Exam Questions Flashcards
1
Q
Kate is a 24-year-old woman with asthma. She requests a refill of her albuterol inhaler on November 1st. Kate’s immunization record indicates that she completed the primary series of MMR, varicella, DTaP, HepA, and HepB vaccines, and she received a dose of Tdap 2 years ago. For complete coverage, which of the following vaccines should she receive? PCV13 and IIV. PPSV23, IIV, and HPV. PPSV23, IIV, HPV, and Td. IIV, HPV, and Td.
A
PPSV23, IIV, and HPV.
2
Q
With the exception of rotavirus, the routinely recommended live vaccines are contraindicated in a patient who:
Is finishing a course of antibiotics.
Is breastfeeding.
Is immunosuppressed.
Received another live vaccine 6 weeks ago.
A
Is immunosuppressed.
3
Q
Alex is a 32-year-old man who is scheduled to travel to a country where hepatitis A is endemic. He leaves in 3 weeks and will be gone a month. He received his first dose of hepatitis A vaccine today. Alex should be counseled to return for his second dose of hepatitis A vaccine: In 4 weeks. In 6 months. In 2 years. Immediately after travel.
A
In 6 months.
4
Q
Tom is a 9-year old boy who has never had an influenza vaccine. Tom’s mother shows you his up-to-date immunization record and reports that he has never had any adverse reactions to vaccinations. What dose and schedule of IIV should be administered to Tom? Inject 0.5 mL now and again in 4 weeks Inject 0.25 mL now and again in 1 year Inject 0.25 mL now and again in 4 weeks Inject 0.5 mL; one dose only
A
Inject 0.5 mL; one dose only
5
Q
Which of the following statements about pharmacy-based vaccination programs is true?
Pharmacists in any state can administer a vaccine under a collaborative practice agreement.
All states require pharmacists to have a signed standing order or protocol to administer vaccines.
Administratively, billing for vaccines covered by Medicare Part D may be easier for pharmacists than physicians.
Influenza vaccine programs are less likely to have initial high demand than other vaccine programs.
A
Administratively, billing for vaccines covered by Medicare Part D may be easier for pharmacists than physicians.
6
Q
Prior to the introduction of a vaccine, what was the leading cause of bacterial meningitis in children younger than 5 years of age? Haemophilus influenzae type b. Diphtheria. Varicella. Streptococcus pneumoniae.
A
Haemophilus influenzae
7
Q
The presence of fever, diffuse maculopapular rash, and Koplik spots are characteristic of which of the following diseases? Rubella. Varicella. Measles. Mumps.
A
Measles.
8
Q
Alan is a 47-year-old man who has no documentation of a primary series of tetanus-containing vaccine. Which of the following would be an appropriate primary series for Alan?
DTaP today; Td in 4 weeks; Td 6 months after the second dose.
Tdap today; Tdap in 4 weeks; Tdap 6 months after the second dose.
DTaP today; DTaP in 4 weeks, DTaP 6 months after the second dose.
Tdap today; Td in 4 weeks; Td 6 months after the second dose.
A
Tdap today; Td in 4 weeks; Td 6 months after the second dose.
9
Q
A history of anaphylaxis caused by gelatin would be a contraindication to receiving which of the following vaccines? Varicella. Tdap. Pneumococcal. Hepatitis B.
A
Varicella.
10
Q
How often are the Healthy People targets for vaccination rates updated?
Every year
Every 5 years
Every 10 years
Every 20 years
A
Every 10 years
11
Q
Which of the following patients are appropriate candidates for the 2-dose schedule of HPV9?
15 year-old boy with no medical conditions, series has not been started
11 year-old girl with no medical conditions, series has not been started
12 year-old boy with no medical conditions, 1st dose given on May 9th, 2nd dose given on September 14th
9 year-old boy who had a heart transplant at age 2 and has a history of sexual abuse, 1st dose given on February 23rd, 2nd dose has not been given
A
11 year-old girl with no medical conditions, series has not been started
12
Q
Which vaccine does ACIP recommend for all college freshmen, aged 21 years or younger, living in dormitories, who have not been previously vaccinated? PPSV23. MCV4. 9vHPV. Varicella.
A
MCV4.
13
Q
A 69 year-old man received Td vaccination 4 years ago. He is preparing to travel to see his newborn granddaughter next month. Which of the following vaccines containing tetanus, diphtheria, and/or pertussis would be most appropriate for him?
Td.
Tdap.
He is over 64 years of age; neither Td or Tdap are recommended at this time.
It is too soon to administer any tetanus-containing vaccines.
A
Tdap.
14
Q
Aiden is a 6-month-old healthy boy with no known allergies. He has received vaccinations in the past with no reported adverse reactions. Aiden’s father asks about having his son vaccinated against influenza. The most appropriate response would be to inform the father that Aiden:
Is too young to be vaccinated against influenza
Should receive 1 dose of IIV4 today followed by a second dose of IIV4 administered 4 weeks later
Should receive 1 dose of LAIV today followed by a second dose of LAIV administered 4 weeks later
Should receive 1 dose of IIV3 or IIV4 today followed by a second dose 1 year later
A
Should receive 1 dose of IIV4 today followed by a second dose of IIV4 administered 4 weeks later
15
Q
According to ACIP, which of the following is a contraindication to receiving HZV?
Current treatment for lymphoma.
Age 59 years or younger.
Past history of herpes zoster.
Has never received the varicella zoster vaccine (VAR).
A
Current treatment for lymphoma.
16
Q
What is the minimum needle length recommended for administering HepB vaccine to an adult patient weighing 130 lb? ½ inch. ⅝ inch. 1 inch. 1½ inch.
A
1 inch.
17
Q
Even though state laws may have specific mandates, how long should pharmacists maintain records of immunizations? 5 years. 10 years. 20 years. For the patient’s lifetime.
A
For the patient’s lifetime.
18
Q
Ava has arrived at the clinic for her well-child visit. She is 4 months old. Ava’s immunization record reveals that she has received the following vaccines:
2 doses of HepB
1 dose of Hib
1 dose of rotavirus
1 dose of PCV13
1 dose of DTaP
1 dose of IPV
Which vaccines should Ava receive at today’s visit?
