Deck 70: The Immune System and Immunizations

Question 1

The primary care NP sees a 2-month-old infant for a well-baby examination in late November.The infant was born at 34 weeks' gestation,does not have underlying cardiac or pulmonary conditions,and does not attend daycare.The NP should recommend:

A) one dose of palivizumab (Synagis) today.
B) no respiratory syncytial virus prophylaxis.
C) three monthly doses of palivizumab (Synagis).
D) monthly doses of palivizumab (Synagis) until April.

Answer 1

three monthly doses of palivizumab (Synagis).

Question 2

The primary care NP sees a 12-month-old infant who needs the MMR,Varivax,influenza,and hepatitis A vaccines.The child's mother tells the NP that she is pregnant.The NP should:

A) administer all of these vaccines today.
B) give the hepatitis A and influenza vaccines.
C) give the Varivax, hepatitis A, and influenza vaccines.
D) withhold all of these vaccines until after the baby is born.

Answer 2

administer all of these vaccines today.

Question 3

The primary care NP sees an 11-month-old infant for the first time and notes that the infant has not received the Hib vaccine.The NP should:

A) give the Hib vaccine now with no boosters.
B) give the Hib vaccine now and booster in 2 to 3 months.
C) give the Hib vaccine now and booster at age 4 to 6 years.
D) tell the parents that the child is too old to begin receiving the Hib vaccine.

Answer 3

give the Hib vaccine now and booster in 2 to 3 months.

Question 4

The parents of a 2-month-old infant ask the primary care nurse practitioner (NP)if they can immunize their child by giving one or two immunizations per month instead of following the recommended immunization schedule for vaccines at 2,4,6,12,and 15 months of age.The NP should:

A) respect the parents' wishes and agree to the revised schedule for immunizations.
B) explain that prolonging the vaccine regimen will lead to a decrease in final antibody concentrations.
C) tell the parents that protection from diseases may be delayed until all immunizations have been given.
D) inform the parents that a prolonged interval between some vaccines may require restarting the series for those vaccines.

Question 5

The primary care NP sees a 5-year-old child for a prekindergarten physical examination.The child's parents do not have immunization records,and a local record search does not provide proof of vaccinations,although the parent thinks the child may have had some vaccines several years ago.The NP's initial action will be to:

A) perform serologic tests for measles, rubella, and tetanus antigens.
B) administer TdaP, MMR, Varivax, PCV13, hepatitis A, hepatitis B, and IPV vaccines.
C) administer DTaP, Hib, hepatitis A, hepatitis B, MMR, Varivax, IPV, RV, and PCV13 vaccines.
D) ask the parent to look for immunization records and schedule an appointment for vaccines when those are found.

Question 6

A parent whose child received a fourth DTaP at a recent 15-month visit calls the primary care NP to report that the child is fussy,has a temperature of 38.3° C,and has redness and swelling at the injection site.The NP should:

A) admit the child to the hospital for observation of developing symptoms.
B) flag the child's chart to avoid administration of pertussis vaccine in the future.
C) report these adverse reactions to the Vaccine Adverse Event Reporting System (VAERS).
D) instruct the parent to give the child acetaminophen as needed for fever or localized discomfort.

Question 7

A patient receives a hepatitis A vaccine and 4 weeks later develops symptoms of hepatitis.The patient has no history of exposure to blood or body fluids.The primary care NP should tell the patient that:

A) the symptoms are most likely caused by hepatitis B or C.
B) these symptoms are common adverse effects of the vaccine.
C) a prevaccine exposure to hepatitis A could be causing symptoms.
D) the vaccine is effective only after the second dose of hepatitis A vaccine.

Question 8

The primary care NP performs a physical examination on an 89-year-old patient who is about to enter a skilled nursing facility.The patient reports having had chickenpox as a child.The NP should:

A) obtain a varicella titer.
B) administer the Varivax vaccine.
C) give the patient the Zostavax vaccine.
D) plan to prescribe Zovirax if the patient is exposed to shingles.

Question 9

The primary care NP sees a 4-year-old child who has persistent asthma episodes for a well-child visit in October.The child recently completed a 7-day course of oral steroids.The NP plans to give the child flu vaccine and should:

A) administer LAIV today.
B) administer 0.5 mg TIV today.
C) wait 4 weeks and administer LAIV.
D) wait 4 weeks and administer 0.5 mg TIV.

Question 10

The primary care NP sees a 4-year-old child who has received four doses of PCV 7 in the first 15 months of life.The NP should administer:

A) PCV 7.
B) PCV 13.
C) PPV 23.
D) no PCV.

Question 11

A woman who is pregnant and is planning to breastfeed tells the primary care NP that she has never had chickenpox.The NP should:

A) administer the Varivax vaccine today.
B) administer the varicella-zoster immune globulin.
C) recommend the Varivax vaccine as soon as possible after her baby is born.
D) instruct her to receive the Varivax vaccine after her baby has been weaned.

Question 12

A 23-year-old woman who is sexually active has an abnormal Pap smear.She asks the primary care NP about the human papillomavirus vaccine (HPV).The NP should recommend:

A) no HPV vaccine.
B) a single HPV vaccine.
C) a three-vaccine series of HPV.
D) HPV vaccine for her partner.

Question 13

The parent of a 2-month-old infant who will soon begin daycare refuses the rotavirus vaccine (RV)because of fears of intussusception.The parent tells the primary care NP that the daycare is strict about preventing infants who have fever or gastrointestinal symptoms from attending.The NP should tell the parent that:

A) herd immunity will protect the infant from infection.
B) asymptomatic children can spread rotavirus infection.
C) the risk of intussusception is nonexistent with the newer vaccine.
D) the infant can be treated with antibiotics if rotavirus infection occurs.

Question 14

The primary care NP is performing a physical examination on a 6-month-old infant with cerebral palsy who has not had previous immunizations.The NP plans to begin vaccinations and should include:

A) DTaP vaccine.
B) TdaP vaccine.
C) TD vaccine only.
D) tetanus vaccine only.

Question 15

The primary care NP sees a 65-year-old patient in October.The patient has a history of COPD and has not had any vaccines for more than 20 years.The NP should administer:

A) influenza and Td vaccines.
B) PCV 13 and influenza vaccines.
C) PPV 23, Td, and influenza vaccines.
D) PPV 23, influenza, and TdaP vaccines.

Question 16

The primary care NP sees a 6-month-old infant for a routine physical examination and notes that the infant has a runny nose and a cough.The parents report a 2-day history of a temperature of 99° F to 100° F and two to three loose stools per day.Other family members have similar symptoms.The infant has had two sets of immunizations at 2 and 4 months of age.The NP should:

A) administer the 6-month immunizations at this visit today.
B) schedule an appointment in 2 weeks for 6-month immunizations.
C) administer DTaP, Hib, IPV, hepatitis B, and PCV13 today and RV in 2 weeks.
D) withhold all immunizations until the infant's temperature returns to normal and the cough is gone.