Immunizations

Question 1

A small community pharmacy just received a delivery of influenza vaccines. The pharmacy owner needs to instruct the staff on storage requirements. He should include the following information:

a. The refrigerator temp is recorded in a log once daily.
b. The temp log is kept for at least one year.
c. The stock should be rotated so that the oldest vaccines (earliest expiration dates) are in the front.
d. The temp log can only be maintained by a registered pharmacist or intern.
e. If administering vaccines, the temp log must be checked every day (including the days in which the pharmacy is closed).

Answer 1

e

Refrigerator and freezer temps must be recorded in a temp log twice each workday. The log should be kept for at least 3 years.

Question 2

A 64 y/o female is in the pharmacy on September 10 to pick up her meloxicam prescription. The pharmacist notices that she’s congested, with sneezing, and she mentions a sore throat. Upon questioning, she states that she hasn’t received her influenza vaccine yet this season. Which of the following is correct?

a. She should wait to receive the influenza vaccine when she’s no longer sick.
b. She shouldn’t receive the influenza vaccine today because of an interaction with her med.
c. She can receive the influenza vaccine since mild acute illness isn’t a contraindication.
d. She should wait to receive the influenza vaccine until after October 1 to avoid immunity waning before the end of the influenza season.
e. She will need to receive 2 doses of the influenza vaccine this year, one dose today and the second in 4 weeks.

Answer 2

c

Question 3

A 20 y/o female has no evidence of immunity to varicella and is being vaccinated to prevent chickenpox. Which screening question must be asked before administering Varivax?

a. Have you ever had a life-threatening allergic reaction to eggs?
b. Do you have a hx of smoking?
c. Have you ever had Guillan-Barre syndrome after the flu vaccine?
d. Are you taking more than 5 mg prednisone per day for at least the past 2 months?
e. Have you ever had a severe reaction to gelatin?

Answer 3

e

Question 4

The Shingrix vaccine is recommended for which of the following patients?

a. A 40 y/o adult with no medical conditions
b. A 52 y/o adult with HTN
c. A 12 month old child
d. A 10 y/o child
e. An 18 y/o adult living in a college dorm

Answer 4

b

Question 5

VR is 20 weeks pregnant with her 2nd child. She’s unsure what childhood vaccines she received and is certain that she’s not been vaccinated for anything in at least 15 years. Which vaccines are recommended for VR during her pregnancy?

a. FluMist (during flu season)
b. Tdap
c. MMR
d. Varivax
e. Afluria (during flu season)

Answer 5

b, e

Inactivated influenza vaccine is recommended during flu season for all stages of pregnancy. One dose of Tdap is recommended with every pregnancy, ideally between 27-36 weeks gestation. Live vaccines are contraindicated during pregnancy.

Question 6

Which of the following statements about the Shingrix vaccine is correct?

a. It’s administered subcutaneously in the fatty tissue above the triceps.
b. Antivirals (e.g., acyclovir) can interfere with vaccine response.
c. It should be administered even if the pt has a hx of shingles.
d. It prevents infections caused by the herpes simplex virus.
e. It should be injected into the gluteus muscle.

Answer 6

c

Question 7

HY is a 77 y/o female with diabetes, HF, and RA. She would like to get a flu vaccine while her prescriptions are filled. Which of the following formulations wouldn’t be appropriate for her?

a. Fluarix
b. Fluad
c. FluLaval
d. FluMist
e. Fluzone High-Dose

Answer 7

d

FluMist is indicated for healthy patients age 2-49 years.

Question 8

A 12 month old child was hospitalized two months ago and received immune globulin for Kawasaki disease. Which vaccines would be adversely affected by this tx if administered today?

a. Pneumococcal conjugate vaccine
b. Inactivated polio vaccine
c. Measles, mumps, and rubella vaccine
d. Influenza vaccine, inactivated
e. Varicella vaccine

Answer 8

c, e

Antibodies, found in some blood products and IVIG, can interfere with live vaccine replication.

