chapter 19: immunologic medications edmunds: introduction ... · key: nursing process step: n/a...

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clinical-pharmacology-8th-edition-by-edmunds/ Chapter 19: Immunologic Medications

Edmunds: Introduction to Clinical Pharmacology, 8th Edition

MULTIPLE CHOICE

1. Which term refers to a medication containing a weakened or dead antigen?

a. Toxoid

b. Vaccine

c. Antiserum

d. Antidote

ANS: B

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Laboratories can produce vaccines that contain either attenuated or killed antigens so that people can be immunized to prevent them from getting the disease.

DIF: Cognitive Level: Remember REF: p. 400 OBJ: 1

TOP: Vaccines KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

2. TD (tetanus and diphtheria) boosters are recommended at which interval?

a. Every 5 years

b. Every 7 years

c. Every 10 years

d. Every 15 years

ANS: C

TD (tetanus and diphtheria) boosters are recommended every 10 years.

DIF: Cognitive Level: Remember REF: p. 401 | Table 19-1

OBJ: 3 TOP: Immunization Schedule

KEY: Nursing Process Step: Planning


3. A patient comes into the clinic with complaints of a cold. He is also there for a flu shot. Which represents the reason a flu shot is not recommended in this case?

a. Active infection is present.

b. WBCs are too low.

c. CBCs are high.

d. Susceptibility is down.

ANS: A

The best policy is that immunizations should not be given to patients with active infection, severe febrile illness, or history of a serious side effect from previous vaccinations.

DIF:

Cognitive Level: Understand

REF:

p. 403

OBJ:

4

TOP:

Immunizations

KEY:

Nursing

Process Step: Planning


4. The nurse would recommend a yearly influenza virus vaccine to which person?

a. Teenager

b. Young mother

c. Middle-aged man

d. Older adult woman

ANS: D

Older adults are at high risk for pneumonia and flu, so it is recommended that this patient population receive the annual flu vaccine to prevent infection.

DIF: Cognitive Level: Understand REF: p. 402 OBJ: 3

TOP: Vaccines KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

5. Protection from which infectious disease can be offered by routine immunization with PCV (children) or PPV (adults) vaccine?

a. Streptococcus pneumoniae

b. Typhoid

c. Cholera

d. Toxoid

ANS: A

Pneumococcal conjugate vaccine (PCV) for children and pneumococcal polysaccharide vaccine (PPV) for adults produce immunity against a variety of pneumococcal infections. Since Streptococcus pneumoniae is responsible for illnesses ranging from ear infections to meningitis, blood infections, and pneumonia, the Centers for Disease Control and Prevention recommend the polyvalent pneumococcal vaccines for all children and susceptible adults.

DIF:


REF: p. 403 | Table 19-1

OBJ:

3

TOP:

Vaccines

KEY:

Nursing Process Step:

Diagnosis


6. Which patient is at an increased risk if using an immunologic agent?

a. A postal worker

b. A college student

c. A neonate

d. A pilot

ANS: C

There is an increased risk in using immunologic agents in any person with a compromised immune status, for example, neonates, older adult patients, and patients on immunosuppressive therapy.

DIF:

Cognitive Level: Analyze

REF:

p. 403

OBJ:

4

TOP:

Immunizations

KEY:

Nursing

Process Step: Assessment


7. The nurse observes the arm of a patient who was given the Mantoux skin test for tuberculosis. There is induration of 3 mm. How should the nurse document the results?

a. Negative

b. Questionable

c. Positive for exposure

d. Positive for TB

ANS: A

The Mantoux test is designed to identify people with active tuberculosis,

with exposure to tuberculosis, or needing further testing. Positive reaction

must have erythema and induration of 9 mm or more in size; a reaction of 5 to 9 mm is questionable, and areas under 5 mm are negative.

DIF:

Cognitive Level: Apply

REF: p. 402 | Table 19-1

OBJ:

5

TOP:

Tuberculosis Testing

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

8. A child is scheduled for immunizations, but the mother states that his temperature has been 100.2° F all day. The nurse will take which action next?

a. Tell the mother to go home.

b. Give the immunizations.

c. Give a higher dose because of the fever.

d. Tell the mother to wait 1 month.

ANS: B

Many children are taken to the health care provider only when they are ill, so clinicians may have to give the immunizations then. Otherwise, they may lose a very valuable opportunity to provide increased protection to the child.

DIF:


REF:

p. 403

OBJ:

3

TOP: Immunizations

KEY:

Nursing Process Step: Implementation


9. Which patient should take the varicella vaccine?

a. A child who stepped on a rusty nail

b. An adult who has never been immunized

c. A health care worker

d. Any child under 1 year of age

ANS: B

In special circumstances, certain biologic agents may be used to modify a disease process in the previously unimmunized person.

