Ch 16 Drugs Affecting the Immune System

Question 1

Which of these would be a contraindication for a patient to receive the hepatitis B vaccine (HBV)?

1. Yeast allergy
2. Renal disease
3. Pregnancy
4. Immunocompromised

Answer 1

1. Yeast allergy

Rationales
Option 1:The only true contraindication to HBV is hypersensitivity to yeast or other components of the vaccine.
Option 2:Patients with renal disease requiring hemodialysis may require larger doses to achieve adequate serum levels of antihepatitis B surface antigen antibodies (anti-HBs).
Option 3:The Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) have stated that pregnancy is not a contraindication to HBV, and women at risk for HBV should be vaccinated.
Option 4:Patients who are immunocompromised may require larger doses.
[Page reference: 458]

Question 2

The pneumococcal vaccine contains polysaccharides from which bacteria?

1. Streptococcus pneumoniae
2. H. influenzae
3. Neisseria meningitidis
4. E. coli

Answer 2

1. Streptococcus pneumoniae

Rationales
Option 1: PPSV23 contains 23 highly purified capsular polysaccharides from Streptococcus pneumoniae. These are 23 of the most prevalent or invasive pneumococcal types, accounting for at least 90% of all blood isolates associated with clinical infection.
Option 2: Pneumococcal disease–causing pneumococcal pneumonia is not caused by H. influenzae.
Option 3: Neisseria meningitidis accounts for most meningococcal disease in persons age 11 years and older.
Option 4: Pneumococcal disease–causing pneumococcal pneumonia is not caused by E. coli.
[Page reference: 461]

Question 3

Which of these is an attenuated (live) vaccine?

1. Measles, mumps, rubella (MMR)
2. Diphtheria, tetanus, and pertussis (DTP)
3. Hepatitis
4. Pneumococcal

Answer 3

1. MMR

Rationales
Option 1: MMR is an attenuated (live) vaccine.
Option 2: DTP is an inactivated vaccine.
Option 3: Hepatitis A and hepatitis B are both inactivated vaccines.
Option 4: Pneumococcal polysaccharide (PPSV23) and pneumococcal conjugate vaccine (PCV13) are both inactivated vaccines.
[Page reference: 427]

Question 4

The polyvalent pneumococcal polysaccharide vaccine (Pneumovax, PPSV23) is recommended for all adults after which age?

1. 50 years old
2. 55 years old
3. 60 years old
4. 65 years old

Answer 4

4. 65 y.o.

Rationales
Option 1: PPSV23 is recommended for all adults starting from an age older than 50 years.
Option 2: PPSV23 is recommended for all adults starting from an age older than 55 years.
Option 3: PPSV23 is recommended for all adults starting from an age older than 60 years.
Option 4: PPSV23 is recommended for all adults age 65 and older.
[Page reference: 462]

Question 5

Which should the health-care provider consider when administering the influenza vaccine to a patient?

1. The vaccine is contraindicated in a patient with a history of a mild egg allergy.
2. The use is limited to ages 2 years and older.
3. The vaccine contains a live virus.
4. Its use is for all persons age 6 months and older, including pregnant women.

Answer 5

4. Its use is for all persons age 6 months and older, including pregnant women

Rationales
Option 1:The Centers for Disease Control and Prevention (CDC) has developed an algorithm to be used with patients who report an allergy to eggs. The recommendation includes administering the inactivated influenza vaccine to patients who can eat lightly cooked eggs without a reaction.
Option 2:The influenza vaccine should be administered annually to all persons age 6 months and older, including pregnant women.
Option 3:The influenza vaccine uses cell-based technology and is an inactivated vaccine.
Option 4:The influenza vaccine should be administered annually to all persons age 6 months and older, including pregnant women.
[Page reference: 461]

Question 6

A patient comes to the emergency department after a dog bite from a stray dog, and the dog now cannot be located. It is recommended that he receive post-exposure prophylaxis for rabies. He asks how many shots he will need. Which response by the APN is most appropriate?