Question 9

One dose of Prevnar 20 is recommended before age 65 years in patients with which of the following medical conditions?

a. Diabetes
b. Asthma
c. Smokes cigarettes
d. Heart failure
e. Depression

Answer 9

a, b, c, d

Age 19-64 y/o with a specific medical condition: PCV20 x 1 or PCV15 x 1 followed by PPSV23 >/= 12 months later (or >/= 8 weeks later if immunocompromised

Alcohol use disorder, cigarette smoking, diabetes, chronic heart/lung/liver disease, sickle cell/asplenia, HIV, malignancy, solid organ transplant, chronic renal failure, immunosuppressive drugs (chemo, long-term systemic steroids)

Question 10

A mother asks if her 11 month old son will receive thimerosal from vaccines. She’s concerned that this mercury-containing preservative might increase the risk of autism in her son. Select the correct statements.

a. Children whose parents don’t wish to vaccinate can choose to do so if they live in an urban (not rural) center where the child will likely be protected by “herd” immunity

b. While it’s true that thimerosal is contained in most childhood vaccines, it’s not linked to autism

c. The occurrence of vaccine-preventable diseases has declined in recent years; instruct the mother to avoid vaccines in her children

d. Thimerosal may be present in multi-dose influenza vaccines and can be avoided upon request

e. A link between vaccines and autism has been shown to be invalid; pharmacists should promote vaccination to reduce disease spread

Answer 10

d, e

Thimerosal is a preservative that contains a small amount of mercury and has been removed from most childhood vaccines

Question 11

Which of the following statements concerning the recombinant vaccine Flublok are correct?

a. Must be administered in a medical office for patients with severe reactions to eggs
b. Egg-free vaccine
c. Recommended for patients 6 months and older
d. Administered subcutaneously
e. Approved for use in patients 18 years and older

Answer 11

b, e

Question 12

Which of the following is not correct regarding vaccine storage?

a. Cholera vaccine must be stored in the fridge
b. MMR vaccine can be stored in the fridge
c. MMR vaccine can be stored in the freezer
d. Typhoid oral vaccine must be stored in the fridge
e. MMRV vaccine must be stored in the freezer

Answer 12

a

The oral cholera vaccine (Vaxchora) must be stored in the freezer prior to reconstitution with water

Question 13

Which of the following patients should receive the MenB vaccine?

a. A 6 y/o with sickle cell disease
b. A 19 y/o on a college campus during a meningitis serogroup B outbreak
c. A 25 y/o lab worker exposed to N. meningitidis
d. A 10 y/o with sickle cell disease
e. A 38 y/o person traveling to the meningitis belt of Sub-Saharan Africa

Answer 13

b, c, d

Indicated for age 10-25 years at high risk: asplenia/sickle cell disease, lab workers with N. meningitidis exposure, during an outbreak

Question 14

Which vaccine can cause a false-positive reaction to the Tuberculin Skin Test (TST)?

a. Varivax
b. Fluzone
c. Bacille Calmette-Guerin (BCG)
d. HPV
e. Menveo

Answer 14

c

Question 15

JB is a 71 y/o male who’s due for his tetanus vaccine. He lives in an apartment with his daughter, a 3 month old granddaughter, and a 2 y/o grandson. He doesn’t know if he ever received the pertussis vaccine. Which vaccine should JB receive?

a. Td
b. Tdap
c. TdP
d. Tetanus only
e. DTaP

Answer 15

b

As part of the routine childhood vaccine schedule, children receive 5 doses of DTaP. Children >/= 7 y/o, adolescents and adults receive Tdap. Although a Td boost is available, Tdap is recommended to protect against transmission of pertussis to children and infants at the highest risk of severe illness and death

Question 16

LM, a 28 y/o female, is starting her 1st job as a hospital pharmacist in September. She completed the hep B vaccine series during pharmacy school but states that she didn’t receive most childhood vaccines and can’t recall any other vaccines during adulthood. What vaccines should LM receive today?

a. Seasonal flu vaccine
b. Tdap
c. Varivax
d. RotaTeq
e. Hib vaccine

Answer 16

a, b, c

Healthcare professionals:
- Annual flu vaccine
- Hep b: If there’s no evidence of vaccine series completion or a blood test showing immunity
- Tdap: 1 dose, if not UTD, then Td or Tdap every 10 years
- Varicella: If there’s no history of vaccine or chickenpox
- MMR: If there’s no history of vaccine or blood test showing immunity

Question 17

Choose the correct statements concerning the HPV vaccine:

a. HPV vaccination is not recommended for patients age 9-26 years
b. 3 doses are required for a 24 y/o male with HIV receiving his 1st dose
c. 2 doses are required for a 12 y/o female receiving her 1st dose
d. 3 doses are required for a 16 y/o female receiving her 1st dose
e. HPV vaccination is only indicated in patients < 15 y/o who are sexually active

Answer 17

b, c, d

Question 18

What is the recommended age for the HPV vaccine?

