APhA Immunization Home Study

The National Childhood Vaccine Injury Act of 1986 established national vaccine documentation requirements which include: a) Documentation of informed consent. b) The patient/caregiver must be given a Vaccine Information Statement (VIS) for only the first dose in a series. c) Edition date of the Vaccine Information Statement (VIS) d) Site of injection.

c) Edition date of the Vaccine Information Statement (VIS)

Which of the following is the reason for the most recent hepatitis A outbreaks? a) Person-to-person transmission b) Imported food c) domestic food d) International travelers

a) Person-to-person transmission Since these outbreaks were first identified in 2016, 37 states have reported cases. As of October 15, 2021, there have been 42,683 cases and nearly 400 deaths resulting from these person-to-person transmission outbreaks.

Which vaccination is NOT part of a combined antigen vaccine? a) Rotavirus b) Haemophilus influenzae c) Polio d) DTaP

a) Rotavirus DTaP, Hep B, IPV, Hib, MenCY, MMR, Varicella are all part of various combined antigen vaccines. Rotavirus is not a component of any of these vaccines because it is orally administered.

Which of the following is one of the five guidelines identified by the APhA Board of Trustees in 2019 to assist pharmacists in incorporating immunization activities into their practice?

Prevention

Which of the following statements would be appropriate for a pharmacy technician to make? a) "We are now offering herpes zoster vaccines in the pharmacy." b) "After reviewing your records, I think you should receive the hepatitis B vaccine." c) "Because you are high risk, you should receive the pneumococcal vaccine." d) "You should receive the influenza vaccine."

a) "We are now offering herpes zoster vaccines in the pharmacy." Pharmacy technicians can make patients aware of vaccines that are available in the pharmacy, but only a pharmacist should recommend a vaccine to a patient.

What is the recommended timing for Tdap during pregnancy? a) 27-36 weeks b) before pregnancy c) 13-26 weeks d) 1-12 weeks

a) 27-36 weeks

Health literacy is considered a part of which domain of social determinants of health? a) Health care access b) Economic stability c) Social and community context d) Neighborhood and built environment

a) Health care access Health literacy is a component of the education and health care access domains of SDOH.

A potential advantage of accommodating walk-in vaccines, compared with only scheduling appointments, is that: a) It may allow greater flexibility and convenience for the patient.. c) It helps the patient receive multi-dose series vaccines according to the recommended schedule. d) It allows the pharmacy to ensure that enough vaccine is on hand.

a) It may allow greater flexibility and convenience for the patient. Because patients do not need to plan ahead and arrive at the pharmacy to receive a vaccine at a specific time, it may be more convenient for patients.

Which disease state(s) can potentially lead to meningitis? a) Polio and Haemophilus influenzae b) Rotavirus and Polio c) Polio c) Haemophilus influenzae

a) Polio and Haemophilus influenzae Before a vaccine was available in the 1980s, Haemophilus influenzae was the leading cause of bacterial meningitis in children younger than 5 years. Nonparalytic aseptic meningitis occurs in 1% to 5% of polio infections in children. Although Rotavirus can cause fluid loss that leads to dehydration, electrolyte imbalances, and even death, there is no connection to meningitis.

The Vaccine for Children (VFC) program pays for which of the following? a) The vaccine b) The vaccine administration supplies c) The refrigerator needed to store the vaccine d) The administration fee

a) The vaccine The Vaccine for Children (VFC) program pays for vaccines.

Which of the following vaccines is used as a booster every 10 years? a) DT b) Td c) DTaP-IPV d) DTaP

b) Td A tetanus-containing vaccine should then be used every ten years as a booster, and Tdap could be substituted for each of those boosters.

Children less than what age do not mount an adequate immune response to T-cell independent immunity? a) 5 years b) 11 years c) 2 years d) 18 years

c) 2 years

Which of the following awareness campaigns is typically conducted in December? a) National Immunization Awareness Month b) World Pneumonia Day c) National Influenza Vaccination Week d) American Pharmacists Month

c) National Influenza Vaccination Week The National Influenza Vaccination Week typically takes place in December.

Which of the following is found in vaccines to evoke an immune response? a) antigens b) antibodies c) macrophages d) B cells

a) antigens

Which of the following is a clinical feature of hepatitis B but not hepatitis A? a) chronic infection b) jaundice c) fulminant hepatitis d) dark urine

a) chronic infection Hepatitis A has not been shown to cause chronic infection as is the case with other viral hepatitis infections.

A young adult presenting with swelling of the parotid glands most likely has which of the following diseases: a) mumps b) measles c) rubella d) congenital rubella

a) mumps Symptoms only consistent with mumps.

Although the primary series for Hib varies between 2-3 doses, all vaccines are recommended to have a booster dose at age: a) A booster is not recommended b) 12-15 months c) 2 years d) 4-6 years

b) 12-15 months The primary series for Hib is at 2 and 4 months, with a dose at 6 months, depending on the brand. With all Hib vaccines, a booster dose is recommended at 12-15 months of age.

DTaP is recommended to be administered using which of the following schedules? a) 7-10 years b) 2, 4, 6, 12-15 months, 4-6 years c) 2, 4, 12-15 months d) 11-12 years

b) 2, 4, 6, 12-15 months, 4-6 years DTaP is indicated for persons less than 7 years old. It is routinely recommended as a three-dose series at 2 months, 4 months, 6 months, followed by boosters at 15-18 months and 4-6 years.

Based on the adult immunization schedule, at what age is the live attenuated influenza vaccine (LAIV) no longer recommended? a) 65 years b) 50 years c) 27 years d) 19years

b) 50 years The yellow bar for LAIV stops at age 50. LAIV is not recommended at ages 50 years or older. Patients in this age group will need to receive the inactivated influenza vaccine.

What percentage of HPV infections are cleared by the body and do not develop to CIN2 or CIN3? a) 38% b) 70% c) 54% d) 92%

b) 70% Although the incidence of HPV infection is high, with most sexually active adults having an HPV infection at some point in their lives, about 70% of infections, however, resolve spontaneously in a year or two. Most HPV infections are asymptomatic and result in no clinical disease.

Which COVID-19 vaccination has 2 doses administered 28 days apart? a) Janssen b) Moderna c) Pfizer-BioNTech d) Pfizer-BioNTech (Comimaty)

b) Moderna Moderna is 2 doses administered 28 days apart. Pfizer-BioNTech and Pfizer-BioNTech (Comirnaty) are 2 doses administered 21 days apart. Janssen is 1 dose.

Which of the following over-the-counter medications may be recommended to treat systemic reactions after vaccination? a) Diphenhydramine and guaifenesin b) NSAIDs and acetaminophen c) Dextromethorphan and cetirizine d) Loperamide and bismuth subsalicylate

b) NSAIDs and acetaminophen NSAIDs and acetaminophen may be used to treat fever and pain, which may occur as systemic reactions to vaccines.

Which of the following is an example of passive immunity? a) contracting measles b) maternal antibodies c) Hepatitis B vaccine d) skin barrier

b) maternal antibodies

Which of the following organizations provides standing order templates? a) Infectious Diseases Society of America b) Public Health Institute c) National Institutes of Health d) Immunization Action Coalition

d) Immunization Action Coalition Immunization Action Coalition provides standing order templates on its website.

Which if the following is true regarding transmission of SARS-CoV-2? a) Incubation period is 14 days (range 7-14 days) b) Is not transmitted through contaminated surfaces or objects c)It is only spread through respiratory droplets d) Infected individuals who may be presymptomatic, asymptomatic, or symptomatic can transmit the virus.

d) Infected individuals who may be presymptomatic, asymptomatic, or symptomatic can transmit the virus. Infected individuals who may be presymptomatic, asymptomatic, or symptomatic can transmit the virus. The risk of transmission from fomites (contaminated surfaces) is low, but may be more likely when there is high prevalence of infection in the community, higher amounts of virus are expelled (particularly when not wearing masks), and poor ventilation allowing particles to deposit on surfaces. May also be transmitted via aerosolized droplets Incubation period is 5 days (range 2-7days)

Post-vaccination counseling for patients should include: a) Warnings to self-isolate for 48 hours so that the vaccine does not spread disease to others b) A discussion of the risks and benefits of the vaccine c) A review of all steps in the shared decision-making process d) Information about adverse reactions that require contact with the health care system

d) Information about adverse reactions that require contact with the health care system Post-vaccination counseling should include information about adverse events they may experience and when to call the pharmacy or 9-1-1

Vaccine hesitancy is defined as: a) Lack of confidence in the reliability and competence of the health system. b) A lack of trust in the safety and effectiveness of vaccines. c) The perception that the risk of a disease is low and that vaccines are not necessary. d) The delay in acceptance or refusal of a vaccination despite the availability of vaccination services.

d) The delay in acceptance or refusal of a vaccination despite the availability of vaccination services. Vaccine hesitancy is defined as the delay in acceptance or refusal of a vaccination despite the availability of vaccination services.

Which of the following diseases have been eradicated worldwide, allowing vaccination to be discontinued?

Smallpox

Under the direction of the U.S. Department of Health and Human Services, the Healthy People initiative has identified the following as a goal for 2030:

Increase the proportion of persons who are vaccinated annually against seasonal influenza

Which of the following is considered a print marketing strategy? a) Flyers and brochures b) Voice response system messages c) Radio announcements d) Social media advertising

a) Flyers and brochures Flyers and brochures are printed materials that are used for marketing.

Which of the following vaccines contains a synthetic adjuvant? a) Heplisav b) Recombivax c) Engerix d) Havrix

a) Heplisav The newest vaccine is Heplisav-B. It contains a novel, synthetic adjuvant

Which of the following is NOT a benefit of a reminder and recall system? a) Incentivizes patients to make a primary care appointment. b) Helps improve immunization rates c) Provides continuity of care d) Complies with ACIP recommendations

a) Incentivizes patients to make a primary care appointment. Encouraging patients to return to you to receive a recommended vaccine has several advantages, including that it • Helps improve immunization rates • Maintains consistent and accurate immunization records • Provides continuity of care • Keeps patients healthy • Sustains your immunization delivery service • Complies with ACIP recommendations

According to the Affordable Care Act, which of the following must be covered without cost-share to the patient? a) An ACIP recommended travel vaccine b) An ACIP routinely recommended vaccine. c) A vaccine from an Out of Network provider. d) A vaccine using Medicare Part D.

b) An ACIP routinely recommended vaccine. There is no cost-share for patients for routinely recommended vaccines

Which of the following activities should only be performed by a pharmacist? a) Document the vaccine in the pharmacy's electronic record. b) Decide whether a patient needs a vaccine. c) Gather information about a patient's vaccination history. d) Communicate information about the vaccination to the patient's primary care provider.

b) Decide whether a patient needs a vaccine. The determination whether a patient should receive a vaccine is a clinical judgement and should only be made by a pharmacist.

Which of the following is a government-run volunteer organization for medical and public health professionals? a) Peace Corps b) Medical Reserve Corps c) National Guard d) Immunization Action Coalition

b) Medical Reserve Corps The Medical Reserve Corps is a government-run volunteer organization for medical and public health professionals.

Which of the following is a non-governmental organization that participates in disaster relief efforts? a) Public Health Department b) Red Cross c) Medical Reserve Corps d) World Health Organization

b) Red Cross The Red Cross is a non-governmental organization; the Medical Reserve Corps, public health departments, and the World Health Organizations are government-run.

Which of the following is the most common type of tetanus? a) neonatal b) generalized c) cephalic d) local

b) generalized The most common type (more than 80% of reported cases) is generalized tetanus.

If an 11 year old child never got the hepatitis B vaccine series, what is the minimum amount of time that must occur between dose 1 and dose 3 when getting this child caught up? a) 6 months b) 8 weeks c) 16 weeks d) 4 weeks

c) 16 weeks Dose #3 must be at least 8 weeks after dose #2 and 16 weeks after dose #1.

Which of the following individuals are contraindicated from receiving the MMR vaccine? a) 30-year-old with asplenia b) 75-year-old with COPD c) 23-year-old in her 3rd trimester d) 50-year-old with a low platelet count

c) 23-year-old in her 3rd trimester Pregnancy is contraindication to live vaccines. The other patients are not immunocompromised or pregnant.

Generalized urticaria following a vaccine is considered: a) A localized reaction b) Unrelated to vaccine administration c) An allergic reaction d) A reactogenicity symptom

c) An allergic reaction Local or generalized urticaria is an allergic reaction that may occur following vaccination.

The community pharmacist, while filling discharge orders from the hospital, recognizes a patient's need for receiving the pneumococcal vaccine during a transition of care to a personal care home. This is an example of what part of the patient care process? a) Access b) Follow-Up, Monitor, and Evaluate c) Assess d) Implement

c) Assess The patient was screened using the data collected during their recent hospitalization. This occurrence-based screening was triggered from the recent hospitalization. The next step in the Patient Care Process is to create a plan and then implement it.

IISs have been shown to increase immunization rates and reduce vaccine-preventable diseases by: a) All states reporting into the same vaccination registry. b) Requiring all vaccines for pediatric, adolescent, and adults be entered. c) Assisting in vaccination status assessment. d) Tracking vaccine adverse events.

c) Assisting in vaccination status assessment. Benefits include: • Facilitating timely interventions, • Assisting in vaccination status assessment • Guiding the response to outbreaks • Identifying coverage gaps • Facilitating vaccine management and accountability The Vaccine Adverse Event Reporting System (VAERS) is the website for tracking adverse reactions to vaccines. The IISs registry is not the location for this. Each state may have their own information system/registry. There is not currently a universal system. Pediatric reporting was the original reason for registries and most/ if not all states require this; however, some are now more consistently reporting adolescent and adults- this varies by health care practice and state.

For which of the following conditions are both PCV13 and PPSV23 recommended? a) chronic liver disease b) alcoholism c) asplenia d) diabetes

c) asplenia Both PCV13 and PPSV23 are recommended for patients with immunocompromising conditions. This includes asplenia. Those with diabetes, chronic liver disease, or alcoholism are not considered immunocompromised and are only recommended to receive PPSV23

How long does it take for the immune system to provide protection by producing disease-specific antibodies and memory cells? a) 21 days b) 7 days c) 5 days d) 14 days

d) 14 days

Which of the following best describes a standing order? a) An order from the state board of pharmacy allowing pharmacists to administer vaccines. b) The order of steps that must be followed when administering a vaccine. c) A directive from a third-party payer indicating that pharmacists can be reimbursed for administering vaccines. d) A preapproved document signed by a collaborating physician who authorizes the pharmacist to administer a vaccine.

d) A preapproved document signed by a collaborating physician who authorizes the pharmacist to administer a vaccine. A standing order is a pre-approved document signed by a collaborating physician who authorizes the pharmacist to administer a vaccine.

Which of the following vaccines would be best delivered in a mass vaccination clinic? a) Herpes zoster vaccine b) Meningitis vaccines c) Tetanus/diphtheria/pertussis vaccine d) Influenza vaccine

d) Influenza vaccine Influenza is a seasonal vaccine that has a high patient demand during a specific window of time. Scheduling an influenza vaccination clinic during this window would help increase access.

Which of the following is true regarding the recombinant herpes zoster vaccination? a) It should not be given to someone who previously received the zoster vaccine live. b) It cannot be given to someone who has had the varicella vaccine. c) It is approved as a treatment of herpes zoster if administered within 48 hours of onset of symptoms. d) It is indicated for prevention of herpes zoster and its complications in patients ≥50 years of age.

d) It is indicated for prevention of herpes zoster and its complications in patients ≥50 years of age. Recombinant zoster vaccine is not approved as a treatment, only as prevention. It can be given irrespective of prior receipt of the varicella vaccine. People who previously received ZVL could additionally receive the two doses of RZV, as well as persons who may have received a varicella vaccine.

Which of the following vaccines is contraindicated for an adult patient with HIV and a CD4 count <200 mm2? a) Inactivated influenza vaccine (IIV) b) Recombinant zoster vaccine (RZV) c) Human papillomavirus vaccine (HPV) d) Measles, mumps, rubella (MMR)

d) Measles, mumps, rubella (MMR) MMR is a live vaccine and contraindicated in someone who is severely immunocompromised, which includes having HIV with a CV4 count less than 200 mm2. This is indicated by the red bars. IIV, RZV, and HPV are not in red for this column.

Which of the following is TRUE for the 23-valent pneumococcal polysaccharide vaccine (PPSV23)? a) PPSV23 relies on T-cell to mount an immune response b) PPSV23 is a live vaccine c) PPSV23 is routinely recommended for all children d) PPSV23 should not be given to children less than 2 years of age

d) PPSV23 should not be given to children less than 2 years of age PPSV23 is an inactivated polysaccharide vaccine and is T-cell independent. Therefore, it does not mount a sufficient immune response in young children. We do not give this vaccine to children less than 2 years of age. PCV13 is conjugated with a protein and is the vaccine recommended for all children, beginning at 2 months of age.

Which of the following best describes how to roll with resistance? a) Tell patients that you believe in their ability to change. b) Use open-ended questions and reflective statements. c) Change strategies to avoid arguing with patients. d) Explain to the patient the errors in their thinking.

c) Change strategies to avoid arguing with patients. When rolling with resistance, practitioners avoid arguing with patients. Instead, they help the patient develop their own motivations for change. When resistance occurs, practitioners change strategies.

Which of the following statements about standing orders and protocols is true? a) Standing orders and protocols may be needed for nonprescription products. b) A standing order is similar to a protocol but is usually broader, authorizing the administration of multiple vaccines. c) Standing orders and protocols must consider which vaccines may be administered by pharmacists according to state laws and regulations. d) Protocols, by definition, apply to all patients within a state.

c) Standing orders and protocols must consider which vaccines may be administered by pharmacists according to state laws and regulations Standing orders and protocols must consider which vaccines may be administered by pharmacists according to state laws and regulations

Refrigerated vaccines should be maintained at temperatures between: a) 33°F and +40°F b) 34°F and +42°F c) 32°F and +40°F d) 35°F and +46°FComments: Refrigerators for vaccines should maintain temperatures 35°F and +46°F.

d) 35°F and +46°F Refrigerators for vaccines should maintain temperatures 35°F and +46°F.

The National Vaccine Advisory Committee 2013 Standards for Adult Immunization Practice and the 2016 International Pharmaceutical Federation global report identify pharmacists as:

Integral to increasing vaccination rates

Opportunities for Advocacy and Collaboration include:

Membership in state immunization coalition to serve as an expert on policy and practice issues affecting pharmacy

Which of the following is considered a systemic symptom of anaphylaxis? a) Diarrhea and vomiting b) Myalgia c) Fever d) Headache

a) Diarrhea and vomiting Diarrhea and vomiting are systemic symptoms of anaphylaxis. Fever, myalgia, and headaches are systemic reactions but are not considered anaphylactic.