1. “A person who is exposed and has never been vaccinated against rabies should get three doses of rabies vaccine.”
2. “A person who is exposed and has never been vaccinated against rabies should get four doses of rabies vaccine.”
3. “A person who is exposed and has never been vaccinated against rabies should get one booster shot.”
4. “A person who is exposed and has never been vaccinated against rabies should get rabies immune globulin [RIG].”

Answer 6

2. “A person who is exposed and has never been vaccinated against rabies should get four doses of rabies vaccine.”

Rationales
Option 1:
Preexposure vaccine dosing consists of three injections.
Option 2:
Four doses of rabies vaccine for postprophylaxis is administered: one right away, and additional doses on days 3, 7, and 14. The patient should also get a rabies immune globulin (RIG) at the same time for the first dose.
Option 3:
A booster is given every 2 years to those who have had preexposure vaccines and are considered at frequent risk if their titer is low.
Option 4:
Rabies immune globulin (RIG) can partially suppress the antibody response to rabies vaccine and should be given on day 1 only of patients who have never been vaccinated who are receiving the four-dose vaccine. No RIG is needed for patients that have been previously vaccinated.
[Page reference: 466]

Question 7

Which vaccine is considered safe to administer to a pregnant woman?

1. Zoster vaccine (Zostavax)
2. Measles, mumps, rubella (MMR) vaccine
3. Influenza vaccine
4. Varicella vaccine (Varivax)

Answer 7

3. Influenze vaccine

Rationales
Option 1:
Zoster vaccine is not approved for women of childbearing age and should not be administered to pregnant woman.
Option 2:
MMR should not be given to pregnant women or women who may become pregnant within 3 months after administration.
Option 3:
Influenza vaccine is Pregnancy Category C, but according to the Centers for Disease Control and Prevention (CDC, 2017), influenza vaccine may be safely administered to pregnant women. Influenza vaccine may be administered to lactating women with no effect on the infant.
Option 4:
Varicella vaccine is Pregnancy Category C and should be avoided. Pregnancy should be avoided for 1 to 3 months after vaccination.
[Page reference: 426]

Question 8

The varicella virus vaccine should be avoided in which patient?

1. A pregnant patient
2. A patient on systemic steroids
3. A patient who has an immunocompromised family member in the household
4. A child patient more than 12 months of age

Answer 8

1. A pregnant patient

Rationales
Option 1:
Vaccination of pregnant women should be avoided. The varicella virus vaccine is Pregnancy Category C, and pregnancy should be avoided for 1 to 3 months after vaccination.
Option 2:
Patients who are on systemic steroids (e.g., for asthma) may be vaccinated if they are receiving less than 2 mg/kg or less than 20 mg per day of prednisone and are not otherwise immunocompromised in the household.
Option 3:
The varicella virus vaccine may be given to a patient if an immunocompromised person is in the household.
Option 4:
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend that all healthy children who lack a reliable history of varicella infection be routinely vaccinated at age 12 to 15 months. A second dose of varicella vaccine is recommended at age 4 to 6 years (before entering kindergarten).
[Page reference: 441]

Question 9

A patient from Europe states that he or she has had the bacillus Calmette–Guérin (BCG) vaccine. The APN knows this is given in non–US countries for immunity against bacteria causing which disease?

1. Tuberculosis (TB)
2. Polio
3. Typhoid
4. Yellow fever

Answer 9

1. Tuberculosis (TB)

Rationales
Option 1: Immunization with BCG vaccine lowers the risk of serious complications of primary TB in children. It is not used in the US but is given to infants and young children in countries where TB is endemic.
Option 2: Polio vaccines are used to prevent polio. Two types are used: inactivated polio virus given by injection (IPV) and a weakened poliovirus given by mouth (OPV).
Option 3: There are two vaccines available to prevent typhoid fever. Inactivated typhoid vaccine (shot) and live typhoid vaccine (oral).
Option 4: Yellow fever vaccine is effective against the viral illness spread by some species of mosquitos.
[Page reference: 452]

Question 10

Which statement is most accurate regarding cholera?

