Pharmacology: Chapter 18: Vaccines and Sera

The nurse is caring for a 30-year-old woman who presented to her gynecologist today to receive a Gardasil injection, stating that she believes that she may have genital warts. What should the nurse teach this client?

"The drug is only effective if administered before exposure to human papillomavirus (HPV)." Response Feedback: This client is not a candidate for Gardasil primarily because she has most likely already been exposed to HPV, and there would be no benefit to the injection. Gardasil is a vaccine that needs to be administered before exposure to be effective. Although the drug is normally given to women aged 9 to 26 years old, it could be given to an older person who has not become sexually active yet. Although sexual activity would not preclude administering the injection to a young girl who has had only one sexual partner, multiple partners increase the likelihood of exposure to HPV. The FDA continues to monitor testing related to the need for booster shots and the length of time the immunity remains active, as well as long-term adverse effects of the drug, but the drug is available to the public by prescription.

A 69-year-old client presents to the clinic to talk to the nurse. The client asks the nurse about whether the pneumonia vaccine is necessary. The client's health record reveals that the client received the vaccine at age 55. What should the nurse tell the client?

"This vaccine gives you lifetime protection, so you shouldn't need it again."

A mother and her healthy neonate will be discharged from the hospital 36 hours postpartum. How should the nurse best promote the neonate's immune function?

Administer hepatitis B vaccination as prescribed Response Feedback: The only vaccination normally administered at birth is for hepatitis B. Varicella, MMR, and pneumococcal vaccines are given later in life.

A male client, aged 78 years presents in the emergency department after stepping on a nail. The client tells the nurse that he had his last tetanus shot 12 years ago and asks whether he will need another shot today. What is the nurse's priority action?

Administer tetanus immune globulin as prescribed

The mother of a 2-month-old child tells the nurse, "I've been reading about how vaccines cause autism so I have decided not to give my child any of these vaccines." What is the nurse's best response?

"Extensive studies have found no link between the measles-mumps-rubella (MMR) vaccine and autism." Response Feedback: The Immunization Safety Review Committee Board of Health Promotion and Disease Prevention of the Institute of Medicine under the auspices of the Centers for Disease Control and Prevention and the National Institutes of Health have concluded that no evidence supports any linkage between the use of MMR vaccine and the development of autism. The chickenpox virus is not involved in the debate. Although it is the mother's choice to make, many parents make an uninformed decision out of fear, so it is important for the nurse to provide the necessary education because children who do not receive essential immunizations put the community at risk. A child who is exposed to measles and then comes in contact with a pregnant woman can cause fetal damage or death.

The nurse is assigned to perform telephone triage for the clinic and receives a call from a young mother whose 6-month-old baby received her third diphtheria-pertussis-tetanus immunization that morning. The mother reports the baby's temperature is 99.8° axillary, the site of injection is "a little red," and the baby is irritable. After checking the standing orders provided by the pediatrician, what teaching would the nurse provide this mother?

"Symptoms should subside within 2 to 3 days." "These are common adverse effects reported after immunizations." "Apply a warm moist compress to the baby's leg." "Symptoms should subside within 2 to 3 days."

A client, aged 82, is brought to the clinic by her daughter. The daughter asks how often her mother should receive the influenza vaccine. What would be the nurse's best response?

"Your mother needs the influenza vaccine once each year." Response Feedback: In general, all adults with chronic diseases are advised to be immunized yearly with an influenza vaccine and once with a pneumococcal pneumonia vaccine. Boosters are not required.

What client would be the most appropriate recipient of the zoster vaccine?

A 71-year-old client who is concerned about getting shingles Response Feedback: The zoster vaccine is given to prevent shingles in adults aged 50 years and older. It would be given to an immunocompromised client or a child. Employment in a health care facility would not be an indication for the zoster vaccine.

What client would be most likely to benefit from the administration of an antitoxin?

A client in distress who is showing signs and symptoms of botulism Response Feedback: Botulism is an example of a health problem that can be treated with an antitoxin. HPV and yellow fever do not have a toxic etiology and cannot be treated by an antitoxin. Antitoxins are not used in the treatment of anaphylaxis.

The infection control nurse is assessing the immunization status of many of the hospital's current clients. For what client would vaccination most likely be contraindicated?

