Unit5: Chapter 18 (Karch 7th Ed) - Vaccines and Sera Flashcards
- The nursing instructor is discussing immunity with her clinical group. What statement would the
instructor make that would be accurate about immunity?
A) Active immunity occurs with injected antibodies that react with specific antigens.
B) Serum sickness results when the body fights antibodies injected as a form of active immunity.
C) Passive immunity occurs when foreign proteins are recognized and the body produces antibodies.
D) Passive immunity is limited, lasting only as long as the antibodies circulate.
Ans: D
Feedback:
Unlike active immunity, passive immunity is limited. It lasts only as long as the circulating antibodies
last because the body does not produce its own antibodies as found in active immunity. People are born
with active immunity in which the body recognizes a foreign protein and begins producing antibodies
to react with specific proteins or antigens. Serum sickness is a massive immune reaction against the
injected antibodies that occur with passive immunity.
- A mother brings her 18-month-old child into the clinic for a well-baby check-up. A nurse will
administer measles, mumps, and rubella vaccine (MMR) to the child. What dosage will the nurse
administer?
A) 1.0 mL subcutaneously
B) 0.75 mL subcutaneously
C) 0.5 mL subcutaneously
D) 0.25 mL subcutaneously
Ans: C
Feedback:
The nurse will administer 0.5 mL. This is the recommended dose for adults and children older than 15
months of age.
- A public health nurse is on a mission trip to Africa where she is administering Dryvax. The patient asks
the purpose of this drug and the nurse explains it will prevent what?
A) Yellow fever
B) Smallpox
C) Chickenpox
D) Rabies
Ans: B
Feedback:
Dryvax is the immunization for smallpox disease. Varivax is the immunization for chickenpox
infection. YF-Vax is the immunization for yellow fever and RabAvert is the immunization for rabies.
- The mother of a newborn is learning about immunization schedules. The nurse tells this mother her
child will ideally receive the immunization for measles, mumps, and rubella (MMR) on what schedule?
A) 2 months, 4 months, between 6 and 18 months, and between 4 and 6 years
B) 2 months, 4 months, 6 months, and between 12 and 15 months
C) Between 12 and 15 months and between 4 and 6 years
D) Between 24 months and 18 years of age
Ans: C
Feedback:
The recommended schedule for the MMR is the first dose between 12 and 15 months and the second
dose between 4 and 6 years. The schedule for inactivated poliovirus is 2 and 4 months, between 6 and
18 months, and between 4 and 6 years. Immunization for Haemophilus influenzae is 2, 4, and 6 months
and between 12 and 15 months. The schedule for hepatitis A is between 24 months and 18 years of age.
- A 14-year-old boy is brought to the clinic by his mother. The patient has a note from his basketball
coach explaining that a member of the team has been diagnosed with hepatitis A infection. The nurse
notes that the patient has an extensive list of allergies. What is the nurse’s priority action when
administering the immune globulin?
A) Perform a hepatitis A antibody check.
B) Monitor the patient carefully and have emergency equipment ready if needed
C) Apply ice to the injection site to slow the absorption of the serum.
D) Give the patient aspirin and a corticosteroid before the injection to modulate reaction.
Ans: B
Feedback:
If a patient has known allergies, it is important to monitor the patient carefully and have emergency
equipment ready if needed after injection of proteins such as immune globulin. Severe allergic
reactions, including anaphylaxis, could occur. Ice would slow absorption of the immune globulin,
delaying the reaction and delivery of the immune globulin to the bloodstream where it can act on the
hepatitis A virus. If a person had hepatitis A antibodies, the immune globulin would not be needed. The
delay in getting that information could be problematic if the patient had been exposed to hepatitis A.
Aspirin should be avoided in children due to risk of Reye’s syndrome. Corticosteroids can reduce
immune response and so would be contraindicated.
- A nurse is providing patient education to the mother of a child receiving a first immunization. The
nurse tells the mother that after the injection, it is normal for the child to exhibit what signs and
symptoms?
A) Vomiting and diarrhea
B) High fever and sweating
C) Lethargy, drowsiness, and irritability
D) Pain, redness, and swelling at site of injection
Ans: D
Feedback:
Normal reactions to immunizations include pain, redness, and swelling at the site of the injection.
Vomiting, diarrhea, high fever, sweating, lethargy, or drowsiness would not be expected and should be
reported. The child could also be slightly irritable due to the pain at the injection site.
- A 69-year-old patient comes to the clinic to talk to the nurse. The patient asks the nurse about when he
should get the pneumonia vaccine. The patient’s medical record reveals that he received the vaccine at
age 55. What should the nurse tell the patient?
A) This vaccine is only given once and you have already had it.
B) This vaccine is given every 10 years and you will be due next year.
C) This vaccine is only repeated if the first dose was given before age 65. You should have another
vaccine.
D) This vaccine is no longer recommended. Don’t worry about getting pneumonia.
Ans: A
Feedback:
The pneumonia vaccine contains 23 strains and is believed to offer lifetime protection. The tetanus
vaccine is given every 10 years. The vaccine is recommended for anyone at risk, especially those over
age 65. Options C and D are distracters
- A mother has brought her infant to the clinic for the first immunization. What would the nurse be sure
to include when providing patient education for the infant’s mother?
A) Avoid having her child get more than one vaccine at a time.
B) Stop the immunizations after 2 years of age.
C) Keep a written record of the child’s immunizations.
D) Omit immunizations if the injections are too upsetting for her child.
