# In October, a 67-year-old client with COPD comes for a wellness visit. Records show a Tdap dose at age 58, PCV20 at age 65, and one dose of recombinant zoster vaccine 8 months ago. The client has never received an RSV vaccine and has not had an influenza vaccine this season. Which vaccines should the nurse prepare to give today? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617284&lang=en  
> language: en  
> subject: Health Promotion/Disease Prevention  
> category: HPM

## Question

In October, a 67-year-old client with COPD comes for a wellness visit. Records show a Tdap dose at age 58, PCV20 at age 65, and one dose of recombinant zoster vaccine 8 months ago. The client has never received an RSV vaccine and has not had an influenza vaccine this season. Which vaccines should the nurse prepare to give today? Select all that apply.

1

A single dose of respiratory syncytial virus vaccine

2

An influenza vaccine formulation preferred at age 65 or older

3

The second dose of the recombinant zoster vaccine series

4

A Td or Tdap booster to update tetanus protection

5

PPSV23 to complete the pneumococcal vaccine series

6

A new first dose to restart the recombinant zoster vaccine series

## Explanation

The client needs this season's influenza vaccine (high-dose, adjuvanted, or recombinant preferred at 65 and older), the second recombinant zoster dose without restarting the series, and one RSV dose because chronic lung disease increases risk at age 60 to 74. PCV20 alone completes pneumococcal vaccination, and Tdap 9 years ago means the 10-year booster is not yet due.

## In-depth explanation

Quick answer
Options 2, 3, and 1: age-preferred influenza vaccine, second zoster dose, and one RSV dose.

Why this is correct
Adults 65 and older should preferentially receive high-dose, adjuvanted, or recombinant influenza vaccine each season. The recombinant zoster series is 2 doses 2 to 6 months apart, but a late second dose is simply given; the series is never restarted. RSV vaccine is recommended as a single lifetime dose for adults 75 and older and for adults 60 to 74 at increased risk, and COPD is a qualifying chronic lung condition.

Easy analogy or mental picture
A vaccine record is like a punch card: a late punch still counts, a completed card needs no more punches, and a punch not due yet waits.

Memory hook
Late dose? Continue, don't restart. PCV20 = done. Tdap clock = 10 years.

NCLEX decision rule
For immunization items, calculate each vaccine from the dates in the stem (interval, age, risk condition) rather than listing every vaccine an older adult could receive.

Why the other choices are wrong
Restarting the zoster series (option 6): tempting because the 2-to-6-month interval was exceeded, but CDC advises giving the second dose without restarting. PPSV23 (option 5): tempting because it used to follow PCV13 or PCV15, but PCV20 alone completes the series for this age group. Td/Tdap booster (option 4): tempting because tetanus protection is routine, but the last dose was 9 years ago, so the 10-year booster is not yet due in the absence of a wound.

References
1CDC Adult Immunization Schedule by AgeInfluenza, pneumococcal, Td/Tdap, and zoster recommendations for adults 65 and older
2CDC RSV Vaccine Guidance for Older AdultsSingle RSV dose for adults 60-74 at increased risk, including chronic lung disease
3CDC Shingles Vaccine Clinical ConsiderationsIf more than 6 months have passed, give the second RZV dose; do not restart the series

## Clinical scenario

Scenario
A 67-year-old with COPD attends a fall wellness visit with a documented history of Tdap at 58, PCV20 at 65, and one recombinant zoster dose 8 months ago.

## Key concepts

- **Recombinant zoster vaccine** — A non-live, two-dose shingles vaccine recommended for adults 50 and older.
- **PCV20** — A 20-valent pneumococcal conjugate vaccine that completes pneumococcal vaccination as a single dose for adults 65 and older.
- **RSV vaccine** — A single-dose vaccine against respiratory syncytial virus recommended for older adults at higher risk of severe disease.

## Related questions

- [A 6-month-old infant is brought to the well-child clinic for routine vaccinations. The par…](https://mymerci.kr/pages/nclex_q.php?qn_id=363351&lang=en)
- [A 70-year-old adult with COPD has no prior RSV vaccine and an unknown pneumococcal conjuga…](https://mymerci.kr/pages/nclex_q.php?qn_id=393386&lang=en)
- [A client who may become pregnant asks how to reduce the risk for neural tube defects. Whic…](https://mymerci.kr/pages/nclex_q.php?qn_id=393684&lang=en)
- [The nurse teaches new parents about safe sleep for a 2-month-old infant. Which statement b…](https://mymerci.kr/pages/nclex_q.php?qn_id=394028&lang=en)
- [A pregnant client asks whether an inactivated influenza vaccine is recommended during preg…](https://mymerci.kr/pages/nclex_q.php?qn_id=394095&lang=en)
- [A client asks how to notice possible breast changes between routine screening visits. Whic…](https://mymerci.kr/pages/nclex_q.php?qn_id=394127&lang=en)
- [A client who smokes says, "I know smoking is bad, but I am not ready to quit." Which respo…](https://mymerci.kr/pages/nclex_q.php?qn_id=394172&lang=en)
- [A nurse provides anticipatory guidance about infant sleep. For each caregiver statement or…](https://mymerci.kr/pages/nclex_q.php?qn_id=395663&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=617284&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=617284&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=617284&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=617284&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=617284&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._