Prep U: Chapter 18: Vaccines and Sera
The nurse is working with an 18-year-old client who recently immigrated and who did not receive childhood immunizations. The client is "catching up" on immunizations and is scheduled to receive a measles, mumps and rubella (MMR) vaccine today. What should the nurse teach the client about potential adverse effects? "You might feel a bit unwell or get a slight fever after receiving your immunization." "Make sure you seek care immediately if you experience any chills because it could be a sign of an emergency." "Some people have a strong reaction to immunizations so we'll ask you to stay at the clinic for the next few hours." "Fortunately, modern vaccines are effective without causing any adverse effects."
"You might feel a bit unwell or get a slight fever after receiving your immunization." In general, immunizations are well tolerated. However, there is a possibility of a mild immune or inflammation reaction that sometimes causes a mild fever or malaise. Chills can also occur, but this does not constitute an emergency unless it is accompanied by other symptoms that cause distress. Clients are often monitored briefly after receiving a vaccine, but this does not normally require multiple hours of direct observation.
An adult client is scheduled to receive the inactivated hepatitis A vaccine. The nurse should provide what education to the client? "It will take up to 48 hours before your immune system protects you against hepatitis." "If possible, you should get annual booster of the vaccine to make sure you're protected." "It's best if you avoid drinking any alcohol for the next week." "You'll need another dose of the vaccine in six to 12 months from now."
"You'll need another dose of the vaccine in six to 12 months from now." Hepatitis A vaccine requires a repeat dose in six to twelve months. There is no prohibition against drinking alcohol after receiving the vaccine. B cells take more than 48 hours to create the necessary immunoglobulins for conferring immunity. The hepatitis A vaccine does not require an annual booster.
The nurse at an ambulatory clinic has seen several clients with suspected or confirmed infectious diseases in recent days. Which client is most likely to benefit from the administration of an immune serum. An older adult who has respiratory distress due to an influenza infection A client who is known to have contracted hepatitis B from sexual activity A client whose tuberculin skin test is positive A child who has signs and symptoms of varicella (chicken pox) infection
A client who is known to have contracted hepatitis B from sexual activity There is a hepatitis B immune globulin, but none exists for influenza, tuberculosis or varicella.
The nurse is working in a clinic which is providing the annual influenza A vaccine for staff and residents of a large long-term care facility. For which client would the vaccine most likely be unsafe? A resident who received four units of packed red blood cells for a gastrointestinal bleed three weeks ago A staff member with a three month-old infant that she is breastfeeding A resident who is 91 years old and who has chronic obstructive pulmonary disease A staff member who received the combination hepatitis A and B vaccine two weeks ago
A resident who received four units of packed red blood cells for a gastrointestinal bleed three weeks ago Recent blood transfusions contraindicate the use of vaccines because there is an associated risk of an unpredictable immune response. The influenza vaccine, like most vaccines, is not contraindicated during breastfeeding. Old age, COPD and recent hepatitis vaccinations are not contraindications.
Which is an example of artificially acquired active immunity? (Select all that apply.) Administration of the rubella vaccine to an individual who has no immunity to the disease. Administration of the varicella vaccine to an individual who has no immunity to the disease. An individual who is exposed to pertussis for the first time and has no immunity to the disease. Administration of the influenza vaccine to an individual who has no immunity to the disease. An individual who is exposed to chickenpox for the first time and has no immunity to the disease.
Administration of the rubella vaccine to an individual who has no immunity to the disease. Administration of the varicella vaccine to an individual who has no immunity to the disease. Administration of the influenza vaccine to an individual who has no immunity to the disease. Administration of the varicella, influenza, and rubella vaccine to an individual who has no immunity to the disease are examples of artificially acquired active immunity.
What immunizations are recommended for older adults? (Select all that apply.) An MMR every 7 to 10 years An annual influenza vaccine A one-time administration of pneumococcal vaccine at 65 years of age Rotavirus vaccine A tetanus-diphtheria (Td) booster every 10 years
An annual influenza vaccine A one-time administration of pneumococcal vaccine at 65 years of age A tetanus-diphtheria (Td) booster every 10 years Recommended immunizations for older adults have usually consisted of a tetanus- diphtheria (Td) booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age. Rotavirus vaccine is recommended for infants.
