# A 70-year-old adult with COPD has no prior RSV vaccine and an unknown pneumococcal conjugate-vaccine history. Complete the current CDC vaccination plan.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393386&lang=en  
> language: en  
> subject: Health Promotion/Disease Prevention  
> category: HPM

## Question

A 70-year-old adult with COPD has no prior RSV vaccine and an unknown pneumococcal conjugate-vaccine history. Complete the current CDC vaccination plan.

Recommend ::선택::influenza vaccine only when symptoms beginseasonal influenza vaccine; high-dose inactivated, recombinant, or adjuvanted inactivated preferred at age 65 or olderinfluenza vaccine once at age 50influenza vaccine every 5 years. Because the pneumococcal conjugate-vaccine history is unknown, use ::선택::PCV20 or PCV21 once, or PCV15 followed by PPSV23 1 year latertetanus vaccine as the only age-based vaccinehepatitis A vaccine instead of pneumococcal vaccineHPV vaccine as a substitute for pneumococcal vaccine. Because the client has not received RSV vaccine, recommend ::선택::annual yellow-fever vaccinationBCG vaccination because COPD is presentone RSV vaccine dose because age 50–74 with COPD is increased riskoral polio vaccination.

## Explanation

Adults should receive influenza vaccine each season; at age 65 or older, high-dose inactivated, recombinant, or adjuvanted inactivated influenza vaccine is preferred when available. For an adult age 50 or older with no previous pneumococcal conjugate vaccine or unknown history, use PCV20 or PCV21 alone, or PCV15 followed by PPSV23 one year later. CDC recommends one RSV vaccine dose for adults age 50–74 who are at increased risk, including those with COPD. RSV vaccine is not currently annual. Prior vaccine records must still be checked to prevent unnecessary doses.

## In-depth explanation

Correct Answer
This 70-year-old needs seasonal influenza vaccination, an indicated pneumococcal regimen based on the unknown conjugate-vaccine history, and one RSV vaccine dose because COPD increases risk.

Why It Fits
Age drives the influenza and pneumococcal recommendations. Age 50–74 plus chronic lung disease meets the CDC risk-based RSV recommendation.

Clinical Picture
Think of the record as three separate lanes: influenza repeats each season, pneumococcal products depend on what was previously received, and RSV is currently a single dose rather than an annual series.

Memory Link
Flu every season; PCV by history; RSV once when age or risk qualifies.

NCLEX Rule
Use the stated vaccination history and risk factors. For an unknown pneumococcal conjugate-vaccine history, PCV20 or PCV21 completes the regimen, while PCV15 requires PPSV23 afterward.

Why the Alternatives Fail
Vaccinating only when symptomatic provides no prevention. BCG, oral polio, and annual yellow-fever vaccination do not match this client's routine U.S. adult schedule. Shared decision-making language should not replace the current risk-based RSV recommendation for COPD.

Sources
1CDC: RSV Vaccine Guidance for Adults
2CDC: Pneumococcal Vaccine Recommendations
3CDC: ACIP Influenza Recommendations

## Clinical scenario

The client has no vaccine contraindication. Prior records do not show an RSV vaccine or a pneumococcal conjugate vaccine. The nurse applies the current CDC adult recommendations and verifies the final schedule with the vaccination record.

## Key concepts

- **ACIP adult immunization 65+** — Annual influenza, pneumococcal (PCV20 or PCV15+PPSV23), Tdap booster, zoster (Shingrix), RSV per shared decision-making.
- **High-dose influenza vaccine** — Preferred for adults ≥ 65; higher antigen content produces stronger antibody response in older adults.
- **RSV vaccine (older adults)** — Single dose recommended for adults ≥ 75; 60-74 with risk factors (chronic lung, heart, kidney, liver, diabetes, immunocompromise).

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