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Vaccine APhA

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1
1 point

Which of the following influenza vaccines would be appropriate to recommend for a 7-month-old girl?

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The Fluzone quadrivalent vaccine is approved for individuals ages 6 months and older. The Fluzone High-Dose IIV3 is approved for ages 65 years and older. There is also a Fluzone Intradermal vaccine, which is approved for 18 through 64 years of age. Flublock is the trivalent recombinant influenza vaccine (RIV3) which is approved for individuals 18 years of age and older. Fluad is the adjuvanted IIV3 approved for individuals ages 65 years and older.

2
1 point

Which of the following patients would be an appropriate candidate for adjuvanted influenza vaccine (aIIV3)?

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The adjuvanted inactivated influenza vaccine, trivalent (aIIV3) is approved for individuals aged 65 years and older. Because it is an inactivated vaccine, it can be given to patients regardless of medical condition. In fact, someone who has diabetes is higher risk for influenza-related complications and should be vaccinated against influenza. An individual younger than 65 years would need to receive either the trivalent or quadrivalent unadjuvanted standard-dose influenza vaccine. Note that age indications vary depending on the type of vaccine used.

3
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Missy is a 36-year-old woman with diabetes mellitus. She requests a refill of her insulin on November 1. She has completed the primary series of MMR, DTaP, and hepatitis A vaccines, and she received a dose of Tdap 2 years ago. She had a physician-confirmed case of chickenpox as a child. Missy is not pregnant. Which of the following vaccines should Missy receive?

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Because Missy has diabetes both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines she needs. Having diabetes means she is high-risk for pneumococcal disease, hepatitis B, and influenza-related complications. She will need the PPSV23, hepatitis B, and influenza vaccines. She does not need Td for another 8 years. HPV is recommended up through age 26 so she does not need this vaccine.

4
1 point

Which of the following patients would be a candidate now for revaccination with PPSV23?

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Individuals at high-risk for pneumococcal disease may require one, two, or three doses of PPSV23, depending on age and condition. When revaccination is necessary, the interval between doses should be 5 years. For example, if someone under the age of 65 at high-risk for pneumococcal disease received either one or two doses of PPSV23, another dose would be given when the patient turns 65. However, there needs to be 5 years in between doses. Once a dose has been given at age 65 years or older, no additional doses are recommended.

5
1 point

Which of these vaccines is an inactivated vaccine?

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Diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (DTaP) is an inactivated vaccine. The varicella (VAR), rotavirus (RV5), and measles, mumps, and rubella (MMR) vaccines are all live vaccines.

6
1 point

Among all states in the United States, which of the following is the youngest minimum patient age for vaccination by a pharmacist allowed by a state?

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State laws and practice acts dictate the ages of individuals who may receive vaccines from pharmacists. As such, these vary by state. As of July 2016, 28 states permitted pharmacists to vaccinate individuals of any age. However, some of these states may require individual prescriptions or limit the type of vaccines that may be administered.

7
1 point

Olivia, a 9-year-old girl, has no record of ever receiving an influenza vaccination. She has a fear of needles. The only medication she receives on a regular basis is albuterol. Which of the following would be an appropriate recommendation for an influenza vaccination for Olivia?

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Olivia is a candidate for influenza vaccine and would receive one dose of inactivated influenza vaccine (IIV). LAIV is approved for healthy individuals ages 2 through 49 years. It should not be used in people with asthma. However, in light of the evidence for poor effectiveness of LAIV in the U.S. over the last three influenza seasons (2013-2016), the ACIP has made the interimrecommendation that LAIV should not be used in anyone. Even though Olivia has a fear of needles, she will still need to receive an intramuscular injection. Two doses (separated by four weeks) of inactivated influenza vaccine (IIV) should be given to children ages 6 months through 8 years who are receiving influenza vaccine for the first time or who have not previously received at least 2 doses of trivalent or quadrivalent influenza vaccine before July 1.

8
1 point

Which of the following best describes IIV intradermal administration?

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Epinephrine is the first-line treatment of choice for acute anaphylaxis. Epinephrine is dosed on the basis of the patient’s body weight. Aqueous epinephrine (1 mg/mL preparation) should be administered at a dose of 0.01 mg/kg/dose, up to a maximum of 0.5 mg per dose. Note that 0.01 mg equals 0.01 mL. Some providers may use auto-injectors that contain fixed doses (i.e., 0.15 mg or 0.3 mg). These doses will vary depending on the age and weight of the patient.

9
1 point

Which of the following is the recommended schedule for administration of the hepatitis A vaccine?

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The hepatitis A vaccine is given as a two-dose series at least 6 months apart. The dose for individuals 18 years and younger is 0.5 mL IM and 1 mL IM for those 19 years and older.

10
1 point

Which of the following is the correct dose and route of administration for the high-dose influenza vaccine?

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High-dose inactivated influenza vaccine is approved for adults ages 65 years and older. The dose is 0.5 mL intramuscularly into the deltoid muscle.

11
1 point

Before administering a vaccine covered by the Vaccine Injury Compensation Program (VICP), the National Childhood Vaccine Injury Compensation Act requires vaccine providers to provide a vaccine information statement to all patients:

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The National Vaccine Injury Compensation Program (VICP) was established under the National Childhood Vaccine Injury Act (NCVIA) in 1986. The VICP offers a no-fault approach to dealing with petitions related to injuries from certain vaccines. The vaccines that fall within VICP include most of the vaccines routinely recommended by ACIP. VICP applies to any individual of any age. One stipulation to this no-fault approach is that a current Vaccine Information Statement (VIS) must be given to the individual or caregiver prior to vaccination.

12
1 point

Which of the following patients would be a ACIP recommended candidate for PPSV23?

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The 23-valent pneumococcal polysaccharide vaccine is recommended for all adults age 65 years an older and those 2 years of age and older who are considered high-risk for pneumococcal disease. These individuals are immunocompromised, those with cerebrospinal fluid leak or cochlear implants, those with diabetes, chronic heart disease, chronic lung disease, chronic liver disease, and alcoholism, and those ages 19 through 64 with asthma or who smoke cigarettes. Children with asthma would only be candidates for PPSV23 if they are treated with high-dose corticosteroids. A case of shingles is not considered a risk factor for pneumococcal disease.

13
1 point

Which of these vaccines must replicate to stimulate an immune response?

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MMR is a live attenuated vaccine. Live attenuated vaccines are produced by weakening the virus or bacteria to reduce the likelihood that it can cause disease. Live attenuated vaccines tend to produce more persistent, longer-lasting immunity than inactivated vaccines. Live attenuated vaccines must replicate in order for the body to produce an immune response. 9vHPV, MCV4, and Tdap are inactivated vaccines. Inactivated vaccines are produced by killing the virus or bacteria. They include polysaccharide vaccines (which can be conjugated or unconjugated), toxoids, or cellular vaccines (which can be viruses or bacteria, or fractions of either).

14
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Liz, a 37-year-old woman, was diagnosed with HIV 2 months ago. She received one dose of MCV4 at that time and is now getting her 2nd dose. Which of the following would be an appropriate recommendation for MCV4 vaccination for Liz?

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According to ACIP, adults with human immunodeficiency virus (HIV) infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY (MCV4) at least 2 months apart. Following the 2nd dose, they should be revaccinated every 5 years. Children who completed the primary series at ages 2 months through 6 years and remain at high risk for meningococcal disease should receive another dose after 3 years. Booster doses are given every 5 years after that.

15
1 point

Which of the following best describes immunization coalitions?

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Immunization coalitions are organizations that foster collaboration among stakeholders to increase immunization rates. They vary in size and structure and can include people who are dedicated to vaccination activities at local, state, national, and international levels.

16
1 point

Which of the following patients would be an appropriate candidate for the HPV vaccine?

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The HPV vaccine is recommended for all adolescents ages 11 through 12 years of age. It may be given as early as age 9 if there is a history of sexual abuse or assault. Females through 26 years of age and males through 21 years of age should receive HPV vaccine if they did not previously get vaccinated. Males 22 through 26 years of age may receive the HPV vaccine if they were not previously vaccinated if protection against HPV is warranted.

17
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Lily is a 15-month-old girl who is up to date with her vaccinations. Which of the following tetanus toxoid-containing vaccines would be appropriate for Lily?

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DTaP contains higher amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years of age to avoid injection site reactions in adolescents and adults. Individuals 7 years of age and older who need protection against tetanus, diphtheria, and pertussis should receive Tdap, not DTaP. Since Lily is up to date, she would have already received the first three doses of DTaP at ages 2, 4, and 6 months. Her fourth dose is to be given at ages 15 through 18 months. The fifth and final dose is given at ages 4 through 6 years. At ages 11 through 12 years, she would receive a dose of Tdap, followed by Td every 10 years. DT is reserved for children who should not receive acellular pertussis-containing vaccines.

18
1 point

Theresa is a 23-year-old woman with rheumatoid arthritis who is treated with immunosuppressive therapies. Which of the following vaccines should be avoided for Theresa?

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As a general rule, live vaccines should be avoided in patients with altered immunocompetence. Varicella is a live vaccine and is contraindicated. Live attenuated vaccines must replicate in order for the body to produce an immune response. If given to a patient with a compromised immune system, there is a chance they could replicate in an uncontrolled fashion and cause disease. Herpes zoster vaccine may be given to patients with low-level immunosuppression and rotavirus vaccine can be given to immunocompromised children, unless they have severe combined immunodeficiency (SCID). Additionally, if the immune system is not working properly, an adequate immune response may not occur following vaccination. This is true for live and inactivated vaccines. Tdap, hepatitis B, and PPSV23 vaccines are inactivated and can be given to patients with compromised immune systems, however, they may be less effective than in those who are immunocompetent.

19
1 point

Which of the following statements best describes the approach to take with patients regarding simultaneous administration of vaccines?

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In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person’s immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines. Delaying vaccination and using alternative schedules increases the time during which children are susceptible to diseases. With more unprotected children, the chance of an outbreak spreading increases.

20
1 point

Vaccines should be avoided or delayed for which of the following patients?

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Before giving any vaccine, it is important to determine how the patient is feeling. It is okay to administer vaccines if the patient has a mild illness, such as low-grade fever, mild respiratory tract infection, mild diarrhea, or otitis media. However, if the patient has moderate to severe acute illness that requires additional care, it is advised to defer vaccination until the illness resolves. Smallpox and yellow fever vaccines are the only vaccines that should not be administered to a woman who is breastfeeding—all routinely recommended vaccines are safe to administer. Vaccine schedules do not need to be altered if a child is born prematurely. A newborn whose mother is HIV positive is not a precaution or contraindication to receiving vaccines.

21
1 point

Which of the following live vaccines is recommended to be administered prior to one year of age?