DTaP, Hib, PCV13, IPV, rotavirus, and IIV.
DTaP, Hib, PCV13, IPV, and rotavirus.
DTaP, HepB, MMR, and varicella.
DTaP, PCV13, IPV, and IIV.
A
DTaP, Hib, PCV13, IPV, and rotavirus.
19
Q
Vaccines as well as exposure to natural disease are both examples of which type of immunity? Innate immunity Temporary immunity Active immunity Passive immunity
A
Active immunity
20
Q
Which of the following best describes an opportunity for pharmacists to use diagnosis-based screening to identify people at risk for vaccine-preventable diseases?
Performing a medication review for a patient who has diabetes.
Recommending vaccinations for a patient undergoing a splenectomy.
Providing hospital discharge counseling to a patient.
Providing vaccine information at a booth of a health fair.
A
Performing a medication review for a patient who has diabetes.
21
Q
Which disease is characterized by the development of a membrane on the tonsils, pharynx, or larynx, leading to respiratory obstruction? Pertussis. Diphtheria. Haemophilus influenzae type b. Meningitis.
A
Diphtheria.
22
Q
What is meant by the term “immunization neighborhood”?
Pharmacists live in a community where the population has met Healthy People 2020 immunization targets.
A community has adequate access to vaccines.
Immunization stakeholders collaborate to meet community immunization needs.
Patient-centered medical homes provide immunization services.
A
Immunization stakeholders collaborate to meet community immunization needs.
23
Q
For which age group is the adjuvanted inactivated influenza vaccine approved? 2 through 49 years 19 through 64 years 4 years and older 65 years and older
A
65 years and older
24
Q
David is a healthy 5-year-old boy who is scheduled to see his pediatrician for a checkup in July prior to starting kindergarten. David’s immunization record reveals that he has received the following vaccines:
3 doses of HepB
4 doses of PCV13
2 doses of HepA
3 doses of IPV
2 doses of rotavirus
1 dose of MMRV
4 doses of DTaP
4 doses of Hib
Which vaccines should David receive at this visit?
DTaP, IPV, MMR, and varicella.
DTaP, MMR, and MCV4.
DTaP, MMR, rotavirus, and IPV.
MMR and varicella.
A
DTaP, IPV, MMR, and varicella.
25
```
According to ACIP recommendations, which of the following needle lengths would be appropriate for administering HZV to an adult patient?
½ inch.
⅝ inch.
1 inch.
1½ inch.
```
⅝ inch.
26
```
Which of the following documents must be given to every patient or patient’s caregiver before administration of a vaccine covered under the National Childhood Vaccine Injury Act (NCVIA)?
CMS-1500.
VIS.
PHS-731.
CMS-855B.
```
VIS.
27
What is the standard dose of epinephrine for managing anaphylaxis?
0.01 mg per kg body weight, up to a maximum of 0.5 mg.
0.1 mg per kg body weight, up to a maximum of 5 mg.
0.5 mg for all patients.
5 mg for all patients.
0.01 mg per kg body weight, up to a maximum of 0.5 mg.
28
```
According to ACIP recommendations, HZV is indicated for the prevention of herpes zoster in adults aged:
18 years and older.
50 years and older.
60 years and older.
65 years and older.
```
60 years and older.
29
```
After completion of a primary vaccine series and documentation of a one-time dose of Tdap, Td booster doses are recommended every:
1 year.
2 years.
5 years.
10 years.
```
10 years.
30
There should be a flat hard surface in the area where vaccines will be administered to ensure:
The pharmacist has an area to prepare the vaccines.
The supply cart can be easily moved.
There is room for the patient to lie down if fainting occurs or CPR is required.
The pharmacy is in compliance with OSHA standards.
There is room for the patient to lie down if fainting occurs or CPR is required.
31
Which viruses are associated with the development of cancer?
Human papillomavirus and hepatitis B virus.
Varicella virus and hepatitis A virus.
Hepatitis A and herpes zoster.
Rubella and varicella virus.
Human papillomavirus and hepatitis B virus.
32
```
Kimberly is a 34 year-old woman who is 30 weeks pregnant. She received a Td booster dose 1 year ago when she cut her hand while working in the kitchen. She has no documentation of receiving a Tdap vaccine. The most appropriate recommendation would be to administer:
Tdap as soon as possible.
Tdap immediately postpartum.
DTaP as soon as possible.
Td in 9 years.
```
Tdap as soon as possible.
33
```
Which of the following patients should receive the MMR vaccine?
A 6-month-old infant with no documentation of MMR vaccine.
An adolescent with documentation of 2 doses of MMR vaccine.
An adult (who is not a health care provider) born in 1955 with no documentation of MMR vaccine.
A pharmacist born in 1975 with documentation of 1 dose of MMR vaccine.
```
A pharmacist born in 1975 with documentation of 1 dose of MMR vaccine.
34
```
What is the type of immunity that occurs when a pregnant woman is vaccinated with Tdap to protect the infant from pertussis after birth?
Active immunity
Acquired immunity
Cell-mediated immunity
Passive immunity
```
Passive immunity
35
```
After reconstitution, within what time frame must HZV be administered?
30 minutes.
1 hour.
24 hours.
72 hours.
```
30 minutes.
36
```
HPV vaccine is recommended for which of the following individuals?
36-year-old woman.
27-year-old woman.
12-year-old boy.
8-year-old girl.
```
12-year-old boy.
LO 3.4; Module 3—Human Papillomavirus, Vaccine Recommendations
According to ACIP, both males and females between ages 9 through 26 years may receive the HPV vaccine. It is routinely recommended at 11 or 12 years of age.
37
If a patient with an egg allergy experiences hives following influenza vaccination, what is ACIP’s recommendation for vaccinating this patient against influenza?