1. Cholera bacterium is usually spread by mosquitos.
2. Cholera causes a bullseye rash.
3. Cholera is commonly found in the US.
4. Cholera can be prevented with a vaccine.

Answer 10

4. Cholera can be prevented with a vaccine.

Rationales
Option 1: Cholera is caused by Vibrio cholera bacteria and is usually found in water or food sources that have been contaminated by feces from a person infected with cholera.
Option 2: Cholera is a severe, watery diarrheal illness caused by Vibrio cholera bacteria that can be rapidly fatal without rehydration, leading to 2.9 million cases of disease and 95,000 deaths worldwide each year.
Option 3: Cholera is rare in the US but is endemic in 60 countries, and travelers may be at risk of contracting the disease.
Option 4: In 2016, lyophilized CVD 103-HGR (Vaxchora), a live, attenuated oral cholera vaccine was approved by the U.S. Food and Drug Administration (FDA) for adults traveling to areas with endemic or epidemic cholera.
[Page reference: 451]

Question 11

Which hepatitis B serologic test result would be positive in a patient who has received the hepatitis B vaccine (HBV)?

1. Hepatitis B surface antigen (HBsAg)
2. Serum cyclosporine
3. Antihepatitis B surface antigen antibodies (anti-HBs)
4. HIB capsule–specific antibodies

Answer 11

3. Antihepatitis B surface antigen antibodies (anti-HBs)

Rationales
Option 1: If this is present, it demonstrates that the patient is acutely or chronically infected with hepatitis.
Option 2: Patients taking cyclosporine need to have serum cyclosporine levels checked periodically.
Option 3: If this is present, it demonstrates that the patient is immune due to the hepatitis vaccine.
Option 4: HIB capsule–specific antibodies are produced following administration of the HIB conjugate vaccine.
[Page reference: 458]

Question 12

Which vaccination is contraindicated in asthma patients?

1. Measles, mumps, and rubella (MMR)
2. Oral polio vaccine (OPV)
3. Live attenuated virus influenza vaccine (LAIV)
4. Varicella virus vaccine (Varivax)

Answer 12

3. Live attenuated virus influenza vaccine (LAIV)

Rationales
Option 1:
MMR is an attenuated (modified live) vaccine, but there are a few true contraindications to administering MMR vaccine. This includes anaphylactic reaction to MMR.
Option 2:
OPV is an attenuated (modified live) vaccine. An anaphylactic reactive to any previous dose of OPV is a contraindication to its use.
Option 3:
LAIV is contraindicated in patients with egg hypersensitivity, asthma, reactive airway disease, other disorders of the pulmonary or cardiovascular systems; metabolic diseases such as diabetes, renal dysfunction, hemoglobinopathies; known or suspected immunodeficiency diseases; or in patients who are receiving immunosuppressive therapies.
Option 4:
Varicella vaccine is an attenuated (modified live) vaccine and is contraindicated in patients with neomycin or gelatin hypersensitivity, HIV infection.
[Page reference: 427]

Question 13

Which statement is most accurate regarding the varicella zoster virus (VZV)?

1. Both shingles and chickenpox are caused by the same VZV.
2. Zostavax and Varivax are the same vaccine.
3. Shingles is caused by an initial infection with varicella virus.
4. A person who has never had the chickenpox can get shingles at an older age.

Answer 13

1. Both shingles and chickenpox are caused by the same VZV.

Rationales
Option 1:
Shingles and chickenpox are both caused by VZV. When a person is first infected, usually as a child, he or she can get chickenpox. Years later the virus can reactivate and cause shingles. Anyone who has had chickenpox is at risk for shingles.
Option 2:
Varicella virus vaccine (Varivax) is a live vaccine that produces an IgG antibody humoral immune response to VZV and is effective in preventing chickenpox. Zostavax vaccine live (Zostavax) is a live attenuated varicella zoster vaccine from the same strain used to develop the varicella vaccine and is 70% effective in preventing herpes zoster (shingles) in persons ages 50 to 59 years, 64% effective in persons ages 60 to 69 years, and 38% effective in persons age 70 years or older.
Option 3:
Shingles is a localized, painful cutaneous eruption caused by the reactivation of VZV, the same virus that causes chickenpox in children.
Option 4:
A person cannot get shingles without first having chickenpox or the chickenpox vaccine (Varivax).
[Page reference: 441]

Question 14

After receiving the human papillomavirus (HPV) vaccine (Gardasil-9), the patient should be monitored for 15 minutes to watch for which side effect?

