A member of a community disaster response team received the smallpox vaccine 3 weeks ago and sees a nurse for a follow-up appointment. The nurse examines the area and should expect to see a:
a. necrotic vesicle.
b. small area of scarification.
c. small, fluid-filled blister.
d. red bump.
ANS: B
With smallpox vaccination, the scab falls off in the third week, leaving a small scar; the nurse should expect to see a scar. A necrotic vesicle would be a symptom of progressive vaccinia (vaccinia necrosum), which develops almost exclusively in those who are immunodeficient. There is progressive necrosis at the inoculation site. During the first week after inoculation, the bump becomes a blister, which begins to dry and develop a scab. Within 3 to 4 days of administration of the vaccine, a red, itchy bump appears.
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