# A nurse is preparing to administer the influenza vaccine to a 65-year-old client. Which assessment finding would require the nurse to delay the vaccination?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=540815  
> language: ko  
> subject: Adult Health

## 문제

A nurse is preparing to administer the influenza vaccine to a 65-year-old client. Which assessment finding would require the nurse to delay the vaccination?

## 보기

1. Client reports a mild allergy to shellfish
2. Client's temperature is 98.8°F (37.1°C)
3. Client reports having a moderate to severe acute illness with fever **✔ 정답**
4. Client received a pneumococcal vaccine 2 weeks ago

**정답: 3**

## 해설

Moderate to severe acute illness with fever is a contraindication for vaccination, requiring delay until recovery. Other options (mild shellfish allergy, normal temperature, recent pneumococcal vaccine) are not contraindications.

## 심화 해설

Understanding the Contraindications and Precautions for Influenza Vaccination

The decision to delay an influenza vaccination hinges on distinguishing between true contraindications, precautions, and invalid reasons to withhold the vaccine. For a 65-year-old client, the recommended vaccines are typically inactivated influenza vaccines (IIV) or recombinant influenza vaccine (RIV), not the live attenuated vaccine (LAIV) [1]. The core principle is that a moderate or severe acute illness, with or without fever, is a standard precaution for all vaccinations, including influenza.

Let's analyze why option 3 is the correct reason to delay, and why the other options are not.

*   Option 1: Client reports a mild allergy to shellfish.

This is not a valid reason to delay. A shellfish allergy is a common misconception. Shellfish allergens are not components of influenza vaccines. The only allergy that constitutes a contraindication to inactivated influenza vaccines is a severe allergic reaction (e.g., anaphylaxis) to a previous dose of any influenza vaccine or to a vaccine component, such as egg protein for egg-based vaccines [1]. A mild allergy, especially to an unrelated substance like shellfish, does not preclude vaccination.

*   Option 2: Client's temperature is 98.8°F (37.1°C).

This is a normal body temperature. A low-grade fever or a normal temperature is not a precaution. The guideline specifies that an acute illness must be moderate or severe to warrant postponement [1]. An afebrile, healthy state is the ideal time to administer the vaccine.

*   Option 4: Client received a pneumococcal vaccine 2 weeks ago.

This is not a reason to delay. Inactivated influenza vaccines can be administered simultaneously with or at any interval before or after other inactivated or live vaccines. There is no required waiting period between an inactivated pneumococcal vaccine and an inactivated influenza vaccine [1]. Co-administration is a common and recommended practice to improve vaccination coverage.

*   Option 3: Client reports having a moderate to severe acute illness with fever.

This is the correct reason to delay vaccination. The Advisory Committee on Immunization Practices (ACIP) identifies a moderate or severe acute illness with or without fever as a precaution for administering any vaccine, including the influenza vaccine [1]. The clinical rationale is twofold: first, to avoid superimposing vaccine-related adverse effects (like myalgia or fever) on the underlying illness, which would complicate the clinical picture; and second, to prevent the possibility that a fever developing after vaccination could be mistakenly attributed to the vaccine when it is actually a progression of the patient's acute illness. Once the acute episode of the illness has resolved, the vaccine can be safely administered.References (research sources)

- [1]Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2025-26 Influenza Season.GuidelineGrohskopf LA, Blanton LH, Ferdinands JM, Reed C, Dugan VG, Daskalakis DC. (2025) · DOI: 10.15585/mmwr.mm7432a2

## 임상 시나리오

Influenza Vaccination: Delay vs. ProceedAssessing Acute Illness and Allergies in Older Adults
The primary reason to defer an inactivated influenza vaccine (IIV) is a moderate or severe acute illness with or without fever. This precaution prevents superimposing vaccine side effects on the underlying illness or confusing the clinical picture. Vaccinate after the acute episode resolves.

A mild illness (e.g., afebrile upper respiratory infection) is not a reason to delay. A normal oral temperature like 98.8°F (37.1°C) confirms the absence of significant fever.

A shellfish allergy is not a contraindication or precaution. The only allergy requiring deferral is a severe allergic reaction (e.g., anaphylaxis) to a prior influenza vaccine dose or its component (e.g., egg protein).

Inactivated influenza vaccine can be given simultaneously with other inactivated vaccines (e.g., pneumococcal) or at any interval. No waiting period is needed.

CautionFor patients 65 years and older, always verify you are administering an age-appropriate inactivated or recombinant formulation, not the live attenuated influenza vaccine (LAIV).

## 핵심 개념

- **Vaccination Precaution** — A condition that might increase the risk of a serious adverse reaction or compromise the vaccine's effectiveness; vaccination may be deferred.
- **Moderate or Severe Acute Illness** — An acute illness of sufficient severity to warrant medical attention, with or without fever, where deferring vaccination avoids superimposing vaccine side effects or confusing the clinical picture.
- **Inactivated Influenza Vaccine (IIV)** — A non-live vaccine recommended for adults aged 65 and older, containing killed virus particles.
- **Contraindication** — A condition in a recipient that greatly increases the chance of a serious adverse reaction; the vaccine should not be administered.

## 같은 주제 문제

- [A nurse is preparing to administer the influenza vaccine to a 70-year-old client with chro…](https://mymerci.kr/pages/nclex_q.php?qn_id=540814)
- [A nurse is preparing to administer the seasonal influenza vaccine to a 45-year-old client.…](https://mymerci.kr/pages/nclex_q.php?qn_id=540816)
- [A 65-year-old client with a history of chronic obstructive pulmonary disease (COPD) is sch…](https://mymerci.kr/pages/nclex_q.php?qn_id=540817)
- [A nurse is reviewing immunization schedules with the parents of a 2-year-old child. The ch…](https://mymerci.kr/pages/nclex_q.php?qn_id=541766)
- [A nurse is reviewing immunization schedules with parents of a 15-month-old child. The pare…](https://mymerci.kr/pages/nclex_q.php?qn_id=541767)
- [A 12-month-old toddler is brought to the pediatric clinic for routine immunizations. The m…](https://mymerci.kr/pages/nclex_q.php?qn_id=541768)
- [A nurse is reviewing immunization schedules with parents of a 15-month-old child. Which st…](https://mymerci.kr/pages/nclex_q.php?qn_id=541769)
- [A 4-year-old child is brought to the pediatric clinic for routine immunizations. The child…](https://mymerci.kr/pages/nclex_q.php?qn_id=542318)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._