Immunizations Exam

(T/F) Anaphylaxis generally will not occur until 1-2 hours after administration of a vaccine.

False

(T/F) If a patient has a history of contact dermatitis from neomycin, they cannot receive vaccines that contain neomycin.

False

(T/F) In general, increasing the interval between doses of a multi-dose vaccine diminishes the effectiveness of the vaccine.

False

(T/F) In general, the first dose of an inactivated vaccine usually provides protection.

False

(T/F) Per OSHA (Occupational Safety and Health Administration), bloodborne pathogens training must be completed every 2 years for immunizers.

False

(T/F) Polio is currently considered eradicated worldwide.

False

Why is the safety of vaccines held to a higher standard than for most medications?

They are administered to healthy people to prevent disease rather than to sick people to cure disease

(T/F) Boosters are usually not necessary for live attenuated vaccines.

True

(T/F) In general, giving two or more vaccines on the same day (simultaneous administration) of all recommended vaccines is appropriate.

True

(T/F) Live attenuated vaccines are contraindicated in patients who are pregnant.

True

(T/F) One of the Clinical Immunization Safety Assessment (CISA) project's main goal is to serve as a vaccine safety resource for consultation on clinical vaccine safety issues.

True

What is the threshold dose of prednisone at which a patient is considered immunosuppressed? a. 20 mg per day for 14 days or longer b. 20 mg per day for 5 days or longer c. 10 mg per day for 5 days or longer d. 20 mg per day for 3 months or longer e. 10 mg per day for 14 days or longer

a. 20 mg per day for 14 days or longer

Refrigerator and freezer temperature logs must be kept for a period of at least ______. a. 3 years b. 1 year c. 5 years d. 7 years

a. 3 years

Which of the following is a valid contraindication to vaccination? a. Anaphylaxis after a previous dose or vaccine component b. Minor acute illness c. Syncope after a previous vaccination d. Allergies to products not in vaccine

a. Anaphylaxis after a previous dose or vaccine component

What is the correct interval between two live vaccines? a. At least 4 weeks b. At least 4 day s c. No interval needed d. At least 4 months

a. At least 4 weeks

Which of the following skills is among the standards of practice among immunizing pharmacists? a. Basic life support (BLS) b. Emergency medical technician c. Advanced cardiac life support d. First aid training

a. Basic life support (BLS)

Which of the following is specifically listed as a VAERS reportable event for tetanus vaccine? a. Brachial neuritis b. Encephalopathy c. Thrombocytopenic purpura d. Chronic arthritis

a. Brachial neuritis

Classify the following combinations as a precaution or contraindication to vaccination. Anaphylaxis to a dose of vaccine and a subsequent dose of that vaccine a. Contraindication b. Precaution

a. Contraindication

Classify the following combinations as a precaution or contraindication to vaccination. History of intussusception and rotavirus vaccine a. Contraindication b. Precaution

a. Contraindication

Classify the following combinations as a precaution or contraindication to vaccination. Severe immunosuppression and live attenuated vaccines a. Contraindication b. Precaution

a. Contraindication

Which of the following statements is true? a. Employers must offer the hepatitis B vaccine series to immunizing employees free of charge b. Immunizers must finish the hepatitis B vaccine series prior to providing immunizations c. Employees do not have the right to decline hepatitis B vaccination

a. Employers must offer the hepatitis B vaccine series to immunizing employees free of charge

Which manifestation of anaphylaxis is epinephrine used to treat? a. Hypotension b. Arrhythmias c. Decreased oxygen saturation d. Hemorrhage

a. Hypotension

Which of the following is an advantage of immunization in nontraditional settings, such as a pharmacy? a. Increased access and convenience for the patient b. Higher cost of immunization to the patient c. Decreased public awareness regarding vaccinations d. Consolidated immunization records for the patient

a. Increased access and convenience for the patient

In general, which of the following is TRUE? a. Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine. b. Decreasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine.

a. Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine.