When administering a subcutaneous injection, pharmacists should: a) Pinch a fold of skin over the triceps muscle b) Insert the needle at a 90-degree angle. c) Tell the patient to flex the muscle under the injection site. d) Use a 1 to 1-1/2 inch needle.

a) Pinch a fold of skin over the triceps muscle When administering a subcutaneous injection, pharmacists should pinch a fold of skin over the triceps muscle, and then insert the needle at a 45-degree angle. The patient should be told to relax the arm and the needle should be 5/8 to 3/4 inch in length.

Which of the following vaccines must be frozen? a) Zostavax b) Live attenuated influenza c) Tdap d) Inactivated influenza

a) Zostavax MMRV, varicella, and Zostavax must be frozen

Which of the following requires no cost share for the patient and is mainly for those 65 years and older? a) Medicare Part C b) Medicare Part B c) Medicaid d) Medicare Part D

b) Medicare Part B

When counseling the parent of a 1-year-old receiving the MMR vaccine, they should be told that their child may get a measles-like rash after how long from vaccination? a) 1 week b) 48 hours c) immediately d) 6 weeks

a) 1 week Systemic reactions, such as a rash, take 7-10 days to develop. Immediately and 48 hours is too early for this reaction; 6 weeks is unlikely to be related to vaccination.

In a patient experiencing anaphylaxis, pharmacists should administer epinephrine: a) As a first-line treatment b) Intramuscularly in the deltoid c) Only in conjunction with diphenhydramine d) Every 2 minutes until EMS arrives

a) As a first-line treatment Epinephrine is used as first line treatment for anaphylaxis and should be administered intramuscularly into the anterolateral aspect of the thigh. It should be administered every 5 to 15 minutes as needed until EMS arrives, up to 3 doses. Diphenhydramine may be used as adjunctive treatment in some cases, but it is not required.

A 16-year-old patient presents to the pharmacy for her first dose of 9vHPV. The patient is instructed to wait in the pharmacy for 15 minutes after receiving the dose. Three minutes after receiving the dose, the patient experiences syncope. What is the recommended response to treat the patient's syncope? a) Lay the patient flat on the ground and elevate her legs. Monitor the patient's vitals and initiate emergency services if the patient does not regain consciousness. b) Stand the patient up into a vertical position. c) Call 9-1-1 and wait for emergency services to address the situation. d) Call the patient's emergency contact to take her to the emergency department.

a) Lay the patient flat on the ground and elevate her legs. Monitor the patient's vitals and initiate emergency services if the patient does not regain consciousness. Lying a person on the ground and elevating his or her feet will often restore cerebral perfusion and may resolve the syncope and seizure-like activity. To be prepared for these adverse effects, pharmacists are recommended to observe patients for at least 15 minutes after vaccination.

Which of the following vaccines listed is a live attenuated vaccine? a) Varicella (VAR) b) Recombinant zoster vaccine (RZV) c) Hepatitis B d) Hepatitis A

a) Varicella (VAR) Varicella (VAR) is a live attenuated vaccine. The remaining vaccines listed are types of inactivated vaccines.

A simple way to communicate information about risks and benefits of vaccines to all patients is to: a) Schedule a 10-minute counseling session prior to each vaccine b) Give them Vaccine Information Statements c) Offer town-hall style events for your community to ask questions about vaccines d) Recommend patients do their own research online prior to their vaccine appointment

b) Give them Vaccine Information Statements The risks and benefits of vaccines can be communicated to patients by giving them Vaccine Information Statements.

Why is spacing and timing of vaccines important? a) memory T-cells interfere with immune response b) circulating antibodies may interfere with immune response c) antibodies interfere with inactive vaccines d) antigen load may interfere with immune response

b) circulating antibodies may interfere with immune response

How is streptococcus pneumoniae primarily transmitted? a) fecal-oral route b) respiratory droplets or secretions c) direct contact with an open wound d) spores in the environment

b) respiratory droplets or secretions Strep pneumoniae can be transmitted in several ways. It is typically transmitted from one person to another person via airborne respiratory droplets or by direct contact with infected respiratory secretions.

Westend Pharmacy is launching an immunization program next month. The pharmacy manager, John, has a list of items that still need to be completed. Which item below is not required by OSHA to be completed before implementing the program? a) Ensure safety devices are available for vaccinators to use while administering immunizations. b) Evaluate employees with potential exposure to bloodborne pathogens for Hepatitis B vaccination status and ensure immunizers have at least one dose prior to administering vaccines. c) Create a network with local physicians to refer patients to the new immunization program. d) Implement a method for sharps disposal, including having sharps containers available at the pharmacy and a system or vendor to dispose of full containers.

c) Create a network with local physicians to refer patients to the new immunization program. Health care workers who handle equipment such as contaminated needs are at risk for exposure to bloodborne pathogens such as HIV, hepatitis B virus, and hepatitis C virus. The OSHA Bloodborne Pathogens Standard is designed to reduce the risk of such exposure. Employees, including pharmacists, who participate in vaccination programs must be in compliance with the OSHA Bloodborne Pathogens Standard. Though establishing a referral network would greatly support the success of the program, it is not required by law to be established prior to beginning.

An electronic prescription for glipizide 10mg is received by a pharmacist for a new patient. The prescription indicates a diagnosis of E11, Type 2 diabetes mellitus. In addition to filling the prescription, the pharmacist could assess the patient for potential immunizations to recommend. What form of assessment is the pharmacist utilizing? a) Occurrence-based screening b) Procedure-based screening c) Diagnosis based screening d) Mass screening

c) Diagnosis-based screening The pharmacist can utilize the diagnosis of diabetes, provided by the prescriber on the prescription, to recommend vaccines indicated for patients with diabetes. This form of assessment is diagnosis-based screening.

Which of the following is a source of free print materials that can be used to market vaccination services? a) International Pharmaceutical Federation b) Centers for Disease Control and prevention c) Infectious Diseases Society of America d) National Academy of Medicine

c) Infectious Diseases Society of America

Which of the following best describes immunization coalitions? a) Professional membership associations for health care providers who immunize b) Nongovernmental public health organizations c) Organizations that bring together vaccination stakeholders to improve vaccination rates d) Patient advocacy organizations

c) Organizations that bring together vaccination stakeholders to improve vaccination rates Immunization coalitions are defined as organizations that bring together vaccination stakeholders to improve vaccination rates.

Which of the following facility features is most important for maintaining the cold chain? a) Access to high-speed internet service b) Proximity to public transportation c) Space for vaccine storage and temperature monitoring d) Adequate seating in the waiting area

c) Space for vaccine storage and temperature monitoring The facility must have space for vaccine storage and the ability to monitor temperatures in order to maintain the vaccine cold chain.

Which vaccine technology listed below is an ingredient added typically to inactivated vaccines to boost its immune response by targeting pathogen recognition receptors that are expressed on dendritic cells to trigger a pro-inflammatory response? Though this technology creates a more robust immune response, it can also increase local site reactions and systemic reactions, such as fevers, chills, and body aches. a) Conjugation b) Attenuation c) mRNA technology d) adjuvants

d) Adjuvants Adjuvants are developed and patented by manufacturers to produce a more robust immune response to the vaccine. These ingredients target types of pathogen recognition receptors that, when activated, trigger a pro-inflammatory response that enhances the body's adaptive immune response. Because of the larger pro-inflammatory response, this vaccine technology will not only provide a stronger immune response but also increase the likelihood of local and systemic reactions.

What type of code is used to identify the diagnosis for a patient receiving a vaccine? a) ACIP b) CPT c) NCPDP d) ICD-10

d) ICD-10

A child received the MMR vaccine when he was 9 months of age before moving out of the country with his parents. He is now 4 years old and about to enter Kindergarten. How many, if any, doses of MMR should the child receive now? a) 2 b) 3 c) 1 d) None

a) 2 The MMR dose administered before 12 months of age needs to be re-administered and the child is due for a dose of MMR at 4 years of age.

Which of the following vaccines is not recommended during pregnancy? a) Human papillomavirus vaccine (HPV) b) Tetanus, diphtheria, acellular pertussis (Tdap) c) Hepatitis B (HepB) d) Inactivated influenza vaccine (IIV)

a) Human papillomavirus vaccine (HPV) HPV is listed as a contraindication for pregnant women and should not be given until after pregnancy. Tdap andthe inactivated influenza vaccines are indicated during pregnancy. Hepatitis B may be given during pregnancy if the woman has other risk factors that place her at high risk for getting hepatitis B.

Which of the following best describes the preparation stage of the Transtheoretical Model of Health Behavior Change? a) Patients intend to take action in the next month to change their behavior b) Patients are aware that a problem exists and are seriously thinking about overcoming it. c) Patients modify their behavior. d) Patients have no intention to change behavior.

a) Patients intend to take action in the next month to change their behavior. The description of "preparation" in the Transtheoretical Model of Health Behavior Change is that patients intend to take action in the next month.

Which of the following are true regarding the influenza virus? a) Only Type B influenza has surface antigens of hemagglutinin (HA) and neuraminidase (NA). b) It is transmitted through respiratory droplets that contain the virus. c) It cannot be transmitted from surfaces. d) People exposed are contagious within minutes of exposure.

b) It is transmitted through respiratory droplets that contain the virus.

When reconstituting a vaccine for injection, pharmacists should: a) Always shake the vaccine prior to reconstitution. b) Always shake the diluent prior to reconstitution. c) Always refer to the vaccine's package insert for specific information d) Always withdraw the entire contents from the reconstituted vial.

c) Always refer to the vaccine's package insert for specific information. When reconstituting a vaccine for injection, pharmacists should always refer to the vaccine's package insert for specific information. While, some vaccines and diluents need to be shaken, not all do. Additional for some vaccines, pharmacists should only withdraw the dose needed, leaving excess vaccine in the vial.

Which of the following best describes the definition of "vaccine hesitancy"? a) When patients do not receive vaccinations due to misinformation. b) Refusal to receive vaccinations due to religious beliefs. c) Patients who express a desire to receive a vaccine, but then refuse due to fear of needles. d) A delay in the acceptance of, or refusal of, a vaccination despite availability of vaccination services.

d) A delay in the acceptance of, or refusal of, a vaccination despite availability of vaccination services. Vaccine hesitancy is defined as a delay in the acceptance of, or refusal of, a vaccination despite availability of vaccination services

An important benefit of standing orders and protocols is that they: a) Improve patient access to vaccines and efficiency of services. b) Ensure that all members of a patient's health care team are informed of vaccines. c) Allow for pharmacists to bill as providers for Medicare Part D. d) Provide education to patients about the risks and benefits of vaccines.

a) Improve patient access to vaccines and efficiency of services. Standing orders improve efficiency and patient access to vaccines.

ACIP recommends the hepatitis A vaccine be administered to all children starting at which age? a) 11 years b) 12 months c) 5 years d) 6 months

b) 12 months All children beginning at 1 year of age should get this vaccine.

Star Pharmacy has been providing influenza vaccines for years and is now implementing a Hepatitis B vaccine program in their pharmacy next month. A crucial step in the Pharmacists' Patient Care Process for this vaccine is: a) Review staffing levels b) Create a reminder and recall system c) Purchase the Hepatitis B vaccine d) Plan a large marketing event

b) Create a reminder and recall system An important aspect of the Patient Care Process for a vaccine with multiple doses, such as Hepatitis B, is to have a reminder and recall system in place. Patients need to be informed and scheduled for subsequent doses prior to leaving from their initial appointment to ensure they become fully vaccinated. This is part of the Follow-up, Monitor, Evaluate step of the Patient Care Process.

The first step in AHRQ's "SHARE" approach to vaccines is to: a) Assess your patient's values and preferences. b) Seek your patient's participation in a discussion. c) Ask if your patient has any questions about the vaccine. d) Ask if your patient is ready to make a decision about getting the vaccine.

b) Seek your patient's participation in a discussion. The first step in AHRQ's SHARE approach is to seek the patient's participation.

What is youngest age that hepatitis B vaccine is recommended in infants and children? a) 6 months b) at birth c) 1 year d) 4 weeks

b) at birth ACIP recommends hepatitis b vaccine for all infants within 24 hours of birth.

An adverse event that is considered a systemic reaction to a vaccine is: a) Tenderness b) Wheezing c) Fever d) Angioedema

c) Fever Fever is considered a systemic reaction. Tenderness is considered a local reaction; angioedema and wheezing are considered allergic reactions.

When administering measles, mumps, rubella (MMR) and pneumococcal conjugate vaccine (PCV13) to a patient at their 15-month appointment, what must be considered regarding vaccine spacing? a) MMR and PCV13 should not be administered simultaneously. They must be separated by a 28-day minimum interval. b) MMR and PCV13 may be administered simultaneously or must be separated by a 28-day minimum interval. c) Vaccines should never be administered simultaneously. As such these vaccines should be separated by a 7-day minimum interval. d) MMR and PCV13 may be administered simultaneously or at any interval between doses.

d) MMR and PCV13 may be administered simultaneously or at any interval between doses. Measles, mumps, rubella (MMR) is a live attenuated vaccine and pneumococcal conjugate vaccine (PCV13) is an inactivated vaccine. In general, an inactivated vaccine can be administered either at the same clinic visit, or at any time before or after a different inactivated vaccine or live vaccine.

A 9 year-old was just diagnosed with asplenia. This child is up to date on all routinely recommended vaccines. Which additional vaccine does this child need? a) MenB b) PCV13 c) MenACWY d) Hib

c) MenACWY A fully vaccinated 9 year old would have already received the PCV13 and Hib routine series. MenB is not indicated for use until 10 years of age. MenACWY is not routinely recommended before 11 years of age, but is recommended before 9 years of age for asplenia.

Preparing a vaccine for administration may include which of the following tasks? a) Ensuring the vaccine is at room temperature before it is administered. b) Sterilizing the area for preparing the vaccine. c) Selecting the needle for administering the vaccine. d) Disposing of the needle in a sharps container.

c) Selecting the needle for administering the vaccine. For many vaccines, it is necessary to select a needle that is appropriate for administration.

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination with the meningococcal conjugated quadrivalent vaccine (MenACWY) in which of the following age groups? a) 4-6 years of age b) 2-3 years of age c) 7-8 years of age d) 11-12 years of age

d) 11-12 years of age All adolescents 11 to 12 years of age should get a dose of MenACWY

Why is it important to preserve the cold chain for vaccines? a) Vaccines stored at temperatures outside the recommended range are more likely to cause localized adverse events. b) Vaccines stored at temperatures outside the recommended range are more likely to cause systemic adverse events. c) Maintaining the cold chain extends the shelf-life for vaccines. d) Exposure to heat, cold, or light outside recommended ranges can reduce vaccine potency.

d) Exposure to heat, cold, or light outside recommended ranges can reduce vaccine potency. Temperature and storage conditions for vaccines must be maintained within approved ranges. Failure to store and handle vaccines properly can reduce vaccine potency, resulting in inadequate immune responses in patients and poor protection against disease.

Which of the following is a law or program that may grant immunity from civil liability during emergencies for covered activities? a) Immunization Action Coalition b) Medical Reserve Corps c) NABP emergency passport d) U.S. Public Readiness and Emergency Preparedness Act

d) U.S. Public Readiness and Emergency Preparedness Act U.S. Public Readiness and Emergency Preparedness Act may grant immunity from civil liability during emergencies for covered activities (e.g., vaccinations).

Using shared clinical decision-making, which of the following recommendation is most appropriate for a 65-year-old living in a skilled nursing facility with multiple co-morbid conditions? This patient has no record of receiving either pneumococcal vaccine and is immune competent. a) Give PCV15 now, then give PPSV23 one year later. b) PPSV23 only c) PCV13 only d) PPSV23 now, 1 year later PCV13

a) Give PCV15 now, then give PPSV23 one year later Those in nursing homes may attain higher than average benefit from PCV15 vaccination in addition to PPSV23. Sequencing is important to have the conjugate before the pure polysaccharide.

Which of the following is TRUE of the emergency use authorization process? a) Manufacturers must include a plan for safety monitoring b) Risks are not evaluated until long-term safety data is available c) Clinical trial data are not required d) Used when approved or licensed alternatives are too expensive

a) Manufacturers must include a plan for safety monitoring The EUA submitted by manufacturers must include a plan to continuously monitor safety and a means to communicate benefits and risks to patients. Clinical data are required. The FDA weighs both risks and benefits. EUA's are used during emergency situations when there are no approved alternatives.

Which of the following is the correct answer and reason for a 64-year-old patient who asks you if it is better to get their shingles vaccine now or wait till it is covered by Medicare at 65 years? a) Now because it must be covered at no cost by commercial insurance. b) Wait till 65 years as it is not indicated before 65 years. c) Wait till 65 years when it is covered by Medicare part B. d) Now because it is not covered at 65 years or above.

a) Now because it must be covered at no cost by commercial insurance. Commercial insurance has no cost-share for patients for routinely recommended vaccines like the shingles vaccine, but Medicare Part D may have co-pays if they wait till 65.

Which of the following symptoms are usually associated with influenza? a) nausea/vomiting b) chills c) sneezing d) normal temperature

b) chills Fever, muscle aches and chills are more prevalent in influenza than in the common cold. Sneezing would be more common with a cold. Viral gastroenteritis is often referred to as the "stomach flu" but it is not caused by the influenza virus and gastrointestinal symptoms are not common with influenza.

What type of vaccine is meningococcal quadrivalent vaccine? a) recombinant b) viral vector c) conjugate d) polysaccharide

c) conjugate A, C, W, and Y serotypes can be found in the quadrivalent conjugate vaccines and serogroup B is in the recombinant vaccines. In order to involve T-cells, which would be a T-cell dependent response, the antigen needs to contain a protein. By conjugating a polysaccharide vaccine with a protein, it activates T-cells and B cells. This provides a stronger immune response and is the reason we can give vaccines to young children.

Which of the following issues affecting international access to vaccines is best aligned to efforts by pharmacist volunteers? a) Lack of clean drinking water b) Poor infrastructure c) Unstable governments d) Suboptimal levels of health care providers

d) Suboptimal levels of health care providers Because there is a shortage of health care professionals internationally, pharmacists who volunteer can help fill gaps in access to vaccines by volunteering overseas.

Which setting best facilitates the delivery of a mass vaccination clinic for the general population? a) On-site community event b) Long-term care facility c) Community pharmacy d) Physician practice

a) On-site community event Mass vaccination clinics are typically held off-site in a facility designed to accommodate large numbers of patients. A clinic could be offered in a long-term care facility for residents, but generally would not be opened to the general population.

Which of the following complications are correctly matched to the associated condition? a) Pneumonia-herpes zoster b) Zoster ophthalmicus-varicella zoster c) Postherpetic neuralgia-herpes zoster d) Ramsey hunt syndrome-varicella zoster

c) Postherpetic neuralgia-herpes zoster Common complications of herpes zoster are postherpetic neuralgia and zoster ophthalmicus. Ramsay Hunt syndrome, a peripheral facial nerve palsy is a complication that can occur when the herpes zoster reactivates around the facial nerves. Common complications of varicella zoster include bacterial infections of the lesions, pneumonia, CNS malfunctions, and Reye syndrome.

To prevent errors of vaccine administration, pharmacists should: a) Use the same diluent for all vaccines prepared in one sitting. b) Memorize vaccine schedules. c) Select the appropriate needle length. d) Prepare enough vaccine for the entire shift at the beginning of the day.

c) Select the appropriate needle length. Pharmacists should always ensure that they are selecting the correct needle length, depending on route of administration and patient factors. Vaccine schedules change from time to time, pharmacists should refer to them as needed rather than trying to memorize them. Pharmacists should always use the correct diluent for each vaccine, as these differ among vaccines. Pharmacists should draw up vaccines at the time of administration.

Which of the following statements best illustrates the affirmation skill in motivational interviewing? a) "Can you tell me more about your concerns?" b) "What information do you have about this disease?" c) "It sounds like that was a really frustrating experience for you." d) "Thank you for sharing your concerns with me, I enjoyed speaking with you today"

d) "Thank you for sharing your concerns with me, I enjoyed speaking with you today" "Thank you for sharing your concerns with me, I enjoyed speaking with you today" is an example of an affirmation that offers support for desirable behaviors.

A 3-year old child recently underwent a splenectomy. Previous to the surgery, the child was up to date on all pediatric vaccinations. According to the CDC, which of the following vaccines should be recommended? a) PPSV23 b) PCV13 c) PCV20 d) PCV15

a) PPVS23 PCV13 was previously given as part of the routine pediatric immunization schedule and PCV15 and 20 are not FDA approved children nor CDC recommended for anyone as of September 2021.

When preparing vaccines for administration, pharmacists should: a) Reuse needles and syringes if multiple vaccines are administered to the same patient. b) Always use aseptic technique. c) Prepare all vaccines in a multi-dose vial at the same time. d) Prepare enough vaccine for the entire shift at the beginning of the day.

b) Always use aseptic technique. When preparing vaccines for administration, pharmacists should always use aseptic technique. Pharmacists should also always use a separate needle and syringe for each injection and prepare the vaccines only when ready to administer them.

When storing vaccines in the refrigerator, pharmacists should: a) Store vaccines on the bottom of the refrigerator. b) Use water bottles to help stabilize temperatures. s. c) Keep vaccines and food on separate shelves. d) Use dorm-style units.

b) Use water bottles to help stabilize temperatures. The refrigerator or freezer used for storing vaccines should not be used for storing food or beverages to avoid frequent opening of the door. Keeping water bottles in the refrigerator and ice packs in the freezer can help to stabilize the temperature. Finally, store the vaccines in the middle of the refrigerator or freezer—not on the door, on the bottom, or against the sides.

Which of the following is a potential long term complication from meningococcal disease? a) stiff neck b) amputations c) photophobia d) headaches

b) amputations Unfortunately, death is a possible outcome, even with appropriate treatment. Twenty percent of those who survive end up with long term sequelae or disabilities, which include amputations, hearing loss, and neurologic or brain damage. Preventing meningococcal infections and these serious complications is the reason we vaccinate. Stiff neck, headache, and photophobia are symptoms of meningococcal disease.

A 25-year-old female comes to the pharmacy inquiring about the 9vHPV series. What would be the recommended vaccination series? a) Patient is not eligible to receive the vaccine due to age b) 2 doses administered intramuscularly at 0 and 6-12 months c) 1 dose administered intramuscularly d) 3 doses administered intramuscularly at 0, 1-2, 6 months

d) 3 doses administered intramuscularly at 0, 1-2, 6 months Female and males aged 13 to 26 years of age that have not been previously vaccinated should receive the 3-dose series at 0, 1-2, 6 months. 9vHPV is administered intramuscularly. The 2-dose series is only for patients 9 to 14 years of age that are immunocompetent.

Which of the following are true regarding vaccine efficacy and safety for the live varicella vaccine and the recombinant zoster vaccine? a) Systemic grade 3 reactions (preventing normal activities) were lower after dose 2 for the recombinant zoster vaccine. b) Postherpetic neuralgia was not reduced in patients >70 years of age receiving the recombinant zoster vaccine. c) Injection site pain for both vaccines was <5%. d) Both vaccines have over 90% effectiveness in prevention of disease after two doses.

d) Both vaccines have over 90% effectiveness in prevention of disease after two doses. Prevention of all varicella 2 doses: 98.3%; Prevention of herpes zoster 50-59 years: 96.6% 60-69 years: 97.4% ≥ 70 years: 91.3%. Live varicella vaccine was at 25.4% for injection site pain and recombinant zoster vaccine was 78% for pain. Systemic grade 3 reactions (preventing normal activities) were higher after dose 2 for the recombinant zoster vaccine. For the varicella live vaccine systemic reaction (i.e., fever) was slightly lower after dose 2 (7% dose 1, 4% dose 2). Post herpetic neuralgia prevention in ≥ 70 years: 88.8%.

Which vaccine is required by OSHA to be offered to all employees with potential exposure to bloodborne pathogens? a) Hepatitis A vaccine b) Influenza vaccine c) Tetanus containing vaccine per current ACIP recommendations (Td or Tdap) d) Hepatitis B vaccine

d) Hepatitis B vaccine OSHA requires that all employees with potential exposure to bloodborne pathogens are offered hepatitis B vaccination. Immunizers should receive at least 1 dose of hepatitis B vaccine prior to administering vaccines. Documentation of hepatitis B vaccination should be maintained for all employees with potential exposure to bloodborne pathogens. If the employee declines the hepatitis B vaccination, it is mandatory that the employee does so in writing, using specific language.

Which of the following patient scenarios regarding influenza vaccination is correct? a) A 65-year-old patient with thimerosal allergy would be eligible to receive adjuvanted inactivated Fluad or high dose inactivated Fluzone. b) A 40-year-old who is allergic to eggs would be contraindicated to receive Flublock (RIV4) c) An annual influenza vaccination is recommended for 2 years and older due to being a polysaccharide vaccination. d) A 5-year-old who received one dose of influenza vaccination when they were 3 years old, should receive only one dose this year.

a) A 65-year-old patient with thimerosal allergy would be eligible to receive adjuvanted inactivated Fluad or high dose inactivated Fluzone. Patients age 65 and older would be eligible to receive age recommended influenza vaccinations, including those indicated for patients over age 65 (including Fluad and High dose Fluzone which are single dose syringes that are preservative free). Annual influenza vaccination is recommended for 6 months and older. If a child 2-8 years of age does not have documentation of 2 or more doses of any influenza vaccine prior to July 1st, then they should also receive two doses separated by 4 weeks. Flublok is indicated for those with egg allergy.

A pharmacy technician may perform which of the following roles? a) Ask patients to complete screening questionnaires. b) Make clinical judgements about a patient's health. c) Educate patients about the risks of vaccines. d) Determine whether a vaccine is appropriate for a patient.

a) Ask patients to complete screening questionnaires. Pharmacy technicians should only perform tasks that do not require clinical judgement. An example of such a task is asking a patient to complete a screening questionnaire. Educating patients and making decisions about vaccine administration for patients are tasks that should be performed by pharmacists

Options to increase influenza vaccine effectiveness include: a) Avoid vaccination in July and August to minimize chances of suboptimal immunity later in the season. b) Administer high dose influenza vaccination to children ages 2-8 years to ensure appropriate immune response. c) Administer in combination with pneumococcal vaccination to boost titer levels. d) Receive one influenza vaccination in the fall and one in the spring.

a) Avoid vaccination in July and August to minimize chances of suboptimal immunity later in the season. Studies have shown that the immunity from an influenza vaccination lasts about 5 or 6 months. It is recommended not to administer in July and August but to target most patients for vaccination in October. The vaccine schedule does not recommend receipt of influenza vaccination twice during a season. High dose influenza vaccination is for patients age 65 and older and has data that shows 24% increased effectiveness compared to standard dose vaccination. Although proactive review of immunization status and encouraging patients to receive necessary vaccines can increase vaccination rates, there is no data available that cites the influenza vaccination effectiveness would be improved by administering same day as pneumococcal vaccine.

Counseling on vaccine safety should include: a) Fever, chills, malaise could occur within 6-12 hours post vaccination and may last up to 1-2 days. b) Nasal congestion is common with the influenza vaccine administered intramuscularly. c) Injection site pain should resolve within 5-10 minutes post vaccination. d) A history of severe allergic reaction (anaphylaxis) to a previous dose or component of influenza vaccine is no longer a contraindication.

a) Fever, chills, malaise could occur within 6-12 hours post vaccination and may last up to 1-2 days. Fever, chills, malaise, and myalgia could occur within 6-12 hours post vaccination and may last up to 1-2 days. Patients may also experience injection site reactions such as soreness, tenderness, swelling, redness lasting 1-2 days. Although those with egg allergy may now be able to receive influenza vaccination; anaphylactic history to any component of the vaccine is still an absolute contraindication The intranasal influenza vaccination (Flumist) has side effects of runny nose, nasal congestion, sore throat, muscle aches, cough, chills, sinusitis; these are not common with the injectable influenza vaccination administered by intramuscular route.

Which of the following factors does not need to be considered when utilizing shared decision-making to evaluate the need to vaccinate an adult (27-45 years of age) with 9vHPV vaccine? a) HPV antibody test results b) Patient's immunocompetency c) Patient's sexual history, including lifetime sexual partners. d) Patient current relationship status

a) HPV antibody test results At any age, having a new sex partner is a risk factor. Conversely, if persons 27-45 years old are in a long-term, mutually monogamous sexual relationship, the risk of new HPV infection is low, and the vaccine may not be as necessary. It is important to understand that most sexually active adults have already been exposed to HPV. There is no antibody testing that will determine what type of HPV a person may have been exposed to. The vaccine will not improve the prognosis of an already acquired HPV infection. In fact, HPV vaccine effectiveness might be low among persons with risk factors for HPV, such as multiple lifetime sex partners or those with immunocompromising conditions. HPV vaccine works best when a person has not been previously exposed to a type of HPV that is found in the vaccine.

Which of the following is true regarding risk for COVID-19? a) Older adults and people with underlying medical conditions are some of the patients at highest risk for severe disease and complications. b) Coronary atherosclerosis and other heart disease patients have the highest risk of death. c) In the workforce, only healthcare professionals are flagged as at high risk for exposure. d) There has not been an association between number of comorbid conditions and increase in death.

a) Older adults and people with underlying medical conditions are some of the patients at highest risk for severe disease and complications. Older adults, People from certain racial and ethnic minority groups, People with disabilities, and People with underlying medical conditions are at highest risk for severe disease and complications from COVID-19 COVID-19 is so contagious, there are numerous groups at high risk for exposure or transmission. These include: People who live or work in long-term care settings, correctional facilities, or homeless shelters, First responders (for example, healthcare workers, firefighters, police, congregate care staff), Education staff (for example, teachers, support staff, daycare workers), Food and agriculture workers, Manufacturing workers, U.S. Postal Service workers, Public transit workers, and Grocery store workers. In addition to type of medical condition, the more medical conditions a person has, the greater the risk of death. Even two to five comorbid conditions increases the risk ratio to 2.6. Obesity and complications from diabetes are the highest risk comorbidities for death.

Which of the following statements is true regarding how pharmacy technicians can gather information about a patient's vaccination history? a) Pharmacy technicians can review electronic health records b) Pharmacy technicians can review information from immunization coalitions. c) Pharmacy technicians can access Immunization Information Systems in all states. d) Pharmacy technicians should not be involved in gathering information about a patient's vaccination history.

a) Pharmacy technicians can review electronic health records. Pharmacy technicians can gather information about vaccinations a patient has received by reviewing electronic health records.

Which of the following statements is false regarding polysaccharide and conjugated vaccines? a) The conjugate protein used, such as diphtheria, can also provide adequate protection against itself in addition to the polysaccharide. b) Conjugated vaccines can be used in children as young as 2 months of age because they stimulate both B cell and T helper cell immune responses. c) Conjugated vaccines link a polysaccharide to a protein that stimulates a wider immune response. d) Polysaccharide vaccines stimulate B cell or humoral responses only, reserving their use for patients over 2 years of age. e) Polysaccharide vaccines use carbohydrates found in the external capsule of the bacteria as antigens.

a) The conjugate protein used, such as diphtheria, can also provide adequate protection against itself in addition to the polysaccharide. Polysaccharide vaccines use a carbohydrate found in the external capsule of bacteria as antigens and stimulate only a B cell response. Children younger than 2 years of age typically do not have a mature enough immune system for polysaccharide vaccines to be effective. Conjugated vaccines link a polysaccharide to a protein that boosts the immune response to the bacterial carbohydrate. The presence of this protein stimulates both a B cell and T helper cell response, allowing it to be used in children as young as 2 months of age. The conjugated protein does not add additional protection to another antigen. For example, diphtheria conjugated with the meningococcal vaccine (MCV4) does not add protection against diphtheria.

After the routine administration of a vaccine, the pharmacy technician should send documentation of the vaccination to: a) The patient's primary care physician. b) The Vaccine Adverse Event Reporting System (VAERS). c) All of the patient's prescribers in the pharmacy's records. d) The National Vaccine Errors Reporting Program (VERP).

a) The patient's primary care physician. Pharmacy technicians can assist with documentation, which includes sharing a documentation of the vaccine with the patient's primary care provider. Information should only be shared with specialists, VAERS, or VERP when it is appropriate to do so.

During a public health declared mumps outbreak, a 21-year-old college student with a history of 2 MMR vaccine doses as a child wants to know if she needs a dose of MMR now. Which of the following is the best response? a) Yes, since there is a declared mumps outbreak. b) No, as a third dose of MMR is only for measles outbreaks c) Yes, since all college students should have 3 doses of MMR. d) No, as a third dose of MMR is only for rubella outbreaks.

a) Yes, since there is a declared mumps outbreak. Yes because it was during a public health declared mumps outbreak.

Which of the following patients is eligible to receive their first dose of the rotavirus vaccine? a) An 8-month old b) A 10-week-old presenting to the pediatrician for their 2-month well check. c) A newborn 3 days before leaving the hospital d) A 1-year-old with severe GERD

b) A 10-week-old presenting to the pediatrician for their 2-month well check The minimum age for the first dose is 6 weeks. The maximum age for the first dose is 14 weeks and 6 days. The maximum age for the last dose is 8 months and 0 days.

Which of the following best describes a public health department? a) A volunteer-led organization that aims to improve vaccination rates. b) A department which helps prevent the start and spread of disease. c) An international organization that provides resources for pharmacists in multiple countries. d) A department within a pharmacy's corporate office that focuses on population health.

b) A department which helps prevent the start and spread of disease.

Which of the following scenarios is an appropriate shared clinical decision-making for meningococcal vaccine? a) 29 year old with asplenia who receives MenB vaccine b) Healthy 16 year old who received meningococcal B vaccine c) 25 year old microbiologist who receives MenACWY d) 2-year old with complement deficiency who received MenACWY

b) Healthy 16 year old who received meningococcal B vaccine Shared clinical decision-making is specific for the MenB vaccines and applies to individuals ages 16-23 years who are not at high risk for disease. ACIP prefers those who elect to get the vaccine do so at ages 16-18 years. Providers should discuss the risks and benefits of vaccination with patients and/or caregivers of patients in this age group who may benefit from MenB.

A patient presents to the pediatric clinic for their 5-year-old well check before entering kindergarten. They received rotavirus at 2 and 4 months and Pentacel (DTaP/IPV/Hib) at 2 and 4 and 6 and 15 months. What vaccine should they need to receive today? a) Hib b) IPV c) Rotavirus d) Another dose of Pentacel

b) IPV The ACIP recommendations call for another dose of poliovirus vaccine at age 4 years. An additional booster dose of age-appropriate IPV-containing vaccine, such as IPV or DTaP-IPV (Kinrix) should be administered at age 4-6 years. For those starting with Pentacel, this will result in a 5-dose IPV vaccine series, which is considered acceptable by ACIP. Rotavirus series was completed and patient is older than vaccine age approved. Hib series has been completed with 4 dose Pentacel series.

The cold chain for vaccines: a) Applies to vaccines but not to diluents. b) Must be maintained from manufacture until the vaccine is administered to the patient. c) Requires that all vaccines be kept refrigerated until they are ready to be prepared for administration. d) Begins when the provider assumes responsibility when accepting delivery of the vaccine.

b) Must be maintained from manufacture until the vaccine is administered to the patient The cold chain refers to the temperature-controlled supply chain that ensures that vaccines are maintained at the proper temperature from the time they leave the manufacturer until they are administered to patients. Some diluents must also be refrigerated. Some vaccines must be kept frozen while others are refrigerated.

Which of the following functions should be performed prior to the mass vaccination clinic? a) Documentation of any adverse events and submission to the Vaccine Adverse Event Reporting System (VAERS) b) Ordering of adequate inventory of vaccines and supplies c) Communication of wait-times d) Continuous quality improvement activities

b) Ordering of adequate inventory of vaccines and supplies Vaccines and supplies should be ordered before the mass vaccination clinic to ensure that they are available to meet the needs of the highest anticipated number of patients.

Which of the following is true regarding varicella zoster transmission? a) It is not respiratory transmitted b) Period of contagiousness: 1-2 days before rash to 4-7 days later. c) The incidence of varicella disease has remained unchanged since vaccinations became available. d) Covering the lesions will prevent chance of transmission to others.

b) Period of contagiousness: 1-2 days before rash to 4-7 days later. The total incubation period is about 2 weeks. A person can be contagious a day or two before they develop symptoms up through about a week after symptoms develop. Primary varicella infection from the varicella-zoster virus occurs with human transmission from direct contact with lesions or inhalation of respiratory secretions or vesicle aerosols. The incidence of varicella disease has decreased since vaccinations were available.

