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Difficulty: MediumPharmacological Therapies

During a pediatric clinic visit, a practical nurse prepares to administer a scheduled measles, mumps, and rubella (MMR) vaccine to a 15-month-old child. The client's health record indicates a current prescription for high-dose systemic corticosteroids to manage an autoimmune disorder. What is the most appropriate action for the practical nurse to take?

  1. Withhold the MMR vaccine and notify the healthcare provider about the client's corticosteroid therapy.Answer
  2. B
    Administer the vaccine as scheduled to ensure the child remains compliant with standard immunization timelines.
  3. C
    Administer the vaccine without completing the electronic barcode scan as long as the parent verbally confirms the child's identity.
  4. D
    Accept a delegation to administer a prophylactic intravenous (IV) push antihistamine prior to giving the immunization.

Answer

The practical nurse should withhold the MMR vaccine and notify the healthcare provider, as live attenuated vaccines are contraindicated for clients receiving immunosuppressive therapies such as high-dose corticosteroids.
The measles, mumps, and rubella (MMR) vaccine is a live attenuated vaccine. Clients receiving high-dose systemic corticosteroids are immunocompromised and lack the necessary cellular immune response to safely process live viruses. Administering a live vaccine to this client could result in a severe or life-threatening infection. Therefore, the safest and most appropriate action is to withhold the dose and alert the provider.

Step-by-Step Solution

1
Review the client's current medication list and medical history prior to administering any vaccine.
The nurse identifies that the client is actively taking high-dose systemic corticosteroids.
Identifying current medications is essential to determine potential drug interactions or contraindications before proceeding with administration.
2
Analyze the pharmacological properties of the prescribed vaccine in relation to the client's immune status.
The nurse recognizes that the MMR vaccine contains live attenuated viruses, which are contraindicated for immunocompromised individuals.
High-dose corticosteroids suppress the immune system, significantly increasing the risk of a severe, disseminated infection from a live vaccine.
3
Determine the appropriate nursing action within the practical nurse scope of practice.
The nurse withholds the immunization and escalates the finding to the prescribing healthcare provider or registered nurse.
Practical nurses must advocate for client safety by holding unsafe medications and communicating critical contraindications to the healthcare team.

Key Concept

Contraindications for live attenuated vaccines in immunocompromised clients
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Topics

Pharmacological Therapies

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