Which is an example of naturally acquired active immunity? (Select all that apply.) An individual who is exposed to chickenpox for the first time and has no immunity to the disease. Administration of the rubella vaccine to an individual who has no immunity to the disease. Administration of the varicella vaccine to an individual who has no immunity to the disease. Administration of the influenza vaccine to an individual who has no immunity to the disease. An individual who is exposed to pertussis for the first time and has no immunity to the disease.
An individual who is exposed to chickenpox for the first time and has no immunity to the disease. An individual who is exposed to pertussis for the first time and has no immunity to the disease. An individual who is exposed to chickenpox or pertussis for the first time and has no immunity to the disease.
A client was bitten by a poisonous snake. Which treatment would be most appropriate to administer? Antivenin Immune sera Toxoid Antitoxin
Antivenin Antivenin is used to treat snake bites. An antitoxin would be used to treat poisonous substances released by invading pathogens. Toxoids are vaccines. Immune sera typically refers to sera that contain antibodies to specific bacteria or viruses.
The administration of immunizations to a client is a form of what type of immunity? Artificial active immunity Attenuated active immunity Passive active immunity Naturally active immunity
Artificial active immunity Immunizations are a form of artificial active immunity.
When describing the action of vaccines, the nurse identifies their action as primarily affecting: effector T cells. B lymphocytes. histamine release. interleukins.
B lymphocytes. Vaccines exert their action on B cells, which in turn stimulate the formation of antibodies. Interleukins, histamine release, and effector T cells are not affected by vaccines.
What is the best source of information for current recommendations regarding immunizations and immunization schedules? Department of Epidemiology Centers for Disease Control and Prevention Department of Public Health Local health care provider's office
Centers for Disease Control and Prevention Recommendations regarding immunizations change periodically as additional information and new immunizing agents become available. Consequently, health care providers need to update their knowledge at least annually. The best source of information for current recommendations is the Centers for Disease Control and Prevention (http://www.cdc.gov).
A group of students are role-playing scenarios involving biological weapon exposure. Which medication would the students identify as using for a client with cutaneous anthrax? Ribavirin Streptomycin Ciprofloxacin Gentamicin
Ciprofloxacin For cutaneous anthrax, ciprofloxacin or doxycycline would be used. Ribavirin would be used for hemorrhagic fever; streptomycin or gentamicin would be used for tularemia.
A client who was bitten by a pit viper is to receive antivenin. What is the nurse's best action? Obtain a 1 mL syringe Establish IV access Assess the client's oral mucosa Obtain a 3 mL syringe
Establish IV access Antivenin given to neutralize the venom of a pit viper is administered intravenously.
An adult client received the annual influenza vaccine yesterday afternoon and has now presented back to the clinic reporting malaise. The client's oral temperature is 37.4°C (99.3°F). What is the nurse's best action? Explain to the client that the malaise is likely caused by a mild case of influenza Explain that vaccines often cause a mild immune response and have the client self-monitor Ask the client to remain at the clinic to be monitored for signs of anaphylaxis Administer epinephrine as prescribed
Explain that vaccines often cause a mild immune response and have the client self-monitor Vaccines often cause symptoms such as fever, malaise, chills or agitation due to their stimulation of the immune system and the inflammatory process. However, this does not mean the client has an active influenza infection. Anaphylaxis would occur much earlier and with more significant signs and symptoms. Monitoring at the clinic would consequently not be necessary. The client's temperature does not constitute a fever.
A nurse is receiving post-exposure prophylaxis for hepatitis B. What would the nurse most likely receive? BCG vaccine Zoster vaccine Antivenin crotalidae Immune globulin
Immune globulin Hepatitis B immune globulin would be used for post-exposure prophylaxis for hepatitis B. This vaccine would be used to prevent herpes zoster (shingles) in persons over the age of 60 years. Antivenin (crotalidae) would be used to neutralize the venom of pit vipers, rattlesnakes, and copperheads. BCG vaccine would be used to prevent tuberculosis in those with a high risk for exposure.
A client is undergoing a yearly physical. While discussing immunizations, the client states not wanting any immunizations because they can cause diseases. The nurse's best response is: Some vaccines are made from live viruses. Those vaccines can cause illnesses, but it is only used for clients with immunosuppression. Immunizing agents are quite safe, and risks of the diseases they prevent are greater than the risks of the vaccines. Vaccines are no longer made with live viruses, so she does not have to worry about being infected. That was a long time ago; the new vaccines are completely safe.
