Chapter 44: Immunizations and Communicable Diseases
The pediatric clinic has set a goal that 95% or more of the children attending the clinic will be fully immunized. To reach this goal, clinic nurses will teach the families that: A. The benefits of immunizations outweigh the risks of communicable diseases B. Immunizations should be completed by the time the child starts school C. Once a child receives a vaccination, that individual has lifelong immunity against that disease D. Vaccinations are 100% safe
A. The benefits of immunizations outweigh the risks of communicable diseases The risks and benefits of vaccines far outweigh the risks from communicable diseases and resulting complications. The immunization schedule is not completed by the time the child starts school. Immunizations continue throughout the life of the individual. It is important that the families realize that to be fully protected, many vaccinations will need to be repeated at specified times. Vaccinations can cause illness or injury. No medication is 100% safe.
The nurse prepares a DTaP (diphtheria, tetanus toxoid, and acellular pertussis) immunization for a six-month-old infant. To administer this injection safely, the nurse chooses which of the following needles (size and length), injection type, and injection site? A. 25-gauge, 5/8-inch needle; IM (intramuscular); anterolateral thigh B. 25-gauge, 5/8-inch needle; ID (intradermal); deltoid C. 22-gauge, 1/2-inch needle; IM (intramuscular); dorsogluteal D. 25-gauge, 3/4-inch needle; SQ (subcutaneous); anterolateral thigh
A. 25-gauge, 5/8-inch needle; IM (intramuscular); anterolateral thigh This vaccine is only given SQ to infants, not IM. Infants do not receive medication/vaccines in the deltoids. A 22-gauge needle is too big for infants, and injections should not be given in the dorsogluteal site. The dose of DTaP is 0.5 cc or 0.5 mL, to be given with a 22 to 25-gauge, 5/8—3/4-inch needle; IM (intramuscularly). The anterolateral thigh is safe to use for this age infant. Research has shown that the ventrogluteal site also may be used safely for this age infant.
A two-year-old child with a fever is prescribed amoxicillin clavulanate 250 mg/5 ml three times daily by mouth for ten days for otitis media. To guard against antibiotic resistance, the nurse instructs the parent to: A. Give the antibiotic for the full ten days B. Measure the prescribed dose in a household teaspoon C. Spread the dose evenly during daylight hours D. Stop the antibiotic when the child is afebrile
A. Give the antibiotic for the full ten days Antibiotics must be administered for the full number of days ordered to prevent mutation of resistant strains of bacteria. A household teaspoon could contain less than 5 cc, and the full dose must be given. The antibiotic should be administered around the clock to maintain a blood level. Stopping the antibiotic before the prescribed time will permit remaining bacteria to reproduce, and the otitis media will return, possibly with antibiotic-resistant organisms.
A nurse is providing education to a group of young mothers. The nurse would explain that as children grow, they develop immunity through: A. Immunization or exposure to the natural disease B. Acquiring diseases from family members who had the disease C. Acquiring diseases from other children D. Being born with diseases already in their systems
A. Immunization or exposure to the natural disease As children grow, they develop immunity through immunization or exposure to the natural disease. As children mature and become more active, they interact more frequently with other children and adults and increase their exposure to infectious agents. Children cannot acquire diseases from family members who had the disease. Acquiring disease from other children would not give children immunity. Newborns cannot be born with childhood disease.
A nurse is providing information to a group of new mothers. The nurse would explain that newborns and young infants are more susceptible to infection because they have: A. Low levels of antibodies B. High levels of maternal antibodies to diseases to which the mother has been exposed C. Passive transplacental immunity from maternal immunoglobulin G D. Been exposed to microorganisms during the birth process
A. Low levels of antibodies The infant's immune system is not fully developed at birth, and the infant has low levels of antibodies due to lack of exposure to antigens. Newborns and young infants do have high levels of maternal antibodies, but this answer is incorrect because it does not explain the susceptibility of newborns and young infants to infection.
The nurse explains to new parents that as healthy children are exposed to more infections, they: A. Naturally develop antibodies B. Are found to be healthier C. Will acquire terminal illnesses D. Will weaken their immune systems
A. Naturally develop antibodies. As healthy children are exposed to more infections, they naturally develop antibodies. Being exposed to infections will not lead to healthy children. Exposure to infections will not lead children to acquire terminal illnesses. Exposure to infectious disease will not weaken children's immune systems.