Administer the recombinant influenza vaccine (RIV) only
Administer the cell culture-based (ccIIV) or recombinant influenza vaccine (RIV)
Administer any age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV)
Refer the patient to a medical setting with the resources to recognize and manage severe allergic reactions
Administer any age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV)
38
Barbara is a 60-year-old woman who presents to the pharmacy for two vaccines: HZV and IIV. Which of the following are the appropriate doses and routes for administering these vaccines to this patient?
HZV 0.50 mL intramuscularly; IIV 0.65 mL subcutaneously.
HZV 0.65 mL intramuscularly; IIV 0.5 mL subcutaneously.
HZV 0.50 mL subcutaneously; IIV 0.65 mL intramuscularly.
HZV 0.65 mL subcutaneously; IIV 0.5 mL intramuscularly.
HZV 0.65 mL subcutaneously; IIV 0.5 mL intramuscularly.
39
```
Which of the following vaccines is recommended for infants to receive within 24 hours of birth?
IIV3, if during influenza season.
Hepatitis A.
Hepatitis B.
MMR.
```
Hepatitis B.
40
```
At what point during pregnancy is it recommended to administer the influenza vaccine?
Anytime is safe
During the 1st trimester
27 to 36 weeks
Wait until after the baby is delivered
```
Anytime is safe
41
```
he monitoring system that health care providers should use to report serious adverse events after vaccination is:
VAERS.
OSHA.
CMS-1500.
VICP.
```
VAERS.
42
Which of the following statements about live attenuated vaccines is true?
They should generally be avoided in immunocompromised individuals.
Their effectiveness wanes faster than inactivated vaccines.
They can be either whole cell, fractional, or toxoids.
Circulating antibodies have no impact on their effectiveness.
They should generally be avoided in immunocompromised individuals.
43
```
Which type of vaccine involves stimulation of B cells without the assistance of T helper cells?
Live attenuated vaccines
Conjugated vaccines
Pure polysaccharide vaccines
Recombinant vaccines
```
Pure polysaccharide vaccines
44
Emily is a 16-year-old high-school student with no chronic medical conditions. Emily’s immunization record shows that she completed the primary series for IPV, HepA, Hib, DTaP, and MMR, and she had a physician-diagnosed case of chickenpox at 2 years of age. Which of the following would be the most appropriate recommendation for her today?
Tdap, HPV, MCV, HepB, and influenza, if during influenza season.
DTaP, HPV, MCV, HepB, and influenza, if during influenza season.
Tdap, HPV, MCV, and influenza, if during influenza season.
Because Emily is healthy, she does not require any vaccinations.
Tdap, HPV, MCV, HepB, and influenza, if during influenza season.
45
Why was the live attenuated influenza vaccine (LAIV) removed from the ACIP’s influenza vaccine recommendations?
It was shown to cause influenza in children and adolescents.
Low effectiveness of this vaccine was seen during the 2013–2014 and 2015–2016 influenza seasons.
Serious adverse events were reported with LAIV.
There was concern about vaccine supply issues.
Low effectiveness of this vaccine was seen during the 2013–2014 and 2015–2016 influenza seasons.
46
```
Which of the following diseases has been successfully eradicated worldwide through vaccination efforts?
Polio
Tetanus
Smallpox
Rubella
```
Smallpox
47
```
Which of the following is recognized by sociologists as a factor in a patient’s decision whether to be vaccinated?
History of medication use.
History of chronic medical conditions.
Influence of a health care provider.
Discount coupon in local newspaper.
```
Influence of a health care provider.
48
Upon giving a VIS to a patient who is to receive a vaccine cover under the National Childhood Vaccine Injury Act, what must be documented?
The date the VIS was given to the patient or caregiver and the title of the VIS.
The date printed on the VIS and signed confirmation that the patient has read the VIS.
The date the VIS was given to the patient or caregiver and the date printed on the VIS.
Signed confirmation that the patient has read the VIS and the title of the VIS.
The date the VIS was given to the patient or caregiver and the date printed on the VIS.
49
Why are adjuvants added to vaccines?
To minimize the adverse reactions of the vaccine.
To strengthen the immune response to the antigen.
To extend the vaccines expiration date.
To provide immediate protection from disease.
To strengthen the immune response to the antigen.
50
HealthMap Vaccine Finder is a free online tool that allows pharmacists to:
Order vaccines from multiple distributors through a centralized hub.
Manage vaccine inventory during shortages.
List their vaccination services so patients can find them when searching the website for nearby immunizers.
Order free print marketing materials.
List their vaccination services so patients can find them when searching the website for nearby immunizers.
51
Which of the following key questions is important to ask a patient before administering IIV?
Are you sick today?
During the past year, have you received a blood transfusion or immune (gamma) globulin?
Have you received any vaccinations in the past 4 weeks?
Do you have cancer, leukemia, AIDS, or any other immune system problem?
Are you sick today?
52
```
The incubation period for influenza can range from:
1 to 4 days
7 to 10 days
2 to 3 weeks
3 to 4 weeks
```
1 to 4 days
53
Which entity determines the specific vaccines that a pharmacist may administer?
States through laws and regulations
U.S. Food and Drug Administration
Local health departments
Advisory Committee on Immunization Practices
States through laws and regulations
54
```
Jackie is a 34-year-old woman who received an influenza vaccine from you today. She wants to know how long it will take for the vaccine to begin working to protect her from getting the flu. What would be the most appropriate response to this patient?
90 days
28 days
14 days
2 days
```
14 days
55
Adolescents should be routinely vaccinated with MCV4 on the following schedule:
1 dose at age 11 to 12 years.
1 dose at age 16 years.
1 dose at age 11 to 12 years, followed by a booster dose at age 16 years.
1 dose at age 16 years, followed by a booster dose at age 18 years.
1 dose at age 11 to 12 years, followed by a booster dose at age 16 years.
56
When looking at the schedule for vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications, what does the orange bar represent?
Contraindicated.
Precautions for vaccination.
Recommended if an additional risk factor is present.
Additional doses may be needed based on condition.
Precautions for vaccination.
57
```
Which of these vaccines is a live attenuated vaccine?
IIV4.
Zoster.