DIF: Cognitive Level: Analyze REF: p. 401 | Table 19-1

OBJ: 2 TOP: Immunizations

KEY: Nursing Process Step: Diagnosis MSC: NCLEX: Physiological Integrity

10. Which is the best intervention to relieve local discomfort from an immunization?

a. Application of emollients

b. Application of ice

c. Application of lidocaine ointment

d. Acetaminophen

ANS: D

Localized discomfort may be relieved by treating the symptoms using warm

compresses to the area, acetaminophen, rest, and sometimes antihistamines.

DIF:


REF:

p. 406

OBJ:

4

TOP:

Immunizations

KEY:

Nursing

Process Step: Implementation


11. A mother has concerns about the immunization scheduled for this clinic visit having adverse effects on her child. Which would be the nurse’s best response to the mother?

a. “The doctor wants the child to

b. “We will give the heinjecxtionvisiat.

c. “More complications are caused than by the

immunization.”

d. “Side effects are expected, and worry about.”

ANS: C

Although some parents are afraid of adverse effects from immunizations, their

children are statistically more likely to have complications from the disease than

they are to experience serious side effects from the immunization.

DIF:


REF:

p. 402

OBJ:

4

TOP:

Immunizations

KEY:

Nursing



12. The biologic agent purified protein derivative (PPD) is used to screen for exposure to which disease?

a. Tuberculosis

b. Yellow fever

c. Pneumonia

d. Cholera

ANS: A

Purified protein derivative (PPD) is used to screen people who have been exposed to tuberculosis.

DIF:

Cognitive Level: Remember

REF:

p. 402 | Table 19-1

OBJ: 2 TOP:

Immunizations

KEY:

N

ursing Process Step: N/A


13. Which biologic agents are used in a routine schedule for active immunizations?

a. PPD

b. Toxoids

c. Antigens

d. Toxins

ANS: B

Toxoids are biologic agents used in the routine schedule of active immunizations for adults and children.

DIF:


REF:

p. 402

OBJ:

2

TOP: Immunizations

Process Step: N/A

KEY:

Nursing


14. Which is the nurse’s best means of determining is immunized against a certain disease?

a. Ask the patient for records.

b. Look for vaccination scars.

c. Call the health department.

d. Obtain a blood titer.

ANS: D

Occasionally, determining antibody blood titers before vaccine administration is helpful to assess antibody development.

DIF:


REF:

p. 403

OBJ:

3

TOP: Immunizations

Process Step: Diagnosis

KEY:

Nursing


15. Which is an example of artificially acquired active immunity?

a. Developing chickenpox as a child

b. Developing measles as an adult

c. Receiving a PPD yearly

d. Receiving prophylactic vaccines

ANS: D

Artificially acquired active immunity is given by a vaccine that contains either

attenuated or killed antigens that prevent patients from getting diseases.

DIF:


REF: p. 401

OBJ:

2

TOP:

Artificially Acquired Immunity

KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. Which patient is at high risk for needing a booster injection of vaccine?

a. A 45-year-old high school secretary

b. A second-grade student

c. A teacher just finishing college

d. A soldier on active duty

ANS: D

Few adults obtain the booster immunization they need unless they are in the military, travel to foreign countries, or work in the food industry.

DIF:

Cognitive Level: Analyze

REF:

p. 403

OBJ:

3

TOP: Immunizations

Process Step: Diagnosis

KEY:

Nursing


17. Why is it important for the nurse giving a vaccine to know whether the patient has an allergy to eggs and feathers?

a. Many biologic agents come from chick embryos.

b. Viruses are found in all eggs.

c. Chicken egg cells are close to human cells.

d. There is clotted blood in egg cells.

ANS: A

Many biologic agents are prepared with animal serum or chick embryos; thus, people with known allergies may have sensitivity reactions to these preparations.

DIF:


REF:

p. 402

OBJ:

4

TOP: Sensitivity Reactions


KEY:

Nursing


18. The development of immunity to the chickenpox virus after having the disease is an example of which kind of immunity?

a. Passive

b. Artificial

c. Natural

d. Antigen

ANS: C

After getting chickenpox, a child develops antibodies to the virus that travel around in the bloodstream for the rest of the

person’

DIF:


REF:

p. 396

OBJ:

2

TOP:

Immunity

KEY: Nursing Process Step: N/A

MSC: NCLEX:

N/A

19. Which circumstance indicates that a 5-year-old about to enter grade school should be screened for current illness before receiving her immunizations?

a. She will cry and hurt too much.

b. Her father is chronically ill at home.

c. She has another year before she needs them.

d. Her mother passed immunity to her at birth.