Answer 18

11-12 y/o

Question 19

In which of the following patients if the MMR vaccine contraindicated?

a. A 23 y/o male with a “head cold” and a fever of 100.1 the previous evening
b. A 31 y/o female who is 31 weeks pregnant
c. A 51 y/o patient with HIV and a CD4 count of 292
d. A 27 y/o patient who’s currently on day 5 of 7 of an amoxicillin prescription for a tooth abscess
e. A 56 y/o female that lives with her elderly mother who takes MTX for rheumatoid arthritis

Answer 19

b

Question 20

Which tetanus-containing vaccine requires 5 doses to be given as a part of the routine childhood vaccine series?

a. DTaP
b. DT
c. Td
d. Tdap
e. VAQTA

Answer 20

a

Question 21

DV is a healthy 66 y/o female. Her PCP believes that she would benefit from receiving both Vaxneuvance and Pneumovax 23. How should the vaccines be sequenced?

a. Vaxneuvance today, Pneumovax 23 in 8 weeks
b. Vaxneuvance today, Pneumovax 23 in 5 years
c. Vaxneuvance today, Pneumovax 23 in 1 year
d. Pneumovax 23 today, Vaxneuvance in 8 weeks
e. Pneumovax 23 today, Vaxneuvance in 1 year

Answer 21

c

Question 22

During a routine well-visit, a pediatrician recommends the HPV vaccine for a 13 y/o. The mother isn’t sure if this vaccine is appropriate for her daughter. Which of the following statements should be included in the patient education?

a. It prevents cervical, vaginal, and oropharyngeal cancers, as well as genital warts
b. If the pt receives the vaccine today, only 2 doses are required
c. It should only be administered to males and females who are sexually active
d. It should only be administered to females >/= 15 years old
e. It should only be administered to males; females aren’t candidates for the vaccine

Answer 22

a, b

Indicated for both males and females

Question 23

A 67 y/o pt at your pharmacy has diabetes and heart disease. Which of the following vaccines is the pt eligible to receive today?

a. Prevnar 20
b. Hib
c. DTaP
d. HPV
e. Havrix

Answer 23

a

One dose of Prevnar 20 is recommended for all patients >/= 65 y/o

Question 24

Patients aged 19-64 years can receive Vaxneuvance by Pneumovax 23 at least eight weeks later if they have which of the following conditions?

a. HIV
b. Chronic renal failure on HD
c. Solid organ transplant
d. Heart failure
e. Multiple myeloma treated with chemo

Answer 24

a, b, c, e

Question 25

What does the “a” in DTaP stand for?

a. Acellular
b. Atypical
c. Antigen
d. Alkaline
e. Aspart

Answer 25

a

Acellular - pertussis component contains only a part of the pertussis organism

Uppercase letters - full strength does of diphtheria (D), tetanus (T), and pertussis (P) in the vaccine

Lowercase “d” and “p” - reduced doses of diphtheria and pertussis used in the adolescent/adult formulations

Question 26

Which of the following could interfere with the effectiveness of a dose of Varivax?

a. Acyclovir
b. Denavir
c. Valtrex
d. MMR given 2 weeks prior to Varivax
e. Oseltamivir

Answer 26

a, c, d

• Systemic antivirals with activity against herpes can inactivate the vaccine strain and shouldn’t be used within 24 hours before or 14 days after giving the vaccine
• If not administered simultaneously, live vaccines should be separated by 28 days (4 weeks) to avoid antibody interference
• Denavir is a topical medication

Question 27

Choose the correct statements regarding SC administration of vaccines.

a. Varivax, yellow fever, and MMR are administered subcutaneously
b. SC injections are administered into the fatty tissue over the triceps
c. FluMist, Fluzone, and Pediarix are administered subcutaneously
d. SC injections are administered at a 45-degree angle
e. SC injections are administered using a needle that’s 5/8 inch long

Answer 27

a, b, d, e

Question 28

Which vaccine is contraindicated in patients with a severe allergy to eggs or gelatin?

a. Rabies
b. Typhoid
c. Cholera
d. Yellow fever
e. Japanese encephalitis

Answer 28

d

Question 29

A community pharmacist who runs a vaccination clinic has run. out of Vaccine Information Statements (VIS) for one of the vaccines being administered today. The pharmacist can use which of the following websites to obtain a copy of the VIS to provide to patients?

a. The Pharmacist’s Letter
b. The Institute for Safe Medication Practices (ISMP)
c. The Immunization Action Coalition
d. The Centers for Disease Control and Prevention (CDC)
e. The World Health Organization (WHO)

Answer 29

c, d

Question 30

Which of the following vaccines can be given in the time interval as stated below?