1. Tachycardia
2. Headache
3. Syncope
4. Pain and redness at the site

Answer 14

3. Syncope

Rationales
Option 1:
Tachycardia is not an adverse reaction to the HPV vaccine.
Option 2:
This is a common, general adverse reaction to the HPV vaccine but does not require monitoring post-injection.
Option 3:
The most common serious reaction to HPV vaccine is syncopal episodes. Recommendations are that all patients who receive the HPV vaccine be observed for 15 minutes.
Option 4:
Pain, redness, and swelling at the infection site were the most common local adverse reactions reported but do not require monitoring post-injection.
[Page reference: 460]

Question 15

The live attenuated influenza vaccine (LAIV3 [FluMist] & LAIV4 [FluMist Quadrivalent]) is administered by which route?

1. Oral
2. Intranasal
3. Subcutaneously
4. Intramuscularly

Answer 15

2. Intranasal

Rationales
Option 1: FluMist is not administered orally.
Option 2: FluMist is administered intranasally with half of the dose administered in each nostril.
Option 3: FluMist is not administered subcutaneously.
Option 4: FluMist is not administered intramuscularly.
[Page reference: 426]

Question 16

A patient traveling to Central America asks if a yellow fever vaccine will be needed. Which response by the APN is most appropriate?

1. “Yellow fever has been eradicated.”
2. “You will need this vaccine when traveling to Central and South America.”
3. “There is not a vaccine for yellow fever.”
4. “You will need this vaccine every year to prevent the viral infection of yellow fever.”

Answer 16

2. “You will need this vaccine when traveling to Central and South America.”

Rationales
Option 1:
Yellow fever has not been eradicated, and it is endemic in sub-Saharan Africa and tropical South America.
Option 2:
Yellow fever is a viral illness spread by some species of mosquitoes in Central and South America and in Africa. A vaccine will be necessary.
Option 3:
There is a vaccine for yellow fever, and vaccination is recommended for travel to endemic areas.
Option 4:
After subcutaneous administration of the vaccine, active immunity to yellow fever occurs in 7 to 10 days and lasts for 10 years or more.
[Page reference: 450]

Question 17

The human papillomavirus (HPV) vaccine is recommended for girls of which age group?

1. Any age
2. Age 11 and older
3. Age 15 and older
4. Age 18 and older

Answer 17

2. Age 11 and older

Rationales
Option 1:
The HPV vaccine is not recommended for girls of all ages.
Option 2:
The HPV vaccine (Gardasil) is approved for use in girls and women ages 9 to 26 years old. It is recommended for all girls starting at age 11 to 12 years old but may be started as early as 9 years old.
Option 3:
The HPV vaccine is recommended for all girls starting at ages younger than 15 years.
Option 4:
The HPV vaccine is recommended for all girls starting at ages younger than 18 years.
[Page reference: 460]

Question 18

Which patient is recommended to get the typhoid vaccine?

1. A patient living in the US
2. A patient traveling overseas
3. A patient receiving sulfonamides
4. A patient receiving antibiotics

Answer 18

2. A patient traveling overseas

Rationales
Option 1:
Routine typhoid vaccination is not recommended in the US. Generally, people get typhoid from contaminated food or water. Typhoid is rare in the US.
Option 2:
The typhoid vaccine is recommended for travelers to parts of the world where typhoid is common.
Option 3:
The manufacturer recommends that oral typhoid vaccine not be administered to individuals receiving sulfonamides, which may be active against the vaccine strains and prevent a sufficient degree of multiplication to induce a protective immune response.
Option 4:
The manufacturer recommends that oral typhoid vaccine not be administered to individuals receiving antibiotics, which may be active against the vaccine strains and prevent a sufficient degree of multiplication to induce a protective immune response.
[Page reference: 450]

Question 19

Each patient listed received pneumococcal polysaccharide vaccine (PPSV23) 5 years ago. Who should receive a second dose of PPSV23 immunization now?

