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A sanitation worker has experienced a needle stick by a contaminated needle that was placed in a trash can. The employee health nurse expects that which drug will be used to provide passive immunity to hepatitis B infection?
- A. Haemophilus influenzae type b
- B. Varicella virus vaccine
- C. Hepatitis B immunoglobulin
- D. Hepatitis B virus vaccine (inactivated)
Correct Answer: C
Rationale: Hepatitis B immunoglobulin provides passive immunity for individuals exposed to hepatitis B, such as through a needle stick. The hepatitis B virus vaccine promotes active immunity, not passive. The other options are not appropriate for this situation.
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A 45-year-old man has received a series of immunizing drugs in preparation for a trip to a developing country. Within hours, his wife brings him to the emergency department because he has developed edema of the face, tongue, and throat and is having trouble breathing. The nurse suspects that, based on the patient's history and symptoms, he is experiencing which condition?
- A. Serum sickness
- B. Cross-sensitivity
- C. Thrombocytopenic purpura
- D. Anaphylaxis
Correct Answer: D
Rationale: The symptoms of edema of the face, tongue, and throat along with difficulty breathing suggest an anaphylactic reaction, which is a severe allergic response that can occur after receiving immunizing drugs. Serum sickness is characterized by symptoms like fever, rash, and joint pain, typically appearing days to weeks after exposure. Cross-sensitivity refers to allergic reactions to related substances, and thrombocytopenic purpura involves bleeding issues due to low platelet counts, neither of which match the described symptoms.
A nurse is working in an immunization clinic. A new colleague asks, 'When is the first dose of the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine given?' The nurse knows that this series is started at what age?
- A. At birth
- B. 6 weeks
- C. 3 months
- D. 1 year
Correct Answer: B
Rationale: The first dose of the DTaP vaccine series is given at 6 weeks of age. The other options are incorrect.
A 12-month-old infant has received an MMR II (measles, mumps, and rubella virus vaccine), and her mother calls the clinic that afternoon to ask about helping her fussy infant to 'feel better.' What will the nurse suggest?
- A. Apply ice packs
- B. Apply warm compresses
- C. Observe the site for further swelling
- D. Bring the infant in to the emergency department for an immediate exam
Correct Answer: B
Rationale: Applying warm compresses to the injection site and using acetaminophen (not aspirin, which carries the risk for Reye's syndrome) should help to relieve the discomfort. The other options are incorrect.
A patient who received the Zostavax herpes zoster vaccine 5 years ago is asking about the newer Shingrix vaccine. The nurse is reviewing the information with the patient. Which statements about the Shingrix vaccine are true? (Select all that apply.)
- A. It is a one-time vaccine.
- B. It is given in a two-dose series.
- C. The vaccine is given to children to prevent chickenpox.
- D. It is contraindicated in patients who have had the Zostavax vaccine.
- E. It is given to adults to prevent shingles.
- F. It provides active immunity to the herpes zoster virus.
Correct Answer: B,E
Rationale: The Shingrix (herpes zoster vaccine, recombinant) is used to prevent shingles. It is given to adults, and it is a two-dose vaccine. It is not given to prevent chickenpox or given to children. It provides active immunity against the herpes zoster virus. It is not contraindicated in patients who have had the Zostavax vaccine.
The nurse is reviewing the health history of a new patient who may need immunizations. Active immunizations are usually contraindicated in which patients? (Select all that apply.)
- A. Patients with a febrile illness
- B. Children younger than 1 year of age
- C. Elderly patients
- D. Patients who are immunosuppressed
- E. Those receiving cancer chemotherapy
Correct Answer: A,D,E
Rationale: Contraindications to the administration of immunizing drugs include a history of reactions to or serious adverse effects resulting from the drugs, and patients who are already immunosuppressed (patients with AIDS and patients receiving chemotherapy). Immunizations are best deferred until after a febrile illness. Children younger than 1 year of age and the elderly may receive immunizing drugs.