Hepatitis B is given at birth; the full primary series spans 0-18 months.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is teaching new parents about recommended infant immunizations. The nurse correctly states that the hepatitis B vaccine series should begin at what age?
Answer: A. The first dose of the hepatitis B vaccine is recommended at birth, before hospital discharge, per the standard U.S. immunization schedule. Beginning at 2, 6, or 12 months would delay protection and is not consistent with the recommended schedule.
Question 2 of 5
Which vaccine is recommended at birth in the routine U.S. immunization schedule?
Answer: A. The first dose of hepatitis B vaccine is recommended at birth, ideally within 24 hours, to prevent perinatal transmission. Subsequent doses follow at later visits.
Question 3 of 5
Which vaccine schedule teaching is correct for a healthy infant?
Answer: B. Infants receive a series of vaccines on the recommended schedule (e.g., DTaP, IPV, Hib, PCV, rotavirus, hepatitis B, with MMR/varicella at ~12 months); keep records and follow catch-up if delayed. Skipping the schedule leaves the child unprotected.
Question 4 of 5
A parent is hesitant about vaccines and wants to delay the schedule. Which response by the nurse is most appropriate?
Answer: A. Therapeutic communication begins with exploring the parent's specific concerns and providing accurate information. Acknowledging concerns and offering evidence-based education respects the parent while supporting timely immunization.
Question 5 of 5
A nurse is counseling a client who wants to quit smoking and is prescribed varenicline. Which teaching point is most important for the nurse to emphasize?
Answer: A. Varenicline aids smoking cessation by reducing cravings and the rewarding effects of nicotine. An important safety concern is the potential for mood changes, depression, and suicidal thoughts; the client and family should report new or worsening mood symptoms. The drug is taken regardless of cravings on a schedule, is not a nicotine patch, and does not require alcohol avoidance as the primary safety message, though heavy drinking should be limited.
Keep the streak going with more questions like these, each with a full rationale.
What is immunization schedule?
Following the CDC/ACIP schedule is a core well-child nursing responsibility. Key principle: live vaccines (MMR, varicella, rotavirus, intranasal flu) are deferred or avoided in immunocompromised and pregnant clients.
Key points to remember
- Hepatitis B is given at birth; the full primary series spans 0-18 months.
- MMR and varicella are live vaccines first given at 12-15 months, with a booster at 4-6 years.
- Rotavirus is an oral live vaccine; the series must START before 15 weeks and finish by 8 months.
- DTaP is the pediatric series (under 7 years); Tdap is the adolescent/adult booster given at 11-12 years.
- HPV vaccine is routinely given at 11-12 years as a 2-dose series.
- A minor acute illness with low-grade fever is NOT a contraindication to vaccination.
Nursing priorities
- Screen for true contraindications (anaphylaxis to a prior dose or component, immunosuppression for live vaccines, encephalopathy after pertussis).
- Verify and document the vaccine name, lot number, expiration, site, and route in the immunization record.
- Give IM vaccines in the vastus lateralis for infants and the deltoid once the child is walking/older.
- Provide the current Vaccine Information Statement (VIS) and obtain informed consent before administering.
- Observe for 15-30 minutes after administration for an allergic reaction and have epinephrine available.
Patient teaching
- Expect mild low-grade fever, fussiness, and soreness or redness at the injection site for 1-2 days.
- Give weight-based acetaminophen or ibuprofen for fever or pain, and apply a cool compress to the site.
- Keep an updated immunization record; catch-up schedules exist if doses are missed, so don't restart the series.
- Spacing or skipping vaccines leaves the child unprotected and increases community disease risk.
Red flags: report now
- Anaphylaxis (wheezing, hives, hypotension, airway swelling) after a dose is an emergency and a contraindication to future doses.
- Never give live vaccines (MMR, varicella, rotavirus) to a pregnant or significantly immunocompromised child.
- Report encephalopathy within 7 days of a prior pertussis-containing vaccine as a contraindication.
References
Clinical references for this topic