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The majority of live vaccines should not be administered to children less than 1 year of age. This is due to the presence of circulating antibodies passed along to the child from the mother. The vaccine would not be effective because the antibodies may interfere with a live attenuated vaccine’s ability to replicate. The exception to this is the rotavirus vaccine, which is given to all infants beginning at age 2 months. The first doses of the varicella and MMR vaccines are given at age 1 year. The live attenuated influenza vaccine, which is the intranasal influenza vaccine, is approved for ages 2 through 49 years. However, LAIV is not currently recommended due to failure to demonstrate efficacy.

22
1 point

Which age group is appropriate to receive the 2-dose HPV9 vaccine series?

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The 2-dose schedule of the 9-valent HPV vaccine is approved and recommended for immunocompetent males and females ages 9 through 14 years. It is routinely recommended for ages 11 through 12 years. If the series is begun after the 15th birthday, then 3 doses should be given at 0, 1 to 2, and 6 months.

23
1 point

Which of the following should be one of the first steps involved in establishing a pharmacy-based immunization program?

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A crucial step when establishing immunization services is deciding which vaccines to offer. The vaccines that pharmacists are permitted to administer vary from state to state. Pharmacists must determine what is allowed by state laws and regulations where they practice. This is an important first step as it will dictate vaccine supply acquisition, marketing initiatives, and billing procedures.

24
1 point

Which of the following statements is true about risks associated with vaccines and vaccine-preventable diseases?

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Vaccine-preventable diseases are still prevalent throughout the world and many of the outbreaks in the US have been attributed to international travelers. A substantial and authoritative body of research has investigated potential links between vaccines and autism and found no association. Additionally, there is no scientific evidence showing any short- or long-term harm from exposure to thimerosal in vaccines. There is no objective evidence that autoimmune diseases are caused by vaccinations. They occur at the same rates among vaccinated and unvaccinated people. In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person’s immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines.

25
1 point

Which of the following is a requirement of the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard?

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The OSHA bloodborne pathogens standard states that training for employees on the standard be provided annually. Universal precautions, which is treating all blood and bodily fluids as if they are infectious, should always be observed. Hepatitis B vaccination should be offered at no charge to all employees with exposure risk. Needles should not be recapped after use – this greatly increases the chance of a needle stick. Influenza is not considered a BBP exposure risk and influenza vaccination is not included in the Standard.

26
1 point

What is the most appropriate recommendation for administering Tdap to pregnant patients?

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One dose of Tdap should be administered to women during each pregnancy, preferably within 27 – 36 weeks gestation (third trimester) to protect newborns against pertussis. This allows for maternal antibody transfer to the newborn who is too young to be vaccinated with DTaP. In fact, when given earlier in this time frame (28 to 32 weeks), there were higher titers in the infants when compared to later in this time frame (33 to 36 weeks). As such, the 27 to 36 window to give Tdap is still advised but with the added caveat that giving it sooner within this range will provide the maximum antibody transfer. There is a concern that giving Tdap earlier than the third trimester may result in the waning of antibody titers before the infants are old enough to be vaccinated.

27
1 point

Which of the following types of vaccines represents an opportunity to collaborate with physicians to meet the needs of the community?

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When a vaccine requires a series of doses for adequate protection, it can sometimes be challenging to get individuals to return for follow-up doses. Collaborating with other health care professionals to make vaccine access easier is one way to increase vaccination for the additional doses needed in the series. For instance, if the first dose was given in the physician’s office, instead of scheduling another office appointment, the patient could then be referred to the local pharmacy for the additional doses.

28
1 point

Which influenza vaccine is approved to be used with the jet injector needle-free system?

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The FDA must approve each specific medication that is administered via a jet injector needle-free system. The only vaccines approved for such use are Afluria and Afluria Quadrivalent. This approval is for individuals ages 18 through 64 years.

29
1 point

Which of the following vaccines should be administered to boys and young men aged 9 through 26 years to reduce their likelihood of acquiring genital warts?

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HPV types 16, 18, 31, 33, 45, 52, and 58 account for approximately 85% to 90% of all cervical cancers. These are considered the high-risk types.In addition to cervical cancer, high-risk HPV has been associated with vulvar, vaginal, anal, penile, oral, and pharyngeal cancers.Low-risk HPV types (e.g., 6, 11) cause the majority of cases of genital warts. The 9-valent HPV vaccine (9vHPV or HPV9) covers types 6, 11, 16, 18, 31, 33, 45, 52, and 58. It is indicated for males and females ages 9 through 26 years to protect against cancers and genital warts.

30
1 point

Which of the following is a provider factor associated with low vaccination rates in adults?

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There are a variety of factors that may present barriers to increasing vaccination coverage in adults. These include patient, provider, and system factors, as well as a complex vaccination schedule for adults. Patient factors include a lack of adequate insurance coverage, inconvenient access, and lack of a regular health care provider. Provider factors include inadequate focus on preventive services, failure to make vaccine recommendations, and lack of effective recall and reminder systems. System factors include minimal to no requirements to be vaccinated and varying state regulations.

31
1 point

Which of the following best describes how to administer hepatitis B vaccine to an adult man who weighs 225 lbs?

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The hepatitis B vaccine is administered intramuscularly at a 90-degree angle. In older children and adults, it should be injected into the deltoid muscle. The weight of the patient does not change the site of injection.

32
1 point

Larry is a 65-year-old man with heart disease who comes to the pharmacy to refill a prescription on October 21. His immunization record indicates that he has completed the primary series of DTaP, MMR, hepatitis B, and hepatitis A. His last Td booster dose was 12 years ago. In addition to influenza, which of the following vaccines should Larry receive?

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Because Larry has heart disease both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines he needs. Both PCV13 and PPSV23 are recommended for all patients when they turn age 65. PPSV23 is also recommended for patients with heart disease. Larry will need to receive PCV13 now and PPSV23 in 12 months. Tdap is recommended for all adults who have not previously received Tdap. Adults ages 60 and older need herpes zoster vaccine. Since he was born before 1980, he does not need varicella vaccine.

33
1 point

Five minutes after receiving a vaccine, a patient tells you that his face "feels funny" and he is starting to feel itchy all over. You notice that his lips are swollen. Which of the following would be the most appropriate action to take?

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If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Prepare your staff for a potential emergency situation. If you suspect anaphylaxis, then you instruct a staff member to call 911. You would then prepare and administer epinephrine. The patient should not take him or herself to the emergency department. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. While diphenhydramine is sometimes used in conjunction with epinephrine, it is typically given intravenously. Epinephrine remains first-line treatment for anaphylaxis.
34
1 point

Vaccines evoke an immune response because they contain:

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Vaccines contain antigens that stimulate an immune response and result in immunologic memory. B cells are activated in this process. Except for pure polysaccharide vaccines, T cells are also activated and are able to generate additional B cells. B cells express unique receptors that recognize and bind to only one particular antigen. B cells are the major cells involved in the creation of antibodies that circulate in blood plasma and lymph. This is referred to as humoral immunity. B cells mature to plasma cells and antibodies that help the body eliminate the antigen are formed.

35
1 point

Which of the following statements best describes recommendations for vaccine administration during pregnancy?

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There are two vaccines recommended during pregnancy. Tdap should be given with each pregnancy in the beginning of the third trimester (27 to 36 weeks gestation). Influenza vaccine is recommended if the woman is pregnant during flu season. It can be given in any trimester. Live vaccines are a temporary contraindication during pregnancy. They should be administered after the woman gives birth. There is no risk to a pregnant woman who is in close contact with someone who received a live vaccine. There is also no risk if pregnant providers administer live vaccines.

36
1 point

Hugh, a 56-year-old health care worker, has no laboratory evidence of immunity to measles or mumps and cannot confirm that he had either disease. How many doses of MMR vaccine should Hugh receive?

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At age 56, Hugh would have been born after 1957. Health care personnel born in or after 1957 without evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease should receive two doses of MMR. Evidence of immunity includes laboratory evidence or documentation of vaccination. Provider diagnosis is not adequate evidence of immunity.

37
1 point

Which of the following is the minimum needle length recommended for intramuscular administration of the influenza vaccine to an adult woman weighing 215 lbs?

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When giving intramuscular injections to adults, the ACIP provides recommendations for needle length based on gender and weight. This is to help ensure the vaccine is injected into muscle tissue. Women who weigh more than 200 lbs and men who weigh more than 260 pounds should use a 1.5 inch needle. A 1 inch needle is used for men and women who weigh less than 152 lbs. Those with weights in between these parameters would use either a 1 or 1.5 inch needle. A 5/8 inch needle is used for subcutaneous injections. A ½ inch needle should never be used for vaccine administration.

38
1 point

The majority of cases of vasovagal syncope occur within which of the following time frames following vaccination?

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Fainting, or vasovagal syncope, is a brief loss of consciousness. Although it is not that common, if fainting occurs following vaccination, it is usually within 5 to 15 minutes. It is important to vaccinate patients while they are seated or lying down and observe them for at least 15 minutes following vaccination.

39
1 point

Which of the following is the youngest age at which a child should receive inactivated influenza vaccine?

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Influenza vaccination is universally recommended for all individuals beginning at 6 months of age. The vaccines recommended prior to 6 months include hepatitis B (given at birth), rotavirus, DTaP, Hib, PCV13, and IPV.

40
1 point

Which of the following is a symptom of a true allergic reaction?

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An allergic response to a vaccine is considered an immediate (or type I) hypersensitivity reaction. It typically occurs within minutes to an hour of vaccination. Such an allergic reaction can include itching, erythema, hives, urticarial, and anaphylaxis. Fever, headache, and GI distress are not considered allergic reactions to vaccines.

41
1 point

What could potentially happen if an intramuscular vaccine is administered too high?

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If a vaccine is injected into or around the bursa, which surrounds the shoulder joint, severe, persistent shoulder pain and lack of function may occur. In fact, Shoulder Injury Related to Vaccine Administration (SIRVA) has now been added to the Vaccine Injury Table in accordance with the National Vaccine Injury Compensation Program (VICP). Proper injection technique is important to avoid this type of injury. Intramuscular vaccines should be administered in the thickest, most central portion of the deltoid muscle.

42
1 point

If a patient experiences symptoms of anaphylaxis, which of the following would be the first action to take?

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If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Prepare your staff for a potential emergency situation. If you suspect anaphylaxis, then you instruct a staff member to call 911. You would then prepare and administer epinephrine. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. While diphenhydramine is sometimes used in conjunction with epinephrine, it is typically given intravenously. Epinephrine remains first-line treatment for anaphylaxis.

43
0 points

Albert is a 61-year-old man who wants to receive the herpes zoster vaccine. He is up to date on his other immunizations and reports receiving his inactivated influenza vaccine two weeks ago. Which of the following would be the best recommendation to make regarding the herpes zoster vaccine for Albert?

