A nurse in an influenza clinic is collecting data from four clients. Which of the following clients should the nurse identify as having a contraindication for receiving the live attenuated form of the influenza vaccine?

D. The INR is the standard laboratory test used to monitor the effectiveness of warfarin therapy. Warfarin interferes with the synthesis of vitamin K-dependent clotting factors, primarily factors II, VII, IX, and X. The INR provides a standardized measure of coagulation status, allowing healthcare providers to adjust warfarin dosage to maintain therapeutic anticoagulation while minimizing the risk of bleeding or thrombosis.
A. Platelets are involved in the process of blood clotting, but checking platelet levels is not specific to monitoring warfarin therapy. Platelet count may be relevant in assessing overall coagulation status, but it is not the primary laboratory value monitored for warfarin therapy.
B. OPTT measures the time it takes for blood to clot after specific clotting factors are activated. While OPTT is used to monitor the effectiveness of heparin therapy, it is not routinely monitored for warfarin therapy. Warfarin primarily affects the extrinsic pathway of the coagulation cascade, and the international normalized ratio (INR) is the standard laboratory test used to monitor warfarin therapy.
C. White blood cell count assesses the number of white blood cells in the blood and is used to evaluate the immune system and detect infections. Monitoring white blood cell count is not specific to warfarin therapy and is not routinely checked prior to administering warfarin.

A. According to the recommended immunization schedule, the second dose of the MMR vaccine is typically administered at 4 to 6 years of age, before starting school. This booster dose helps ensure long- term immunity against measles, mumps, and rubella.
B. The MMR vaccine is typically administered in two doses: the first dose at 12 to 15 months of age and the second dose at 4 to 6 years of age. There is no need for additional MMR immunizations over the next 2 years if the child receives the recommended doses.
C. While the child may receive additional immunizations at 3 years of age, such as the hepatitis B vaccine, the second dose of the MMR vaccine is typically administered at 4 to 6 years of age, not 3 years.
D. Titer testing is typically not recommended for determining the need for further MMR immunizations in young children. The immunization schedule provides specific recommendations for MMR vaccine doses based on age, rather than individual titers.