A nurse is reinforcing teaching with a parent about the pneumococcal vaccine. Which of the following should the nurse include?

The vaccine is administered subcutaneously, or just underneath the skin.

The first dose of the vaccine is administered at 2 months of age.

The vaccine is contraindicated in individuals who are allergic to gelatin.

The vaccine in given in a series of six doses spread throughout the first 5 years of life.

Answer and Explanation

The Correct Answer is B

A. The vaccine is administered subcutaneously, or just underneath the skin. The pneumococcal vaccine (PCV13) is given intramuscularly (IM), not subcutaneously. The preferred injection sites are the anterolateral thigh (for infants) or the deltoid muscle (for older children).

B. The first dose of the vaccine is administered at 2 months of age. This is correct. The pneumococcal conjugate vaccine (PCV13) is routinely given at 2, 4, 6, and 12–15 months of age to protect against Streptococcus pneumoniae, which can cause pneumonia, meningitis, and sepsis.

C. The vaccine is contraindicated in individuals who are allergic to gelatin. This is incorrect. The pneumococcal vaccine is not formulated with gelatin. Gelatin allergies are more relevant for vaccines like MMR and varicella. However, PCV13 should not be given to those with severe allergic reactions to any previous dose of the vaccine.

D. The vaccine is given in a series of six doses spread throughout the first 5 years of life. The PCV13 vaccine is given in a series of four doses, not six. While some high-risk children may require additional doses of PPSV23 (pneumococcal polysaccharide vaccine), the routine childhood schedule consists of four doses.

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Correct Answer is B

Explanation

A. Cough, edema, and increased work of breathing. While these symptoms can indicate worsening heart failure, cough and edema are less prominent signs in infants compared to respiratory distress and feeding difficulties.

B. Tachypnea and diaphoresis with feeding, poor weight gain, and irritability. This is correct. Infants with worsening heart failure often struggle with feeding due to increased energy demands and difficulty breathing. Tachypnea (rapid breathing) and diaphoresis (excessive sweating) during feeding are classic early signs. Poor weight gain results from inadequate caloric intake, and irritability may be due to fatigue and hypoxia.

C. Abdominal pain, poor appetite, and cough. Abdominal pain is difficult to assess in infants, and poor appetite alone is not a definitive sign of heart failure. Cough may occur but is not a primary indicator of worsening heart failure in infants.

D. Bradycardia, rapid weight gain, and irritability. Bradycardia is not a common sign of worsening heart failure in infants; tachycardia (fast heart rate) is more typical. Rapid weight gain could suggest fluid retention but is not as reliable a sign as feeding difficulties and respiratory distress.

A. Liver enzymes should be checked before starting B. Consult the prescriber for any dose adjustments. C. Do not take with anti-anxiety medications. D. Do not take the medication longer than a week. E. An increased risk of suicide is associated with this medication.

Correct Answer is ["A","B","E"]

Explanation

A. Liver enzymes should be checked before starting. Some anticonvulsants, such as valproic acid and carbamazepine, can affect liver function. Baseline liver enzyme testing is recommended before starting therapy to monitor for potential hepatotoxicity.

B. Consult the prescriber for any dose adjustments. Anticonvulsants require careful dose titration based on the child's response, side effects, and therapeutic drug levels. The prescriber should be consulted for any necessary adjustments.

C. Do not take with anti-anxiety medications. While caution is needed when combining CNS depressants, anticonvulsants can sometimes be used alongside anti-anxiety medications if prescribed and monitored by a healthcare provider. The statement is too restrictive and does not apply universally.

D. Do not take the medication longer than a week. This is incorrect. Anticonvulsants prescribed for chronic pain management may be used for extended periods under medical supervision. Discontinuing the medication too soon can reduce effectiveness and may require a gradual taper.

E. An increased risk of suicide is associated with this medication. Certain anticonvulsants, including gabapentin, pregabalin, and carbamazepine, carry an FDA warning for an increased risk of suicidal thoughts and behaviors. Monitoring for mood changes, depression, or suicidal ideation is important.

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A nurse is reinforcing teaching with a parent about the pneumococcal vaccine. Which of the following should the nurse include?

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