A client who takes immunosuppressants postrenal transplant Response Feedback: The use of vaccines is contraindicated in the presence of immune deficiency because the vaccine could cause disease, and the body would not be able to respond as anticipated if in an immunodeficient state. Vaccines are not contraindicated in people with renal impairment or who have hepatic failure nor are they contraindicated in people over the age of 65.

The nurse explains the purpose of vaccines is to promote what?

Active immunity Lifetime immunity Activation of the immune system

A mother brings her 12-month-old child into the clinic, and the nurse will administer measles, mumps, and rubella vaccine (MMR) to the child. What nursing action is most appropriate?

Administer 0.5 mL of the vaccine subcutaneously

A 55-year-old client presents at the emergency department reporting chest tightness and difficulty breathing. The client tells the nurse he had immune sera earlier that day at the clinic. What should the nurse suspect?

An allergic reaction to the immune sera Response Feedback: Adverse effects can be attributed either to the effect of immune sera on the immune system (e.g., rash, nausea, vomiting, chills, fever) or to allergic reactions (e.g., chest tightness, falling blood pressure, difficulty breathing). Local reactions (e.g., swelling, tenderness, pain, muscle stiffness at the injection site) are very common. Serum sickness would manifest with fever, arthritis, flank pain, myalgia, and arthralgia.

A client is brought to the emergency department after being bitten by a snake. The nurse asks the client to carefully describe the snake that bit him. Why would the nurse ask this question?

Antivenin is very specific with regard to the venoms it can treat.

The mother of a newborn is learning about immunization schedules. The nurse tells this mother that her child will ideally receive the immunization for measles, mumps, and rubella (MMR) on what schedule?

Between 12 and 15 months and between 4 and 6 years

A client is to receive a physical examination before starting immune sera therapy. What assessment should the nurse prioritize?

Breath sounds

A 79-year-old client has been prescribed a single dose of influenza A vaccine 0.5 mL SC. What is the nurse's best action?

Contact the provider to confirm the route

The nurse is preparing for a visit with a 4-month-old infant. What immunizations will the nurse prepare?

Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) Inactivated poliovirus vaccine (IPV) Haemophilus influenzae type b vaccine (Hib) Response Feedback: At 4 months of age, the child will receive a DTaP, Hib, IPV, and PCV. Varicella vaccine is not given until the child is at least 1 year of age, and meningococcal is usually given at age 11 to 12 years unless the client is at high risk for development of the disease before that age.

The mother of a preschool-aged child brings her child to the clinic and asks what immunizations the child needs before starting school. What immunizations will the nurse expect this child needs if the child is healthy and has received immunizations on schedule in the past?

Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) Inactivated poliovirus vaccine (IPV) Measles, mumps, and rubella vaccine (MMR) Hepatitis A

A parent has contacted the nurse and is concerned about media reports of a measles outbreak. The parent's child is 9 months old and is wanting to confirm that the child has been immunized against measles. How should the nurse best respond?

Fifteen months is the youngest age at which the child should be vaccinated. Response Feedback: MMR is administered initially as a combined vaccine at 15 to 18 months.

The school nurse is addressing a parents' group and is discussing an upcoming campaign of human papillomavirus (HPV) vaccination. What should the nurse teach this group of parents?

HPV vaccination is recommended for both boys and girls. Response Feedback: HPV vaccination is recommended for males and females alike. It is not offered or withheld on the basis of health history, though high-risk individuals may be offered it at a younger age. Protection is exclusive to the human papillomavirus.

A parent brings the 18-month-old client into the clinic for his diphtheria, tetanus, and pertussis vaccine. The child has a runny nose, a fever of 102.4°F (39.1°C), and is coughing. What is the nurse's best action?

Hold the immunization until the child is free of allergic or cold-like symptoms. Response Feedback: The nurse should not administer the immunization if the child exhibits signs of acute infection because the vaccine can cause mild infection and can exacerbate acute infections. The child should be free of infection for several days before the immunization is given. Treating the fever, extended monitoring, or smaller doses will not overcome this risk and the, only option is to hold the immunization until the child is healthy.

A client has present to the clinic for an allergy shot. The client asks the nurse what immunoglobulin (Ig) is located in the body's tissues and is thought to be responsible for allergic reactions. What is the nurse's best response?