Immunizing agents are quite safe, and risks of the diseases they prevent are greater than the risks of the vaccines. In general, immunizing agents are quite safe, and risks of the diseases they prevent are greater than the risks of the vaccines. However, risks and benefits for particular recipients should be considered because no vaccine is completely effective or completely safe. Some people may develop a disease after being immunized against it. However, if this happens, symptoms are usually less severe and complications are fewer than if the person had not been immunized. Adverse effects are usually mild and of short duration. Although the FDA evaluates vaccine safety before and after a vaccine is marketed, some adverse effects become apparent only after a vaccine is used in a large population.
When providing client teaching to parents regarding measles, mumps, and rubella vaccine administration, which is most important regarding the schedule for administration? It is administered at 5 to 6 months. It is administered at 12 to 15 months. It is administered at 1 to 2 months. It is administered at 3 to 4 months.
It is administered at 12 to 15 months. Measles, mumps, and rubella immunization is administered initially at 12 to 15 months of age. The vaccine is not administered under the age of 1 year.
An infant is being administered an immunization. Which statement provides an accurate description of an immunization? It is the administration of an antigen for an antibody response. It should be administered to a pregnant woman prior to the infant's birth. It protects the infant from exposure to infectious antibodies. It produces many adverse reactions, particularly autism, in the infant.
It is the administration of an antigen for an antibody response. Immunization involves administration of an antigen to induce antibody formation. There are limited adverse effects associated with immunization. The immunization protects the infant from infectious antigens, producing an antibody response. It does not protect from antibodies.
A nursing instructor is discussing the intended populations for various vaccines. Which groups might the instructor mention when discussing the hepatitis B vaccine? Paramedics and emergency medical technicians Day care workers Ventilator-dependent patients People over the age of 65
Paramedics and emergency medical technicians Pre-exposure immunization against hepatitis B is recommended for people at high risk for exposure to the disease. This can include health care workers (e.g., paramedics and EMTs); patients with cancer, organ transplants, hemodialysis, immunosuppression drug therapy, or multiple infusions of blood products; male homosexuals; IV drug users; household contacts of HBV carriers; and residents and staff of institutions for mentally challenged people.
When educating a group of nursing students on immunologic agents, the nurse explains about a particular kind of immunity that develops by injecting ready-made antibodies found in the serum of immune individuals or animals. The nurse is referring to what kind of immunity? Humoral immunity Active immunity Cell-mediated immunity Passive immunity
Passive immunity The nurse is referring to passive immunity. The injection of ready-made antibodies found in the serum of immune individuals or animals is called passive immunity. When a person is exposed to antigens, the body begins to form antibodies. This is called active immunity. Humoral and cell-mediated immunity involve the action by B lymphocytes and T lymphocytes.
A forest ranger arrives at a community clinic for prophylactic vaccination. Which vaccine would be most important to be administered to the ranger? Rotavirus vaccine MMR vaccine Rabies vaccine Varicella vaccine
Rabies vaccine The ranger has to be administered the rabies vaccine as prophylaxis as he is at high risk for contracting the virus. The MMR vaccine is used in treating measles, mumps, and rubella. The varicella vaccine is used in chickenpox, and the rotavirus vaccine is used in preventing gastroenteritis caused by the rota virus.
Antivenins are used for passive, transient protection from which bites? (Select all that apply.) Rattlesnake Copperhead Black widow Canine Human
Rattlesnake Copperhead Black widow Antivenins are used for passive, transient protection from the toxic effects of bites by black widows, rattlesnakes, copperheads, cottonmouth, and coral snakes.
A patient develops fever and arthralgia 4 days after the administration of tetanus toxoid. What reaction to the vaccine is this? Infectious process Anaphylaxis Serum sickness Distress syndrome
Serum sickness Serum sickness presents several days after the administration of a vaccine with symptoms of urticaria, fever, arthralgia, and enlarged lymph nodes. The presence of fever and arthralgia after the administration of an immunization is not noted as an infectious process, serum sickness, or distress syndrome.
