Never give live vaccines to pregnant or significantly immunocompromised patients.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A pregnant client is found to be nonimmune to rubella on prenatal screening. Which instruction should the nurse provide regarding the rubella vaccine?
Answer: A. The rubella vaccine is a live attenuated vaccine and is contraindicated during pregnancy; it is given postpartum, and the client should avoid becoming pregnant for at least 4 weeks (about one month) after vaccination. Telling her to receive it now during pregnancy is unsafe.
Question 2 of 3
A 4-year-old is scheduled for the second dose of the MMR vaccine. The parent reports the child has a runny nose and a temperature of 99.8 F (37.7 C). What is the nurse's most appropriate action?
Answer: A. A mild illness such as a low-grade fever or runny nose is not a contraindication to immunization, so the nurse should administer the MMR as scheduled. Vaccination is deferred only for moderate-to-severe acute illness. A true egg allergy is no longer a contraindication to MMR.
Question 3 of 3
The nurse prepares to give an intramuscular injection to an adult. The preferred site is:
Answer: B. The ventrogluteal site is preferred for IM injections in adults — it avoids major nerves/vessels and accommodates larger volumes. The dorsogluteal site is avoided (sciatic nerve risk).
Keep the streak going with more questions like these, each with a full rationale.
What is vaccination for adults?
Recommendations vary by age, health conditions, and risk. Live vaccines are contraindicated in pregnancy and immunocompromised patients.
Key points to remember
- Influenza vaccine is recommended annually for all adults.
- Td or Tdap booster is given every 10 years; Tdap is given each pregnancy.
- Shingles (recombinant zoster) vaccine is recommended at age 50 and older, given as two doses.
- Pneumococcal vaccine is recommended at age 65 and older, and earlier with chronic conditions.
- Live vaccines (MMR, varicella, intranasal flu) are contraindicated in pregnancy and immunocompromise.
- COVID-19 and RSV vaccines are recommended for older and high-risk adults.
Nursing priorities
- Review immunization history and identify due or overdue vaccines at each visit.
- Screen for contraindications such as pregnancy, immunosuppression, and severe egg or component allergy.
- Administer vaccines correctly and document site, route, lot number, and education provided.
- Observe for an immediate allergic reaction after administration and have epinephrine available.
- Educate patients on expected mild side effects versus reactions to report.
Patient teaching
- Mild soreness, low-grade fever, and fatigue are common and resolve in a day or two.
- Get the flu vaccine every year and a Td/Tdap booster every 10 years; report any difficulty breathing or swelling.
Red flags: report now
- Never give live vaccines to pregnant or significantly immunocompromised patients.
- Signs of anaphylaxis (wheezing, swelling, hypotension) after a vaccine require epinephrine and rapid response now.
- A history of anaphylaxis to a prior dose or vaccine component is a contraindication and is verified before giving.
References
Clinical references for this topic