PPSV23.
Td.
```
Zoster.
58
Which of the following immunization strategies is preferred for adults under the age of 65 years with immunocompromising conditions who require both PCV13 and PPSV23?
PCV13 first, followed by PPSV23 at least 8 weeks later.
PCV13 first, followed by PPSV23 at least 1 year later.
PPSV23 first, followed by PCV13 at least 8 weeks later.
PPSV23 first, followed by PCV13 at least 6 months later.
PCV13 and PPSV23?
| PCV13 first, followed by PPSV23 at least 8 weeks later.
59
Which of the following diseases are transmitted through mosquito bites?
Typhoid fever and Haemophilus influenzae type b
Hepatitis A and typhoid fever.
Yellow fever and Japanese encephalitis.
Hepatitis A and measles.
Yellow fever and Japanese encephalitis.
60
```
A history of anaphylaxis caused by neomycin would be a contraindication to receiving which of the following vaccines?
IPV.
Tdap.
PCV13.
HPV.
```
IPV.
61
If pharmacists are called upon to assist with vaccination efforts following a natural disaster, which vaccine is likely to be needed by many of the victims?
Tetanus
Pneumococcal
MMR
Meningococcal B
Tetanus
62
Why should refrigerated vaccines be stored in the middle of the refrigerator?
To keep them separated from food on the bottom shelf.
To be at eye level.
There are fewer temperature fluctuations.
They are easier to reach.
There are fewer temperature fluctuations.
63
RotaTeq (RV5) should be administered as a:
2-dose series to infants at 2 and 4 months of age.
2-dose series to infants at 0 and 6 months of age.
3-dose series to infants at 2, 4, and 6 months of age.
3-dose series to infants at 1, 2, and 6 months of age.
3-dose series to infants at 2, 4, and 6 months of age.
64
Which of the following best describes how to administer MMR vaccine to an adult patient weighing 210 lb?
Inject subcutaneously at a 45° angle in the outer aspect of the upper arm.
Inject intramuscularly at a 45° angle in the deltoid muscle.
Inject subcutaneously at a 90° angle in the outer aspect of the upper arm.
Inject intramuscularly at a 90° angle in the deltoid muscle.
Inject subcutaneously at a 45° angle in the outer aspect of the upper arm
65
Which of the following statements would be accurate when responding to a patient’s concerns about the safety of vaccines?
In recent years, several hot lots of the vaccine have been known to cause severe adverse events. We do not stock these vaccines.
Thimerosal in vaccines poses a risk for autism—we can use a vaccine that is thimerosal-free.
The immune system is capable of stimulating an immune response to multiple vaccines administered at the same time.
While influenza vaccines may cause the flu, the extent of the illness and risk for hospitalization are greatly reduced.
The immune system is capable of stimulating an immune response to multiple vaccines administered at the same time.
66
In the event that a young child is fussy following the receipt of a vaccine, pharmacists should advise parents to:
Comfort the child and engage in quiet activities.
Administer aspirin.
Call the pediatrician.
Seek emergency care
Comfort the child and engage in quiet activities.
67
```
Which of the following tetanus booster vaccines would be most appropriate for administration to a 12-year-old boy who has completed a primary series with DTaP and has no known allergies?
DTaP.
DT.
Td.
Tdap.
```
Tdap.
LO 3.4; Module 3— Pertussis. Target Groups for Vaccination. Tdap Vaccine
One dose of Tdap is routinely recommended for all adolescents who have completed the primary series of DTaP. This should be given at 11 to 12 years of age. DTaP contains higher amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years of age to avoid injection site reactions in adolescents and adults. Following the one-time dose of Tdap, a Td booster should be given every 10 years. DT, which has a higher amount of diphtheria toxin is only reserved for children who have a contraindication to the pertussis component in DTaP.
68
Which of the following patients would be a candidate for PPSV23?
12-month-old boy with asthma.
25-year-old man who smokes cigarettes.
33-year-old woman who is pregnant.
50-year-old woman with no medical conditions.
25-year-old man who smokes cigarettes.
69
Which of the following best describes how to administer Tdap vaccine to an adult patient weighing 185 lb?
Inject subcutaneously at a 45° angle in the outer aspect of the upper arm.
Inject intramuscularly at a 45° angle in the deltoid muscle.
Inject subcutaneously at a 90° angle in the outer aspect of the upper arm.
Inject intramuscularly at a 90° angle in the deltoid muscle.
Inject intramuscularly at a 90° angle in the deltoid muscle.
70
```
What is the time interval for which the development of Guillain-Barré syndrome following influenza vaccination would result in a precaution for future influenza vaccines?
Within 6 weeks
Within 6 months
Within a year
Within 5 years
```
Within 6 weeks
71
In which publication does the CDC initially publish new or updated vaccine recommendations?
Epidemiology and Prevention of Vaccine-Preventable Diseases
Needle Tips
Morbidity and Mortality Weekly Report (MMWR)
Vaccine
Morbidity and Mortality Weekly Report (MMWR)
72
Which of these vaccines is an inactivated vaccine?
LAIV.
Varicella.
MMR.
Tdap.
Tdap.
73
If a patient received the first dose of HepB but did not return for the remaining doses in the series, under what circumstances should the HepB series be restarted?
If more than 2 months have passed since the second dose was due.
If more than 1 year has passed since the second dose was due.
If more than 5 years have passed since the second dose was due.
The series should not be restarted; resume the series where it was interrupted.
The series should not be restarted; resume the series where it was interrupted.
74
```
If a patient is a candidate for revaccination with PPSV23, what is the ACIP-recommended interval between doses of this vaccine?
1 year.
2 years.
3 years.
5 years.
```
5 years.
75
```
Robert is a 48-year-old pharmacist who is preparing to provide immunizations in his pharmacy for the first time next fall. He has no documentation of receiving the hepatitis B vaccine and would like to be vaccinated before administering vaccines in his practice. What is the recommended routine schedule for vaccination against hepatitis B?
0 and 2 months.
0 and 6 months.
0, 1, and 2 months.