The school nurse is trying to prevent the spread of a flu virus through the school. Infection-control strategies that could be employed include: A. Sanitizing toys, telephones, and doorknobs to kill pathogens B. Teaching parents safe food preparation and storage C. Withholding immunizations for children with compromised immune systems D. Not separating children with infections from well children
A. Sanitizing toys, telephones, and doorknobs to kill pathogens Sanitizing toys and all contact surfaces, separating children with infections, and teaching children to wash their hands all control the growth and spread of microorganisms. Teaching parents safe food preparation and storage is another tool to prevent the spread of microorganisms, but it is not related to the flu virus. Immunizations should not be withheld from immunocompromised children, and this is not an infection-control strategy. To prevent the spread of communicable diseases, microorganisms must be killed or their growth controlled.
Which should the nurse use when reconstituting vaccines? A. The diluents provided B. Normal saline C. Any solution available D. Sterile water
A. The diluents provided When reconstituting vaccines, it is important to use the solution provided and follow the manufacturer's directions. Not all medications are compatible with normal saline. Only use what is suggested by the manufacturer. Unless otherwise suggested, use what is suggested by the manufacturer.
The mother of an immunocompromised child brings her child to the clinic for a routine check-up and recommended immunizations. The mother expresses concern that her child will "catch" the disease from the vaccination. The nurse would explain that which of the following carry no risk of acquiring the infection? (Select all that apply.) A. Toxoid B. Killed virus vaccine C. Live virus vaccine D. Attenuated vaccine E. Immunoglobulins
A. Toxoid B. Killed virus vaccine E. Immunoglobulins A toxoid is not an organism but a chemical produced by the organism. The toxoid has been treated to weaken its toxic effect. The killed virus immunization contains organisms that are dead and incapable of reproducing. Immunoglobulins are the antibodies produced by others against a disease. They do not contain the live or killed virus. This immunization contains live but weakened organisms. These organisms can mutate and reproduce and may cause disease in a weakened immune system. An attenuated vaccine is the same as a live virus vaccine.
The nurse is teaching a class on infectious disease; the nurse understands that zoonosis is only transmitted by: A. Person to person B. Animals to person C. Adult to child D. Person to insects
B. Animals to person Some infectious diseases are transmitted by insects or animals and are not communicable from person to person.
The nurse is teaching a child care class for mothers of young children. The nurse tells the parent that the most common mode of transmission of infectious disease is: A. Children who are playing with the same toy B. Children who are coughing C. Children who are sitting together eating meals D. Children who are playing board games
B. Children who are coughing The fecal-oral and respiratory routes are the most common sources of transmission in children. Microorganisms might be left on toys that children share, but this is not the most common mode of transmission of infectious diseases. Eating together will not transmit infectious disease. Playing with board games will not transmit infectious disease.
The nurse is explaining the importance of hand washing after using the toilet to parents of young children. Which is the most important reason for this practice? A. Children's immune systems are not fully developed B. Hand washing is the main way to limit the transmission of disease C. Not all bathrooms are clean D. Children do not like to have dirty hands
B. Hand washing is the main way to limit the transmission of disease The fecal-oral and respiratory routes are the most common sources of transmission in children. Underdeveloped immune systems will not transmit disease. Children usually do not wash their hands after toileting unless they are closely supervised. This is not a reason for washing hands after using the toilet.
The nurse is evaluating the immunization status of a child. The nurse recognizes that the child can acquire active immunity against a disease by: (Select all that apply.) A. Receiving a dose of immunoglobulins B. Immunization with a killed virus vaccine C. Immunization with a toxoid D. Antibiotic therapy E. Acquiring the disease
B. Immunization with a killed virus vaccine C. Immunization with a toxoid E. Acquiring the disease This immunization will stimulate antibody production in the child which is active immunity. This immunization will also stimulate antibody production in the child. Having the disease will cause the body to develop antibodies against the organism which is active immunity. Immunoglobulins provide passive immunity. No active immunity is acquired. Antibiotic therapy provides no immunity.
The hospital has just provided its nurses with information about biologic threats and terrorism. After completing the course, a group of nurses are discussing their responsibility in relation to terrorism. The nurse who correctly understood the presentation is the one who identifies their action to be: A. Initiating isolation precautions for a hospitalized client with methicillin-resistant staphylococcus aureus (MRSA) B. Notifying the Centers for Disease Control and Prevention (CDC) if a large number of persons with the same life-threatening infection present to the emergency department C. Separating clients according to age and illness to prevent the spread of disease D. Disposing of blood-contaminated needles in the lead-lined container
B. Notifying the Centers for Disease Control and Prevention (CDC) if a large number of persons with the same life-threatening infection present to the emergency department The CDC must be contacted to investigate the source of serious infections and to determine if a terrorist threat exists. Initiating isolation precautions for a hospitalized client with methicillin-resistant staphylococcus aureus (MRSA) is an appropriate nursing action but does not relate to terrorism. Separating clients according to age will do nothing to stop terrorism. Proper disposal of blood-contaminated needles in the sharps container is appropriate nursing actions but does not relate to terrorism.