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The herpes zoster vaccine is a live vaccine and is recommended for those ages 60 and older. Inactivated vaccines do not interfere with the immune response to other vaccines, live or inactivated. There is no need to observe any minimum interval between doses of two different inactivated vaccines, nor between combinations of inactivated and live vaccines. The concern is when two live vaccines are not administered at the same clinic visit. If two live vaccines are not given simultaneously, at least 4 weeks must pass before giving the other live vaccine.

44
1 point

A patient who reports an allergy to eggs but is able to eat lightly cooked eggs (e.g., scrambled eggs) without a reaction could receive which of the following influenza vaccines?

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Someone who is able to eat lightly cooked egg without a reaction is not likely to be allergic to eggs. Any recommended influenza vaccine can be administered. Furthermore, individuals with a history of egg allergy who have experienced only urticaria (hives) after exposure to egg should receive any recommended influenza vaccine. A person with a more severe reaction to egg can also receive any recommended influenza vaccine, but it should be administered by a health care provider who is trained and equipped to manage a severe allergic reaction.

45
1 point

Within a few minutes after receiving a vaccine, a patient reports not feeling well and would like a drink of water. Which of the following would be the most appropriate action to take?

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If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Assess the patient’s symptoms and vital signs. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. Prepare your staff for a potential emergency situation. If the condition worsens and you suspect anaphylaxis, then you would prepare and administer epinephrine. A sugar-containing beverage would only be warranted if the patient was experiencing hypoglycemia.

