Test Bank for Introduction to Clinical Pharmacology 8th Edition by Edmunds Chapter 19: Immunologic Medications Edmunds: Introduction to Clinical Pharmacology, 8th Edition MULTIPLE CHOICE Which term refers to a medication containing a weakened or dead antigen? a Toxoid b Vaccine c Antiserum d Antidote ANS: B 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 TOP: Vaccines REF: p 400 OBJ: KEY: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control TD (tetanus and diphtheria) boosters are recommended at which interval? a Every years b Every 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 OBJ: REF: p 401 | Table 19-1 TOP: Immunization Schedule KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 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 TOP: Immunizations Process Step: Planning REF: p 403 KEY: OBJ: Nursing MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 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 TOP: Vaccines REF: p 402 OBJ: KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 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: Cognitive Level: Understand OBJ: Diagnosis TOP: Vaccines REF: p 403 | Table 19-1 KEY: Nursing Process Step: MSC: NCLEX: Physiological Integrity 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 TOP: Immunizations Process Step: Assessment REF: p 403 KEY: OBJ: Nursing MSC: NCLEX: Physiological Integrity The nurse observes the arm of a patient who was given the Mantoux skin test for tuberculosis There is induration of 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 mm or more in size; a reaction of to mm is questionable, and areas under mm are negative DIF: Cognitive Level: Apply OBJ: REF: p 402 | Table 19-1 TOP: Tuberculosis Testing KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 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 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: Cognitive Level: Apply REF: p 403 OBJ: KEY: Nursing TOP: Immunizations Process Step: Implementation MSC: NCLEX: Physiological Integrity 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 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: 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: Cognitive Level: Apply REF: p 406 OBJ: TOP: Immunizations Process Step: Implementation KEY: Nursing MSC: NCLEX: Physiological Integrity 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: Cognitive Level: Apply REF: p 402 TOP: Immunizations Process Step: Implementation KEY: OBJ: Nursing MSC: NCLEX: Physiological Integrity 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: TOP: Immunizations ursing Process Step: N/A KEY: N MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 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: Cognitive Level: Understand TOP: Immunizations Process Step: N/A REF: p 402 KEY: OBJ: Nursing MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 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: Cognitive Level: Understand REF: p 403 TOP: Immunizations Process Step: Diagnosis KEY: OBJ: Nursing MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 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: Cognitive Level: Understand TOP: Artificially Acquired Immunity REF: p 401 OBJ: 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 TOP: Immunizations Process Step: Diagnosis MSC: NCLEX: Physiological Integrity REF: p 403 KEY: OBJ: 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: Cognitive Level: Understand TOP: Sensitivity Reactions Process Step: Assessment REF: p 402 KEY: OBJ: Nursing MSC: NCLEX: Physiological Integrity 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 DIF: Cognitive Level: Understand TOP: Immunity N/A REF: p 396 KEY: Nursing Process Step: N/A OBJ: MSC: NCLEX: 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 person’ 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: Cognitive Level: Apply TOP: Immunizations Process Step: Assessment REF: p 403 KEY: OBJ: Nursing MSC: NCLEX: Physiological Integrity 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 TOP: Immunity REF: p 401 OBJ: KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 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 TOP: Immune System REF: p 396 OBJ: 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 TOP: Immunity REF: p 401 OBJ: KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 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 TOP: Immunity REF: p 403 KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity OBJ: 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: Cognitive Level: Understand TOP: Immunity REF: p 401 OBJ: KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 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: Cognitive Level: Remember TOP: Immunizations Process Step: N/A REF: Table 19-1 OBJ: 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: Cognitive Level: Remember TOP: Immunity REF: p 401 KEY: Nursing Process Step: Diagnosis MSC: NCLEX: Physiological Integrity 27 Which may be used to relieve localized discomfort after immunization injections? (Select all that apply.) a Warm compresses OBJ: 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: Cognitive Level: Apply REF: p 406 OBJ: TOP: Immunizations Process Step: Implementation KEY: Nursing MSC: NCLEX: Physiological Integrity 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  ... Mantoux skin test for tuberculosis There is induration of 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. .. 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... 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: Cognitive Level: Understand TOP: Immunizations