Deck 16: Drugs Affecting the Immune System

Question 1

Varicella vaccine may be given to patients who are:

A)HIV positive with a CD4+ T-lymphocyte percentage less than 15%
B)Taking corticosteroids (up to 2 mg/kg/day or less than 20 mg/day)
C)Pregnant
D)Immunocompromised

Answer 1

Taking corticosteroids (up to 2 mg/kg/day or less than 20 mg/day)

Question 2

True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine include:

A)Fever up to 104^oF (40.5^oC) after previous DTaP vaccine
B)Family history of seizures after DTaP vaccine
C)Adolescent pregnancy
D)Anaphylactic reaction with a previous dose

Answer 2

Anaphylactic reaction with a previous dose

Question 3

Hepatitis B immune globulin is administered to provide passive immunity to:

A)Infants born to HBsAg-positive mothers
B)Sexual contacts of those infected with hepatitis B virus
C)Persons exposed to blood containing hepatitis B virus
D)All of the above

Answer 3

Infants born to HBsAg-positive mothers

Question 4

The MMR vaccine is not recommended for pregnant women because:

A)Pregnant women do not build adequate immunity to the vaccine.
B)There is a risk of pregnant women developing measles encephalopathy.
C)There is a risk of the fetus developing congenital rubella syndrome.
D)Pregnant women can receive the MMR vaccine.

Question 5

Live attenuated influenza vaccine (FluMist) may be administered to:

A)All patients over six months of age
B)Patients between ages 2 and 49 with no risk factors
C)Patients with an upper respiratory infection (URI) or asthma
D)Pregnant women

Question 6

Rh_o(D) immune globulin (RhoGAM) is given to:

A)Infants born to women who are Rh positive
B)Sexual partners of Rh-positive women
C)Rh-negative women after a birth, miscarriage, or abortion
D)Rh-negative women at 36 weeks gestation

Question 7

Pregnant women should receive the Tdap vaccine:

A)In the first trimester
B)Once every 10 years
C)In the third trimester of every pregnancy
D)Tdap is contraindicated in pregnancy

Question 8

Tuberculin purified protein derivative:

A)Is administered to patients who are known tuberculin-positive reactors
B)May be administered to patients who are on immunosuppressives
C)Should be administered two to three weeks after an MMR or varicella vaccine
D)May be administered the same day as the MMR and/or varicella vaccine

Question 9

Human papillomavirus (HPV) vaccine (Gardasil):

A)Is a live virus vaccine that provides immunity to six strains of HPV virus
B)Has a common adverse effect of syncope within 15 minutes of giving the vaccine
C)Should not be given to males younger than age 12 years
D)May be given to pregnant women

Question 10

Meningococcal B vaccine is administered to:

A)Infants and children traveling to Saudi Arabia or other hyperendemic areas
B)Pregnant adolescents who are attending school
C)Patients 10 to 25 years of age during an outbreak
D)Infants with functional asplenia

Question 11

Immune globulin serums:

A)Provide active immunity against infectious diseases
B)Are contraindicated during pregnancy
C)Are heated to above body temperature to kill most hepatitis, human immunodeficiency virus (HIV), and other viruses such as parvovirus
D)Are derived from pooled plasma of adults and contain specific antibodies in proportion to the donor population

Question 12

A patient may benefit from cyclosporine (Sandimmune). Cyclosporine may be prescribed to:

A)Treat rheumatoid arthritis
B)Treat patients with a corn allergy
C)Pregnant patients
D)Treat patients with liver dysfunction

Question 13

Azathioprine has significant adverse drug effects, including:

A)Hypertension
B)Hirsutism
C)Risk of cancer
D)Gingival hyperplasia

Question 14

The reason that two measles, mumps, and rubella (MMR) vaccines at least a month apart are recommended is:

A)The second dose of MMR "boosts" the immunity built from the first dose.
B)Two vaccines one month apart is the standard dosing for all live virus vaccines.
C)If the two MMR vaccine doses are given too closely together there is a greater likelihood of severe localized reaction to the vaccine.
D)Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR.

Question 15

Attenuated vaccines are also known as:

A)Killed vaccines
B)Booster vaccines
C)Inactivated vaccines
D)Live vaccines

Question 16

If the measles, mumps, rubella, and varicella (MMRV) combined vaccine is ordered to be given as the first MMR and varicella dose to a child the Centers for Disease Control and Prevention (CDC) recommends:

A)Parents be informed of the increased risk of fever and febrile seizures over the MMR plus varicella two-shot regimen.
B)Patients must also receive MMRV as the second dose of MMR and varicella in order to build adequate immunity.
C)Patients be premedicated with acetaminophen 15 minutes before the vaccine is given.
D)Patients should not be around pregnant women for the first 48 hours after the vaccine is given.

Question 17

The rotavirus vaccine (RotaTeq, Rotarix):

A)Is a live vaccine that replicates in the small intestine, providing active immunity against rotavirus
B)Should not be administered to infants who are or may be immunocompromised
C)Is not given to an infant who has a febrile illness (temperature greater than 100.5^oF)
D)All of the above

Question 18

Recombinant influenza vaccine (Flucelvax, Flublok) may be administered annually to:

A)Patients with an egg allergy
B)Pregnant adolescent patients
C)Patients age six weeks or older
D)Patients with acute febrile illness

Question 19

Hepatitis B vaccine is contraindicated in patients who:

A)Were born at less than 32 weeks gestation
B)Are pregnant
C)Are on hemodialysis
D)Are allergic to yeast

Question 20

Zoster vaccine (Zostavax) is:

A)A live varicella zoster vaccine from the same strain used to develop the varicella vaccine
B)Effective in preventing varicella zoster in patients of all ages
C)Recommended for patients age 40 to 80 who have had chickenpox
D)Administered at the same time as other live vaccines, as long as they are given the same day

Question 21

Who should receive a third dose of MMR vaccine:

A)Children traveling internationally who have had two doses of MMR
B)Pregnant women who are exposed to measles
C)People who have had two doses of MMR and are at risk during a mumps outbreak
D)No one; a third dose is never recommended

Question 22

Hepatitis A virus (HAV) vaccination is recommended for:

A)All infants traveling internationally, but the dose is not counted
B)All health-care providers
C)Members of a household with children adopted from Africa
D)Immunocompromised patients

Question 23

A two-year-old child recently immigrated and has presented for immunization review. Their immunization record indicates they have received three doses of bivalent oral polio (bOPV). What polio vaccine(s) does the child need?

A)None, they are fully vaccinated for polio as recommended
B)Three doses of inactivated poliovirus (IPV)
C)One dose of IPV after four years of age
D)One dose of trivalent oral polio virus (tOPV)

Question 24

The following pediatric patients should receive meningococcal ACWY conjugate vaccine:

A)Infants who are HIV infected
B)All school-age children
C)Children who attend daycare
D)Infants with congenital hearing defects