0, 1, and 6 months.
```
0, 1, and 6 months.
76
Arthus reactions, which are exaggerated local reactions that can occur if a patient is vaccinated too frequently, are most commonly reported after which vaccine?
Inactivated influenza vaccine (IIV).
Tetanus and diphtheria toxoid–containing vaccines.
Pneumococcal polysaccharide vaccine (PPSV).
Hepatitis B vaccine.
Tetanus and diphtheria toxoid–containing vaccines.
77
If a vial of influenza vaccine is left out of the refrigerator on the pharmacy counter overnight, what should be done with the vaccine?
Dispose of it as biohazardous waste immediately.
Refrigerate immediately and use within 30 days.
Mark “do not use,” place in the refrigerator, and call the manufacturer for further guidance.
Mark “do not use,” place in the freezer, and call the manufacturer for further guidance.
Mark “do not use,” place in the refrigerator, and call the manufacturer for further guidance.
78
```
A health care provider who has not been vaccinated against hepatitis B is stuck by a contaminated needle after administering an immunization to a hepatitis B-positive patient. In addition to hepatitis B vaccine, the health care provider also should receive hepatitis B Immunoglobulin (HBIG) as postexposure prophylaxis because the HBIG provides:
Long-term protection
Both short- and long-term protection
A booster effect for the vaccine
Prompt immunity
```
Prompt immunity
79
```
All Medicare Part B enrollees are covered for which vaccines?
Influenza, PPSV23, and PCV13
HZV, influenza, and PPSV23
Tdap, PCV13, and influenza
HZV, Tdap, and PPSV23
```
Influenza, PPSV23, and PCV13
80
```
What is the most common complication of pertussis?
Seizures
Pneumonia
Hypoxemia
Colic
```
Pneumonia
81
Which of the following statements best describes appropriate administration of pneumococcal vaccines for adults 19 to 64 years of age who are immunocompromised?
Whenever both PCV13 and PPSV23 are recommended, PCV13 should ideally be given first. The body produces a better immune response to the vaccines when given in this order. For those with immunocompromising conditions at high-risk for pneumococcal disease, the interval between PCV13 and PPSV23 is at least 8 weeks. This 8-week interval also applies to those with asplenia, cochlear implants, and cerebrospinal fluid leaks. All others would wait at least one year between the two vaccines.
82
Larry is a 65-year-old man with heart disease who comes to the pharmacy to refill a prescription on October 21. His immunization record indicates that he has completed the primary series of DTaP, MMR, hepatitis B, and hepatitis A. His last Td booster dose was 12 years ago. In addition to influenza, which of the following vaccines should Larry receive?
Because Larry has heart disease both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines he needs. Both PCV13 and PPSV23 are recommended for all patients when they turn age 65. PPSV23 is also recommended for patients with heart disease. Larry will need to receive PCV13 now and PPSV23 in 12 months. Tdap is recommended for all adults who have not previously received Tdap. Adults ages 60 and older need herpes zoster vaccine. Since he was born before 1980, he does not need varicella vaccine.
83
Five minutes after receiving a vaccine, a patient tells you that his face “feels funny” and he is starting to feel itchy all over. You notice that his lips are swollen. Which of the following would be the most appropriate action to take?
If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Prepare your staff for a potential emergency situation. If you suspect anaphylaxis, then you instruct a staff member to call 911. You would then prepare and administer epinephrine. The patient should not take him or herself to the emergency department. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. While diphenhydramine is sometimes used in conjunction with epinephrine, it is typically given intravenously. Epinephrine remains first-line treatment for anaphylaxis.
84
Which of the following is the youngest age at which a child should receive inactivated influenza vaccine?
Influenza vaccination is universally recommended for all individuals beginning at 6 months of age. The vaccines recommended prior to 6 months include hepatitis B (given at birth), rotavirus, DTaP, Hib, PCV13, and IPV.
85
What is the most appropriate recommendation for administering Tdap to pregnant patients?
One dose of Tdap should be administered to women during each pregnancy, preferably within 27 – 36 weeks gestation (third trimester) to protect newborns against pertussis. This allows for maternal antibody transfer to the newborn who is too young to be vaccinated with DTaP. In fact, when given earlier in this time frame (28 to 32 weeks), there were higher titers in the infants when compared to later in this time frame (33 to 36 weeks). As such, the 27 to 36 window to give Tdap is still advised but with the added caveat that giving it sooner within this range will provide the maximum antibody transfer. There is a concern that giving Tdap earlier than the third trimester may result in the waning of antibody titers before the infants are old enough to be vaccinated.
86
Which of the following best describes how to administer hepatitis B vaccine to an adult man who weighs 225 lbs?
The hepatitis B vaccine is administered intramuscularly at a 90-degree angle. In older children and adults, it should be injected into the deltoid muscle. The weight of the patient does not change the site of injection.
87
Vaccines evoke an immune response because they contain:
Vaccines contain antigens that stimulate an immune response and result in immunologic memory. B cells are activated in this process. Except for pure polysaccharide vaccines, T cells are also activated and are able to generate additional B cells. B cells express unique receptors that recognize and bind to only one particular antigen. B cells are the major cells involved in the creation of antibodies that circulate in blood plasma and lymph. This is referred to as humoral immunity. B cells mature to plasma cells and antibodies that help the body eliminate the antigen are formed.
88
Which of the following patients would be an appropriate candidate for the HPV vaccine?
The HPV vaccine is recommended for all adolescents ages 11 through 12 years of age. It may be given as early as age 9 if there is a history of sexual abuse or assault. Females through 26 years of age and males through 21 years of age should receive HPV vaccine if they did not previously get vaccinated. Males 22 through 26 years of age may receive the HPV vaccine if they were not previously vaccinated if protection against HPV is warranted.
89
Which of the following would be an appropriate needle size and length for administering varicella vaccine to an adult woman who weighs 175 lbs?
Varicella vaccine, a live vaccine, is administered subcutaneously. All subcutaneous vaccinations should use a 23 to 25 gauge, 5/8 inch needle. Age and weight of the patient do not matter.
