The public health nurse audits adult wellness plans. Which plans require follow-up? Highlight the plans that do not match current age- or risk-based vaccine guidance.
Highlight in Table
Choose your responses, then check the answer.
Explanation
Follow up on annual repeat RSV vaccination, delaying pneumococcal vaccination beyond age 50, delaying zoster vaccination in an immunocompromised adult, and denying RSV vaccine to an at-risk adult aged 50-74. Current recommendations use age, risk, and prior doses.
Quick answer Correct the plans for annual RSV revaccination, waiting until age 65 for a pneumococcal-naive adult aged 54, waiting until age 65 for zoster vaccine in an immunocompromised adult aged 61, and denying RSV vaccine to an at-risk adult aged 50-74.
Why this is correct Current CDC recommendations include pneumococcal conjugate vaccination beginning at age 50 for adults without a prior conjugate vaccine, recombinant zoster vaccine from age 50 and from age 19 for immunocompromised adults, and one RSV vaccine dose for all adults aged 75 or older and adults aged 50-74 at increased risk. RSV vaccine is not currently annual.[2]
Easy analogy or mental picture Think of the schedule as a route map with two entry ramps: age and risk. A client may enter through either ramp, but prior doses determine the next turn. The map changes over time, so the analogy also reminds the nurse to use the current schedule rather than memory alone.
Memory hook Check age, check risk, check prior dose, then choose the current route.
NCLEX decision rule For preventive-care questions, do not use one age cutoff for every vaccine. Match the client's age, risk conditions, pregnancy status, and vaccine history to the current recommendation and identify whether the dose is routine, risk-based, shared-decision, or not repeated.
Why the other choices are wrong One RSV dose for an unvaccinated adult aged 76, PCV20 for a pneumococcal-naive adult aged 52, starting the two-dose zoster series at age 50, Tdap during each pregnancy, and no PPSV23 after PCV20 fit the displayed histories.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
CDC: Adult Immunization Schedule NotesCenters for Disease Control and Prevention
[3]
CDC: RSV Vaccine Guidance for AdultsCenters for Disease Control and Prevention