1 1 point Which of the following influenza vaccines would be appropriate to recommend for a 7-month-old girl? Feedback The Fluzone quadrivalent vaccine is approved for individuals ages 6 months and older. The Fluzone High-Dose IIV3 is approved for ages 65 years and older. There is also a Fluzone Intradermal vaccine, which is approved for 18 through 64 years of age. Flublock is the trivalent recombinant influenza vaccine (RIV3) which is approved for individuals 18 years of age and older. Fluad is the adjuvanted IIV3 approved for individuals ages 65 years and older. 2 1 point Which of the following patients would be an appropriate candidate for adjuvanted influenza vaccine (aIIV3)? Feedback The adjuvanted inactivated influenza vaccine, trivalent (aIIV3) is approved for individuals aged 65 years and older. Because it is an inactivated vaccine, it can be given to patients regardless of medical condition. In fact, someone who has diabetes is higher risk for influenza-related complications and should be vaccinated against influenza. An individual younger than 65 years would need to receive either the trivalent or quadrivalent unadjuvanted standard-dose influenza vaccine. Note that age indications vary depending on the type of vaccine used. 3 1 point Missy is a 36-year-old woman with diabetes mellitus. She requests a refill of her insulin on November 1. She has completed the primary series of MMR, DTaP, and hepatitis A vaccines, and she received a dose of Tdap 2 years ago. She had a physician-confirmed case of chickenpox as a child. Missy is not pregnant. Which of the following vaccines should Missy receive? Feedback Because Missy has diabetes both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines she needs. Having diabetes means she is high-risk for pneumococcal disease, hepatitis B, and influenza-related complications. She will need the PPSV23, hepatitis B, and influenza vaccines. She does not need Td for another 8 years. HPV is recommended up through age 26 so she does not need this vaccine. 4 1 point Which of the following patients would be a candidate now for revaccination with PPSV23? Feedback Individuals at high-risk for pneumococcal disease may require one, two, or three doses of PPSV23, depending on age and condition. When revaccination is necessary, the interval between doses should be 5 years. For example, if someone under the age of 65 at high-risk for pneumococcal disease received either one or two doses of PPSV23, another dose would be given when the patient turns 65. However, there needs to be 5 years in between doses. Once a dose has been given at age 65 years or older, no additional doses are recommended. 5 1 point Which of these vaccines is an inactivated vaccine? Feedback Diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (DTaP) is an inactivated vaccine. The varicella (VAR), rotavirus (RV5), and measles, mumps, and rubella (MMR) vaccines are all live vaccines. 6 1 point Among all states in the United States, which of the following is the youngest minimum patient age for vaccination by a pharmacist allowed by a state? Feedback State laws and practice acts dictate the ages of individuals who may receive vaccines from pharmacists. As such, these vary by state. As of July 2016, 28 states permitted pharmacists to vaccinate individuals of any age. However, some of these states may require individual prescriptions or limit the type of vaccines that may be administered. 7 1 point Olivia, a 9-year-old girl, has no record of ever receiving an influenza vaccination. She has a fear of needles. The only medication she receives on a regular basis is albuterol. Which of the following would be an appropriate recommendation for an influenza vaccination for Olivia? Feedback Olivia is a candidate for influenza vaccine and would receive one dose of inactivated influenza vaccine (IIV). LAIV is approved for healthy individuals ages 2 through 49 years. It should not be used in people with asthma. However, in light of the evidence for poor effectiveness of LAIV in the U.S. over the last three influenza seasons (2013-2016), the ACIP has made the interimrecommendation that LAIV should not be used in anyone. Even though Olivia has a fear of needles, she will still need to receive an intramuscular injection. Two doses (separated by four weeks) of inactivated influenza vaccine (IIV) should be given to children ages 6 months through 8 years who are receiving influenza vaccine for the first time or who have not previously received at least 2 doses of trivalent or quadrivalent influenza vaccine before July 1. 8 1 point Which of the following best describes IIV intradermal administration? Feedback Epinephrine is the first-line treatment of choice for acute anaphylaxis. Epinephrine is dosed on the basis of the patient’s body weight. Aqueous epinephrine (1 mg/mL preparation) should be administered at a dose of 0.01 mg/kg/dose, up to a maximum of 0.5 mg per dose. Note that 0.01 mg equals 0.01 mL. Some providers may use auto-injectors that contain fixed doses (i.e., 0.15 mg or 0.3 mg). These doses will vary depending on the age and weight of the patient. 9 1 point Which of the following is the recommended schedule for administration of the hepatitis A vaccine? Feedback The hepatitis A vaccine is given as a two-dose series at least 6 months apart. The dose for individuals 18 years and younger is 0.5 mL IM and 1 mL IM for those 19 years and older. 10 1 point Which of the following is the correct dose and route of administration for the high-dose influenza vaccine? Feedback High-dose inactivated influenza vaccine is approved for adults ages 65 years and older. The dose is 0.5 mL intramuscularly into the deltoid muscle. 11 1 point Before administering a vaccine covered by the Vaccine Injury Compensation Program (VICP), the National Childhood Vaccine Injury Compensation Act requires vaccine providers to provide a vaccine information statement to all patients: Feedback The National Vaccine Injury Compensation Program (VICP) was established under the National Childhood Vaccine Injury Act (NCVIA) in 1986. The VICP offers a no-fault approach to dealing with petitions related to injuries from certain vaccines. The vaccines that fall within VICP include most of the vaccines routinely recommended by ACIP. VICP applies to any individual of any age. One stipulation to this no-fault approach is that a current Vaccine Information Statement (VIS) must be given to the individual or caregiver prior to vaccination. 12 1 point Which of the following patients would be a ACIP recommended candidate for PPSV23? Feedback The 23-valent pneumococcal polysaccharide vaccine is recommended for all adults age 65 years an older and those 2 years of age and older who are considered high-risk for pneumococcal disease. These individuals are immunocompromised, those with cerebrospinal fluid leak or cochlear implants, those with diabetes, chronic heart disease, chronic lung disease, chronic liver disease, and alcoholism, and those ages 19 through 64 with asthma or who smoke cigarettes. Children with asthma would only be candidates for PPSV23 if they are treated with high-dose corticosteroids. A case of shingles is not considered a risk factor for pneumococcal disease. 13 1 point Which of these vaccines must replicate to stimulate an immune response? Feedback MMR is a live attenuated vaccine. Live attenuated vaccines are produced by weakening the virus or bacteria to reduce the likelihood that it can cause disease. Live attenuated vaccines tend to produce more persistent, longer-lasting immunity than inactivated vaccines. Live attenuated vaccines must replicate in order for the body to pro
duce an immune response. 9vHPV, MCV4, and Tdap are inactivated vaccines. Inactivated vaccines are produced by killing the virus or bacteria. They include polysaccharide vaccines (which can be conjugated or unconjugated), toxoids, or cellular vaccines (which can be viruses or bacteria, or fractions of either). 14 1 point Liz, a 37-year-old woman, was diagnosed with HIV 2 months ago. She received one dose of MCV4 at that time and is now getting her 2nd dose. Which of the following would be an appropriate recommendation for MCV4 vaccination for Liz? Feedback According to ACIP, adults with human immunodeficiency virus (HIV) infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY (MCV4) at least 2 months apart. Following the 2nd dose, they should be revaccinated every 5 years. Children who completed the primary series at ages 2 months through 6 years and remain at high risk for meningococcal disease should receive another dose after 3 years. Booster doses are given every 5 years after that. 15 1 point Which of the following best describes immunization coalitions? Feedback Immunization coalitions are organizations that foster collaboration among stakeholders to increase immunization rates. They vary in size and structure and can include people who are dedicated to vaccination activities at local, state, national, and international levels. 16 1 point Which of the following patients would be an appropriate candidate for the HPV vaccine? Feedback The HPV vaccine is recommended for all adolescents ages 11 through 12 years of age. It may be given as early as age 9 if there is a history of sexual abuse or assault. Females through 26 years of age and males through 21 years of age should receive HPV vaccine if they did not previously get vaccinated. Males 22 through 26 years of age may receive the HPV vaccine if they were not previously vaccinated if protection against HPV is warranted. 17 1 point Lily is a 15-month-old girl who is up to date with her vaccinations. Which of the following tetanus toxoid-containing vaccines would be appropriate for Lily? Feedback DTaP contains higher amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years of age to avoid injection site reactions in adolescents and adults. Individuals 7 years of age and older who need protection against tetanus, diphtheria, and pertussis should receive Tdap, not DTaP. Since Lily is up to date, she would have already received the first three doses of DTaP at ages 2, 4, and 6 months. Her fourth dose is to be given at ages 15 through 18 months. The fifth and final dose is given at ages 4 through 6 years. At ages 11 through 12 years, she would receive a dose of Tdap, followed by Td every 10 years. DT is reserved for children who should not receive acellular pertussis-containing vaccines. 18 1 point Theresa is a 23-year-old woman with rheumatoid arthritis who is treated with immunosuppressive therapies. Which of the following vaccines should be avoided for Theresa? Feedback As a general rule, live vaccines should be avoided in patients with altered immunocompetence. Varicella is a live vaccine and is contraindicated. Live attenuated vaccines must replicate in order for the body to produce an immune response. If given to a patient with a compromised immune system, there is a chance they could replicate in an uncontrolled fashion and cause disease. Herpes zoster vaccine may be given to patients with low-level immunosuppression and rotavirus vaccine can be given to immunocompromised children, unless they have severe combined immunodeficiency (SCID). Additionally, if the immune system is not working properly, an adequate immune response may not occur following vaccination. This is true for live and inactivated vaccines. Tdap, hepatitis B, and PPSV23 vaccines are inactivated and can be given to patients with compromised immune systems, however, they may be less effective than in those who are immunocompetent. 19 1 point Which of the following statements best describes the approach to take with patients regarding simultaneous administration of vaccines? Feedback In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person’s immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines. Delaying vaccination and using alternative schedules increases the time during which children are susceptible to diseases. With more unprotected children, the chance of an outbreak spreading increases. 20 1 point Vaccines should be avoided or delayed for which of the following patients? Feedback Before giving any vaccine, it is important to determine how the patient is feeling. It is okay to administer vaccines if the patient has a mild illness, such as low-grade fever, mild respiratory tract infection, mild diarrhea, or otitis media. However, if the patient has moderate to severe acute illness that requires additional care, it is advised to defer vaccination until the illness resolves. Smallpox and yellow fever vaccines are the only vaccines that should not be administered to a woman who is breastfeeding—all routinely recommended vaccines are safe to administer. Vaccine schedules do not need to be altered if a child is born prematurely. A newborn whose mother is HIV positive is not a precaution or contraindication to receiving vaccines. 21 1 point Which of the following live vaccines is recommended to be administered prior to one year of age? Feedback The majority of live vaccines should not be administered to children less than 1 year of age. This is due to the presence of circulating antibodies passed along to the child from the mother. The vaccine would not be effective because the antibodies may interfere with a live attenuated vaccine’s ability to replicate. The exception to this is the rotavirus vaccine, which is given to all infants beginning at age 2 months. The first doses of the varicella and MMR vaccines are given at age 1 year. The live attenuated influenza vaccine, which is the intranasal influenza vaccine, is approved for ages 2 through 49 years. However, LAIV is not currently recommended due to failure to demonstrate efficacy. 22 1 point Which age group is appropriate to receive the 2-dose HPV9 vaccine series? Feedback The 2-dose schedule of the 9-valent HPV vaccine is approved and recommended for immunocompetent males and females ages 9 through 14 years. It is routinely recommended for ages 11 through 12 years. If the series is begun after the 15th birthday, then 3 doses should be given at 0, 1 to 2, and 6 months. 23 1 point Which of the following should be one of the first steps involved in establishing a pharmacy-based immunization program? Feedback A crucial step when establishing immunization services is deciding which vaccines to offer. The vaccines that pharmacists are permitted to administer vary from state to state. Pharmacists must determine what is allowed by state laws and regulations where they practice. This is an important first step as it will dictate vaccine supply acquisition, marketing initiatives, and billing procedures. 24 1 point Which of the following statements is true about risks associated with vaccines and vaccine-preventable diseases? Feedback Vaccine-preventable diseases are still prevalent throughout the world and many of the outbreaks in the US have been attributed to international travelers. A substantial and authoritative body of research has investigated potential links between vaccines and autism and found no association. Additionally, there is no scientific evidence showing any short- or long-term harm from exposure to thimerosal in vaccines. There is no objective evidence that autoimmune diseases are caused by vaccinations. They occur at the same rates among vaccinated a
nd unvaccinated people. In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person’s immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines. 25 1 point Which of the following is a requirement of the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard? Feedback The OSHA bloodborne pathogens standard states that training for employees on the standard be provided annually. Universal precautions, which is treating all blood and bodily fluids as if they are infectious, should always be observed. Hepatitis B vaccination should be offered at no charge to all employees with exposure risk. Needles should not be recapped after use – this greatly increases the chance of a needle stick. Influenza is not considered a BBP exposure risk and influenza vaccination is not included in the Standard. 26 1 point What is the most appropriate recommendation for administering Tdap to pregnant patients? Feedback One dose of Tdap should be administered to women during each pregnancy, preferably within 27 – 36 weeks gestation (third trimester) to protect newborns against pertussis. This allows for maternal antibody transfer to the newborn who is too young to be vaccinated with DTaP. In fact, when given earlier in this time frame (28 to 32 weeks), there were higher titers in the infants when compared to later in this time frame (33 to 36 weeks). As such, the 27 to 36 window to give Tdap is still advised but with the added caveat that giving it sooner within this range will provide the maximum antibody transfer. There is a concern that giving Tdap earlier than the third trimester may result in the waning of antibody titers before the infants are old enough to be vaccinated. 27 1 point Which of the following types of vaccines represents an opportunity to collaborate with physicians to meet the needs of the community? Feedback When a vaccine requires a series of doses for adequate protection, it can sometimes be challenging to get individuals to return for follow-up doses. Collaborating with other health care professionals to make vaccine access easier is one way to increase vaccination for the additional doses needed in the series. For instance, if the first dose was given in the physician’s office, instead of scheduling another office appointment, the patient could then be referred to the local pharmacy for the additional doses. 28 1 point Which influenza vaccine is approved to be used with the jet injector needle-free system? Feedback The FDA must approve each specific medication that is administered via a jet injector needle-free system. The only vaccines approved for such use are Afluria and Afluria Quadrivalent. This approval is for individuals ages 18 through 64 years. 29 1 point Which of the following vaccines should be administered to boys and young men aged 9 through 26 years to reduce their likelihood of acquiring genital warts? Feedback HPV types 16, 18, 31, 33, 45, 52, and 58 account for approximately 85% to 90% of all cervical cancers. These are considered the high-risk types.In addition to cervical cancer, high-risk HPV has been associated with vulvar, vaginal, anal, penile, oral, and pharyngeal cancers.Low-risk HPV types (e.g., 6, 11) cause the majority of cases of genital warts. The 9-valent HPV vaccine (9vHPV or HPV9) covers types 6, 11, 16, 18, 31, 33, 45, 52, and 58. It is indicated for males and females ages 9 through 26 years to protect against cancers and genital warts. 30 1 point Which of the following is a provider factor associated with low vaccination rates in adults? Feedback There are a variety of factors that may present barriers to increasing vaccination coverage in adults. These include patient, provider, and system factors, as well as a complex vaccination schedule for adults. Patient factors include a lack of adequate insurance coverage, inconvenient access, and lack of a regular health care provider. Provider factors include inadequate focus on preventive services, failure to make vaccine recommendations, and lack of effective recall and reminder systems. System factors include minimal to no requirements to be vaccinated and varying state regulations. 31 1 point Which of the following best describes how to administer hepatitis B vaccine to an adult man who weighs 225 lbs? Feedback The hepatitis B vaccine is administered intramuscularly at a 90-degree angle. In older children and adults, it should be injected into the deltoid muscle. The weight of the patient does not change the site of injection. 32 1 point Larry is a 65-year-old man with heart disease who comes to the pharmacy to refill a prescription on October 21. His immunization record indicates that he has completed the primary series of DTaP, MMR, hepatitis B, and hepatitis A. His last Td booster dose was 12 years ago. In addition to influenza, which of the following vaccines should Larry receive? Feedback Because Larry has heart disease both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines he needs. Both PCV13 and PPSV23 are recommended for all patients when they turn age 65. PPSV23 is also recommended for patients with heart disease. Larry will need to receive PCV13 now and PPSV23 in 12 months. Tdap is recommended for all adults who have not previously received Tdap. Adults ages 60 and older need herpes zoster vaccine. Since he was born before 1980, he does not need varicella vaccine. 33 1 point Five minutes after receiving a vaccine, a patient tells you that his face "feels funny" and he is starting to feel itchy all over. You notice that his lips are swollen. Which of the following would be the most appropriate action to take? Feedback If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Prepare your staff for a potential emergency situation. If you suspect anaphylaxis, then you instruct a staff member to call 911. You would then prepare and administer epinephrine. The patient should not take him or herself to the emergency department. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. While diphenhydramine is sometimes used in conjunction with epinephrine, it is typically given intravenously. Epinephrine remains first-line treatment for anaphylaxis. 34 1 point Vaccines evoke an immune response because they contain: Feedback Vaccines contain antigens that stimulate an immune response and result in immunologic memory. B cells are activated in this process. Except for pure polysaccharide vaccines, T cells are also activated and are able to generate additional B cells. B cells express unique receptors that recognize and bind to only one particular antigen. B cells are the major cells involved in the creation of antibodies that circulate in blood plasma and lymph. This is referred to as humoral immunity. B cells mature to plasma cells and antibodies that help the body eliminate the antigen are formed. 35 1 point Which of the following statements best describes recommendations for vaccine administration during pregnancy? Feedback There are two vaccines recommended during pregnancy. Tdap should be given with each pregnancy in the beginning of the third trimester (27 to 36 weeks gestation). Influenza vaccine is recommended if the woman is pregnant during flu season. It can be given in any trimester. Live vaccines are a temporary contraindication during pregnancy. They should be administered after the woman gives birth. There is no risk to a pregnant woman who
is in close contact with someone who received a live vaccine. There is also no risk if pregnant providers administer live vaccines. 36 1 point Hugh, a 56-year-old health care worker, has no laboratory evidence of immunity to measles or mumps and cannot confirm that he had either disease. How many doses of MMR vaccine should Hugh receive? Feedback At age 56, Hugh would have been born after 1957. Health care personnel born in or after 1957 without evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease should receive two doses of MMR. Evidence of immunity includes laboratory evidence or documentation of vaccination. Provider diagnosis is not adequate evidence of immunity. 37 1 point Which of the following is the minimum needle length recommended for intramuscular administration of the influenza vaccine to an adult woman weighing 215 lbs? Feedback When giving intramuscular injections to adults, the ACIP provides recommendations for needle length based on gender and weight. This is to help ensure the vaccine is injected into muscle tissue. Women who weigh more than 200 lbs and men who weigh more than 260 pounds should use a 1.5 inch needle. A 1 inch needle is used for men and women who weigh less than 152 lbs. Those with weights in between these parameters would use either a 1 or 1.5 inch needle. A 5/8 inch needle is used for subcutaneous injections. A ½ inch needle should never be used for vaccine administration. 38 1 point The majority of cases of vasovagal syncope occur within which of the following time frames following vaccination? Feedback Fainting, or vasovagal syncope, is a brief loss of consciousness. Although it is not that common, if fainting occurs following vaccination, it is usually within 5 to 15 minutes. It is important to vaccinate patients while they are seated or lying down and observe them for at least 15 minutes following vaccination. 39 1 point Which of the following is the youngest age at which a child should receive inactivated influenza vaccine? Feedback Influenza vaccination is universally recommended for all individuals beginning at 6 months of age. The vaccines recommended prior to 6 months include hepatitis B (given at birth), rotavirus, DTaP, Hib, PCV13, and IPV. 40 1 point Which of the following is a symptom of a true allergic reaction? Feedback An allergic response to a vaccine is considered an immediate (or type I) hypersensitivity reaction. It typically occurs within minutes to an hour of vaccination. Such an allergic reaction can include itching, erythema, hives, urticarial, and anaphylaxis. Fever, headache, and GI distress are not considered allergic reactions to vaccines. 41 1 point What could potentially happen if an intramuscular vaccine is administered too high? Feedback If a vaccine is injected into or around the bursa, which surrounds the shoulder joint, severe, persistent shoulder pain and lack of function may occur. In fact, Shoulder Injury Related to Vaccine Administration (SIRVA) has now been added to the Vaccine Injury Table in accordance with the National Vaccine Injury Compensation Program (VICP). Proper injection technique is important to avoid this type of injury. Intramuscular vaccines should be administered in the thickest, most central portion of the deltoid muscle. 42 1 point If a patient experiences symptoms of anaphylaxis, which of the following would be the first action to take? Feedback If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Prepare your staff for a potential emergency situation. If you suspect anaphylaxis, then you instruct a staff member to call 911. You would then prepare and administer epinephrine. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. While diphenhydramine is sometimes used in conjunction with epinephrine, it is typically given intravenously. Epinephrine remains first-line treatment for anaphylaxis. 43 0 points Albert is a 61-year-old man who wants to receive the herpes zoster vaccine. He is up to date on his other immunizations and reports receiving his inactivated influenza vaccine two weeks ago. Which of the following would be the best recommendation to make regarding the herpes zoster vaccine for Albert? Feedback The herpes zoster vaccine is a live vaccine and is recommended for those ages 60 and older. Inactivated vaccines do not interfere with the immune response to other vaccines, live or inactivated. There is no need to observe any minimum interval between doses of two different inactivated vaccines, nor between combinations of inactivated and live vaccines. The concern is when two live vaccines are not administered at the same clinic visit. If two live vaccines are not given simultaneously, at least 4 weeks must pass before giving the other live vaccine. 44 1 point A patient who reports an allergy to eggs but is able to eat lightly cooked eggs (e.g., scrambled eggs) without a reaction could receive which of the following influenza vaccines? Feedback Someone who is able to eat lightly cooked egg without a reaction is not likely to be allergic to eggs. Any recommended influenza vaccine can be administered. Furthermore, individuals with a history of egg allergy who have experienced only urticaria (hives) after exposure to egg should receive any recommended influenza vaccine. A person with a more severe reaction to egg can also receive any recommended influenza vaccine, but it should be administered by a health care provider who is trained and equipped to manage a severe allergic reaction. 45 1 point Within a few minutes after receiving a vaccine, a patient reports not feeling well and would like a drink of water. Which of the following would be the most appropriate action to take? Feedback If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Assess the patient’s symptoms and vital signs. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. Prepare your staff for a potential emergency situation. If the condition worsens and you suspect anaphylaxis, then you would prepare and administer epinephrine. A sugar-containing beverage would only be warranted if the patient was experiencing hypoglycemia.

1
1 point

Which of the following influenza vaccines would be appropriate to recommend for a 7-month-old girl?

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The Fluzone quadrivalent vaccine is approved for individuals ages 6 months and older. The Fluzone High-Dose IIV3 is approved for ages 65 years and older. There is also a Fluzone Intradermal vaccine, which is approved for 18 through 64 years of age. Flublock is the trivalent recombinant influenza vaccine (RIV3) which is approved for individuals 18 years of age and older. Fluad is the adjuvanted IIV3 approved for individuals ages 65 years and older.

2
1 point

Which of the following patients would be an appropriate candidate for adjuvanted influenza vaccine (aIIV3)?

Feedback

The adjuvanted inactivated influenza vaccine, trivalent (aIIV3) is approved for individuals aged 65 years and older. Because it is an inactivated vaccine, it can be given to patients regardless of medical condition. In fact, someone who has diabetes is higher risk for influenza-related complications and should be vaccinated against influenza. An individual younger than 65 years would need to receive either the trivalent or quadrivalent unadjuvanted standard-dose influenza vaccine. Note that age indications vary depending on the type of vaccine used.

3
1 point

Missy is a 36-year-old woman with diabetes mellitus. She requests a refill of her insulin on November 1. She has completed the primary series of MMR, DTaP, and hepatitis A vaccines, and she received a dose of Tdap 2 years ago. She had a physician-confirmed case of chickenpox as a child. Missy is not pregnant. Which of the following vaccines should Missy receive?

Feedback

Because Missy has diabetes both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines she needs. Having diabetes means she is high-risk for pneumococcal disease, hepatitis B, and influenza-related complications. She will need the PPSV23, hepatitis B, and influenza vaccines. She does not need Td for another 8 years. HPV is recommended up through age 26 so she does not need this vaccine.

4
1 point

Which of the following patients would be a candidate now for revaccination with PPSV23?

Feedback

Individuals at high-risk for pneumococcal disease may require one, two, or three doses of PPSV23, depending on age and condition. When revaccination is necessary, the interval between doses should be 5 years. For example, if someone under the age of 65 at high-risk for pneumococcal disease received either one or two doses of PPSV23, another dose would be given when the patient turns 65. However, there needs to be 5 years in between doses. Once a dose has been given at age 65 years or older, no additional doses are recommended.

5
1 point

Which of these vaccines is an inactivated vaccine?

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Diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (DTaP) is an inactivated vaccine. The varicella (VAR), rotavirus (RV5), and measles, mumps, and rubella (MMR) vaccines are all live vaccines.

6
1 point

Among all states in the United States, which of the following is the youngest minimum patient age for vaccination by a pharmacist allowed by a state?

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State laws and practice acts dictate the ages of individuals who may receive vaccines from pharmacists. As such, these vary by state. As of July 2016, 28 states permitted pharmacists to vaccinate individuals of any age. However, some of these states may require individual prescriptions or limit the type of vaccines that may be administered.

7
1 point

Olivia, a 9-year-old girl, has no record of ever receiving an influenza vaccination. She has a fear of needles. The only medication she receives on a regular basis is albuterol. Which of the following would be an appropriate recommendation for an influenza vaccination for Olivia?

Feedback

Olivia is a candidate for influenza vaccine and would receive one dose of inactivated influenza vaccine (IIV). LAIV is approved for healthy individuals ages 2 through 49 years. It should not be used in people with asthma. However, in light of the evidence for poor effectiveness of LAIV in the U.S. over the last three influenza seasons (2013-2016), the ACIP has made the interimrecommendation that LAIV should not be used in anyone. Even though Olivia has a fear of needles, she will still need to receive an intramuscular injection. Two doses (separated by four weeks) of inactivated influenza vaccine (IIV) should be given to children ages 6 months through 8 years who are receiving influenza vaccine for the first time or who have not previously received at least 2 doses of trivalent or quadrivalent influenza vaccine before July 1.

8
1 point

Which of the following best describes IIV intradermal administration?

Feedback

Epinephrine is the first-line treatment of choice for acute anaphylaxis. Epinephrine is dosed on the basis of the patient’s body weight. Aqueous epinephrine (1 mg/mL preparation) should be administered at a dose of 0.01 mg/kg/dose, up to a maximum of 0.5 mg per dose. Note that 0.01 mg equals 0.01 mL. Some providers may use auto-injectors that contain fixed doses (i.e., 0.15 mg or 0.3 mg). These doses will vary depending on the age and weight of the patient.

9
1 point

Which of the following is the recommended schedule for administration of the hepatitis A vaccine?

Feedback

The hepatitis A vaccine is given as a two-dose series at least 6 months apart. The dose for individuals 18 years and younger is 0.5 mL IM and 1 mL IM for those 19 years and older.

10
1 point

Which of the following is the correct dose and route of administration for the high-dose influenza vaccine?

Feedback

High-dose inactivated influenza vaccine is approved for adults ages 65 years and older. The dose is 0.5 mL intramuscularly into the deltoid muscle.

11
1 point

Before administering a vaccine covered by the Vaccine Injury Compensation Program (VICP), the National Childhood Vaccine Injury Compensation Act requires vaccine providers to provide a vaccine information statement to all patients:

Feedback

The National Vaccine Injury Compensation Program (VICP) was established under the National Childhood Vaccine Injury Act (NCVIA) in 1986. The VICP offers a no-fault approach to dealing with petitions related to injuries from certain vaccines. The vaccines that fall within VICP include most of the vaccines routinely recommended by ACIP. VICP applies to any individual of any age. One stipulation to this no-fault approach is that a current Vaccine Information Statement (VIS) must be given to the individual or caregiver prior to vaccination.

12
1 point

Which of the following patients would be a ACIP recommended candidate for PPSV23?

Feedback

The 23-valent pneumococcal polysaccharide vaccine is recommended for all adults age 65 years an older and those 2 years of age and older who are considered high-risk for pneumococcal disease. These individuals are immunocompromised, those with cerebrospinal fluid leak or cochlear implants, those with diabetes, chronic heart disease, chronic lung disease, chronic liver disease, and alcoholism, and those ages 19 through 64 with asthma or who smoke cigarettes. Children with asthma would only be candidates for PPSV23 if they are treated with high-dose corticosteroids. A case of shingles is not considered a risk factor for pneumococcal disease.

13
1 point

Which of these vaccines must replicate to stimulate an immune response?

Feedback

MMR is a live attenuated vaccine. Live attenuated vaccines are produced by weakening the virus or bacteria to reduce the likelihood that it can cause disease. Live attenuated vaccines tend to produce more persistent, longer-lasting immunity than inactivated vaccines. Live attenuated vaccines must replicate in order for the body to produce an immune response. 9vHPV, MCV4, and Tdap are inactivated vaccines. Inactivated vaccines are produced by killing the virus or bacteria. They include polysaccharide vaccines (which can be conjugated or unconjugated), toxoids, or cellular vaccines (which can be viruses or bacteria, or fractions of either).

14
1 point

Liz, a 37-year-old woman, was diagnosed with HIV 2 months ago. She received one dose of MCV4 at that time and is now getting her 2nd dose. Which of the following would be an appropriate recommendation for MCV4 vaccination for Liz?

Feedback

According to ACIP, adults with human immunodeficiency virus (HIV) infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY (MCV4) at least 2 months apart. Following the 2nd dose, they should be revaccinated every 5 years. Children who completed the primary series at ages 2 months through 6 years and remain at high risk for meningococcal disease should receive another dose after 3 years. Booster doses are given every 5 years after that.

15
1 point

Which of the following best describes immunization coalitions?

Feedback

Immunization coalitions are organizations that foster collaboration among stakeholders to increase immunization rates. They vary in size and structure and can include people who are dedicated to vaccination activities at local, state, national, and international levels.

16
1 point

Which of the following patients would be an appropriate candidate for the HPV vaccine?