90
Which influenza vaccine is approved to be used with the jet injector needle-free system?
The FDA must approve each specific medication that is administered via a jet injector needle-free system. The only vaccines approved for such use are Afluria and Afluria Quadrivalent. This approval is for individuals ages 18 through 64 years.
91
Which of the following types of vaccines represents an opportunity to collaborate with physicians to meet the needs of the community?
When a vaccine requires a series of doses for adequate protection, it can sometimes be challenging to get individuals to return for follow-up doses. Collaborating with other health care professionals to make vaccine access easier is one way to increase vaccination for the additional doses needed in the series. For instance, if the first dose was given in the physician’s office, instead of scheduling another office appointment, the patient could then be referred to the local pharmacy for the additional doses.
92
Which of these vaccines must replicate to stimulate an immune response?
MMR is a live attenuated vaccine. Live attenuated vaccines are produced by weakening the virus or bacteria to reduce the likelihood that it can cause disease. Live attenuated vaccines tend to produce more persistent, longer-lasting immunity than inactivated vaccines. Live attenuated vaccines must replicate in order for the body to produce an immune response. 9vHPV, MCV4, and Tdap are inactivated vaccines. Inactivated vaccines are produced by killing the virus or bacteria. They include polysaccharide vaccines (which can be conjugated or unconjugated), toxoids, or cellular vaccines (which can be viruses or bacteria, or fractions of either).
93
Which of the following is the correct dose and route of administration for the high-dose influenza vaccine?
High-dose inactivated influenza vaccine is approved for adults ages 65 years and older. The dose is 0.5 mL intramuscularly into the deltoid muscle.
94
Missy is a 36-year-old woman with diabetes mellitus. She requests a refill of her insulin on November 1. She has completed the primary series of MMR, DTaP, and hepatitis A vaccines, and she received a dose of Tdap 2 years ago. She had a physician-confirmed case of chickenpox as a child. Missy is not pregnant. Which of the following vaccines should Missy receive?
Because Missy has diabetes both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines she needs. Having diabetes means she is high-risk for pneumococcal disease, hepatitis B, and influenza-related complications. She will need the PPSV23, hepatitis B, and influenza vaccines. She does not need Td for another 8 years. HPV is recommended up through age 26 so she does not need this vaccine.
95
Hugh, a 56-year-old health care worker, has no laboratory evidence of immunity to measles or mumps and cannot confirm that he had either disease. How many doses of MMR vaccine should Hugh receive?
At age 56, Hugh would have been born after 1957. Health care personnel born in or after 1957 without evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease should receive two doses of MMR. Evidence of immunity includes laboratory evidence or documentation of vaccination. Provider diagnosis is not adequate evidence of immunity.
96
Which of the following vaccines should be administered to boys and young men aged 9 through 26 years to reduce their likelihood of acquiring genital warts?
HPV types 16, 18, 31, 33, 45, 52, and 58 account for approximately 85% to 90% of all cervical cancers. These are considered the high-risk types.In addition to cervical cancer, high-risk HPV has been associated with vulvar, vaginal, anal, penile, oral, and pharyngeal cancers.Low-risk HPV types (e.g., 6, 11) cause the majority of cases of genital warts. The 9-valent HPV vaccine (9vHPV or HPV9) covers types 6, 11, 16, 18, 31, 33, 45, 52, and 58. It is indicated for males and females ages 9 through 26 years to protect against cancers and genital warts.
97
Katy is a 12-year-old middle school student with no chronic medical conditions who comes to your pharmacy on September 30 for her flu shot. She completed the primary series of DTaP, IPV, hepatitis A, hepatitis B, and Hib, and had a physician-diagnosed case of chickenpox at 2 years of age. Which of the following would also be appropriate to recommend for Katy today?
Upon reviewing the immunization schedule for children and adolescents, Katy is due for vaccines routinely recommended at ages 11 through 12 years. In addition to her influenza vaccination, she needs her Tdap and first doses of meningococcal vaccine (MCV4) and 9vHPV. Individuals 7 years of age and older who need protection against tetanus, diphtheria, and pertussis should receive Tdap, not DTaP. It appears she never got her MMR vaccine when she was younger. She will need two doses, 4 weeks apart to get caught up.
98
Which of the following is a symptom of a true allergic reaction?
An allergic response to a vaccine is considered an immediate (or type I) hypersensitivity reaction. It typically occurs within minutes to an hour of vaccination. Such an allergic reaction can include itching, erythema, hives, urticarial, and anaphylaxis. Fever, headache, and GI distress are not considered allergic reactions to vaccines.
99
The majority of cases of vasovagal syncope occur within which of the following time frames following vaccination?
Fainting, or vasovagal syncope, is a brief loss of consciousness. Although it is not that common, if fainting occurs following vaccination, it is usually within 5 to 15 minutes. It is important to vaccinate patients while they are seated or lying down and observe them for at least 15 minutes following vaccination.
100
A 63-year old woman arrives at your pharmacy for her herpes zoster vaccine. Which of the following is the appropriate dose and route of administration?
The herpes zoster vaccine is a live vaccine which is administered subcutaneously into the outer aspect of the upper arm. The dose is 0.65 mL.
101
Which age group is appropriate to receive the 2-dose HPV9 vaccine series?
The 2-dose schedule of the 9-valent HPV vaccine is approved and recommended for immunocompetent males and females ages 9 through 14 years. It is routinely recommended for ages 11 through 12 years. If the series is begun after the 15th birthday, then 3 doses should be given at 0, 1 to 2, and 6 months.
102
Which of the following is the recommended dose of 1:1000 epinephrine for managing anaphylaxis?
Epinephrine is the first-line treatment of choice for acute anaphylaxis. Epinephrine is dosed on the basis of the patient’s body weight. Aqueous epinephrine (1 mg/mL preparation) should be administered at a dose of 0.01 mg/kg/dose, up to a maximum of 0.5 mg per dose. Note that 0.01 mg equals 0.01 mL. Some providers may use auto-injectors that contain fixed doses (i.e., 0.15 mg or 0.3 mg). These doses will vary depending on the age and weight of the patient.