Ans: C
Feedback:
Provide thorough patient teaching, including measures to avoid adverse effects, warning signs of
problems, the need to keep a written record of immunizations, to increase knowledge about drug
therapy, and to increase compliance with the drug regimen. Immunization records are often requested
when the child is being enrolled in school so it is important for the mother to maintain these records.
The nurse would not teach the mother to avoid having her child take more than one vaccine at a time,
or to stop the immunizations after the age of 2, or to omit the immunizations if the injections are too
upsetting to her child.
- A mother brings her 18-month-old son into the clinic for his diphtheria, tetanus, and pertussis vaccine.
The child has a runny nose, a fever of 102.4ºF and is coughing. What should the nurse do?
A) Administer the vaccine but monitor the child afterward for an extended time period.
B) Give an antipyretic and administer vaccine when temperature is within normal range.
C) Administer a reduced dose of the vaccine today and a normal dose when child is healthy.
D) Hold the immunization until the child is free of allergic or cold-like symptoms
Ans: D
Feedback:
The nurse should not administer the immunization if the child exhibits signs of acute infection because
the vaccine can cause mild infection and can exacerbate acute infections. The child should be free of
infection for several days before the immunization is given. Treating the fever, extended monitoring, or
smaller doses will not overcome this risk and the only option is to hold the immunization until the child
is healthy.
- When discussing vaccines in class, a student asks the nursing instructor what an antitoxin is. What is
the instructor’s best response?
A) It is an immune serum for snake bites.
B) It is a type of vaccine.
C) It is a form of active immunity.
D) It is a form of passive immunity.
Ans: D
Feedback:
An antitoxin is an example of passive immunity. Antitoxins contain antibodies to very specific toxins.
The antibodies are injected into the system and react with invading pathogens. Active immunity occurs
when the body recognizes a foreign protein and begins producing antibodies to react against that
specific protein or antigen. Vaccines are immunizations containing weakened or altered protein
antigens that stimulate formation of antibodies against a specific disease. They are used to promote
active immunity. Antivenin is used to refer to immune sera that have antibodies to venom that might be
injected through spider or snake bites.
- The nurse is presenting an educational event about vaccines at a local elementary school. When talking
about vaccines, the nurse explains they are generally contraindicated in what situations?
A) In people who have renal impairment
B) In people who have hepatic failure
C) In people who are immunosuppressed
D) In people who are over 65
Ans: C
Feedback:
The use of vaccines is contraindicated in the presence of immune deficiency because the vaccine could
cause disease and the body would not be able to respond as anticipated if in an immunodeficient state,
during pregnancy because of potential effects on the fetus and on the success of the pregnancy, in
patients with known allergies to any of the components of the vaccine (refer to each individual vaccine
for specifics, sometimes including eggs, where some pathogens are cultured), or in patients who are
receiving immune globulin or who have received blood or blood products within the last 3 months
because a serious immune reaction could occur. Vaccines are not contraindicated in people with renal
impairment or who have hepatic failure nor are they contraindicated in people over the age of 65.
- The clinic nurse is administering vaccines at well-baby checkups. Before administering a diphtheria,
tetanus, and pertussis (DTP) vaccine, what vital sign is most important for the nurse to check?
A) Temperature
B) Pulse
C) Blood pressure
D) Respirations
Ans: A
Feedback:
Caution should be used whenever a vaccine is given to a child with a history of febrile convulsions or
cerebral injury, or in any condition in which a potential fever would be dangerous. Caution also should
be used in the presence of any acute infection. As a result, checking the child’s temperature is most
important because this would be an indicator of potential infection. The nurse should ask the mother
about history of febrile seizures or any condition that would make a fever dangerous
- The nurse is assigned to perform telephone triage for the clinic and receives a call from a young mother
whose 6-month-old baby received her third diphtheria pertussis tetanus immunization that morning. The
mother reports the baby’s temperature is 99.8° axillary, the site of injection is a little red, and the baby
is irritable. After checking the standing orders provided by the pediatrician, what teaching would the
nurse provide this mother? (Select all that apply.)
A) These are common adverse effects reported after immunizations.
B) Bring the baby back to the clinic for an examination.
C) Apply a warm moist compress to the baby’s leg.
D) Aspirin can be given to manage fever symptoms.
E) Symptoms should subside within 2 to 3 days.
Ans: A, C, E
Feedback:
The symptoms reported by this mother are all common adverse effects following immunization that
will subside within 2 to 3 days. In the meantime, the mother can make the baby more comfortable by
administering a weight appropriate dosage of acetaminophen, applying warm compresses to the
injection site, and providing a quiet environment. If the symptoms do not subside within 2 to 3 days, the
baby should be seen for follow-up care. Aspirin should not be given due to risk of Reye’s syndrome.
- The nurse is describing the schedule for vaccinations to the parents of a new baby. The nurse explains
the measles mumps rubella (MMR) vaccine is first administered at what age?
A) 1 month
B) 3 months
C) 6 months
D) 15 months
Ans: D
Feedback:
MMR is administered initially as a combined vaccine at 15 months. Therefore, options A, B, and C are
incorrect.
- A male patient, aged 78 presents in the emergency department after stepping on a nail. The patient tells
the nurse that he had his last tetanus shot 12 years ago and asks whether he will need another shot
today. The nurse explains that tetanus boosters are required how often?
A) Yearly
B) Every 10 years
C) Every 2 years
D) Every 5 years
Ans: B
Feedback: Having a tetanus booster shot every 10 years will help to protect older adults from exposure to that
illness. Ask the patient about any adverse reaction to previous tetanus boosters, and weigh that risk
against the possible exposure to tetanus. Options A, C, and D are incorrect information to give the
patient.