1. A 60-year-old woman with chronic obstructive pulmonary disease (COPD)
2. A 64-year-old adult smoker
3. A 61-year-old asthmatic patient
4. A 65-year-old woman with a history of arthritis

Answer 19

4. A 65-year-old woman with a history of arthritis

Rationales
Option 1:
Revaccination is not recommended in patients aged less than 65 years.
Option 2:
Adult smokers between the ages of 19 and 64 years should be given one dose of PPSV23.
Option 3:
Patients with asthma between the ages of 19 and 64 years should receive one dose of PPS23.
Option 4:
PPSV23 is recommended for all adults age 65 or older, with revaccination every 5 years.
[Page reference: 462]

Question 20

Which group would have a low incidence of exposure to hepatitis A and would not be recommended to receive the hepatitis A vaccine (HAV)?

1. Adults working in other countries
2. Men who have sex with men
3. Illegal drug users
4. The elderly

Answer 20

4. The elderly

Rationales
Option 1:
Adults and children older than 1 year of age, who are traveling or working in other countries that have high or intermediate endemic infection, would have a high incidence of exposure. This includes all of South America, Africa, Greenland, Asia, Russia, and Eastern Europe. Immune globulin (IG) is recommended for children younger than age 1 who are traveling to these areas.
Option 2:
This is a high-risk group that is recommended to get the HAV.
Option 3:
Illegal drug users are a high-risk group.
Option 4:
The elderly are not in high-risk groups for hepatitis A and would not be recommended to get the HAV.
[Page reference: 457]

Question 21

Which age group is appropriate for the administration of the live attenuated influenza vaccine (LAIV)?

1. Newborns
2. Infants
3. Toddlers
4. School age

Answer 21

4. School age

Rationales
Option 1:
Use of live influenza vaccine is contraindicated in children under 2 years owing to significant increased incidence of reactive airway disease and asthma.
Option 2:
Use of live influenza vaccine is contraindicated in children under 2 years owing to significant increased incidence of reactive airway disease and asthma.
Option 3:
Use of live influenza vaccine is contraindicated in children under 2 years owing to significant increased incidence of reactive airway disease and asthma. Toddlers may still be too young to receive the LAIV.
Option 4:
Children and adults ages 9 through 49 years should receive 0.2 mL of LAIV as soon as it becomes available in the fall.
[Page reference: 426]

Question 22

For which age group of patients is the zoster vaccine live (Zostavax) recommended?

1. 50 years and older
2. 60 years and older
3. 70 years and older
4. 80 years and older

Answer 22

1. 50 years and older

Rationales
Option 1:
The Advisory Committee on Immunization Practices (ACIP) recommends the zoster vaccine (Zostavax) in adults aged 50 years and older. Attention should be given to those adults at high risk of exposure or transmission of varicella disease. The zoster vaccine is 70% effective in preventing herpes zoster in persons age 50 to 59 years old.
Option 2:
Although persons age 60 years and older should receive the zoster vaccine (Zostavax), the age at which the vaccine is recommended begins earlier.
Option 3:
Although persons age 70 years and older should receive the zoster vaccine (Zostavax), the age at which the vaccine is recommended begins earlier.
Option 4:
Although persons age 80 years and older should receive the zoster vaccine (Zostavax), the age at which the vaccine is recommended begins earlier.
[Page reference: 441]

Question 23

Which statement about the influenza vaccine is accurate?

1. The flu vaccine should be administered annually to all persons.
2. Influenza vaccines are recommended to be administered in the fall months.
3. Travelers to areas in which influenza is endemic should be vaccinated after returning from traveling.
4. Vaccines are contraindicated in pregnant and nursing mothers.

