NCLEX · Immunizations and Health Screening

A nurse teaches a 50-year-old client about the shingles (herpes zoster) vaccine. Which statement is CORRECT?

  1. A The shingles vaccine is only for people who have never had chickenpox
  2. B The Shingrix vaccine is recommended for adults 50 and older as two doses given 2-6 months apart, even if the person has had shingles before or received the older Zostavax vaccine
  3. C Only one dose of the shingles vaccine is needed
  4. D Shingles vaccines are not recommended for people over 80

Why this is the answer

SHINGLES (herpes zoster) is caused by reactivation of the varicella-zoster virus (VZV) — the same virus that causes chickenpox — which remains dormant in nerve tissue after initial infection. As people age, immunity wanes and VZV can reactivate, causing the painful shingles rash along a dermatome, and potentially postherpetic neuralgia (PHN) — severe, persistent pain lasting months or years. SHINGRIX (RZV — recombinant zoster vaccine): recommended for adults 50 and older; 2-DOSE SERIES, given 2-6 months apart; efficacy: >90% at preventing shingles and PHN; recommended even for: people who previously had shingles (can recur); people who received the older Zostavax vaccine; people who are unsure whether they've had chickenpox. ZOSTAVAX (live attenuated, ZVL): older vaccine; only 51% effective; no longer available in the US; people who received it should still get Shingrix. IMMUNOCOMPROMISED PATIENTS: Shingrix is a non-live vaccine; can be given to many immunocompromised adults but consult provider for specific conditions (guidelines have nuances for immunosuppressed patients). COMMON SIDE EFFECTS of Shingrix: injection site reactions (soreness, redness, swelling), systemic reactions (myalgia, fatigue, headache, fever) — often quite significant and last 2-3 days; clients should be warned so they don't mistake side effects for illness; recommend scheduling injection before a rest day. NURSING ROLE: assess immunization history; provide Shingrix per schedule; educate on side effects and expected response; document administration.
Source: NCLEX-PN Test Plan: Health Promotion — Immunizations, Adults