CMN 571 Final Questions with correct
Answers
Laws related to administering vaccines: VIS - answerAll vaccine providers, public or
private, are required by the National Vaccine Childhood Injury Act to give the
appropriate VIS to the patient (or parent or legal representative) prior to every dose of
specific vaccines.
The appropriate VIS must be given prior to the vaccination, and must be given prior to
each dose of a multi-dose series. It must be given regardless of the age of the recipient.
What is required to be recorded in the medical record? - answerThe edition date of the
VIS (found on the back at the right bottom corner).
The date the VIS is provided (i.e., the date of the visit when the vaccine is
administered).
The office address and name and title of the person who administers the vaccine.
The date the vaccine is administered.
The vaccine manufacturer and lot number.
Vaccines at birth - answerHep B
Vaccines at 4 months - answerD - Dtap
R - Rotovirus
H - HIB
I - IPV
P - PCV
Vaccines at 2 months - answerB - Hep B
D - Dtap
R - Rotovirus
H - HIB
I - IPV
P - PCV
Vaccines at 6 months - answerB - Hep B
D - Dtap
R - Rotovirus
H - HIB
I - IPV
P - PCV
Vaccines at 12-15 months - answerM - MMR
,A - HepA
D - Dtap
H - HIB
P - PCV
V- Varicella
Vaccines at 4-6 years - answerVERY - Varicella
D - DTAP
I - IPV
M - MMR
Active immunity - answerResistance developed in response to infection with an agent
resulting in antibody production. Active immunity is usually permanent. Can be either
naturally acquired through exposure and infection with the disease or artificially
acquired through immunization. Onset is 2-4 weeks and duration is years to lifetime.
Passive Immunity - answerA person is given antibodies to a disease rather than
producing them through his or her own immune system. This is short term immunity
through introduction of antibodies to a disease. Can occur naturally as in the passage of
antibodies from the mother to the fetus during pregnancy or artificially acquired through
injection of antibodies such as gamma globulin. Onset is within 24 hours of the dose
and duration is about 4-6 months.
Herd Immunity - answerThis occurs when a significant portion of the population is
vaccinated and that provides a portion of immunity for those that have not developed
immunity. The population (herd) helps prevent disease in the unprotected population.
The herd protects those who can not safely get vaccinations. Generally 90 -95% of the
population should be to be vaccinated to have effective Herd immunity.
Hep B Vaccine - answer3 dose schedule: 1st Should be given within 24 hours of birth
(12 hours if mother + or unknown HBsAg status). 2nd at 2 months and 3rd at 6 months.
Low rate of adverse events.
Contraindications: Do not give to anyone with serious allergic reaction to yeast.
Can be solo vaccine (engerix-B/Recombivax HB) or combined with Dtap & IPV
(pediarix)
Rotavirus Vaccine - answerRotavirus is the most common cause of severe
gastroenteritis among young children.
Two vaccines available - RV5 (Rotateq) and RV1 (Rotarix).
RV5 is 3 dose schedule at 2, 4, 6 months. RV1 is 2 dose schedule at 2 & 4 months.
Risks and contraindications: Risk of intussusception, should not be given to infants with
history. RV1 should not be given to infants with severe latex allergy (package is latex).
Both vaccines are contraindicated in SCID. Should be deferred in infants with acute
moderate to sever gastroenteritis.
,DTaP Vaccine - answerFor prevention of diphtheria, tetanus, and pertussis (whooping
cough)
Can be in combo with IPV & HepB, combo with IPV & HIB, or combo with IPV.
Should be deferred in individuals with progressive neuromuscular disorders until neuro
status is clarified and stabilized.
Moderate to severe systemic effects: fever, inconsolable crying, hypotonic-
hyporesponsive episodes.
HIB Vaccine - answerHaemophilus influenzae type B - causes a wide spectrum of
serious infections bacterial illnesses, particularly in young children, including meningitis,
epiglottitis, pneumonia, septic arthritis, and cellulitis. Can be solo vaccine or combo with
Dtap and IPV. Given as series of 3 or 4 doses (depending on formula) OMP is 3 - T is 4.
Not recommended in children over 5 yrs
Should not be given to infants under 6 weeks
Adverse effects are uncommon.
Pneumococcal vaccine - answerStreptococcus pneumoniae - leading cause of invasive
bacterial disease in children, causes febrile bacteremia, bacterial sepsis, meningitis,
and pneumonia. Also a common cause of otitis media and sinusitis. Two vaccines in
use: PCV13 and PCV23 (only 2yrs and older).
PCV13 given in 4 doses.
Both vaccines should be deferred during moderate or severe acute illness with or
without fever.
Adverse effects: fever, injection site reactions, irritabilit, and increased or decreased
sleep.
Not proven - when given in conjunction with flu vaccine increased risk of febrile
seizures.
Poliomyelitis - answerPolioviruses cause acute flaccid paralysis via destruction of the
motor neurons.
IPV only vaccine available in the US, CANNOT cause polio.
Can be combined wth Dtap, Hep B, or HIB.
4 Dose series
Contraindications/Precautions: Should be deferred during moderate to severe illnesses
with or without fever. Pregnancy is a precaution.
No serious adverse reactions described.
Influenza - answerOccurs each winter-early spring, often associated with significant
morbidity and mortality in certain high risk groups.
Annual vaccination is recommended for all persons over 6 months.
Fluzone for over 6 months. (fluvirin >4yrs and fluarix >3yrs, and afluria >9yrs)
Intranasal not currently recommened
Optimal time to vaccinate is as soon as the vaccine is available in early fall.
Two doses are recommended for children under 9yrs who did not recieve two doses in
the past.
, Non type 1 egg allergies can still recieve the vaccine, type 1 egg allergies may be
eligible after allergist assessment.
Adverse affects - few have fever, malaise, and myalgia.
MMR vaccine - answerGiven in two doses.
Can cause febrile seizures.
Two vaccines available: MMR II and MMRV(MMR and varicella combo). MMRV only for
> 1 year old, has higher occurrence of febrile seizures.
Ig interfere with immune response - vaccination should be deferred for 3-11 moths after
Ig administration.
Contraindicated in pregnant women or women intending to become pregnant within 28
days, immunocompromised.
Contraindicated in children receiving high dose corticosteroid therapy (except
replacement therapy).
Adverse effects: fever. febrile seizures, transient thrombocytopenia, arthalgia, measles
inclusion body encephalitis.
Varicella vaccine - answerPrevention or decreased severity of Varicella (chickenpox)
Given in two doses - alone or with MMR
Live virus vaccines - contraindicated in children who have acquired treatment related
cellular immunodeficiencies or congenital T cell abnormalities. (can be given to HIV
infected children who are not severely immunosuppresed)
Should not be given to pregnant women, however a pregnant family member is not a
reason to withhold vaccine in a child.
Personal or family Febrile seizure history is a precaution
Adverse effects- minor site reactions.
Hepatitis A vaccine - answerTwo dose schedule between 12 and 23 months, 6 months
apart.
Formulas - Havrix, Vaqta. Combo with Heb B- Twinrix.
Precaution to vaccination include pregnancy and moderate to severe acute illness.
Adverse effects - uncommon and mild. Pain, swelling, and induration at injection site,
headache and loss of appetite.
Development 1-2 Months - answerObserved:
Holds head erect/lifts head
Turns side to back
Regards faces and follows objects through visual field
Drops toys
Becomes alert in response to voice
Related:
Recognizes parents
Engages in vocalizations
Smiles spontaneously
Development 3-5 Months - answerObserved:
