# A nurse is reviewing the immunization status of a 62-year-old patient with type 2 diabetes during an annual wellness visit. According to ACIP recommendations for adults, which vaccines should the nurse anticipate offering or discussing? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372706&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: HPM ## Question A nurse is reviewing the immunization status of a 62-year-old patient with type 2 diabetes during an annual wellness visit. According to ACIP recommendations for adults, which vaccines should the nurse anticipate offering or discussing? Select all that apply. 1 Routine BCG vaccination at this visit to provide tuberculosis immunity for the patient 2 Pneumococcal vaccination (PCV20 alone, or PCV15 followed by PPSV23) because diabetes is a chronic indication 3 A live attenuated MMR booster every year because immunity to measles wanes annually in adults 4 Annual influenza vaccine, ideally before the start of flu season 5 Recombinant zoster vaccine (Shingrix) given as a 2-dose series 2 to 6 months apart to prevent shingles and postherpetic neuralgia 6 Tdap or Td booster if 10 or more years have elapsed since the last tetanus-containing dose ## Explanation For this 62-year-old adult with diabetes, discuss an indicated pneumococcal conjugate vaccine strategy (Choice 2), annual influenza vaccination (Choice 4), the two-dose recombinant zoster vaccine series because the patient is older than 50 (Choice 5), and a Tdap or Td booster when 10 or more years have elapsed since the last tetanus-containing dose (Choice 6). BCG is not routinely given to U.S. adults at wellness visits (Choice 1). MMR is not an annual vaccine; need is based on birth year, evidence of immunity, and risk factors (Choice 3). ## In-depth explanation Memorize the ACIP adult schedule by triggers: AGE-based (everyone gets flu yearly; everyone 65+ gets pneumococcal and zoster; everyone gets Tdap/Td q10y), CHRONIC CONDITION-based (diabetes/heart/lung/kidney/liver/immunocompromise/smoking → pneumococcal regardless of age; immunocompromise → zoster from age 19; HepB risk factors → catch-up), and LIFE-EVENT-based (each pregnancy → Tdap at 27-36 weeks; international travel → typhoid/yellow fever/HepA/MMR). Common distractor traps: live vaccines (MMR, varicella, MMRV, LAIV, yellow fever, Zostavax) are CONTRAINDICATED in pregnancy and severe immunocompromise; Shingrix (recombinant) is preferred and is NOT live. BCG is not part of the routine US adult schedule. Annual vaccines are flu and (currently) COVID-19; most others are once-or-rarely. Always verify shared clinical decision-making vaccines (HPV 27-45, MenB) with the provider before administering. ## Clinical scenario Outpatient primary care, annual wellness visit. Patient: 62-year-old male with type 2 diabetes (HbA1c 7.2%) and well-controlled hypertension on lisinopril. Last Tdap 12 years ago; influenza last year; never received pneumococcal or zoster vaccine; childhood vaccinations complete per record. ## Key concepts - **ACIP Adult Immunization Schedule** — Annually published Centers for Disease Control and Prevention Advisory Committee on Immunization Practices guidance specifying age and condition-based vaccine recommendations for adults; covers routine, catch-up, and special-circumstance vaccines - **Recombinant Zoster Vaccine (Shingrix)** — Two-dose recombinant subunit vaccine for shingles prevention given 2 to 6 months apart for adults 50 years and older and for immunocompromised adults 19 years and older; not a live vaccine, so safer for immunocompromised patients than older Zostavax - **Pneumococcal Adult Indications** — ACIP recommendation that pneumococcal vaccination (PCV20 alone, or PCV15 followed by PPSV23) be offered to all adults 65 years and older AND younger adults with chronic conditions including diabetes, chronic heart/lung/kidney/liver disease, immunocompromise, or cigarette smoking ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. 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