Answer 23

2. Influenza vaccines are recommended to be administered in the fall months.

Rationales
Option 1:
The flu vaccine should be administered annually to all persons 6 months and older.
Option 2:
The optimal time for organized vaccination programs is October through mid-November.
Option 3:
Travelers to areas in which influenza is endemic should be vaccinated 2 to 4 weeks prior to travel.
Option 4:
It is safe to administer the influenza vaccine to pregnant and nursing mothers and is recommended.
[Page reference: 460]

Question 24

For which patient is the measles, mumps and rubella (MMR) vaccine considered unnecessary?

1. An 18-year-old student entering college
2. An older adult born prior to 1957
3. A 24-year-old health-care worker
4. A 50-year-old adult who is traveling internationally

Answer 24

2. An older adult born prior to 1957

Rationales
Option 1:
Adults in high-risk groups, such as students entering college or military recruits, should receive a total of two doses of MMR.
Option 2:
Adults born before 1957 are considered immune, but proof of immunity may be desirable for health-care workers.
Option 3:
Health-care workers should receive a total of two doses of MMR.
Option 4:
International travelers should receive a total of two doses of MMR.
[Page reference: 427]

Question 25

Which of these is recommended for a 30-year-old male who presents with a recently diagnosed HIV infection and has never received a pneumococcal vaccine?

1. PPSV23, followed by a dose PCV13 at least 1 year after the last PPSV23 dose
2. PCV13, followed by a dose of PPSV23 at least 8 weeks later
3. PCV13 or PPSV23, but not both
4. PPSV23, followed by a dose of PCV13 5 years later

Answer 25

2. PCV13, followed by a dose of PPSV23 at least 8 weeks later

Rationales
Option 1:
Immunocompromised adults age 19 years or older who have received PPSV23 should receive a dose of PCV13 at least 1 year after last PPSV23 dose.
Option 2:
Immunocompromised adults age 19 years or older who have not received pneumococcal vaccine should receive a dose of PCV13, followed by a dose of PPS23 at least 8 weeks later.
Option 3:
Immunocompromised adults are required to have both pneumococcal vaccines.
Option 4:
Immunocompromised adults are required to have both pneumococcal vaccines 2 to 12 months after the first vaccine, depending on when the vaccine was begun.
[Page reference: 462]

Question 26

Which type of immunity do immune globulin (IG) serums provide?

1. Passive immunity
2. Active immunity
3. Primary immunity
4. Herd immunity

Answer 26

1. Passive immunity

Rationales
Option 1:
IG serums provide passive immunity to infectious diseases such as hepatitis B, tetanus, respiratory syncytial virus (RSV), varicella, rabies, and botulism. It lasts for only a few months.
Option 2:
Active immunity occurs when the body is exposed to an antigen through a disease or through an immunization. This type of immunity lasts for a long time.
Option 3:
Immunizations and chemoprophylaxis are examples of primary prevention, but there is no such thing as “primary immunity.”
Option 4:
When a critical portion of a population is immunized against a contagious disease, most members, including the unimmunized, are protected against that disease because there is little opportunity for an outbreak.
[Page reference: 470]

Question 27

Which of these is the leading cause of gastroenteritis in infants and young children worldwide?

1. Rotavirus
2. Hepatitis A
3. Rhinovirus
4. Influenza

Answer 27

1. Rotavirus

Rationales
Option 1:
Rotavirus is the leading cause of gastroenteritis in infants and young children worldwide. Almost every child in the US will become infected with rotavirus by age 5 years, causing 400,000 doctor visits and up to 70,000 hospital admissions.
Option 2:
Hepatitis A is a vaccine-preventable communicable disease of the liver that is usually transmitted through fecal-oral route or consumption of contaminated food and water. It can cause gastroenteritis in all age groups.
Option 3:
Rhinovirus causes the common cold, not gastroenteritis.
Option 4:
Influenza is a highly contagious viral infection of the respiratory passages causing fever and respiratory symptoms. It is not the leading cause of gastroenteritis in infants and young children.
[Page reference: 440]

Question 28

Which is the minimum period of time in which the hepatitis vaccine series of three injections may be administered in older children and adults?

