on reexposure to the same antigen. T lymphocytes do not distinguish between sensitized and unsensitized B lymphocytes.

The Infection Control Nurse is lecturing a group of nursing students about naturally acquired active immunity. For what disease is this type of immunity not a good methodology? a. Flu b. Measles c. Mumps d. Diptheria

d. Diptheria Diptheria is a disease for which naturally acquired active immunity is too risky to fight. This type of antibody-mediated immunity starts when a person is invaded by a foreign organism and B cells then learn to make antibodies against the invaders to fight the invading organism without other assistance or methodology. When a person catches diphtheria, that person develops long-lasting immunity to it and will not get sick with diphtheria again. However, diphtheria has a high mortality rate and some people who get the disease die from it. Artificially acquired active immunity is the type of antibody-mediated immunity that is started when an antigen is deliberately placed into a person's body to force B cells to make a specific antibody against it. Artificially acquired active immunity is used to assist the body to learn to make antidiphtheria antibodies without having to get sick with the disease. Here, an antigen is deliberately placed into a person's body to force the B cells to make a specific antibody against it. Artificially acquired active immunity is used to help people develop immunity to a dangerous disease without the risk of becoming sick first, and it is commonly developed in most countries with the widespread use of vaccination, starting in early childhood.

Why can antibody-mediated immunity be transferred from one person to another person? a. White blood cells from one person are recognized as "foreign" by another person and trigger an immunologic response. b. When antibodies bind to antigens, the entire complex can then be totally eliminated from the body. c. Reexposure to the same microorganism results in greatly increased production of specific antibodies. d. Formed antibodies are released as free substances into the blood and other body fluids.

d. Formed antibodies are released as free substances into the blood and other body fluids. Because antibodies are released from the cells that synthesized them and enter the blood, they can be collected from the blood of one person and injected into another person to provide temporary passive immunity to the receiving person.

A mother of a 6-month-old infant who is to receive a vaccination against diphtheria, pertussis, and tetanus today asks why her baby needs this third injection when she has already received two previous vaccinations against these diseases. What is your best answer? a. The first two injections provided your baby with passive immunity and this one will provide active immunity. b. The first two injections provided protection against diphtheria and pertussis whereas this one is against tetanus. c. Infants have some protection against these disorders because you had these vaccinations as a child, but now that protection is gone. d. Infants have immature immune systems that are only capable of making a few antibodies at a time after vaccination and need frequent boosting.

d. Infants have immature immune systems that are only capable of making a few antibodies at a time after vaccination and need frequent boosting. Because an infant's immune system is just beginning to develop, early vaccinations do not result in full immunization. They must receive repeated vaccinations in order to force the immune system to generate enough antibodies to provide sufficient artificially acquired immunity to protect against the development of diphtheria, pertussis, and tetanus. More booster vaccinations are required in childhood and adulthood.

The clinic nurse is administering a vaccination to a patient. What is the correct statement about vaccination? a. Results in antibiotic resistance to an organism b. Must be injected to produce specific antibodies c. Results in T-cell immunity to a disease caused by an antigen d. Purpose is to stimulate B cells to produce antibodies specific to the antigen

d. Purpose is to stimulate B cells to produce antibodies specific to the antigen Vaccination is the deliberate injection or ingestion of an organism or other antigen for the intended purpose of stimulating B cells into producing antibodies specific to the antigen. Although vaccination usually results in the person's B cells becoming sensitized and making the desired antibodies, this artificial method of stimulating antibody-mediated immunity is less efficient than that stimulated by naturally acquired active immunity. As a result, more than one vaccination with the same vaccine may be required and, even then, the resistance is not permanent. The person requires periodic "boosting" of the immunity with revaccination to recruit more B cells to produce the proper antibodies and to remind existing sensitized B cells to continue to make antibodies. Vaccination has nothing to do with antibiotic resistance to an organism. Although vaccine is most often given by injection, it can also be ingested. It results in immunologic resistance and not T-cell immunity to any disease caused by the antigen.