Which of the following is true in regards to student pharmacist immunization? a. Interns who provide immunizations must be current in CPR and blood borne pathogens training b. An intern can delegate administration of a vaccine to a technician c. Interns do not need to complete a certification course if the supervising pharmacist is certified d. None of the Above are true

a. Interns who provide immunizations must be current in CPR and blood borne pathogens training

Which of the following is true regarding the use of Haemophilus influenzae type b vaccine? a. Is a polysaccharide vaccine conjugated to a protein to improve immunogenicity in infants b. Is indicated in patients with COPD c. Is administered as a single dose to infants with a repeat dose prior to entering school

a. Is a polysaccharide vaccine conjugated to a protein to improve immunogenicity in infants

Match the potential adverse reaction to a vaccine with the category of reaction. Redness at Injection Site a. Local Adverse Reaction b. Systemic Adverse Reaction c. Allergic Reaction

a. Local Adverse Reaction

Match the potential adverse reaction to a vaccine with the category of reaction. Swelling at Injection Site a. Local Adverse Reaction b. Systemic Adverse Reaction c. Allergic Reaction

a. Local Adverse Reaction

Match the potential adverse reaction to a vaccine with the category of reaction. Pain at Injection Site a. Local Adverse Reaction b. Systemic Adverse Reaction c. Allergic Reaction

a. Local Adverse Reaction

Which of the following is/are true regarding live attenuated vaccines? a. More than one live attenuated vaccine can be given at the same visit b. Live attenuated vaccines generally have milder reactions versus inactivated vaccines c. They are stronger versions of the "wild" virus d. All of the above

a. More than one live attenuated vaccine can be given at the same visit

Which of the following describes a limitation of the quadrivalent meningococcal conjugate vaccine? a. No protection from serogroup B b. Associated with a high risk of Guillain-Barre syndrome c. Requires multiple doses to induce protection from infection d. Licensed only for use in young children up to 7 years

a. No protection from serogroup B

Which of the following can be done to prevent vaccine storage problems? a. Place containers of water labeled "do not drink" into refrigerator to stabilize temperatures b. Utilize a multi-outlet power strip to plug-in both the freezer and refrigerator c. Utilize extension cords to plug into an outlet that is rarely utilized d. Plug in both the refrigerator and freezer into one outlet

a. Place containers of water labeled "do not drink" into refrigerator to stabilize temperatures

Which process correctly describes cocooning against pertussis? a. Process of vaccinating close contacts including mother, father, siblings, grandparents, and out of home care providers b. Wrapping infant tightly in a blanket to act as a protective barrier c. Taking long naps with a newborn d. Infant vaccine series begins at 2 months and continues at 4, 6, 15-18 months, and a booster at 4-6 years

a. Process of vaccinating close contacts including mother, father, siblings, grandparents, and out of home care providers

Which of the following is a reporting system by the Institute of Safe Medication Practices (ISMP) to report vaccine administration errors? a. VERP b. Medwatch c. VAERS

a. VERP

Which of the following represents a true contraindication to measles vaccine? a. Vaccine candidate is pregnant b. History of thrombocytopenia c. Vaccine candidate's mother is pregnant d. Moderate or severe acute illness with or without fever

a. Vaccine candidate is pregnant

The Countermeasures Injury Compensation Program (CICP) a. Provides benefits to seriously injured individuals that resulted from using certain antivirals b. Reviews all of the adverse effects submitted through the VAERS program c. Reimburses pharmacies the cost of expired or unused vaccines d. Was established from the National Childhood Vaccine Injury Act

a. provides benefits to seriously injured individuals that resulted from using certain antivirals

Which of the following patients should receive one dose of pneumococcal conjugate vaccine (PCV20)? a. 40-year-old with hypertension b. 70-year-old with diabetes who received PPSV23 5 years earlier c. 12-year-old needing catch up for the 4th dose of the childhood PCV series d. 6-month-old receiving the 3rd dose of the childhood PCV series

b. 70-year-old with diabetes who received PPSV23 5 years earlier

Which of the following patients is the best candidate for hepatitis A vaccine? a. A 6-month-old female presenting to the pediatrician for the 6-month wellness exam b. A 15-month-old male also receiving a 3rd dose of hepatitis B vaccine c. A 25-year-old male college student preparing to study abroad in Canada d. A 45-year-old female daycare employee