1. 3 months
2. 4 months
3. 5 months
4. 6 months

Answer 28

2. 4 months

Rationales
Option 1:
The spacing of doses for the hepatitis vaccine requires more than 3 months.
Option 2:
There must be 4 weeks between doses one and two, 2 months between doses two and three, and 4 months between doses one and three, allowing the series to be completed in as little as 4 months.
Option 3:
The hepatitis vaccine series of three injections can be completed in less than 5 months.
Option 4:
The hepatitis vaccine series of three injections can be completed in less than 6 months.
[Page reference: 458]

Question 29

Which age group is recommended to receive the hepatitis B vaccine (HBV)?

1. Patients age 1 year and older
2. Patients age 6 years and older
3. Patients age 50 years and older
4. Patients of all ages

Answer 29

4. Patients of all ages

Rationales
Option 1:
This age group does not represent the full range of the group recommended to receive HBV.
Option 2:
This age group does not represent the full range of the group recommended to receive HBV.
Option 3:
This age group does not represent the full range of the group recommended to receive HBV.
Option 4:
Vaccination with HBV is recommended for all ages, particularly patients at high risk for contracting hepatitis B.
[Page reference: 458]

Question 30

Which patient belongs to a group considered of typical risk for meningococcal disease?

1. A 24-year-old male with asplenia
2. An 18-year-old college freshman living in dorms
3. A 20-year-old military recruit
4. A 60-year-old female with chronic obstructive pulmonary disease (COPD)

Answer 30

4. A 60-year-old female with chronic obstructive pulmonary disease (COPD)

Rationales
Option 1:
The Advisory Committee on Immunization Practices (AICP) recommends high-risk groups receive meningococcal vaccine, and persons with functional or actual asplenia are considered a high-risk group.
Option 2:
The Advisory Committee on Immunization Practices (AICP) recommends high-risk groups receive meningococcal vaccine, and college freshmen living in dorms are considered a high-risk group.
Option 3:
The Advisory Committee on Immunization Practices (AICP) recommends high-risk groups receive meningococcal vaccine, and military recruits are considered a high-risk group.
Option 4:
This vaccine is not recommended in adults older than 55 years old, and COPD is not a risk factor for meningitis.
[Page reference: 463]

Question 31

After receiving the three series of hepatitis B vaccine, a health-care worker has a negative titer showing no immunity to hepatitis B. Which is the next step for this health-care worker to show immunity to hepatitis B?

1. Wait 1 year and revaccinate with three doses.
2. Wait 1 year and repeat the titer.
3. Revaccinate with one to three doses.
4. Continue vaccinating until titer is positive.

Answer 31

3. Revaccinate with one to three doses.

Rationales
Option 1:
The series can be given twice in less than a year, and the patient may not need to have the full three doses given again.
Option 2:
Titers should be drawn 1 month after the third vaccine and develop a serum anti-HB antibody response (greater than or equal to 10 mlU/mL).
Option 3:
If a patient does not develop immunity after the first series of three vaccines, he or she should be revaccinated with one to three doses.
Option 4:
If a patient does not respond after three additional doses, he or she is unlikely to respond to any additional doses.
[Page reference: 458]

Question 32

When is the measles, mumps and rubella (MMR) vaccine routinely given?

1. 12 to 15 months with a repeat dose at age 4 to 6 years
2. 12 to 15 months with a repeat dose at age 12
3. One dose any time prior to the start of school
4. 12 to 15 months with second dose 4 weeks after

Answer 32

Rationales
1. 12 to 15 months with a repeat dose at age 4 to 6 years

Option 1:
MMR is routinely given subcutaneously (SC) at 12 to 15 months of age with a repeat dose at age 4 to 6 years.
Option 2:
Those children who have not received their second dose of MMR by age 12 should have it at this time.
Option 3:
People who receive two doses of MMR develop a higher percentage of immunity.
Option 4:
The second dose of MMR may be given as soon as 4 weeks after the first dose, which is indicated during an epidemic or before international travel.
[Page reference: 427]

Question 33

Which is the lifetime incidence of shingles?