Feedback

The HPV vaccine is recommended for all adolescents ages 11 through 12 years of age. It may be given as early as age 9 if there is a history of sexual abuse or assault. Females through 26 years of age and males through 21 years of age should receive HPV vaccine if they did not previously get vaccinated. Males 22 through 26 years of age may receive the HPV vaccine if they were not previously vaccinated if protection against HPV is warranted.

17
1 point

Lily is a 15-month-old girl who is up to date with her vaccinations. Which of the following tetanus toxoid-containing vaccines would be appropriate for Lily?

Feedback

DTaP contains higher amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years of age to avoid injection site reactions in adolescents and adults. Individuals 7 years of age and older who need protection against tetanus, diphtheria, and pertussis should receive Tdap, not DTaP. Since Lily is up to date, she would have already received the first three doses of DTaP at ages 2, 4, and 6 months. Her fourth dose is to be given at ages 15 through 18 months. The fifth and final dose is given at ages 4 through 6 years. At ages 11 through 12 years, she would receive a dose of Tdap, followed by Td every 10 years. DT is reserved for children who should not receive acellular pertussis-containing vaccines.

18
1 point

Theresa is a 23-year-old woman with rheumatoid arthritis who is treated with immunosuppressive therapies. Which of the following vaccines should be avoided for Theresa?

Feedback
As a general rule, live vaccines should be avoided in patients with altered immunocompetence. Varicella is a live vaccine and is contraindicated. Live attenuated vaccines must replicate in order for the body to produce an immune response. If given to a patient with a compromised immune system, there is a chance they could replicate in an uncontrolled fashion and cause disease. Herpes zoster vaccine may be given to patients with low-level immunosuppression and rotavirus vaccine can be given to immunocompromised children, unless they have severe combined immunodeficiency (SCID). Additionally, if the immune system is not working properly, an adequate immune response may not occur following vaccination. This is true for live and inactivated vaccines. Tdap, hepatitis B, and PPSV23 vaccines are inactivated and can be given to patients with compromised immune systems, however, they may be less effective than in those who are immunocompetent.

19
1 point

Which of the following statements best describes the approach to take with patients regarding simultaneous administration of vaccines?

Feedback

In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person’s immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines. Delaying vaccination and using alternative schedules increases the time during which children are susceptible to diseases. With more unprotected children, the chance of an outbreak spreading increases.

20
1 point

Vaccines should be avoided or delayed for which of the following patients?

Feedback
Before giving any vaccine, it is important to determine how the patient is feeling. It is okay to administer vaccines if the patient has a mild illness, such as low-grade fever, mild respiratory tract infection, mild diarrhea, or otitis media. However, if the patient has moderate to severe acute illness that requires additional care, it is advised to defer vaccination until the illness resolves. Smallpox and yellow fever vaccines are the only vaccines that should not be administered to a woman who is breastfeeding—all routinely recommended vaccines are safe to administer. Vaccine schedules do not need to be altered if a child is born prematurely. A newborn whose mother is HIV positive is not a precaution or contraindication to receiving vaccines.

21
1 point

Which of the following live vaccines is recommended to be administered prior to one year of age?

Feedback

The majority of live vaccines should not be administered to children less than 1 year of age. This is due to the presence of circulating antibodies passed along to the child from the mother. The vaccine would not be effective because the antibodies may interfere with a live attenuated vaccine’s ability to replicate. The exception to this is the rotavirus vaccine, which is given to all infants beginning at age 2 months. The first doses of the varicella and MMR vaccines are given at age 1 year. The live attenuated influenza vaccine, which is the intranasal influenza vaccine, is approved for ages 2 through 49 years. However, LAIV is not currently recommended due to failure to demonstrate efficacy.

22
1 point

Which age group is appropriate to receive the 2-dose HPV9 vaccine series?

Feedback

The 2-dose schedule of the 9-valent HPV vaccine is approved and recommended for immunocompetent males and females ages 9 through 14 years. It is routinely recommended for ages 11 through 12 years. If the series is begun after the 15th birthday, then 3 doses should be given at 0, 1 to 2, and 6 months.

23
1 point

Which of the following should be one of the first steps involved in establishing a pharmacy-based immunization program?

Feedback

A crucial step when establishing immunization services is deciding which vaccines to offer. The vaccines that pharmacists are permitted to administer vary from state to state. Pharmacists must determine what is allowed by state laws and regulations where they practice. This is an important first step as it will dictate vaccine supply acquisition, marketing initiatives, and billing procedures.

24
1 point

Which of the following statements is true about risks associated with vaccines and vaccine-preventable diseases?

Feedback

Vaccine-preventable diseases are still prevalent throughout the world and many of the outbreaks in the US have been attributed to international travelers. A substantial and authoritative body of research has investigated potential links between vaccines and autism and found no association. Additionally, there is no scientific evidence showing any short- or long-term harm from exposure to thimerosal in vaccines. There is no objective evidence that autoimmune diseases are caused by vaccinations. They occur at the same rates among vaccinated and unvaccinated people. In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person’s immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines.

25
1 point

Which of the following is a requirement of the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard?

Feedback
The OSHA bloodborne pathogens standard states that training for employees on the standard be provided annually. Universal precautions, which is treating all blood and bodily fluids as if they are infectious, should always be observed. Hepatitis B vaccination should be offered at no charge to all employees with exposure risk. Needles should not be recapped after use – this greatly increases the chance of a needle stick. Influenza is not considered a BBP exposure risk and influenza vaccination is not included in the Standard.

26
1 point

What is the most appropriate recommendation for administering Tdap to pregnant patients?

Feedback

One dose of Tdap should be administered to women during each pregnancy, preferably within 27 – 36 weeks gestation (third trimester) to protect newborns against pertussis. This allows for maternal antibody transfer to the newborn who is too young to be vaccinated with DTaP. In fact, when given earlier in this time frame (28 to 32 weeks), there were higher titers in the infants when compared to later in this time frame (33 to 36 weeks). As such, the 27 to 36 window to give Tdap is still advised but with the added caveat that giving it sooner within this range will provide the maximum antibody transfer. There is a concern that giving Tdap earlier than the third trimester may result in the waning of antibody titers before the infants are old enough to be vaccinated.

27
1 point

Which of the following types of vaccines represents an opportunity to collaborate with physicians to meet the needs of the community?

Feedback

When a vaccine requires a series of doses for adequate protection, it can sometimes be challenging to get individuals to return for follow-up doses. Collaborating with other health care professionals to make vaccine access easier is one way to increase vaccination for the additional doses needed in the series. For instance, if the first dose was given in the physician’s office, instead of scheduling another office appointment, the patient could then be referred to the local pharmacy for the additional doses.

28
1 point

Which influenza vaccine is approved to be used with the jet injector needle-free system?

Feedback

The FDA must approve each specific medication that is administered via a jet injector needle-free system. The only vaccines approved for such use are Afluria and Afluria Quadrivalent. This approval is for individuals ages 18 through 64 years.

29
1 point

Which of the following vaccines should be administered to boys and young men aged 9 through 26 years to reduce their likelihood of acquiring genital warts?

Feedback

HPV types 16, 18, 31, 33, 45, 52, and 58 account for approximately 85% to 90% of all cervical cancers. These are considered the high-risk types.In addition to cervical cancer, high-risk HPV has been associated with vulvar, vaginal, anal, penile, oral, and pharyngeal cancers.Low-risk HPV types (e.g., 6, 11) cause the majority of cases of genital warts. The 9-valent HPV vaccine (9vHPV or HPV9) covers types 6, 11, 16, 18, 31, 33, 45, 52, and 58. It is indicated for males and females ages 9 through 26 years to protect against cancers and genital warts.

30
1 point

Which of the following is a provider factor associated with low vaccination rates in adults?

Feedback
There are a variety of factors that may present barriers to increasing vaccination coverage in adults. These include patient, provider, and system factors, as well as a complex vaccination schedule for adults. Patient factors include a lack of adequate insurance coverage, inconvenient access, and lack of a regular health care provider. Provider factors include inadequate focus on preventive services, failure to make vaccine recommendations, and lack of effective recall and reminder systems. System factors include minimal to no requirements to be vaccinated and varying state regulations.

31
1 point

Which of the following best describes how to administer hepatitis B vaccine to an adult man who weighs 225 lbs?

Feedback

The hepatitis B vaccine is administered intramuscularly at a 90-degree angle. In older children and adults, it should be injected into the deltoid muscle. The weight of the patient does not change the site of injection.

32
1 point

Larry is a 65-year-old man with heart disease who comes to the pharmacy to refill a prescription on October 21. His immunization record indicates that he has completed the primary series of DTaP, MMR, hepatitis B, and hepatitis A. His last Td booster dose was 12 years ago. In addition to influenza, which of the following vaccines should Larry receive?

Feedback

Because Larry has heart disease both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines he needs. Both PCV13 and PPSV23 are recommended for all patients when they turn age 65. PPSV23 is also recommended for patients with heart disease. Larry will need to receive PCV13 now and PPSV23 in 12 months. Tdap is recommended for all adults who have not previously received Tdap. Adults ages 60 and older need herpes zoster vaccine. Since he was born before 1980, he does not need varicella vaccine.

33
1 point

Five minutes after receiving a vaccine, a patient tells you that his face "feels funny" and he is starting to feel itchy all over. You notice that his lips are swollen. Which of the following would be the most appropriate action to take?

Feedback

If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Prepare your staff for a potential emergency situation. If you suspect anaphylaxis, then you instruct a staff member to call 911. You would then prepare and administer epinephrine. The patient should not take him or herself to the emergency department. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. While diphenhydramine is sometimes used in conjunction with epinephrine, it is typically given intravenously. Epinephrine remains first-line treatment for anaphylaxis.
34
1 point

Vaccines evoke an immune response because they contain:

Feedback

Vaccines contain antigens that stimulate an immune response and result in immunologic memory. B cells are activated in this process. Except for pure polysaccharide vaccines, T cells are also activated and are able to generate additional B cells. B cells express unique receptors that recognize and bind to only one particular antigen. B cells are the major cells involved in the creation of antibodies that circulate in blood plasma and lymph. This is referred to as humoral immunity. B cells mature to plasma cells and antibodies that help the body eliminate the antigen are formed.

35
1 point

Which of the following statements best describes recommendations for vaccine administration during pregnancy?

Feedback

There are two vaccines recommended during pregnancy. Tdap should be given with each pregnancy in the beginning of the third trimester (27 to 36 weeks gestation). Influenza vaccine is recommended if the woman is pregnant during flu season. It can be given in any trimester. Live vaccines are a temporary contraindication during pregnancy. They should be administered after the woman gives birth. There is no risk to a pregnant woman who is in close contact with someone who received a live vaccine. There is also no risk if pregnant providers administer live vaccines.