Middle aged adults and health care workers should receive which immunizations? Tetanus and hepatitis B vaccine Diphtheria-pertussis and influenza vaccine annually Tetanus-diphtheria-pertussis; hepatitis B vaccine once and influenza vaccine annually Influenza vaccine and hepatitis B vaccine annually
Tetanus-diphtheria-pertussis; hepatitis B vaccine once and influenza vaccine annually Middle-aged adults should maintain immunizations against tetanus-diphtheria-pertussis; high-risk groups (e.g., those with chronic illness) and health care providers should receive hepatitis B vaccine once (if not previously taken) and influenza vaccine annually at 50 years of age and older.
A client is 50 years old. The client asks what, if any, vaccines the client should get. The nurse's best response is: Tetanus-diphtheria-pertussis; hepatitis B vaccine once; influenza vaccine annually. Hepatitis B (one dose) and the flu vaccine. Whooping cough. Tetanus and pertussis.
Tetanus-diphtheria-pertussis; hepatitis B vaccine once; influenza vaccine annually. Middle-aged adults should maintain immunizations against tetanus-diphtheria-pertussis; health care providers should receive hepatitis B vaccine once (if not previously taken) and influenza vaccine annually at 50 years of age and older. An additional vaccine to prevent zoster infections (shingles) is available for adults 60 years and older. Middle-aged adults (those born after 1956) should get at least one dose of measles-mumps-rubella (MMR) vaccine unless they have had either the vaccine or each of the three diseases.
After teaching a group of students about the standard childhood immunizations given today, the instructor determines that the students need additional teaching when they identify which as a common disease for which immunizations are given? Tuberculosis Pertussis Diphtheria Poliovirus
Tuberculosis Immunization for tuberculosis occurs worldwide, but it is not routinely used in the United States.
To prevent meningococcal infections, the nurse would administer: Antivenin Vaccine Toxoid Immune globulin
Vaccine Meningococcal infections would be prevented by a vaccine. A toxoid is a type of vaccine made from the toxins produced by the organism. Immune globulins and antivenin are examples of immune sera.
When describing the use of vaccines to a local community group, what would the nurse include? Vaccines promote the development of antigens. Vaccines are used to provide active immunity. Vaccines can result in signs and symptoms of the full-blown disease. Vaccines are associated with severe reactions in children.
Vaccines are used to provide active immunity. Vaccines provide active immunity. They promote the formation of antibodies against a specific disease. The person experiences an immune response without having to suffer the full course of the disease. Severe reactions are rare.
The administration of immune globulins or antivenins to a client is a form of what type of immunity? naturally acquired active immunity active immunity artificially acquired active immunity passive immunity
passive immunity Passive immunity occurs when immune globulins or antivenins are administered. This type of immunity provides the individual with ready-made antibodies from another human or an animal. When a person is exposed to certain infectious microorganisms (the source of antigens), the body actively builds an immunity (forms antibodies) to the invading microorganism. This is called active immunity. Artificially acquired active immunity occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen. The antigen does not cause the disease, but the individual still manufactures specific antibodies against the disease. Naturally acquired active immunity occurs when the person is exposed to and experiences a disease and the body manufactures antibodies to provide future immunity to the disease.
A client has received a rubella immunization. The client was unaware that she was pregnant. What risk is associated with the administration of the rubella immunization in this client? risk of low infant birth weight risk of birth defects risk of preterm labor risk of development of the disease in the newborn
risk of birth defects Rubella during the first trimester of pregnancy is associated with a high incidence of birth defects in the newborn. Rubella is not associated with the development of disease. Rubella is not associated with low birth weight or preterm labor.
A client is scheduled to receive an immunization. Administration of live vaccine is contraindicated in the client with: steroid therapy. hepatic failure. age of 65 years. renal insufficiency.
steroid therapy. A risk of producing disease exists with live vaccines, especially in people with impaired immune function. Clients who are on steroid therapy should not receive live vaccines due to impaired immune function. No evidence supports withholding immunizations related to renal insufficiency or hepatic failure. Clients over the age of 65 should receive immunizations as needed to protect from infectious disease.
When instructing the parents of a child who has received immunization in the vastus lateralis, which reaction is most common in the days after the administration? tenderness and redness at the site weakness and difficulty walking nausea, vomiting, and diarrhea rash and edema
tenderness and redness at the site Pain, tenderness, and redness at the injection site are associated with the administration of immunizations. Nausea, vomiting, diarrhea, rash, edema, weakness, or difficulty walking are not general reactions to immunizations.