The hospital has instructed its nurses that they must participate in disease surveillance associated with infectious agents. The nurses are warned that which of the following disease(s) are likely to be the weapons of terrorists? A. Rocky Mountain spotted fever and Lyme disease B. Plague, anthrax, and smallpox C. Rubella, mumps, and chickenpox D. Severe acute respiratory syndrome (SARS)
B. Plague, anthrax, and smallpox Plague, anthrax, and smallpox are choices of terrorists because they are highly contagious, lethal diseases that can kill large numbers of people in a relatively short time. Rocky Mountain spotted fever and Lyme disease are caused by ticks endemic to wooded areas. Rubella, mumps, and chickenpox are childhood communicable diseases that are not usually fatal. SARS is a rare infectious disease.
The nurse is teaching parents how to prevent the spread of infectious disease. Which of the following is the most important health promotion strategy for all age groups of children? A. Keeping child free from colds B. Proper hand hygiene C. Keeping all toys clean and free from germs D. Keeping child away from sick adults
B. Proper hand hygiene Proper hand hygiene is one of the most important health promotion strategies for all age groups of children as well as child care providers. It is not possible to keep children free from colds. Keeping all toys clean and free from germs is not possible. It is not always possible to keep children away from sick adults.
The nurse administers the flu vaccine to a school age child. After administering the vaccine, the nurse will document: (Select all that apply.) A. The date of the last flu vaccine B. The site of the vaccination C. The lot and serial number of the vaccine D. The date and time of administration E. Who assisted in restraining the child
B. The site of the vaccination C. The lot and serial number of the vaccine D. The date and time of administration The site should be recorded. This information should be recorded in case a problem develops.
A mother brings her four-month-old infant in for a routine checkup and vaccinations. The mother reports that the four-month-old was exposed to a brother who has the flu. In this case, the nurse will: A. Withhold the DTaP vaccination but give the others as scheduled B. Give the infant the flu vaccination but withhold the others C. Give the vaccinations as scheduled D. Withhold the vaccinations
C. Give the vaccinations as scheduled Giving the vaccine as scheduled will keep the infant properly immunized. There is no reason to withhold any of the vaccinations due at this time. The flu vaccination would not routinely be given to a four-month-old. Recent exposure to an infectious disease is not a reason to defer a vaccine.
The hospital admitting nurse is taking a history on a child's illness from the parents. The nurse concludes that the parents treated their six-year-old child appropriately for a fever related to otitis media when they report that they: A. Put the child in a tub of cold water to reduce the fever B. Alternated acetaminophen with ibuprofen every two hours C. Offered generous amounts of fluids frequently D. Used aspirin every four hours to reduce the fever
C. Offered generous amounts of fluids frequently The body's need for fluids increases during a febrile illness. Putting the child in a tub of cold water will chill the child and cause shivering, a response that will increase body temperature. Alternating acetaminophen with ibuprofen every two hours could result in an overdose. Aspirin has been associated with Reye's syndrome and should not be given to children with a febrile illness unless prescribed by the physician.
There has been an outbreak of communicable diseases in the community. To reduce parental anxiety, the nurse presents information about disease at the school's Parent Teacher Association meeting. The nurse explains that children cannot acquire vector-borne diseases from other children. The nurse explains that vector-borne diseases include: (Select all that apply.) A. Measles (Rubeola) B. Pertussis (whooping cough) C. Rocky Mountain Spotted Fever D. West Nile Virus E. Lyme disease
C. Rocky Mountain Spotted Fever D. West Nile Virus E. Lyme disease RMSF is a vector-borne disease spread by a tick. West Nile Virus is transmitted by a mosquito, a vector, and is not transmitted person to person. Lyme disease is also a vector-borne disease spread by a tick. Rubeola is caused by a virus and is transmitted person to person. Pertussis is caused by a gram-positive coccobacilli called bordetella pertussis and is spread person to person.
After her child receives a vaccination, the mother calls the clinic to report the child's reaction to the immunization. The nurse will recommend the mother call 911 when the mother reports: A. A few hives are noted around the injection site B. The child is running a slight temperature C. The child has swelling of the face D. Fever and joint pains occurring within hours of the vaccination
C. The child has swelling of the face This could be the onset of anaphylaxis, and immediate response is essential to the survival of the child. The mother should call 911. The remaining choices are mild allergic reactions and do not require calling 911.