36
1 point

Hugh, a 56-year-old health care worker, has no laboratory evidence of immunity to measles or mumps and cannot confirm that he had either disease. How many doses of MMR vaccine should Hugh receive?

Feedback
At age 56, Hugh would have been born after 1957. Health care personnel born in or after 1957 without evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease should receive two doses of MMR. Evidence of immunity includes laboratory evidence or documentation of vaccination. Provider diagnosis is not adequate evidence of immunity.

37
1 point

Which of the following is the minimum needle length recommended for intramuscular administration of the influenza vaccine to an adult woman weighing 215 lbs?

Feedback

When giving intramuscular injections to adults, the ACIP provides recommendations for needle length based on gender and weight. This is to help ensure the vaccine is injected into muscle tissue. Women who weigh more than 200 lbs and men who weigh more than 260 pounds should use a 1.5 inch needle. A 1 inch needle is used for men and women who weigh less than 152 lbs. Those with weights in between these parameters would use either a 1 or 1.5 inch needle. A 5/8 inch needle is used for subcutaneous injections. A ½ inch needle should never be used for vaccine administration.

38
1 point

The majority of cases of vasovagal syncope occur within which of the following time frames following vaccination?

Feedback

Fainting, or vasovagal syncope, is a brief loss of consciousness. Although it is not that common, if fainting occurs following vaccination, it is usually within 5 to 15 minutes. It is important to vaccinate patients while they are seated or lying down and observe them for at least 15 minutes following vaccination.

39
1 point

Which of the following is the youngest age at which a child should receive inactivated influenza vaccine?

Feedback
Influenza vaccination is universally recommended for all individuals beginning at 6 months of age. The vaccines recommended prior to 6 months include hepatitis B (given at birth), rotavirus, DTaP, Hib, PCV13, and IPV.

40
1 point

Which of the following is a symptom of a true allergic reaction?

Feedback

An allergic response to a vaccine is considered an immediate (or type I) hypersensitivity reaction. It typically occurs within minutes to an hour of vaccination. Such an allergic reaction can include itching, erythema, hives, urticarial, and anaphylaxis. Fever, headache, and GI distress are not considered allergic reactions to vaccines.

41
1 point

What could potentially happen if an intramuscular vaccine is administered too high?

Feedback
If a vaccine is injected into or around the bursa, which surrounds the shoulder joint, severe, persistent shoulder pain and lack of function may occur. In fact, Shoulder Injury Related to Vaccine Administration (SIRVA) has now been added to the Vaccine Injury Table in accordance with the National Vaccine Injury Compensation Program (VICP). Proper injection technique is important to avoid this type of injury. Intramuscular vaccines should be administered in the thickest, most central portion of the deltoid muscle.

42
1 point

If a patient experiences symptoms of anaphylaxis, which of the following would be the first action to take?

Feedback

If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Prepare your staff for a potential emergency situation. If you suspect anaphylaxis, then you instruct a staff member to call 911. You would then prepare and administer epinephrine. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. While diphenhydramine is sometimes used in conjunction with epinephrine, it is typically given intravenously. Epinephrine remains first-line treatment for anaphylaxis.

43
0 points

Albert is a 61-year-old man who wants to receive the herpes zoster vaccine. He is up to date on his other immunizations and reports receiving his inactivated influenza vaccine two weeks ago. Which of the following would be the best recommendation to make regarding the herpes zoster vaccine for Albert?

Feedback

The herpes zoster vaccine is a live vaccine and is recommended for those ages 60 and older. Inactivated vaccines do not interfere with the immune response to other vaccines, live or inactivated. There is no need to observe any minimum interval between doses of two different inactivated vaccines, nor between combinations of inactivated and live vaccines. The concern is when two live vaccines are not administered at the same clinic visit. If two live vaccines are not given simultaneously, at least 4 weeks must pass before giving the other live vaccine.

44
1 point

A patient who reports an allergy to eggs but is able to eat lightly cooked eggs (e.g., scrambled eggs) without a reaction could receive which of the following influenza vaccines?

Feedback

Someone who is able to eat lightly cooked egg without a reaction is not likely to be allergic to eggs. Any recommended influenza vaccine can be administered. Furthermore, individuals with a history of egg allergy who have experienced only urticaria (hives) after exposure to egg should receive any recommended influenza vaccine. A person with a more severe reaction to egg can also receive any recommended influenza vaccine, but it should be administered by a health care provider who is trained and equipped to manage a severe allergic reaction.

45
1 point

Within a few minutes after receiving a vaccine, a patient reports not feeling well and would like a drink of water. Which of the following would be the most appropriate action to take?

Feedback

If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Assess the patient’s symptoms and vital signs. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. Prepare your staff for a potential emergency situation. If the condition worsens and you suspect anaphylaxis, then you would prepare and administer epinephrine. A sugar-containing beverage would only be warranted if the patient was experiencing hypoglycemia.

