Chapter 31: Vaccines QUESTIONS
Which type of immunity is conferred by the Td vaccine?
a. Active
The 45-year-old patient had measles as a child. What is the type of immunity that usually persists for the remainder of the individual's life after being infected with a disease?
a. Active natural (natural acquired)
11. The provider orders the zoster vaccine (Zostavax) for a 60-year-old patient. The patient reports having had chicken pox as a child. Which action will the nurse take?
a. Administer the vaccine as ordered. ANS: A Zostavax is given to boost the immunity to varicella-zoster virus among recipients. (It is not likely to cause severe reaction secondary to prior exposure, since the immune response in most recipients has declined. Zostavax, not Varivax, is approved for this use.)
3. A 4-year-old child is receiving amoxicillin (Amoxil) to treat otitis media and is in the clinic for a well-child checkup on the last day of antibiotic therapy. The provider orders varicella (Varivax); measles-mumps-rubella (MMR); inactivated polio (IPV); and diphtheria, tetanus, and acellular pertussis (DTaP) vaccines to be given. Which action by the nurse is correct?
a. Administer the vaccines as ordered. ANS: A Antibiotic therapy is not generally a contraindication to the use of vaccines. (Vaccines may be given in cases of mild acute illness or during the convalescent phase of an illness. All four vaccines may be given. If the MMR or other live virus vaccine is not given the same day as the varicella vaccine, administration of the two vaccines should be separated by at least 4 weeks. You can give varicella and MMR today, but if you do not, you have to give one today and wait 4 weeks to give the other vaccine. Aspirin should not be given because of the increased risk of Reye syndrome.)
9. Which is an example of acquired (artificial) passive immunity?
a. Administration of IgG to an unimmunized person exposed to a disease ANS: A Passive immunity occurs without stimulation of an immune response. Acquired immunity requires administration of immune globulin. (Inherent resistance to a disease antigen describes the state of natural immunity, not acquired passive immunity. The other answers involve stimulation of an immune response.)
Susceptible individuals age 13 years or older receive two doses of varicella vaccine spaced how long apart?
a. At least 4 weeks
When is a child's first vaccine usually administered?
a. Birth
What is a good source of health and immunization information for nurses assisting patients before international travel?
a. Centers for Disease Control and Prevention
A 4-month-old patient's parent reports that after her first dose of DTaP, the patient experienced some redness and tenderness at the injection site in her left thigh. With this in mind, what should the nurse administer?
a. DTaP again, because these are common side effects, not contraindications
What is rubella commonly known as?
a. German measles
8. With the help of an interpreter, the nurse has just immunized a 35-year-old woman with the tetanus, diphtheria, and acellular pertussis vaccine and the vaccine against measles, mumps, and rubella. It is essential that the nurse proceed with which action(s)? (Select all that apply.)
a. Provide a vaccine information statement in the patient's preferred language for each vaccine received. b. Document in the patient's record the date; site and route of administration; vaccine type, manufacturer, lot number, and expiration date; and the name, business address, and title of the person administering the vaccine.
7. The nurse is preparing to administer rotavirus vaccine to a 4-month-old infant. The nurse notes that the infant received RV1 vaccine at 2 months of age. The nurse will plan to administer
a. RV1 today. ANS: A Patients receiving RV1 receive 2 doses at age 2 and 4 months only.
3. A 38-year-old migrant farm worker is seen in the clinic with a cut to his arm from an old metal drum. The patient has sutures placed, and a tetanus, diphtheria, and acellular pertussis vaccine is given. What is the nurse's most important action after the vaccine has been administered?
a. The nurse provides the patient with a vaccine information statement about the tetanus, diphtheria, and acellular pertussis vaccine in the patient's primary language.
4. The nurse is preparing to administer routine, recommended immunizations to an immunocompromised 1-year-old child. What is the most important information to know prior to administering a vaccination?
a. The type of vaccine to be administered to the child
1. The nurse is discussing vaccines with the mother of a 4-year-old child who attends a day care center that requires the diphtheria, tetanus, acellular pertussis (DTaP) vaccine. The mother, who is pregnant, tells the nurse that she does not want her child to receive the pertussis vaccine because she has heard that the disease is "not that serious" in older children. What information will the nurse include when discussing this with the mother?
b. If the 4-year-old child contracts pertussis, it can be passed on to her newborn. ANS: B Even though pertussis is not as serious in older children, it is important to vaccinate children to prevent the spread of the disease to infants and others who are not immunized (and who are at risk for significant morbidity and mortality from this disease. Vaccinating the mother will not protect the 4-year-old from getting pertussis. The DTaP vaccine may be given to children whose mothers are pregnant. Vaccinating the child does not confer passive immunity to the unborn child.)