The nurse is preparing to administer a vaccine to a 14-month-old infant. Which finding would require that the nurse delay the vaccination until the next well-child visit? A. The child is allergic to a substance in the vaccine B. The child has a low-grade fever and a runny nose C. The child received a dose of immune globulin two months ago D. The child is on antibiotics
C. The child received a dose of immune globulin two months ago The antibodies in the immune globulin will prevent the child from developing immunity to the vaccination. By the next well-child visit, the immune globulins will not prevent immunity from developing. This is a contraindication for this vaccine forever. The child should not receive the vaccine at the next well-child visit or at any other time. A mild upper respiratory infection would not be a contraindication for vaccine administration. Antibiotic administration will not prevent the development of active immunity.
The school nurse wants to protect the students from Reye disease. To this end, the nurse creates a pamphlet that advises the parents to avoid giving which medication to a sick child? A. Antibiotics B. Acetaminophen C. Ibuprofen D. Aspirin
D. Aspirin Administering aspirin to a child with a viral illness has been found to be associated with Reye Syndrome.
A mother refuses to have her child immunized with the measles, mumps, and rubella (MMR) vaccine because she believes that letting her infant get these diseases will help him fight off other diseases later in life. The nurse's most appropriate response to this mother is to: A. Tell the mother that by not immunizing her child she may be exposing pregnant women to the virus, which could cause fetal harm B. Honor her request because she is the parent C. Tell the mother that she is wrong and should have her child immunized D. Explain the potential complications of measles, mumps, and rubella infections
D. Explain the potential complications of measles, mumps, and rubella infections Explaining that if her child contracts measles, mumps, or rubella, he could have very serious and permanent complications from these diseases is correct; measles, mumps, and rubella all have potentially serious sequelae, such as encephalitis, brain damage, and deafness. This mother is not concerned about other women; she is concerned about what is best for her child. Nurses are responsible for helping parents make informed decisions. It is important that the mother has all the facts before she makes a decision. The mother has the right to make the decisions for her child. The nurse's role is not to tell the parents what to do but to give them the information they need to make decisions.
A parent reports that her five-year-old child, who has had all recommended immunizations, had a mild fever one week ago and now has bright red cheeks and a lacy red maculopapular rash on the trunk and arms. The nurse recognizes that this child might have: A. Rubeola (measles) B. German measles (rubella) C. Chickenpox (varicella) D. Fifth disease (erythema infectiosum)
D. Fifth disease (erythema infectiosum) Fifth disease manifests first with a flu-like illness, followed by a red "slapped-cheek" sign. Then a lacy maculopapular erythematous rash spreads symmetrically from the trunk to the extremities, sparing the soles and palms. Children with rubeola have a high temperature and a blotchy maculopapular rash. Because there is a vaccination for rubeola, it is unlikely the child has it. The rash of rubella is a pink, maculopapular rash that begins on the face and progresses downward to the trunk and extremities. The child is fully vaccinated, making this unlikely. Varicella (chickenpox) and rubella (German measles) are unlikely if the child has had all recommended immunizations.
A child who has not had a tetanus immunization steps on a rusty nail. The child needs immediate protection from tetanus. Which of the following should be given to the child at this time? A. Toxoid B. Antigen C. Killed virus D. Passive immunity
D. Passive immunity A child who has never had a tetanus immunization needs immediate protection (passive immunity) from tetanus. Passive immunity is made up of antibodies against the organism and provides immediate protection. Toxoids are chemicals normally associated with a disease that stimulate the production of immunity. An antigen is any substance that causes the body to produce an antibody. In this situation, the goal is to provide the child with passive protection. The goal is to provide the child with immediate protection. Immunizations would lead to the development of immunity but would not provide immediate immunity.
The clinic nurse is checking the potency of the vaccine. Which finding may have rendered the vaccine ineffective? A. The vaccine was frozen as labeled B. The vaccines have been stored in a refrigerator where the temperature has been maintained between 35° to 46° F C. The vaccine's expiration date expires within the next month D. The vaccine is stored in the door of the refrigerator
D. The vaccine is stored in the door of the refrigerator The door will not maintain the temperature of the vaccine. Vaccines should be stored in the middle of the refrigerator. Some vaccines are stored in the freezer. Choice 2 is appropriate to maintain potency. The vaccine is still effective until the expiration day.