a. MMR and yellow fever separated by 7 days
b. MMR and Rotarix separated by 14 days
c. Varivax and FluMist separated by 28 days
d. Cholera and MMRV separated by 10 days
e. ProQuad and FluMist separated by 14 days

Answer 30

c

Live vaccines should be administered on the same day or separated by at least 28 days (4 weeks). There isn’t a minimum time interval required between an inactivated and a live vaccine

Question 31

Exposure to which of the following commonly requires administration of immune globulin at the time of vaccination?

a. Pertussis
b. Cholera
c. Dengue
d. HPV
e. Rabies

Answer 31

e

Question 32

A patient is undergoing a pre-op evaluation for a splenectomy. Which vaccine is specifically indicated in a patient without a spleen?

a. Adacel
b. Menactra
c. Rotarix
d. Heplisav-B
e. Gardasil 9

Answer 32

b

Question 33

LB is a 45 y/o female with no significant PMH who’s at the pharmacy today to get her annual flu vaccine and specifically requests Flumist. LB asks the pharmacist about the outbreaks of measles and Hep A which have been on the local news in the past few months. LB admits she’s not been vaccinated against either of these diseases but asks the pharmacist if she can be vaccinated today. Can the pt receive all 3 vaccines (Flumist, measles, and Hep A) today?

a. Yes, and the measles and Hep A vaccines can be mixed in the same syringe
b. No, the measles vaccine must be administered on a different day
c. Yes, she can get all 3 vaccines today
d. She can get influenza today but needs to wait at least 2 weeks to receive the other vaccines
e. No, she’s not a candidate for any of these vaccines due to her age

Answer 33

c

Simultaneous administration is recommended whenever possible to increase immunization rates

If live injected vaccines and live intranasal flu vaccine are not administered at the same visit, they should be separated by at least 4 weeks.

Question 34

Which of the following statements are correct concerning the prevention of typhoid?

a. The oral form is a live vaccine and must be stored in the fridge
b. Typhoid is transmitted by mosquitos; attempt to reduce exposure
c. The typhoid vaccine is available as oral caps or an IM injection
d. A typhoid vaccine is needed for travelers to the US
e. Vaccination must be completed within 24 hours of travel to be effective

Answer 34

a, c

Vaccination should be completed at least 1-2 weeks before travel.

Question 35

A 62 y/o female pt came into the pharmacy to get a flu shot. It was her 1st time receiving the annual vaccine. 3 days later, she came back complaining of a hacking cough, mild weakness, stuffy nose, and a sore throat. She is afebrile and reports no muscle aches or pains. She states the shot gave her the flu. What’s the most likely reason for the pt’s illness?

a. She has a cold
b. She has a flu infection
c. She has mild illness due to the shot, but it’s not likely a flu infection
d. She was allergic to the flu vaccine
e. The vaccine was administered incorrectly

Answer 35

a

The flu shot is inactivated and can’t cause flu; it may cause a mild illness for a day or 2 afterward.

Question 36

A community pharmacist who runs a vaccination clinic wants to review current vaccine administration recommendations. What source is best to obtain the current vaccine recommendations and other essential immunization information?

a. CDC website
b. Koda Kimble
c. Orange Book
d. The package insert from the vaccine manufacturer
e. Index Nominum

Answer 36

a

Question 37

MP is a 29 y/o female who recently finished nursing school and is ready to start her new job. Her employer requires that she complete a TB screening. The TST was placed on Monday and read as negative by the Employee Health nurse on Wednesday. MP tells the nurse that she received the varicella vaccine last week since she didn’t have chickenpox as a child and is required to have documented immunity to varicella. What info should the Employee Health nurse communicate to MP?

a. Varivax should be given at least 4 weeks after the TST.
b. Since the TST was negative and she received Varivax, she’s cleared to work.
c. The TST will have to be repeated 4 weeks after the Varivax; live vaccines can cause false negative results.
d. MP should have received Shingrix instead of Varivax.
e. The TST can adversely affect the efficacy of the varicella vaccine; repeat Varivax in 4 weeks.

Answer 37

c

Live vaccines can be given on the same day as the TST or after the TST results are obtained (48-72 hours). If given before the TST, it’s recommended to wait 4 weeks after a live vaccine to administer the TST.

Question 38

Which of the following is an inactivated vaccine?

a. Cholera vaccine
b. Typhoid vaccine given intramuscularly
c. FluMist
d. RotaTeq
e. Yellow fever vaccine

Answer 38

b