103
Vaccines should be avoided or delayed for which of the following patients?
Before giving any vaccine, it is important to determine how the patient is feeling. It is okay to administer vaccines if the patient has a mild illness, such as low-grade fever, mild respiratory tract infection, mild diarrhea, or otitis media. However, if the patient has moderate to severe acute illness that requires additional care, it is advised to defer vaccination until the illness resolves. Smallpox and yellow fever vaccines are the only vaccines that should not be administered to a woman who is breastfeeding—all routinely recommended vaccines are safe to administer. Vaccine schedules do not need to be altered if a child is born prematurely. A newborn whose mother is HIV positive is not a precaution or contraindication to receiving vaccines.
104
Which of the following is a provider factor associated with low vaccination rates in adults?
There are a variety of factors that may present barriers to increasing vaccination coverage in adults. These include patient, provider, and system factors, as well as a complex vaccination schedule for adults. Patient factors include a lack of adequate insurance coverage, inconvenient access, and lack of a regular health care provider. Provider factors include inadequate focus on preventive services, failure to make vaccine recommendations, and lack of effective recall and reminder systems. System factors include minimal to no requirements to be vaccinated and varying state regulations.
105
Lily is a 15-month-old girl who is up to date with her vaccinations. Which of the following tetanus toxoid-containing vaccines would be appropriate for Lily?
DTaP contains higher amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years of age to avoid injection site reactions in adolescents and adults. Individuals 7 years of age and older who need protection against tetanus, diphtheria, and pertussis should receive Tdap, not DTaP. Since Lily is up to date, she would have already received the first three doses of DTaP at ages 2, 4, and 6 months. Her fourth dose is to be given at ages 15 through 18 months. The fifth and final dose is given at ages 4 through 6 years. At ages 11 through 12 years, she would receive a dose of Tdap, followed by Td every 10 years. DT is reserved for children who should not receive acellular pertussis-containing vaccines.
106
Which of the following is the recommended schedule for administration of the hepatitis A vaccine?
The hepatitis A vaccine is given as a two-dose series at least 6 months apart. The dose for individuals 18 years and younger is 0.5 mL IM and 1 mL IM for those 19 years and older.
107
Before administering a vaccine covered by the Vaccine Injury Compensation Program (VICP), the National Childhood Vaccine Injury Compensation Act requires vaccine providers to provide a vaccine information statement to all patients:
The National Vaccine Injury Compensation Program (VICP) was established under the National Childhood Vaccine Injury Act (NCVIA) in 1986. The VICP offers a no-fault approach to dealing with petitions related to injuries from certain vaccines. The vaccines that fall within VICP include most of the vaccines routinely recommended by ACIP. VICP applies to any individual of any age. One stipulation to this no-fault approach is that a current Vaccine Information Statement (VIS) must be given to the individual or caregiver prior to vaccination.
108
Among all states in the United States, which of the following is the youngest minimum patient age for vaccination by a pharmacist allowed by a state?
State laws and practice acts dictate the ages of individuals who may receive vaccines from pharmacists. As such, these vary by state. As of July 2016, 28 states permitted pharmacists to vaccinate individuals of any age. However, some of these states may require individual prescriptions or limit the type of vaccines that may be administered.
109
Which of the following influenza vaccines would be appropriate to recommend for a 7-month-old girl?
The Fluzone quadrivalent vaccine is approved for individuals ages 6 months and older. The Fluzone High-Dose IIV3 is approved for ages 65 years and older. There is also a Fluzone Intradermal vaccine, which is approved for 18 through 64 years of age. Flublock is the trivalent recombinant influenza vaccine (RIV3) which is approved for individuals 18 years of age and older. Fluad is the adjuvanted IIV3 approved for individuals ages 65 years and older.
110
Which of the following statements best describes the approach to take with patients regarding simultaneous administration of vaccines?
In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person’s immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines. Delaying vaccination and using alternative schedules increases the time during which children are susceptible to diseases. With more unprotected children, the chance of an outbreak spreading increases.
111
Which of the following is a method to motivate patients to be vaccinated?
If patients are hesitant to receive a vaccine due to a myth or misperception, simply telling them that they are wrong and that there is no credible data to support their belief is unlikely to change their minds and will likely damage the patient-provider relationship. Approach these patients with respect. Acknowledge and have compassion when addressing their concerns. Using scare tactics may only escalate their concerns and negatively impact the patient-provider relationship. If patients wish to search for information about vaccines, point them in the direction of credible resources and websites. While providing patients with vaccine information statements is an important way to convey the risks and benefits of vaccines (and it is legally required), it does not necessarily serve to motivate patients to receive vaccines.
112
Which of the following is the minimum needle length recommended for intramuscular administration of the influenza vaccine to an adult woman weighing 215 lbs?
When giving intramuscular injections to adults, the ACIP provides recommendations for needle length based on gender and weight. This is to help ensure the vaccine is injected into muscle tissue. Women who weigh more than 200 lbs and men who weigh more than 260 pounds should use a 1.5 inch needle. A 1 inch needle is used for men and women who weigh less than 152 lbs. Those with weights in between these parameters would use either a 1 or 1.5 inch needle. A 5/8 inch needle is used for subcutaneous injections. A ½ inch needle should never be used for vaccine administration.
113
Which of the following patients would be an appropriate candidate for adjuvanted influenza vaccine (aIIV3)?
The adjuvanted inactivated influenza vaccine, trivalent (aIIV3) is approved for individuals aged 65 years and older. Because it is an inactivated vaccine, it can be given to patients regardless of medical condition. In fact, someone who has diabetes is higher risk for influenza-related complications and should be vaccinated against influenza. An individual younger than 65 years would need to receive either the trivalent or quadrivalent unadjuvanted standard-dose influenza vaccine. Note that age indications vary depending on the type of vaccine used.
114
Which of the following best describes IIV intradermal administration?