b. A 15-month-old male also receiving a 3rd dose of hepatitis B vaccine

For which of the following patients should the influenza vaccine be delivered in a medical setting under supervision of a healthcare provider experienced in recognition and management of severe allergic reactions? a. A 44-year-old man that experienced hives after eating eggs b. A 30-year-old man with a history of wheezing and vomiting after eating eggs c. A 24-year-old woman with no comorbidities d. A 50-year-old woman with asthma

b. A 30-year-old man with a history of wheezing and vomiting after eating eggs

Which of the following is a CDC best practice in regards to vaccine storage and handling? a. Refrigerator and freezer temperatures only need to be monitored once daily even if the temperature-monitoring device does not have a maximum/minimum display b. A bio-safe glycol-based or buffered thermometer should be used to monitor the temperature of the refrigerator c. One pharmacy employee should be designated to be in charge of storage and handling in case of a temperature related emergency d. Refrigerated vaccines should be kept on the top shelf of the refrigerator

b. A bio-safe glycol-based or buffered thermometer should be used to monitor the temperature of the refrigerator

Which of the following is NOT a permanent contraindication to vaccination? a. Severe allergic reaction to a vaccine component or following a prior dose b. A condition which would compromise the ability of the vaccine to produce immunity or protection from infection c. For rotavirus vaccine, severe combined immunodeficiency or history of intussusception d. Encephalopathy not due to another identifiable cause occuring within 7 days of pertussis vaccination

b. A condition which would compromise the ability of the vaccine to produce immunity or protection from infection

Which of the following scenarios are healthcare professionals encouraged to use Vaccine Adverse Event Reporting System (VAERS) for reporting? a. Only adverse reactions that have not been previously reported b. Any clinical significant adverse event after vaccination c. Only serious, life-threatening adverse reactions d. Serious adverse reactions for which causation is firmly established

b. Any clinical significant adverse event after vaccination

Which of the following is a likely benefit of annual influenza immunization of school-aged children? a. Dramatically decreases the high rates of mortality of influenza in this population b. Decreases the magnitudes of influenza epidemics in the community c. Causes school absenteeism around immunization time that will be offset by the decrease in absenteeism during peak influenza season d. Changes resistance patterns in influenza viruses

b. Decreases the magnitudes of influenza epidemics in the community

Which combination of vaccines can be administered at the same visit? a. Prevnar 13 and Menactra b. Fluzone and Shingrix c. Varivax and smallpox d. Prevnar 13 and Pneumovax 23

b. Fluzone and Shingrix

Which of the following is a contraindication to receipt of the rotavirus vaccine? a. History of anaphylaxis to eggs b. History of intussusception c. History of Guillian-Barre Syndrome d. Receipt of another live attenuated vaccine on the same day

b. History of intussusception

Which of the following antibody classes is the mediator of allergy and anaphylaxis? a. IgG b. IgE c. IgA d. IgM

b. IgE

Refrigerator and freezer temperature(s): a. Logs should be posted near the pharmacist work station b. Must be maintained between +35 and +46 F and -58 and +5 F respectively c. Logs must be kept on hand for 7 years d. Must be checked three times daily

b. Must be maintained between +35 and +46 F and -58 and +5 F respectively

Which of the following is an advantage of passive immunity compared to active immunity? a. Passive immunity is long-lasting b. Passive immunity protects almost immediately c. Passive immunity develops in response to infection or after giving a vaccine or toxoid d. Passive immunity does not interfere with the development immune responses from live vaccines

b. Passive immunity protects almost immediately

Classify the following combinations as a precaution or contraindication to vaccination. Family history of seizures and MMRV vaccine a. Contraindication b. Precaution

b. Precaution

Classify the following combinations as a precaution or contraindication to vaccination. Moderate acute illness without fever and any vaccine a. Contraindication b. Precaution

b. Precaution

Which of the following describes the Vaccine Injury Compensation Program? a. Covers all licensed vaccines b. Protects the immunization provider and vaccine manufacturer from personal liability c. Absolves the immunization provider from personal negligence d. Requires that the injured party prove negligence

b. Protects the immunization provider and vaccine manufacturer from personal liability

Which of the following describe appropriate storage conditions for inactivated vaccines? a. Are stored at room temperature b. Should be stored in the center of the refrigerator c. Are not affected by storage temperature d. Should be stored in the freezer

b. Should be stored in the center of the refrigerator

Match the potential adverse reaction to a vaccine with the category of reaction. Fever a. Local Adverse Reaction b. Systemic Adverse Reaction c. Allergic Reaction

b. Systemic Adverse Reaction

Match the potential adverse reaction to a vaccine with the category of reaction. Headache a. Local Adverse Reaction b. Systemic Adverse Reaction c. Allergic Reaction

b. Systemic Adverse Reaction

Which of the following patients is a candidate for varicella vaccine? a. 6-month-old who needs IIV4 simultaneously and again in 28 days b. 12-month-old who received MMR two weeks ago c. 5-year-old who received DTaP four weeks ago d. 37-year-old pregnant female

c. 5-year-old who received DTaP four weeks ago

For which of the following patients is the human papillomavirus vaccine series indicated? a. A 65-year-old female who has a sister with cervical cancer b. A 50-year-old male with a history of genital warts c. A 16-year-old female who recently became sexually active d. A 5-year-old female who presents for a well child visit prior to entering school

c. A 16-year-old female who recently became sexually active

For which of the following individuals is inactivated influenza vaccine (IIV) NOT recommended? a. A 62-year-old female who sneezes when in contact with feathers b. A 28-year-old female who is in her first trimester of pregnancy c. A 2-month-old healthy infant d. A 68-year-old male who received a heart transplant 6 years ago

c. A 2-month-old healthy infant

For which of the following patients should the influenza vaccine be delivered in a medical setting under supervision of a healthcare provider experienced in recognition and management of severe allergic conditions? a. A 44-year old man that experienced hives after eating eggs b. A 24-year old woman with no comorbidities c. A 30-year old man with a history of wheezing and vomiting after eating eggs d. A 50-year old woman with asthma

c. A 30-year old man with a history of wheezing and vomiting after eating eggs

For which of the following individuals would it be acceptable to use live attenuated influenza vaccine? a. A 13-year-old girl with asthma b. A 19-month-old healthy child c. A 48-year-old healthy mechanical engineer whose spouse has type 2 diabetes d. A 50-year-old construction worker with type 2 diabetes

c. A 48-year-old healthy mechanical engineer whose spouse has type 2 diabetes

Which of the following is an example of passive immunity? a. Infection with natural disease b. Administration of a life attenuated viral vaccine c. Administration of high titer immune globulin d. Administration of a recombinant immunogenic protein

c. Administration of high titer immune globulin

Match the potential adverse reaction to a vaccine with the category of reaction. Anaphylaxis a. Local Adverse Reaction b. Systemic Adverse Reaction c. Allergic Reaction

c. Allergic Reaction

For how long after completing chemotherapy or radiation must a person wait before receiving a live vaccine? a. No waiting period needed b. At least 4 weeks c. At least 3 months d. At least 6 months

c. At least 3 months

Which of the following is the appropriate schedule for polio immunization in the United States? a. Childhood immunization series with IPV at 2, 4, 6-18 months of age d. Childhood immunization series with IPV at 2, 4, 6-18 months, and 4-6 years of age with a booster dose every 10 years c. Childhood immunization series with IPV at 2, 4, 6-18 months, and 4-6 years of age d. Not used anymore because disease is almost eradicated

c. Childhood immunization series with IPV at 2, 4, 6-18 months, and 4-6 years of age

Which of the following antibody classes is the mediator of allergy and anaphylaxis? a. IgG b. IgM c. IgE d. IgA

c. IgE

Which of the following is the appropriate timing for influenza vaccine administration? a. Influenza vaccine should be administered as soon as the clinician has a vaccine supply but should stop no later than October 31 b. Live attenuated influenza vaccine (LAIV) can be administered as early as August, but inactivated influenza vaccine (IIV) should not be administered earlier than October 15 c. Influenza vaccine should be administered no sooner than September or October and should continue throughout the season d. Influenza vaccine should be administered only from October 15 until December 31

c. Influenza vaccine should be administered no sooner than September or October and should continue throughout the season

Which of the following vaccines is contraindicated for a pregnant woman? a. 20-valent pneumococcal conjugate vaccine (PCV20) b. Tetanus, diphtheria, pertussis vaccine (Tdap) c. Live attenuated influenza vaccine (LAIV) d. Inactivated Influenza Vaccine (IIV)

c. Live attenuated influenza vaccine (LAIV)

Which of the following is an appropriate response to a patient who tells you that she is concerned that she will get influenza from the inactivated influenza vaccine (IIV)? a. The influenza vaccine will not cause influenza if the circulating strain matches those contained in the current vaccine b. Injectable influenza vaccine rarely causes influenza in those who receive the vaccine, but the illness is very mild c. Other than a higher incidence of sore arm, influenza vaccine has a side effect profile similar to placebo d. Although the injectable influenza vaccine is a live attenuated viral vaccine, it has never been known to cause influenza in a vaccinated individual

c. Other than a higher incidence of sore arm, influenza vaccine has a side effect profile similar to placebo

Which of the following describes the role of helper T cells in mounting an immune response to a vaccine? a. Produces large amounts of antigen specific antibodies b. Present antigen to antibodies c. Produces cytokines that stimulate B cells to produce antibodies d. Directly kills infected cells

c. Produces cytokines that stimulate B cells to produce antibodies

Pharmacists are an integral part of increasing vaccination rates in the community. Which of the following would be the LEAST effective strategy for a pharmacist to employ? a. Provide a strong recommendation to receive an eligible vaccine b. Encourage all pharmacy staff to be up to date on immunizations c. Recommend that a patient return for a vaccine at a later time when it is less busy d. Call the patient to remind them of immunizations that are due

c. Recommend that a patient return for a vaccine at a later time when it is less busy

How should you proceed if vaccine arrives from the manufacturer under questionable conditions? a. Store the vaccine as recommended separately from other stock and call the Centers for Disease Control and Prevention for advice b. Repack the vaccine and return it to the manufacturer c. Store the vaccine as recommended separately from other stock, label with "Do Not Use", and call the manufacturer's quality control office for advice d. Place the vaccine in stock and use it first

c. Store the vaccine as recommended separately from other stock, label with "Do Not Use", and call the manufacturer's quality control office for advice

Which of the following is true regarding best practices for vaccine preparation? a. Manufacturer-filled syringes may be used for 48 hours once the sterile seal is broken b. Multi-dose vials may be used for 7 days once opened c. Syringes other than those filled by the manufacturer should be administered immediately d. For large influenza clinics, it is good practice to draw up large quantities (15 doses) at one time

c. Syringes other than those filled by the manufacturer should be administered immediately

Which of the following describes a difference between Tdap and DTaP? a. DTaP is used in children and adults for primary series b. Tdap should be used for all three doses of the primary tetanus-diphtheria series for adults c. Tdap has a lower dose of diphtheria toxoid for use in individuals aged 10-11 years and older d. DTaP has a lower dose of diphtheria toxoid for use in individuals less than 7 years

c. Tdap has a lower dose of diphtheria toxoid for use in individuals aged 10-11 years and older

Which of the following is true regarding the timing of immunization? a. Vaccinate premature infants based on gestational age rather than chronological age b. Vaccinate cancer patients immediately upon completion of chemotherapy or radiation c. Vaccinate two weeks before elective splenectomy or after acute recovery from splenectomy d. Vaccinate organ transplant patients three months after transplanta

c. Vaccinate two weeks before elective splenectomy or after acute recovery from splenectomy

Which of the following vaccines must be stored in the freezer? a. Pneumococcal Polysaccharide Vaccine b. Recombinant Zoster Vaccine c. Varicella Vaccine d. Human papillomavirus vaccine

c. Varicella Vaccine

For which of the following individuals is a mumps vaccine recommended? a. A 65-year-old who is healthy and has no record of every receiving a dose of MMR b. A 12-year-old who received a single dose of MMR at age 12 months and has been taking prednisone 40 mg daily for the past month for inflammatory bowel disease c. A 26-year-old female who received a single dose of MMR at age 12 months and is pregnant d. A 22-year-old female who received a single dose of MMR and just accepted a position as a nurse on a general surgery unit

d. A 22-year-old female who received a single dose of MMR and just accepted a position as a nurse on a general surgery unit

Which of the following individuals has a risk factor for poor response to the hepatitis B vaccine series? a. A newborn infant who is apparently healthy d. A 16-year-old female with asthma c. A 21-year-old paramedic d. A 66-year-old male who is waiting for a cadaveric kidney transplant

d. A 66-year-old male who is waiting for a cadaveric kidney transplant

The liquid diluent for recombinant zoster vaccine (RZV) is _____. a. Distilled water b. Should be stored in the freezer c. 0.9% sodium chloride d. AS01B adjuvant suspension

d. AS01B adjuvant suspension

Which of the following is a contraindication to receipt of routine vaccines? a. Patient is taking an antibiotic b. Allergy to penicillin c. Patient is breastfeeding d. Anaphylaxis to a previous dose

d. Anaphylaxis to a previous dose

How should the disposal of sharps containers be handled? a. Dispose routinely with the regular garbage pickup b. They are of little concern because of the puncture-proof nature of the containers c. Done when the container is full to the top d. Arranged with the local waste management company

d. Arranged with the local waste management company

Which of the following influenza vaccines is produced using no eggs and no influenza virus? a. Flumist (LAIV4) b. Afluria (IIV4) c. Fluzone High-Dose (HD-IIV4) d. Flublok (RIV4)

d. Flublok (RIV4)

Which of the following describes the benefits of using standing orders for immunization? a. Makes immunization less costly b. Is generally perceived as substandard practice by immunization policy making bodies c. Limits liability of all healthcare providers d. Increases immunization coverage among adults in a variety of practice settings

d. Increases immunization coverage among adults in a variety of practice settings

All women should optimally receive one dose of Tdap when? a. Optimally between 27 and 36 weeks gestation of their first child b. After the birth of their first child c. Pregnant women should not receive the vaccine d. Optimally between 27 and 36 weeks gestation of each pregnancy

d. Optimally between 27 and 36 weeks gestation of each pregnancy

Which of the following methods describes how vaccines are covered under Medicare Part D? a. As a medical benefit b. Provider must submit a bill plus invoice documenting vaccine cost for reimbursement c. With a universal copay of $10 for every patient enrolled d. Reimbursement based on negotiated amount based on vaccine, dispensing fee, sales tax, and vaccine administration fee

d. Reimbursement based on negotiated amount based on vaccine, dispensing fee, sales tax, and vaccine administration fee

Which of the following is a contraindication to receiving live vaccines? a. Allergy to penicillin b. Diabetes c. Chronic Liver disease d. Taking prednisone 40mg by mouth daily for 21 days

d. Taking prednisone 40mg by mouth daily for 21 days

Which of the following is the reason that a second dose of measles vaccine is recommended for all college students? a. Vaccine-induced immunity wanes over ten years and reimmunization provides a boost b. Most children received a killed vaccine for their first dose c. The measles vaccine used a decade ago was much less effective than the current formulation d. The second dose provides another opportunity for seroconversion for those who failed to respond to the first dose

d. The second dose provides another opportunity for seroconversion for those who failed to respond to the first dose

Which of the following is specifically listed as a VAERS reportable event for measles vaccine? a. Brachial neuritis b. Chronic arthritis c. Leukopenia d. Thrombocytopenic purpura

d. Thrombocytopenic purpura

Which of the following patients is a candidate for recombinant zoster vaccine (RZV)? a. A 48-year-old male recently diagnosed with cancer who will start chemotherapy in two weeks b. A 62-year-old female with autoimmune hepatitis controlled with prednisone 30 mg daily c. A 68-year-old male with COPD treated with inhaled fluticasone/salmeterol d. A 78-year-old female receiving anti-rejection drugs for a kidney transplant two years ago e. All of the Above

e. All of the Above