1. 1:2 persons
2. 1:3 persons
3. 1:4 persons
4. 1:5 persons

Answer 33

2. 1:3 persons

Rationales
Option 1:
Fewer than 1 in 2 persons are expected to get shingles over their lifetimes.
Option 2:
The lifetime incidence of shingles is 1 in 3 persons, and it affects approximately 1 million patients in the US annually. Shingles is a localized, painful, cutaneous eruption caused by the reactivation of varicella zoster virus, the same virus that causes chickenpox in children.
Option 3:
More than 1 in 4 persons are expected to get shingles over their lifetimes.
Option 4:
More than 1 in 5 persons are expected to get shingles over their lifetimes.
[Page reference: 441]

Question 34

In which patient is the influenza vaccine contraindicated?

1. A 16-year-old with a history of an egg allergy that produces hives
2. A 25-year-old pregnant woman
3. A 50-year-old diabetic patient
4. A 4-month-old healthy infant
   Rationales
   Option 1:
   Patients who experience only hives when eating eggs or egg-containing foods can be administered Flublok (a recumbent flu vaccine that is egg-free) and should be observed for 30 minutes.
   Option 2:
   The influenza vaccine should be administered annually to all persons age 6 months and older, including pregnant women.
   Option 3:
   Diabetes is not a contraindication the influenza vaccine.
   Option 4:
   The influenza vaccine should be administered annually to all persons age 6 months and older, including pregnant women.
   [Page reference: 461]

Answer 34

4. A 4-month-old healthy infant

Rationales
Option 1:
Patients who experience only hives when eating eggs or egg-containing foods can be administered Flublok (a recumbent flu vaccine that is egg-free) and should be observed for 30 minutes.
Option 2:
The influenza vaccine should be administered annually to all persons age 6 months and older, including pregnant women.
Option 3:
Diabetes is not a contraindication the influenza vaccine.
Option 4:
The influenza vaccine should be administered annually to all persons age 6 months and older, including pregnant women.
[Page reference: 461]

Question 35

A preadolescent girl received her meningitis vaccine (MCV4) at the age of 11 years. When would the APN recommend for her to get the second dose of the meningitis vaccine?

1. Age 16
2. Age 19
3. Age 21
4. Age 14

Answer 35

1. Age 16

Rationales
Option 1:
One booster dose of MCV4 is administered between ages 16 and 18 years to adolescents who receive the first dose before age 16 years.
Option 2:
Although MCV4 is not routinely recommended for those older than 19 years, a catch-up dose can be administered to those ages 19 to 21 years who have not received a dose after their 16th birthday.
Option 3:
Although MCV4 is not routinely recommended for those older than 19 years, a catch-up dose can be administered to those ages 19 to 21 years who have not received a dose after their 16th birthday.
Option 4:
One booster dose of MCV4 is administered to adolescents who receive the first dose before age 16 years, but age 14 is too soon for this booster.
[Page reference: 464]

Question 36

Which vaccination is contraindicated in asthma patients?

1. Measles, mumps, and rubella (MMR)
2. Oral polio vaccine (OPV)
3. Live attenuated virus influenza vaccine (LAIV)
4. Varicella virus vaccine (Varivax)

Answer 36

3. Live attenuated virus influenza vaccine (LAIV)

Rationales
Option 1:
MMR is an attenuated (modified live) vaccine, but there are a few true contraindications to administering MMR vaccine. This includes anaphylactic reaction to MMR.
Option 2:
OPV is an attenuated (modified live) vaccine. An anaphylactic reactive to any previous dose of OPV is a contraindication to its use.
Option 3:
LAIV is contraindicated in patients with egg hypersensitivity, asthma, reactive airway disease, other disorders of the pulmonary or cardiovascular systems; metabolic diseases such as diabetes, renal dysfunction, hemoglobinopathies; known or suspected immunodeficiency diseases; or in patients who are receiving immunosuppressive therapies.
Option 4:
Varicella vaccine is an attenuated (modified live) vaccine and is contraindicated in patients with neomycin or gelatin hypersensitivity, HIV infection.
[Page reference: 427]