Epinephrine is the first-line treatment of choice for acute anaphylaxis. Epinephrine is dosed on the basis of the patient’s body weight. Aqueous epinephrine (1 mg/mL preparation) should be administered at a dose of 0.01 mg/kg/dose, up to a maximum of 0.5 mg per dose. Note that 0.01 mg equals 0.01 mL. Some providers may use auto-injectors that contain fixed doses (i.e., 0.15 mg or 0.3 mg). These doses will vary depending on the age and weight of the patient.
115
Albert is a 61-year-old man who wants to receive the herpes zoster vaccine. He is up to date on his other immunizations and reports receiving his inactivated influenza vaccine two weeks ago. Which of the following would be the best recommendation to make regarding the herpes zoster vaccine for Albert?
The herpes zoster vaccine is a live vaccine and is recommended for those ages 60 and older. Inactivated vaccines do not interfere with the immune response to other vaccines, live or inactivated. There is no need to observe any minimum interval between doses of two different inactivated vaccines, nor between combinations of inactivated and live vaccines. The concern is when two live vaccines are not administered at the same clinic visit. If two live vaccines are not given simultaneously, at least 4 weeks must pass before giving the other live vaccine.
116
Which of the following best describes immunization coalitions?
Immunization coalitions are organizations that foster collaboration among stakeholders to increase immunization rates. They vary in size and structure and can include people who are dedicated to vaccination activities at local, state, national, and international levels.
117
Which of the following statements best describes recommendations for vaccine administration during pregnancy?
There are two vaccines recommended during pregnancy. Tdap should be given with each pregnancy in the beginning of the third trimester (27 to 36 weeks gestation). Influenza vaccine is recommended if the woman is pregnant during flu season. It can be given in any trimester. Live vaccines are a temporary contraindication during pregnancy. They should be administered after the woman gives birth. There is no risk to a pregnant woman who is in close contact with someone who received a live vaccine. There is also no risk if pregnant providers administer live vaccines.
118
When preparing to offer a vaccination service, which document should be up-to-date and readily available anytime vaccines are given?
As required by the OSHA Bloodborne Pathogens Standard, an employer must establish a written exposure control plan outlining how the employer intends to eliminate or minimize potential exposures to bloodborne pathogens. The exposure control plan must be reviewed and updated annually. It should be available anytime activities occur that involve exposure risk. In the event of an exposure incident, this plan will detail the steps to take.
119
Why are water bottles recommended to be placed in refrigerators in which vaccines are stored?
According to the CDC’s Vaccine Storage & Handling Toolkit, placing water bottles in refrigerator and freezer units can help stabilize the temperatures in the event of a power failure or upon frequent opening and closing of the units. These should be placed along the walls, in the door racks, and on the floor. These water bottles are not for consumption and should be labeled as such. While water bottles can be “conditioned” to be used during transport of vaccines, these water bottles must first be in a frozen state.
120
A patient who reports an allergy to eggs but is able to eat lightly cooked eggs (e.g., scrambled eggs) without a reaction could receive which of the following influenza vaccines?
Someone who is able to eat lightly cooked egg without a reaction is not likely to be allergic to eggs. Any recommended influenza vaccine can be administered. Furthermore, individuals with a history of egg allergy who have experienced only urticaria (hives) after exposure to egg should receive any recommended influenza vaccine. A person with a more severe reaction to egg can also receive any recommended influenza vaccine, but it should be administered by a health care provider who is trained and equipped to manage a severe allergic reaction.
121
Within a few minutes after receiving a vaccine, a patient reports not feeling well and would like a drink of water. Which of the following would be the most appropriate action to take?
If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Assess the patient’s symptoms and vital signs. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. Prepare your staff for a potential emergency situation. If the condition worsens and you suspect anaphylaxis, then you would prepare and administer epinephrine. A sugar-containing beverage would only be warranted if the patient was experiencing hypoglycemia.
122
Theresa is a 23-year-old woman with rheumatoid arthritis who is treated with immunosuppressive therapies. Which of the following vaccines should be avoided for Theresa?
As a general rule, live vaccines should be avoided in patients with altered immunocompetence. Varicella is a live vaccine and is contraindicated. Live attenuated vaccines must replicate in order for the body to produce an immune response. If given to a patient with a compromised immune system, there is a chance they could replicate in an uncontrolled fashion and cause disease. Herpes zoster vaccine may be given to patients with low-level immunosuppression and rotavirus vaccine can be given to immunocompromised children, unless they have severe combined immunodeficiency (SCID). Additionally, if the immune system is not working properly, an adequate immune response may not occur following vaccination. This is true for live and inactivated vaccines. Tdap, hepatitis B, and PPSV23 vaccines are inactivated and can be given to patients with compromised immune systems, however, they may be less effective than in those who are immunocompetent.
123
Which of the following is the routine schedule for vaccinating adolescents with MCV4?
Routine vaccination with the quadrivalent meningococcal conjugate vaccine (MenACWY or MCV4) is one dose at ages 11 to 12 years and a booster dose at age 16 years. A first-year college student aged 21 years or younger living in residential housing who has not been previously vaccinated with MCV4 is considered high-risk for meningococcal disease. One dose should be administered, but this is not the routine recommendation.
124
Which of these vaccines is an inactivated vaccine?
Diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (DTaP) is an inactivated vaccine. The varicella (VAR), rotavirus (RV5), and measles, mumps, and rubella (MMR) vaccines are all live vaccines.
125
Which of the following tetanus toxoid-containing vaccines would be most appropriate to recommend for Linda, a 67-year-old woman and grandmother of six with no record of receiving Tdap?
According the the ACIP recommendations, all adults who have not received tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) or for whom pertussis vaccination status is unknown should receive 1 dose of Tdap followed by a tetanus and diphtheria toxoids (Td) booster every 10 years. Tdap should be administered regardless of when a tetanus or diphtheria toxoid-containing vaccine was last received. DTaP contains higher amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years of age to avoid injection site reactions in adolescents and adults. Individuals 7 years of age and older who need protection against tetanus, diphtheria, and pertussis should receive Tdap, not DTaP.