Which of the following is an example of a common vaccine administration error? a) Providing a vaccination while the patient is standing. b) Wrong vaccine, route, site, or dosage; or improperly prepared. c) Administering a vaccine 3 days after it was due. d) Receiving a second dose of a vaccine in the opposite arm that the first dose was received in.

b) Wrong vaccine, route, site, or dosage; or improperly prepared. CDC provides a list of types of errors: • Wrong vaccine, route, site, or dosage; or improperly prepared • Wrong patient • Documentation errors • Administration of improperly stored or handled vaccine • Vaccine scheduling errors (e.g., doses in a series administered too soon) Administering 3 days later simply delays full immune protection Providing a vaccination while the patient is standing would increase risk of injury should the patient have a syncope episode/fall, but is not listed as an administration error. As long as the site is correct (IM, SQ), it is acceptable to receive the vaccine in the arm based on patient preference

Which of the following statements best meets the definition of precaution? a) The risk of vaccinating outweighs the benefits from the vaccine and the patient cannot be vaccinated. b) A compelling indication for the patient to receive a vaccine. c) A condition that may alter or diminish the patient's response or may increase the patient's risk of a serious reaction to a vaccine. d) Condition that will likely result in a severe, life-threatening event if the patient receives the vaccine.

c) A condition that may alter or diminish the patient's response or may increase the patient's risk of a serious reaction to a vaccine Precautions include conditions that may alter or diminish a response to a vaccine, when a patient has a moderate or severe acute illness that might be difficult to diagnose if the patient experiences side effects from the vaccine, or if giving the vaccine could increase the patient's risk for a serious reaction to the vaccine. A precaution does not necessarily mean the patient cannot be vaccinated.

The OSHA Exposure Control Plan is used by employers to achieve what goal? a) Develop a team-based environment that fosters creativity and collaboration. b) Improve employee health and wellness. c) Create a process of controls that aims to eliminate or minimize employee's potential exposure to bloodborne pathogens in the workplace. d) Creates a system for Human Resources to monitor employee health at the workplace.

c) Create a process of controls that aims to eliminate or minimize employee's potential exposure to bloodborne pathogens in the workplace. The OSHA Exposure Control Plan is a written protocol created by employees to outline how the employer intends to eliminate or minimize potential exposures to bloodborne pathogens. According to the OSHA Bloodborne Pathogens Standard, the exposure control plan must include certain elements, for example Exposure Determination and Safer Medical Device Evaluation, to achieve this goal.

Which of the following is true about the pharmacy technicians' role in managing vaccine inventory? a) After vaccines arrive within the pharmacy, they should be checked with 24 hours of arrival. b) If vaccines are damaged when they arrive, they should immediately be thrown away. c) Expiration dates and beyond use dates should be checked at least weekly. d) Pharmacy technicians are only allowed to check temperatures to maintain the cold chain in some states.

c) Expiration dates and beyond use dates should be checked at least weekly. Pharmacy technicians can check inventory on a weekly basis to ensure that vaccines are used before their expiration date or beyond-use date.

Post-vaccination testing for hepatitis b immunity is recommended for which of the following? a) men who have sex with men b) IV drug users c) health-care workers d) adolescents

c) Health-care workers Testing may also be done after vaccination to determine if certain high-risk groups responded to the vaccine and are protected. Such testing is not routinely done for everyone, but may be useful (or even required by some institutions) for the following groups: Health care and public safety workers at risk of exposure to blood or body fluids in the workplace Infants born to mothers who test positive for hepatitis B or whose mothers' status remains unknown indefinitely Patients on dialysis Immunocompromised individuals, and Sex partners of persons infected with hepatitis B

Which of the below statements regarding Human papillomavirus (HPV) serotypes is true? a) HPV low risk serotypes, such as type 16, cause about 50% of all cervical cancer cases worldwide. b) HPV is a small RNA virus transmitted via sexual skin to skin contact. c) High risk serotypes are estimated to cause 99% of cervical precancers d) There are only 9 known serotypes of HPV.

c) High risk serotypes are estimated to cause 99% of cervical precancers Human papillomavirus (HPV) is a small DNA virus that is transmitted via skin to skin contact through vaginal, penile, anal, or oral sex. There are over 200 distinct known serotypes. High risk serotypes, such as type 16, cause about 50% of all cervical cancer cases worldwide while low risk types, such as type 6 and 11, cause 90% of cases of anogenital warts.

Which of the following statements is true regarding forming relationships with other immunization stakeholders? a) It supersedes the need to create print marketing materials b) It is a function best left to the pharmacy's sales and marketing team c) It can enhance your marketing efforts d) It can be risky if other providers feel threatened by competition

c) It can enhance your marketing efforts Forming relationships with other immunization stakeholders can enhance marketing efforts by increasing the reach and distribution of marketing materials and supporting credibility.

A standing order or protocol should include information about: a) The pharmacy workflow and staffing needed to support the vaccination service. b) Details regarding any liability that the signing practitioner assumes as a result of the standing order or protocol. c) Managing medical emergencies that may occur after administration of a vaccine. d) A statement of indemnification for liability.

c) Managing medical emergencies that may occur after administration of a vaccine. Specific information that should be included in a standing order or protocol includes a protocol for managing medical emergencies that may occur after administration of a vaccine

A healthy 70-year-old female who received PPSV23 at 66-years of age is inquiring about pneumococcal vaccination. Her pneumococcal conjugate vaccine history is unknown. Which of the following should you recommend? a) PPSV23 b) PCV13 c) One dose of either PCV20 or PCV15. d) PCV13 now and then PPSV23 1 year later

c) One dose of either PCV20 or PCV15. Since she has an unknown history of PCV, she should receive one dose of PCV20 or one dose of PCV15. Since she has already received PPSV23 on or after age 65 years, she does not need another PPSV23. Of note, if the patient received PCV13 at any age, her pneumococcal vaccinations are considered complete.

Which of the following is true regarding professional liability? a) Only anaphylaxis needs to be reported to VAERS. b) It is not necessary for a pharmacist to have individual insurance since their place of work would cover them. c) Pharmacists should educate and inform patients and their caregivers about the benefits and risks of vaccination. d) Patients who accept awards from the VICP fund can still file malpractice claims.

c) Pharmacists should educate and inform patients and their caregivers about the benefits and risks of vaccination. Liability Management: Step 1. Immunizing pharmacists should receive specialized training in immunization delivery from a source acknowledged by professional peers and regulators Step 2. Pharmacists should educate and inform patients and their caregivers about the benefits and risks of vaccination Step 3. Immunizing pharmacists should develop a quality program that emulates local standards and abides by the accepted standard of care Although the workplace would likely be primary coverage for an incident, it is strongly encouraged that every pharmacist have their own liability coverage. Patients who accept awards from the VICP fund cannot file malpractice claims Report any adverse event in the VIT to the Vaccine Adverse Event Reporting System (VAERS; vaers.hhs.gov/index)

Documentation requirements for COVID-19 vaccinations include: a) Only cases of COVID-19 that result in hospitalization or death after the recipient has received COVID-19 vaccine should be reported to VAERS. b) Emergency Use Authorization (EUA) Fact Sheets should be provided after the patient receives the vaccine. c) Report administration data to your jurisdiction's system (e.g., IIS) within 72 hours after administration. d) COVID-19 vaccination record cards can be redesigned by the pharmacy.

c) Report administration data to your jurisdiction's system (e.g., IIS) within 72 hours after administration. Any provider who is enrolled in the COVID-19 Vaccination Program, must comply with certain documentation requirements. Document each vaccine administered in your medical record system within 24 hours. Report administration data to your jurisdiction's system (which is likely your state's Immunization Information system, or IIS) within 72 hours Emergency Use Authorization (EUA) Fact Sheets must be provided before vaccination to inform of benefits and risks Each patient receives an official COVID-19 vaccination record card provided by the CDC to document patient name, date of birth, and medical record or IIS number, Vaccine name, manufacturer, and lot number, date administered, and site or provider If any of the following occur, you must report them to the Vaccine Adverse Event Reporting System, or VAERS: Vaccine administration errors, Serious adverse events, Multisystem inflammatory syndrome, or any Cases of COVID-19 that result in hospitalization or death after the recipient has received COVID-19 vaccine

When promoting a mass immunization clinic it is helpful to: a) Explain how the cold chain will be maintained. b) Ask patients to bring their own first aid supplies. c) Share appointment scheduling instructions, if applicable.

c) Share appointment scheduling instructions, if applicable. If there is an option or requirement for scheduling appointments, instructions for how to do so must be communicated.

When administering an intramuscular injection, pharmacists should: a) Insert the needle at a 45-degree angle. b) Administer the vaccine in the deltoid or gluteus maximus. c) Use a 22- to 25-gauge needle. d) Tell patients to flex the muscle into which the vaccine will be injected.

c) Use a 22- to 25-gauge needle. Intramuscular vaccines should be administered with 22- to 25-gauge needles. Intramuscular vaccines should be administered with 22- to 25-gauge needles. The needle should be inserted at a 90-degree angle. Injections should be administered in the deltoid, or the anterolateral thigh for children. Vaccines should never be administered in the gluteus maximus due to proximity to the sciatic nerve. Patients should be told to relax prior to the injection. Injections should be administered in the deltoid, or the anterolateral thigh for children. Vaccines should never be administered in the gluteus maximus due to proximity to the sciatic nerve. Patients should be told to relax prior to the injection.

