Chapter 34: Vaccines Pharmacology

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?

a. If she gets the vaccine, both she and her 4-year-old child will be protected.

b. If the 4-year-old child contracts pertussis, it can be passed on to her newborn.

c. The vaccine will not be given to her child while she is pregnant.

d. Vaccinating the 4-year-old will provide passive immunity for her unborn child.

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.

2. A 32-year-old 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 listed below would be most appropriate to administer to this patient?

a. Human papillomavirus (HPV) quadrivalent vaccine

b. Trivalent influenza vaccine

c. Measles-mumps-rubella (MMR) vaccine

d. Varicella vaccine

ANS: B The influenza vaccine is recommended for everyone 6 months and older, including pregnant women. Pregnant women should not receive the live attenuated influenza vaccine, however. HPV quadrivalent vaccine is given to preteen boys and girls at age 11 or 12 so they are protected before virus exposure. HPV quadrivalent vaccine can be administered in women and men through age 26. The MMR is contraindicated because rubella can cause serious teratogenic effects. Varicella is contraindicated during pregnancy

3. A 4-year-old child is receiving amoxicillin to treat otitis media and is in the clinic for a wellchild checkup on the last day of antibiotic therapy. The provider orders varicella; 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.

b. Discuss giving the MMR vaccine in 4 weeks.

c. Hold all vaccines until 2 weeks after antibiotic therapy.

d. Recommend aspirin for fever and discomfort.

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. Aspirin should not be given because of the increased risk of Reye syndrome.

4. A patient is preparing to travel with a 4-year-old child to India in 15 days and is in the clinic to receive typhoid vaccines. Which vaccines will be given to the parent and the child?

a. Four capsules of live, oral vaccine to both patients.

b. Four capsules of live, oral vaccine for the parent and the intramuscular (IM) polysaccharide vaccine for the child.

c. Four capsules of live, oral vaccine for the child and the IM polysaccharide vaccine for the parent.

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 15 days. Children under age 6 cannot receive the oral vaccine. The IM polysaccharide vaccine should be administered at least 2 weeks before the expected exposure. DIF: Cognitive Level: Applying (Application)

5. A 48-month-old child is scheduled to receive the following vaccines: MMR, varicella vaccine, 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

a. the DTaP and varicella vaccine today and the MMR and IPV in 1 week.

b. the IPV and MMR today and the varicella vaccine and DTaP in 1 week.

c. the MMR and DTaP today and the varicella vaccine and IPV in 1 week.

d. the MMR and varicella vaccine 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.

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?

a. DT

b. DTaP

c. Td

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. 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 which of the following?

a. RV1 today

b. RV1 today and again at age 6 months

c. RV5 today

d. RV5 today and again at age 6 months

ANS: A Patients receiving RV1 receive 2 doses at age 2 and 4 months only.

8. A provider has ordered recombinant HPV quadrivalent vaccine to be given to a prepubertal 11- 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 the vaccine

a. is less effective in older adolescents.

b. is more effective if given before sexual activity begins.

c. is more effective if given prior to the hormonal changes of puberty.

d. is not effective if given after the onset of menses.

ANS: B The HPV quadrivalent vaccine is most effective when the client is not yet sexually active. Ideally, the vaccine is administered to preteen boys and girls at age 11 or 12, but can be given through age 26.

9. Which is an example of acquired passive immunity?

a. Administration of IgG to an unimmunized person exposed to a disease

b. Administration of an antigen via an immunization

c. Inherent resistance to a disease antigen

d. Immune response to an attenuated virus

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.

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?

a. Recommend aspirin or a nonsteroidal anti-inflammatory drug (NSAID) for pain and fever.

b. Recommend acetaminophen and cold compresses.

c. Report these adverse effects to the Vaccine Adverse Event Reporting System (VAERS).

d. Schedule an appointment in clinic so the provider can evaluate the child.

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, but the parent should be encouraged to recontact the clinic if symptoms do not improve.

11. The provider orders the zoster vaccine 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.

b. Counsel the patient that the vaccine may cause a severe reaction because of previous exposure.

c. Hold the vaccine and notify the provider of the patient's history.

d. Request an order for a varicella booster instead of the zoster vaccine.

ANS: A The zoster vaccine 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.