1) Immunizations: Reinforcing Teaching With a Middle Adult Client A. Varicella vaccine: Administer two doses to adults who do not have evidence of immunity. Administer a second dose to adults who had only one previous dose and lack evidence of immunity, or one dose depending on the type of zoster vaccine. B. Zoster vaccine: A 2-dose series is recommended for adults 50 years and older. Second doses should be administered 2 to 6 months after the first C. Meningococcal unconjugated polysaccharide vaccine (MPSV4): MPSV4 is preferred for adults who are 56 years of age or older, require a single dose, and have not had MCV4 previously. Reimmunization with MCV4 is recommended every 5 years for adults who remain at high risk for infection and were previously immunized with MCV4 or MPSV4 Psychosocial integrity-Chemical and Other Dependencies (1 item) 1) Substance Use Disorders: Smoking Cessation A. Bupropion decreases nicotine craving and manifestations of withdrawal. Avoid use in clients who have an increased risk for seizures. To treat dry mouth, chew sugarless gum or suck on hard candy and sip small amounts of water or suck on ice chips. Avoid caffeine and other CNS stimulants to control insomnia B. Varenicline is a nicotine receptor agonist that promotes the release of dopamine to stimulate the pleasurable effects of nicotine. Reduces cravings for nicotine as well as the severity of withdrawal manifestations and reduces the incidence of relapse by blocking the desired effects of nicotine. C. Varenicline : Monitor blood pressure during treatment, monitor clients who have diabetes mellitus for loss of glycemic control, and follow instructions for titration to minimize adverse effects. Take medication after a meal. Notify the provider if nausea, vomiting, insomnia, new-onset depression, or suicidal thoughts. Can cause neuropsychiatric effects (unpredictable behavior, mood changes, and thoughts of suicide)