# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=556762&lang=en  
> language: en  
> subject: Lifestyle Choices  
> category: HPM

## Question

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.

| Wellness record | Planned vaccine action |
| --- | --- |
| Age 76; no previous RSV vaccine | Give one RSV vaccine dose before the local respiratory season. |
| Age 78; RSV vaccine given last year | Schedule another RSV vaccine dose as an annual vaccination. |
| Age 52; no previous pneumococcal conjugate vaccine | Give one dose of PCV20 during the current wellness visit. |
| Age 50; no previous zoster vaccine | Begin the two-dose recombinant zoster vaccine series now. |
| Age 30; pregnant at 29 weeks | Give Tdap during this pregnancy according to the schedule. |
| Age 54; no previous pneumococcal vaccination | Delay all pneumococcal vaccination until the client turns 65. |
| Age 67; previous PCV20 documented | Do not add PPSV23 after the completed PCV20 pathway. |
| Age 61; immunocompromised; no zoster vaccine | Wait until age 65 before beginning recombinant zoster vaccine. |
| Age 58; increased risk for severe RSV illness | Withhold RSV vaccine because the client is younger than 75. |

## 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.

## In-depth explanation

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

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