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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is preparing to administer the measles, mumps, and rubella (MMR) live vaccine to an adult female client in a community health clinic. Which of the following actions should the PN take to ensure safe practice? Select all that apply.

  1. Inquire if the client is currently pregnant or plans to become pregnant within the next four weeks.Answer
  2. Withhold the vaccine and notify the registered nurse if the client is currently receiving immunosuppressive therapy.Answer
  3. C
    Proceed with the immunization without assessing for gelatin or neomycin allergies if the client has received previous vaccines.
  4. D
    Bypass the barcode scanning process because the vaccine is administered as a standard, prepackaged dose.
  5. E
    Calculate the required medication volume to administer by converting the client's current weight from pounds to kilograms.
  6. F
    Accept a delegated task to administer a newly prescribed intravenous (IV) push antibiotic to the client during the same visit.

Answer

The correct actions are to inquire if the client is pregnant or plans to become pregnant, and to withhold the vaccine if the client is receiving immunosuppressive therapy.
The MMR vaccine is a live attenuated virus. It is strictly contraindicated during pregnancy due to the risk of fetal harm, and clients should be advised to avoid pregnancy for at least four weeks after vaccination. Additionally, live vaccines are contraindicated in clients who are severely immunocompromised (such as those receiving immunosuppressive therapy), as they can cause severe or fatal infections. Therefore, the practical nurse must actively screen for these conditions before administration.

Step-by-Step Solution

1
Identify the medication classification and properties.
The MMR vaccine is a live attenuated viral vaccine.
Understanding that the vaccine contains live viruses helps identify absolute contraindications related to immune function and fetal safety.
2
Evaluate the client's current health status against known contraindications.
Pregnancy and severe immunosuppression are absolute contraindications for live vaccines.
Live vaccines can cross the placenta or cause severe systemic infection in clients lacking an adequate immune response.
3
Review the practical nurse (PN) scope of practice and medication safety standards.
The PN must perform all medication rights verification, recognize that adult MMR doses are standardized rather than weight-based, and refuse tasks outside their scope, such as IV push administration.
Adhering to strict safety standards and scope of practice prevents patient harm and professional liability.

Key Concept

Safe administration of live attenuated vaccines and adherence to the practical nurse scope of practice.
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Topics

Pharmacological Therapies

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