IgE is thought to be responsible for allergic reactions. Response Feedback: IgE is the immunoglobulin that is associated with allergic reactions. These antibodies react with mast cells, causing the release of histamine and other inflammatory chemicals when they have combined with the antigen. IgG, IgA, and IgM are not involved in allergic reactions.

Media reports in the community have focused on the risks of hepatitis B. The hepatitis B vaccine is recommended for what individuals?

Infants Individuals with a known risk of hepatitis B exposure

The nurse is educating a couple about the recommended immunization plan for their infant. What should the nurse teach these new parents?

Keep a written record of the child's immunizations. Response Feedback: The nurse should provide thorough client teaching, including measures to avoid adverse effects, warning signs of problems, the need to keep a written record of immunizations, to increase knowledge about drug therapy, and to increase compliance with the drug regimen. Immunization records are often requested when the child is being enrolled in school, so it is important for the mother to maintain these records. The nurse would not teach the parents to avoid having the child receive more than one vaccine at a time or to stop the immunizations after the age of 2; both are acceptable practices. There is no demonstrated link between immunizations and autism.

An employee of a long-term care facility has been administered the hepatitis B series prior to beginning employment. How should the employee's therapeutic response to the vaccination be best assessed?

Measure the employee's serum antibody levels

The nurse notes that the client has an extensive list of allergies. Prior to administering the hepatitis A immune globulin, what action should the nurse prioritize?

Monitor the client carefully and have emergency equipment available

A nurse is providing client education to the parent of a child receiving a first immunization. The nurse should educate the parent that after the injection, it is common for the child to exhibit what signs and symptoms?

Pain, redness, and swelling at site of injection Response Feedback: Normal reactions to immunizations include pain, redness, and swelling at the site of the injection. Vomiting, diarrhea, high fever, sweating, lethargy, or drowsiness would not be expected and should be reported. The child could also be slightly irritable due to the pain at the injection site.

The public health nurse is reviewing immunity with a group of school nurses prior to an immunization campaign. What should the public health nurse teach this group of school nurses?

Passive immunity is limited, lasting only as long as the antibodies circulate. Response Feedback: Unlike active immunity, passive immunity is limited. It lasts only as long as the circulating antibodies last because the body does not produce its own antibodies as found in active immunity. People are born with active immunity in which the body recognizes a foreign protein and begins producing antibodies to react with specific proteins or antigens. Serum sickness is a massive immune reaction against the injected antibodies that occur with passive immunity.

A toddler has been brought to the community clinic and will be administered the ProQuad vaccine. When educating the child's parents about this vaccine, the nurse should explain what benefits?

Protection against measles and varicella Protection against mumps and rubella Protection against measles and varicella

The clinic nurse is administering vaccines at well-baby checkups. Before administering a diphtheria, tetanus, and pertussis (DTP) vaccine, what assessment parameter should the nurse prioritize?

Temperature Response Feedback: Caution should be used whenever a vaccine is given to a child with a history of febrile convulsions or cerebral injury or in any condition in which a potential fever would be dangerous. Caution also should be used in the presence of any acute infection, which would often be signaled by fever. BMI is not a major consideration, and recent use of acetaminophen is not problematic. The recipient's pupillary response does not indicate the presence or absence of risks.

A client has presented to the clinic and is requesting the seasonal influenza vaccine. What aspect of the client's health history may contraindicate the safe and effective use of this vaccine?

The client is current prescribed prednisone. Response Feedback: The use of corticosteroids such as prednisone could alter the body's desired response to a vaccine. A loop diuretic has no significant effect, and the client's age is not a contraindication. It is unnecessary to know the client's blood type.

The nurse works with client in a long-term care facility. What principle should guide the nurse's administration of influenza vaccinations?

Unless contraindicated, residents should receive influenza vaccinations annually. Response Feedback: Older adults should be given the annual influenza vaccine unless directly contraindicated. This includes residents over the age of 80.

Following the injection of a prescribe vaccination, a client has injected antibodies circulating through the body. The client's body will then:

be able to respond to the presence of antigens more quickly.

A client asks the nurse how vaccines provide active immunity. The nurse's best answer explains that active immunity is provided by stimulating production of antibodies to what?

specific protein.