10. The parent of a 12-month-old child who has received the MMR, varicella, and hepatitis A vaccines calls the clinic to report redness and swelling at the vaccine injection sites and a temperature of 100.3° F. The nurse will perform which action?
b. Recommend acetaminophen and cold compresses. ANS: B These are common, minor side effects of vaccines and can be treated with acetaminophen and cold compresses. (Aspirin is contraindicated in children because of its association with Reye's syndrome. Since these are not serious adverse effects, they do not need to be reported to VAERS. It is not necessary to schedule a clinic visit.)
2. A woman who is pregnant tells the nurse she has not had any vaccines but wants to begin so that she can protect her unborn child. Which vaccine(s) may be administered to this patient?
b. Trivalent influenza vaccine ANS: B The influenza vaccine is recommended for pregnant women and should be given. (Gardasil is given to young women who are not yet sexually active. The MMR is contraindicated because rubella can cause serious teratogenic effects. Varicella is contraindicated during pregnancy.)
8. A provider has ordered recombinant HPV quadrivalent vaccine (Gardasil) to be given to a prepubertal 9-year-old female. The parent asks the nurse if this vaccine can be postponed until the child is in high school. The nurse will tell the parent that Gardasil
b. is more effective if given before sexual activity begins. ANS: B Gardasil is most effective when the client is not yet sexually active.
In the case of an anaphylactic reaction to a vaccine, which drug should the nurse have readily available?
c. Epinephrine
The patient presents to his health care provider and states, "I think I have the flu." What are the clinical manifestations of influenza ?
c. Fever, myalgias, and cough
Which immunizations are examples of live, attenuated vaccines?
c. MMR and varicella
What is the process by which antibodies are received by an individual, used for protection against a particular pathogen, and acquired from another source?
c. Passive immunity
1. The father of a 4-month-old infant calls in to the clinic reporting that his child is having a reaction to immunizations. What is the most important piece of information the nurse should elicit?
c. The signs and symptoms the infant is experiencing
6. An 18-month-old child is accompanied to the clinic by her grandmother, the child's legal guardian. The grandmother reports that the child is due for her fourth diphtheria, tetanus, and acellular pertussis vaccination. The nurse determines that the child should not receive the diphtheria, tetanus, and acellular pertussis vaccine that day for which reason?
c. The third diphtheria, tetanus, and acellular pertussis dose was administered 4 months ago. DTaP vaccine should be given in an interval of at least 6 months from the preceding DTaP dose
In the event of an adverse reaction to a vaccine, to whom should a health care provider report the details?
c. Vaccine Adverse Events Reporting System
A mother of a newborn is scheduling her baby's two-month checkup. The nurse advises her that at that time some vaccinations will be given. The mother states, "I'm not really sure I want to have her vaccinated. What do most vaccines really do?" What is the nurse's best response?
d. "Vaccines stimulate an immune response."
When the MMR vaccine is not given the same day as the varicella vaccine, what should be the minimum interval between administrations?
d. 28 days (4 weeks)
4. A patient is preparing to travel with a 4-year-old child to India in 10 days and is in the clinic to receive typhoid vaccines. Which vaccines will be given to the parent and the child?
d. IM polysaccharide for both patients ANS: D While the live, oral vaccine may be given to patients older than 6 years, each capsule must be taken 48 hours apart with the last capsule given 1 week prior to travel. (There would not be enough time to complete the regimen since the patients leave in 10 days.Children under age 6 cannot receive the oral vaccine; this child is 4 years old)
What occurs when there is an acquisition of detectable levels of antibodies in the bloodstream?
d. Seroconversion
6. A young adult patient is in the clinic to receive a tetanus vaccine after sustaining a laceration injury. The nurse learns that the patient, who works in a day care center, has not had any vaccines for more than 10 years. Which vaccine will the nurse expect to administer?
d. Tdap ANS: D Persons who work with children should receive acellular pertussis vaccine. The Tdap is given to adults. The DTaP is given to children up to age 6. The DT and Td do not contain pertussis.
7. Which of the following patients would be eligible to receive the influenza vaccine?
d. The child who is 18 months old
5. A 14-year-old girl requests a vaccination for human papillomavirus. After the nurse administers the first dose, which of the following is important to include in the patient's teaching?
d. The date the patient needs to return to the clinic for the next human papillomavirus dose
2. The nurse is preparing to administer varicella vaccine to a young woman. Which of the following findings has the greatest implication for this young woman's care?
d. The patient appears to be pregnant
5. A 48-month-old child is scheduled to receive the following vaccines: MMR, Varivax, IPV, and DTaP. The child's parents want the child to receive two vaccines today and the other two in 1 week. To accommodate the parents' wishes, the nurse will administer
d. the MMR and Varivax today and the DTaP and IPV in 1 week. ANS: D If the MMR or other live virus vaccine is not given the same day as the varicella vaccine, administration of the two vaccines should be separated by at least 4 weeks. (In the incorrect answers, the two live virus vaccines are given only 1 week apart. That is incorrect because, you have to either give varicella and MMR TOGETHER or give one today MMR or Varicella and then wait 4 weeks to give the other vaccine MMR or varicella. IPV and DTaP can be given in a week)
