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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.
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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.
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.
The nurse is reviewing principles of immunization. What type of immunization occurs when antibodies pass from mother to infant during breastfeeding or through the placenta during pregnancy?
- A. Artificial active immunization
- B. Attenuating immunization
- C. Natural passive immunization
- D. Artificial passive immunization
Correct Answer: C
Rationale: Natural passive immunization occurs when antibodies are transferred from the mother to her infant in breast milk or through the bloodstream via the placenta during pregnancy. Artificial active immunization causes an antigen-antibody response and stimulates the body's defenses to resist any subsequent exposures. Artificial passive immunization is conferred by bypassing the host's immune system and injecting the person with antiserum or concentrated antibodies obtained from other humans or animals.
A 30-year-old woman is in the clinic for her yearly gynecologic exam and asks the nurse about the 'new vaccine that prevents HPV.' She wants to receive the papillomavirus vaccine. Which response by the nurse is most appropriate?
- A. For women, the recommended age for this vaccine is 13 to 26 years of age.
- B. We will need to make sure you are not pregnant first.
- C. There will be a total of three injections.
- D. I will check with your health care provider and then get the first dose of the vaccine ready.
Correct Answer: A
Rationale: The guidelines recommend the HPV vaccine (Gardasil) for women 13 to 26 years of age. It is important to ensure the patient is not pregnant and that the vaccine involves three injections, but the patient's age of 30 years makes her ineligible for the vaccine.
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.