ANS: B

Patients should be screened for current illness because there is an increased

risk in using immunologic agents in people with compromised immune status.

DIF:


REF:

p. 403

OBJ:

3

TOP: Immunizations

KEY:

Nursing



20. A patient asks the nurse why she needs a booster of tetanus

toxoid after she cut her finger, since she already had a shot when she

was a child. What should the nurse explain the booster produces?

a. Active immunity

b. Natural immunity

c. Protective antibodies

d. Passive immunity

ANS: C

Some diseases require periodic booster injections of vaccine to keep the antibody level high enough to protect the patient.

DIF: Cognitive Level: Apply REF: p. 401 OBJ:

TOP: Immunity KEY: Nursing Process Step: Implementation


21. How are foreign substances in the bloodstream removed from the body?

a. The filtering system of the liver

b. Water in the large intestine

c. Urine moving though the ureters

d. The lymphatic system

ANS: D

The immune system is a part of the lymphatic system, which removes foreign substances from the blood and lymph.

DIF: Cognitive Level: Remember REF: p. 396 OBJ: 1

TOP: Immune System KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

22. A 25-year-old patient believed that he still had immunity to childhood illnesses until he developed chickenpox. What is the best explanation of this situation made by the nurse to the patient?

a. He never had an injection for immunity.

b. Artificially acquired active im always confer

lifelong immunity.

c. He never got a booster as a child.

d. There was no immunity injection for this disease.

ANS: B

Some early immunizations lose their ability to provide long-term immunity.

DIF: Cognitive Level: Apply REF: p. 401 OBJ:

TOP: Immunity KEY: Nursing Process Step: Implementation


2

23. Patients receiving immune serums should be evaluated for which effect?

a. Headaches

b. Skin rash

c. Disease suppression

d. Numbness in the fingers

ANS: C

Patients receiving immune serums should be evaluated for suppression of the disease.

DIF: Cognitive Level: Understand REF: p. 403

TOP: Immunity KEY: Nursing Process Step: Evaluation


OBJ:

4

24. A female patient brings her newborn in to the clinic for immunizations. During the visit, the patient asks the nurse what is naturally acquired passive immunity. What is the best example provided by the nurse?

a. Immunity through breastfeeding an infant

b. Immunity through immunoglobulins

c. Immunity through an attenuated

or weakened toxin

d. Immunity through having and recovering from a

disease

ANS: A

Naturally acquired passive immunity is a type of temporary immunity that can occur when antibodies pass from the mother to the fetus through the placenta or to the nursing infant through breast milk.

DIF:


REF:

p. 401

OBJ:

1

TOP:

Immunity

KEY: Nursing Process Step: Implementation


MULTIPLE RESPONSE

25. Pneumococcal vaccine produces immunity against which illnesses? (Select all that apply.)

a. Pneumonitis

b. Meningitis

c. Pneumonia

d. Pertussis

e. Influenza

ANS: B, C

Pneumococcal vaccine provides active immunization for infants and children against pneumonia and meningitis caused by Streptococcus pneumoniae.

DIF:


REF:

Table 19-1

OBJ:

3

TOP: Immunizations

Process Step: N/A

KEY:

Nursing

MSC: NCLEX: N/A

26. Infants and children are immunized to prevent which diseases? (Select all that apply.)

a. Hepatitis B

b. Hepatitis C

c. Polio

d. Varicella

e. Lyme disease

ANS: A, C, D

Infants and children can be immunized against hepatitis B, polio, and varicella in addition to several other conditions.

DIF:


REF: p. 401

OBJ: 3

TOP:

Immunity

KEY: Nursing Process Step: Diagnosis


27. Which may be used to relieve localized discomfort

after immunization injections? (Select all that apply.)

a. Warm compresses

b. Acetaminophen

c. Antihistamines

d. Decongestants

e. Rest

ANS: A, B, C, E

Treating localized discomfort after an immunization injection is done with warm compresses to the area, acetaminophen, rest, and sometimes antihistamines.

DIF:


REF:

p. 406

OBJ:

4

TOP:

Immunizations

KEY:

Nursing



28. Which statements are correct concerning vaccines and toxoids? (Select all that apply.)

a. They are biologic agents that produce active immunization.

b. They are biologic agents that produce passive immunization.

c. They are prepared with animal serum.

d. They are considered a blood product.

e. They are only used in children.

chapter 19: immunologic medications edmunds: introduction ... · key: nursing process step: n/a...

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