Immunizations And Catch-Up Identification
Help Questions
NCLEX-PN › Immunizations And Catch-Up Identification
The mother of a 12-month-old child expresses concern about the measles, mumps, and rubella (MMR) vaccine. Which statement by the PN is most appropriate to reinforce teaching?
This vaccine is required by law for school entry, so your child must receive it.
The MMR vaccine helps protect your child from three common and potentially serious childhood diseases.
You can delay this vaccine until your child is older if you are worried about side effects.
I can give you some research articles that show the vaccine is not linked to autism.
Explanation
The most appropriate response is to provide factual, therapeutic information that reinforces the primary benefit of the vaccine, which is to protect the child from disease. This addresses the parent's concern in a non-confrontational way.
The practical nurse (PN) is preparing to administer routine immunizations to a 2-month-old infant. The PN should prepare to administer which combination of vaccines?
Tetanus, diphtheria, acellular pertussis (Tdap), Human papillomavirus (HPV), Meningococcal
DTaP, Haemophilus influenzae type b (Hib), Rotavirus (RV), Pneumococcal (PCV13), IPV
Hepatitis B (HepB), Varicella, Hib, DTaP
Diphtheria, tetanus, acellular pertussis (DTaP), Measles, mumps, rubella (MMR), Polio (IPV)
Explanation
At the 2-month well-child visit, the infant is scheduled to receive the first doses of DTaP, Hib, RV, PCV13, and IPV. These vaccines protect against several serious childhood diseases and follow the CDC immunization schedule for infants.
The PN is preparing to administer an influenza vaccine to an adult client. The client states, "I got the flu shot last year and I still got sick, so I don't think it works." Which response by the PN is most appropriate?
You must have a weak immune system if you got sick anyway.
The vaccine can sometimes cause a mild case of the flu.
It's possible you were exposed to the flu before the vaccine became fully effective, or you caught a different virus.
The vaccine is not 100% effective, but it is required for all our clients.
Explanation
This response provides accurate, non-judgmental information. It takes about two weeks for the body to develop antibodies after vaccination. It's also possible the client had an illness caused by a different respiratory virus. This reinforces teaching and addresses the client's concern.
A 7-year-old child presents for a physical. The immunization record indicates the child only received one dose of the Hepatitis B vaccine as a newborn. What is the PN's priority action?
Prepare to administer the second dose of the Hepatitis B vaccine today.
Tell the parent that the child is too old to complete the series.
Inform the parent that the series must be restarted.
Administer the second and third doses of the vaccine today to catch up.
Explanation
Immunization series are never restarted, regardless of the time elapsed between doses. The child should receive the second dose, and a plan will be made to administer the third dose at the appropriate interval.
The PN is reviewing the immunization records for several children scheduled for appointments today. Which child will require a catch-up immunization schedule?
A 12-month-old who received all recommended vaccines at 2, 4, and 6 months.
A 7-month-old who missed the 6-month appointment and is here for a well-child visit.
A 5-year-old who received DTaP, IPV, MMR, and Varicella vaccines at age 4.
An 18-month-old who has received three doses of DTaP, with the last one at 6 months.
Explanation
A 7-month-old who missed their 6-month visit is behind schedule for the third doses of DTaP, PCV13, Hib, and second dose of rotavirus vaccine. This child will need to follow a catch-up schedule to get back on track with age-appropriate immunizations.
A 68-year-old client asks the PN if they need the shingles vaccine. The client has a history of chickenpox as a child. What is the most appropriate information for the PN to reinforce?
Since you have already had chickenpox, you are immune to shingles.
The vaccine is not recommended for anyone over the age of 65.
You only need the shingles vaccine if you are frequently around young children.
The recombinant zoster vaccine is recommended for adults 50 years and older.
Explanation
Current guidelines recommend the recombinant zoster vaccine (Shingrix) for all adults 50 years and older to prevent shingles and its complications, regardless of whether they recall having had chickenpox.
The PN is preparing to administer routine immunizations to a 15-month-old child. The child's medical history indicates a diagnosis of a congenital immunodeficiency disorder. The PN should notify the RN and question the administration of which vaccine?
Measles, mumps, rubella (MMR)
Diphtheria, tetanus, acellular pertussis (DTaP)
Inactivated poliovirus (IPV)
Pneumococcal conjugate (PCV13)
Explanation
The MMR vaccine is a live attenuated virus vaccine. Live vaccines are contraindicated in individuals with severe immunodeficiency because they can cause a severe or fatal infection. The PN has a responsibility to recognize and report this potential contraindication.
The PN is preparing to administer the first dose of the DTaP vaccine to a 2-month-old infant. Which piece of data is most important for the PN to collect from the parent before administering the vaccine?
The infant's weight and length percentile.
If the infant had a severe allergic reaction to the Hepatitis B vaccine given at birth.
Whether the infant has any siblings in daycare.
The date of the infant's last bowel movement.
Explanation
The most critical safety check before administering any vaccine is to screen for contraindications and precautions. A history of a severe allergic reaction (anaphylaxis) to a previous dose of a vaccine or to a vaccine component is a contraindication to further doses.
A 6-year-old child, recently adopted from a country with no available immunization records, is brought to the clinic. What is the most appropriate plan for the PN to anticipate?
Assuming the child is fully immunized and requiring no further shots.
Beginning the appropriate catch-up immunization schedule for a 6-year-old.
Drawing blood titers to check for immunity to all vaccine-preventable diseases.
Administering only the vaccines required for school entry.
Explanation
According to the CDC, individuals with no reliable written documentation of vaccination should be considered unimmunized. The standard of care is to begin an age-appropriate catch-up schedule. It is safe to revaccinate, whereas it is unsafe to assume immunity.
An 18-year-old client is preparing to live in a college dormitory. The PN is reviewing the client's immunization record. The record shows a primary dose of meningococcal conjugate (MenACWY) vaccine was given at age 12. Which action should the PN anticipate?
Preparing to administer a booster dose of the MenACWY vaccine.
Reporting to the RN that the client needs to start the series over.
Informing the client that no further meningococcal vaccines are needed.
Administering the meningococcal B (MenB) vaccine instead of a MenACWY booster.
Explanation
A booster dose of the MenACWY vaccine is recommended for adolescents at age 16. This is especially important for those entering settings like college dormitories where the risk of meningitis outbreaks is higher.