The program which collects data regarding errors of vaccine handling and administration is called: a) VICP b) VIT c) VERP d) VAERS

c) VERP VERP-Vaccine Error Reporting Program- is the program run by the Institute of Safe Medical Practices to collect data regarding errors of vaccine handling and administration. VAERS- Vaccine Adverse Event Reporting System is a National vaccine post-marketing safety surveillance program of the CDC and the FDA with a goal to identify potential vaccine safety issues to detect serious, rare, or unexpected events. VIT- Vaccine Injury Table is a list of adverse events covered for liability under the federal no-fault VICP. VICP- Vaccine Injury Compensation Program- helps to reduce malpractice risks. The VICP provides a no-fault insurance fund that covers vaccine-related injuries listed in the Vaccine Injury Table. The intent of the VICP is to balance an individual patient's risk of harm from a vaccine adverse event with society's benefit from having vaccines available that reduce disease transmission.

Which of the following vaccines are best suited to a mass immunization clinic? a) Childhood vaccines b) Vaccines for high-risk patient populations c) Vaccines to address a pandemic pathogen d) Travel health vaccine needs

c) Vaccines to address a pandemic pathogen Mass vaccination clinics are most appropriate for situations in which a large number of people need to be vaccinated in a short period of time, such as in response to a pathogen that is causing a pandemic.

A 10 year-old child received one dose of the hepatitis A vaccine at 1 year of age, but never returned for a second dose. Which of the following is true regarding the need for a second dose of the hepatitis A vaccine for this child? a) Wait until the child is 18 years of age and give the second dose if there are other risk factors b) No further doses of hepatitis A vaccine are required c) Give 1 dose now as catch up d) Restart the series and give 2 doses , 6 months apart

c) give one dose now as a catch up Using the child and adolescent schedule, a 10 year old who received 1 hepatitis A vaccine at 1 year of age would be in the green zone, which is catch up. No routinely recommended vaccine series needs to be restarted for lapsed intervals. Give 1 dose now. There is no need to wait until18 years as the child can be vaccinated now. A hepatitis A series is considered complete after 2 doses.

Which of the following is true regarding the use of mRNA in vaccine technology? a) mRNA vaccine technology requires replication similar to a live attenuated vaccine. b) mRNA vaccine technology elicits its immune response and protects the host by altering the host's DNA c) mRNA is the genetic blueprint that tells your body how to make a particular protein subunit of a virus which, after being produced, will elicit an immune response. d) mRNA is extremely stable in a host's body.

c) mRNA is the genetic blueprint that tells your body how to make a particular protein subunit of a virus which, after being produced, will elicit an immune response. mRNA vaccine technology elicits an immune response in the host by entering the cytoplasm of a host cell and providing a blueprint on how to create a particular protein subunit of a virus. Once produced, the protein will elicit an immune response. mRNA is unstable in the body. To protect the mRNA, it is encapsulated in lipid nanoparticles. mRNA vaccines do not alter a host's DNA.

A male patient presents to the pharmacy for a shingles vaccine appointment. The patient is a new patient to the pharmacy. Which of the following information would be most appropriate to collect as part of the patient care process? a) Patient's age, eye color, and allergies b) Patient's age and vaccine history c) Patient's age, current health, vaccine history, and allergies d) current health and allergies

c) patient's age, current health, vaccine history, and allergies The patient should be assessed for their general health to determine 1) if they could be indicated for another vaccine and 2) to assess if they are acutely ill. A complete assessment of allergies should occur at every visit to determine if they are allergic to the vaccine or a component of the vaccine. Lastly, patient age should be assessed to determine if the patient is in fact eligible to receive the vaccine based on current recommendations. As this vaccine is not a live vaccine, assessing immunosuppression and previously administered antibody-containing products and vaccines do not apply.

An adolescent received his first meningococcal conjugate quadrivalent (MenACWY) vaccine at age 13 years, when should he receive his booster dose? a) 14 years b) 20 years c) no booster is needed d) 16 years

d) 16 years Adolescents who receive their first MenACWY dose at age 11 or 12 should get a booster dose at age 16. For adolescents who miss these doses, the catch-up schedule allows 1 dose to be given at ages 13 through 15, with the booster at ages 16 through 18, so long as there are at least 8 weeks between doses.

A contraindication to receiving a COVID-19 vaccination includes: a) Any immediate allergic reaction to other vaccines or injectable therapies. b) Receipt of COVID-19 vaccine the same day the patient receives an influenza vaccination. c) People with a contraindication to mRNA COVID-19 vaccines who request the Janssen COVID-19 vaccine. d) A known (diagnosed) allergy to a component of a COVID-19 vaccine.

d) A known (diagnosed) allergy to a component of a COVID-19 vaccine. As with any vaccine, a severe allergic reaction (such as anaphylaxis) after a previous dose or to a component in the vaccine is a contraindication. A known (diagnosed) allergy to a component of a COVID-19 vaccine is also a contraindication Any immediate allergic reaction to other vaccines or injectable therapies is a precaution. Note that people with a contraindication to mRNA COVID-19 vaccines have a precaution to Janssen COVID-19 vaccine, and vice versa. COVID-19 vaccines may be administered before, at the same time, or after other vaccines.

Which statement is true regarding gloves and handwashing? a) Pharmacists do not need to wash or use antiseptic cleansers on their hands while providing immunizations if they are wearing gloves. b) Gloves are required to be worn while administering vaccines by the CDC and OSHA. c) It is recommended to keep gloves on for the duration of a clinic and not change them between patients. d) Employers must make available to employees appropriately sized gloves and a hand washing facility or antiseptic hand cleansers for employees to use while providing immunizations.

d) Employers must make available to employees appropriately sized gloves and a hand washing facility or antiseptic hand cleansers for employees to use while providing immunizations. Gloves are regarded as personal protective equipment. Though they are not required to be worn by the CDC or OSHA, employers must provide appropriately sized gloves and make them available for employees providing immunizations. If gloves are worn, pharmacists should change gloves between patients. Employers must also make available a hand washing station and/or antiseptic hand cleanser for employees to use while providing immunizations. Hands should be cleansed with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing the vaccine and between each patient contact. When antiseptic hand cleansers are used, pharmacists should wash their hands with soap and running water as soon as possible.

Which of the following statements is true when operating a mass vaccination clinic? a) Patients do not need to be provided with Vaccine Information Stations. b) The clinic does not need to be able to accommodate patients with disabilities. c) do not need to be observed after vaccination. d) If multiple vaccines are available, they should be administered at different stations.

d) If multiple vaccines are available, they should be administered at different stations. If multiple vaccines are available, different vaccines should be administered at different stations to reduce administration errors.

The whooping cough associated with pertussis occurs in this stage of disease: a) Catarrhal b) Convalescence c) Initial d) Paroxysmal

d) Paroxysmal In the case of pertussis, paroxysmal describes a recurring bursts of numerous, rapid coughs. This is the body's attempt to expel the mucus and inflammation from the infection. At the end of the cough, a long inspiratory effort occurs that is usually accompanied by a high-pitched whoop. This whooping sound is how pertussis got its nickname the whooping cough.

Which of the following is true regarding 3rd dose and booster doses for COVID-19? a) Booster doses must always be from the same product as the primary series. b) Booster doses for all COVID-19 vaccinations are given 6 months after completing the primary series. c) A homologous booster dose is a subsequent dose of the vaccine that is a different product than the primary series. d) The third dose and booster dose recommendations for immunocompromised patients are only for mRNA vaccines.

d) The third dose and booster dose recommendations for immunocompromised patients are only for mRNA vaccines. Patients who are immunocompromised don't always mount an adequate immune response following vaccination. This was found to be the case with the COVID-19 mRNA vaccines. After two doses, they still didn't have the same level of protection as those who were immunocompetent—effectiveness was 77% among immunocompromised patients and 90% for immunocompetent patients. Therefore, a third dose is recommended for those who are moderately and severely immunocompromised. It should be given at least 28 days following the second dose of the 2-dose mRNA series. Use the same product to complete this 3-dose primary series. These individuals should still receive a booster dose 6 months later. The vaccine selected as the booster dose may be the same product as the primary series, which is termed a homologous booster dose, or it may be a different vaccine product. This mix-and-match approach is referred to as a heterologous booster dose. If it was a 2-dose mRNA vaccine, then give the booster 6 months after the 2nd dose was given. If it was the Janssen vaccine, which is only one dose, then the booster is given 2 months later. Homologous booster dose: a subsequent dose of vaccine that is the same product as the primary series

Which of the following correctly describes current ACIP recommendations? a) Patients ≥ 13 years without prior evidence of immunity should only receive one dose of varicella zoster vaccine. b) The herpes zoster vaccine should be given to patients ≥40 years. c) The varicella zoster vaccine should be given at birth. d) The varicella zoster vaccine should be given at 12-15 months and 4-6 years of age.

d) The varicella zoster vaccine should be given at 12-15 months and 4-6 years of age. ACIP recommends varicella zoster vaccine at age 12-15 months and a second dose at 4-6 years of age. It is also indicated for patients ≥13 years of age without prior evidence of immunity and would be given as two doses 4-8 weeks apart. The only vaccination administered at birth is Hepatitis B vaccination. The herpes zoster vaccination is indicated for patients ≥50 years of age.

Which of the following is the primary reason we have measles outbreaks in the U.S.? a) Low effectiveness of the MMR vaccine b) There is a shortage of MMR vaccine in the U.S. c) Low MMR vaccination rates nationally d) Unvaccinated people with measles coming to the U.S.

d) Unvaccinated people with measles coming to the U.S. Imported measles is the main source of measles outbreaks in the U.S. We have high MMR vaccination rates nationally while some communities and schools may have very low vaccination rates, which help to sustain measles transmission. The MMR vaccine is very effective even compared to other vaccines. There is no shortage of MMR in the U.S.