1 1 point Which of the following influenza vaccines would be appropriate to recommend for a 7-month-old girl? Feedback The Fluzone quadrivalent vaccine is approved for individuals ages 6 months and older. The Fluzone High-Dose IIV3 is approved for ages 65 years and older. There is also a Fluzone Intradermal vaccine, which is approved for 18 through 64 years of age. Flublock is the trivalent recombinant influenza vaccine (RIV3) which is approved for individuals 18 years of age and older. Fluad is the adjuvanted IIV3 approved for individuals ages 65 years and older. 2 1 point Which of the following patients would be an appropriate candidate for adjuvanted influenza vaccine (aIIV3)? Feedback The adjuvanted inactivated influenza vaccine, trivalent (aIIV3) is approved for individuals aged 65 years and older. Because it is an inactivated vaccine, it can be given to patients regardless of medical condition. In fact, someone who has diabetes is higher risk for influenza-related complications and should be vaccinated against influenza. An individual younger than 65 years would need to receive either the trivalent or quadrivalent unadjuvanted standard-dose influenza vaccine. Note that age indications vary depending on the type of vaccine used. 3 1 point Missy is a 36-year-old woman with diabetes mellitus. She requests a refill of her insulin on November 1. She has completed the primary series of MMR, DTaP, and hepatitis A vaccines, and she received a dose of Tdap 2 years ago. She had a physician-confirmed case of chickenpox as a child. Missy is not pregnant. Which of the following vaccines should Missy receive? Feedback Because Missy has diabetes both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines she needs. Having diabetes means she is high-risk for pneumococcal disease, hepatitis B, and influenza-related complications. She will need the PPSV23, hepatitis B, and influenza vaccines. She does not need Td for another 8 years. HPV is recommended up through age 26 so she does not need this vaccine. 4 1 point Which of the following patients would be a candidate now for revaccination with PPSV23? Feedback Individuals at high-risk for pneumococcal disease may require one, two, or three doses of PPSV23, depending on age and condition. When revaccination is necessary, the interval between doses should be 5 years. For example, if someone under the age of 65 at high-risk for pneumococcal disease received either one or two doses of PPSV23, another dose would be given when the patient turns 65. However, there needs to be 5 years in between doses. Once a dose has been given at age 65 years or older, no additional doses are recommended. 5 1 point Which of these vaccines is an inactivated vaccine? Feedback Diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (DTaP) is an inactivated vaccine. The varicella (VAR), rotavirus (RV5), and measles, mumps, and rubella (MMR) vaccines are all live vaccines. 6 1 point Among all states in the United States, which of the following is the youngest minimum patient age for vaccination by a pharmacist allowed by a state? Feedback State laws and practice acts dictate the ages of individuals who may receive vaccines from pharmacists. As such, these vary by state. As of July 2016, 28 states permitted pharmacists to vaccinate individuals of any age. However, some of these states may require individual prescriptions or limit the type of vaccines that may be administered. 7 1 point Olivia, a 9-year-old girl, has no record of ever receiving an influenza vaccination. She has a fear of needles. The only medication she receives on a regular basis is albuterol. Which of the following would be an appropriate recommendation for an influenza vaccination for Olivia? Feedback Olivia is a candidate for influenza vaccine and would receive one dose of inactivated influenza vaccine (IIV). LAIV is approved for healthy individuals ages 2 through 49 years. It should not be used in people with asthma. However, in light of the evidence for poor effectiveness of LAIV in the U.S. over the last three influenza seasons (2013-2016), the ACIP has made the interimrecommendation that LAIV should not be used in anyone. Even though Olivia has a fear of needles, she will still need to receive an intramuscular injection. Two doses (separated by four weeks) of inactivated influenza vaccine (IIV) should be given to children ages 6 months through 8 years who are receiving influenza vaccine for the first time or who have not previously received at least 2 doses of trivalent or quadrivalent influenza vaccine before July 1. 8 1 point Which of the following best describes IIV intradermal administration? Feedback Epinephrine is the first-line treatment of choice for acute anaphylaxis. Epinephrine is dosed on the basis of the patient’s body weight. Aqueous epinephrine (1 mg/mL preparation) should be administered at a dose of 0.01 mg/kg/dose, up to a maximum of 0.5 mg per dose. Note that 0.01 mg equals 0.01 mL. Some providers may use auto-injectors that contain fixed doses (i.e., 0.15 mg or 0.3 mg). These doses will vary depending on the age and weight of the patient. 9 1 point Which of the following is the recommended schedule for administration of the hepatitis A vaccine? Feedback The hepatitis A vaccine is given as a two-dose series at least 6 months apart. The dose for individuals 18 years and younger is 0.5 mL IM and 1 mL IM for those 19 years and older. 10 1 point Which of the following is the correct dose and route of administration for the high-dose influenza vaccine? Feedback High-dose inactivated influenza vaccine is approved for adults ages 65 years and older. The dose is 0.5 mL intramuscularly into the deltoid muscle. 11 1 point Before administering a vaccine covered by the Vaccine Injury Compensation Program (VICP), the National Childhood Vaccine Injury Compensation Act requires vaccine providers to provide a vaccine information statement to all patients: Feedback The National Vaccine Injury Compensation Program (VICP) was established under the National Childhood Vaccine Injury Act (NCVIA) in 1986. The VICP offers a no-fault approach to dealing with petitions related to injuries from certain vaccines. The vaccines that fall within VICP include most of the vaccines routinely recommended by ACIP. VICP applies to any individual of any age. One stipulation to this no-fault approach is that a current Vaccine Information Statement (VIS) must be given to the individual or caregiver prior to vaccination. 12 1 point Which of the following patients would be a ACIP recommended candidate for PPSV23? Feedback The 23-valent pneumococcal polysaccharide vaccine is recommended for all adults age 65 years an older and those 2 years of age and older who are considered high-risk for pneumococcal disease. These individuals are immunocompromised, those with cerebrospinal fluid leak or cochlear implants, those with diabetes, chronic heart disease, chronic lung disease, chronic liver disease, and alcoholism, and those ages 19 through 64 with asthma or who smoke cigarettes. Children with asthma would only be candidates for PPSV23 if they are treated with high-dose corticosteroids. A case of shingles is not considered a risk factor for pneumococcal disease. 13 1 point Which of these vaccines must replicate to stimulate an immune response? Feedback MMR is a live attenuated vaccine. Live attenuated vaccines are produced by weakening the virus or bacteria to reduce the likelihood that it can cause disease. Live attenuated vaccines tend to produce more persistent, longer-lasting immunity than inactivated vaccines. Live attenuated vaccines must replicate in order for the body to p
roduce an immune response. 9vHPV, MCV4, and Tdap are inactivated vaccines. Inactivated vaccines are produced by killing the virus or bacteria. They include polysaccharide vaccines (which can be conjugated or unconjugated), toxoids, or cellular vaccines (which can be viruses or bacteria, or fractions of either). 14 1 point Liz, a 37-year-old woman, was diagnosed with HIV 2 months ago. She received one dose of MCV4 at that time and is now getting her 2nd dose. Which of the following would be an appropriate recommendation for MCV4 vaccination for Liz? Feedback According to ACIP, adults with human immunodeficiency virus (HIV) infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY (MCV4) at least 2 months apart. Following the 2nd dose, they should be revaccinated every 5 years. Children who completed the primary series at ages 2 months through 6 years and remain at high risk for meningococcal disease should receive another dose after 3 years. Booster doses are given every 5 years after that. 15 1 point Which of the following best describes immunization coalitions? Feedback Immunization coalitions are organizations that foster collaboration among stakeholders to increase immunization rates. They vary in size and structure and can include people who are dedicated to vaccination activities at local, state, national, and international levels. 16 1 point Which of the following patients would be an appropriate candidate for the HPV vaccine? Feedback The HPV vaccine is recommended for all adolescents ages 11 through 12 years of age. It may be given as early as age 9 if there is a history of sexual abuse or assault. Females through 26 years of age and males through 21 years of age should receive HPV vaccine if they did not previously get vaccinated. Males 22 through 26 years of age may receive the HPV vaccine if they were not previously vaccinated if protection against HPV is warranted. 17 1 point Lily is a 15-month-old girl who is up to date with her vaccinations. Which of the following tetanus toxoid-containing vaccines would be appropriate for Lily? Feedback DTaP contains higher amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years of age to avoid injection site reactions in adolescents and adults. Individuals 7 years of age and older who need protection against tetanus, diphtheria, and pertussis should receive Tdap, not DTaP. Since Lily is up to date, she would have already received the first three doses of DTaP at ages 2, 4, and 6 months. Her fourth dose is to be given at ages 15 through 18 months. The fifth and final dose is given at ages 4 through 6 years. At ages 11 through 12 years, she would receive a dose of Tdap, followed by Td every 10 years. DT is reserved for children who should not receive acellular pertussis-containing vaccines. 18 1 point Theresa is a 23-year-old woman with rheumatoid arthritis who is treated with immunosuppressive therapies. Which of the following vaccines should be avoided for Theresa? Feedback As a general rule, live vaccines should be avoided in patients with altered immunocompetence. Varicella is a live vaccine and is contraindicated. Live attenuated vaccines must replicate in order for the body to produce an immune response. If given to a patient with a compromised immune system, there is a chance they could replicate in an uncontrolled fashion and cause disease. Herpes zoster vaccine may be given to patients with low-level immunosuppression and rotavirus vaccine can be given to immunocompromised children, unless they have severe combined immunodeficiency (SCID). Additionally, if the immune system is not working properly, an adequate immune response may not occur following vaccination. This is true for live and inactivated vaccines. Tdap, hepatitis B, and PPSV23 vaccines are inactivated and can be given to patients with compromised immune systems, however, they may be less effective than in those who are immunocompetent. 19 1 point Which of the following statements best describes the approach to take with patients regarding simultaneous administration of vaccines? Feedback In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person’s immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines. Delaying vaccination and using alternative schedules increases the time during which children are susceptible to diseases. With more unprotected children, the chance of an outbreak spreading increases. 20 1 point Vaccines should be avoided or delayed for which of the following patients? Feedback Before giving any vaccine, it is important to determine how the patient is feeling. It is okay to administer vaccines if the patient has a mild illness, such as low-grade fever, mild respiratory tract infection, mild diarrhea, or otitis media. However, if the patient has moderate to severe acute illness that requires additional care, it is advised to defer vaccination until the illness resolves. Smallpox and yellow fever vaccines are the only vaccines that should not be administered to a woman who is breastfeeding—all routinely recommended vaccines are safe to administer. Vaccine schedules do not need to be altered if a child is born prematurely. A newborn whose mother is HIV positive is not a precaution or contraindication to receiving vaccines. 21 1 point Which of the following live vaccines is recommended to be administered prior to one year of age? Feedback The majority of live vaccines should not be administered to children less than 1 year of age. This is due to the presence of circulating antibodies passed along to the child from the mother. The vaccine would not be effective because the antibodies may interfere with a live attenuated vaccine’s ability to replicate. The exception to this is the rotavirus vaccine, which is given to all infants beginning at age 2 months. The first doses of the varicella and MMR vaccines are given at age 1 year. The live attenuated influenza vaccine, which is the intranasal influenza vaccine, is approved for ages 2 through 49 years. However, LAIV is not currently recommended due to failure to demonstrate efficacy. 22 1 point Which age group is appropriate to receive the 2-dose HPV9 vaccine series? Feedback The 2-dose schedule of the 9-valent HPV vaccine is approved and recommended for immunocompetent males and females ages 9 through 14 years. It is routinely recommended for ages 11 through 12 years. If the series is begun after the 15th birthday, then 3 doses should be given at 0, 1 to 2, and 6 months. 23 1 point Which of the following should be one of the first steps involved in establishing a pharmacy-based immunization program? Feedback A crucial step when establishing immunization services is deciding which vaccines to offer. The vaccines that pharmacists are permitted to administer vary from state to state. Pharmacists must determine what is allowed by state laws and regulations where they practice. This is an important first step as it will dictate vaccine supply acquisition, marketing initiatives, and billing procedures. 24 1 point Which of the following statements is true about risks associated with vaccines and vaccine-preventable diseases? Feedback Vaccine-preventable diseases are still prevalent throughout the world and many of the outbreaks in the US have been attributed to international travelers. A substantial and authoritative body of research has investigated potential links between vaccines and autism and found no association. Additionally, there is no scientific evidence showing any short- or long-term harm from exposure to thimerosal in vaccines. There is no objective evidence that autoimmune diseases are caused by vaccinations. They occur at the same rates among vaccinated
and unvaccinated people. In immunocompetent people of any age, the immune system is fully capable of eliciting an appropriate immune response to multiple antigens administered on the same day through vaccination. In fact, a person’s immune system is exposed to more antigens every day from food or bacteria in the mouth and nose than from some vaccines. 25 1 point Which of the following is a requirement of the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard? Feedback The OSHA bloodborne pathogens standard states that training for employees on the standard be provided annually. Universal precautions, which is treating all blood and bodily fluids as if they are infectious, should always be observed. Hepatitis B vaccination should be offered at no charge to all employees with exposure risk. Needles should not be recapped after use – this greatly increases the chance of a needle stick. Influenza is not considered a BBP exposure risk and influenza vaccination is not included in the Standard. 26 1 point What is the most appropriate recommendation for administering Tdap to pregnant patients? Feedback One dose of Tdap should be administered to women during each pregnancy, preferably within 27 – 36 weeks gestation (third trimester) to protect newborns against pertussis. This allows for maternal antibody transfer to the newborn who is too young to be vaccinated with DTaP. In fact, when given earlier in this time frame (28 to 32 weeks), there were higher titers in the infants when compared to later in this time frame (33 to 36 weeks). As such, the 27 to 36 window to give Tdap is still advised but with the added caveat that giving it sooner within this range will provide the maximum antibody transfer. There is a concern that giving Tdap earlier than the third trimester may result in the waning of antibody titers before the infants are old enough to be vaccinated. 27 1 point Which of the following types of vaccines represents an opportunity to collaborate with physicians to meet the needs of the community? Feedback When a vaccine requires a series of doses for adequate protection, it can sometimes be challenging to get individuals to return for follow-up doses. Collaborating with other health care professionals to make vaccine access easier is one way to increase vaccination for the additional doses needed in the series. For instance, if the first dose was given in the physician’s office, instead of scheduling another office appointment, the patient could then be referred to the local pharmacy for the additional doses. 28 1 point Which influenza vaccine is approved to be used with the jet injector needle-free system? Feedback The FDA must approve each specific medication that is administered via a jet injector needle-free system. The only vaccines approved for such use are Afluria and Afluria Quadrivalent. This approval is for individuals ages 18 through 64 years. 29 1 point Which of the following vaccines should be administered to boys and young men aged 9 through 26 years to reduce their likelihood of acquiring genital warts? Feedback HPV types 16, 18, 31, 33, 45, 52, and 58 account for approximately 85% to 90% of all cervical cancers. These are considered the high-risk types.In addition to cervical cancer, high-risk HPV has been associated with vulvar, vaginal, anal, penile, oral, and pharyngeal cancers.Low-risk HPV types (e.g., 6, 11) cause the majority of cases of genital warts. The 9-valent HPV vaccine (9vHPV or HPV9) covers types 6, 11, 16, 18, 31, 33, 45, 52, and 58. It is indicated for males and females ages 9 through 26 years to protect against cancers and genital warts. 30 1 point Which of the following is a provider factor associated with low vaccination rates in adults? Feedback There are a variety of factors that may present barriers to increasing vaccination coverage in adults. These include patient, provider, and system factors, as well as a complex vaccination schedule for adults. Patient factors include a lack of adequate insurance coverage, inconvenient access, and lack of a regular health care provider. Provider factors include inadequate focus on preventive services, failure to make vaccine recommendations, and lack of effective recall and reminder systems. System factors include minimal to no requirements to be vaccinated and varying state regulations. 31 1 point Which of the following best describes how to administer hepatitis B vaccine to an adult man who weighs 225 lbs? Feedback The hepatitis B vaccine is administered intramuscularly at a 90-degree angle. In older children and adults, it should be injected into the deltoid muscle. The weight of the patient does not change the site of injection. 32 1 point Larry is a 65-year-old man with heart disease who comes to the pharmacy to refill a prescription on October 21. His immunization record indicates that he has completed the primary series of DTaP, MMR, hepatitis B, and hepatitis A. His last Td booster dose was 12 years ago. In addition to influenza, which of the following vaccines should Larry receive? Feedback Because Larry has heart disease both the recommended immunization schedule for adults aged 19 years or older by age group and the recommended immunization schedule for adults aged 19 years or older by medical condition and other indications should be used to determine which vaccines he needs. Both PCV13 and PPSV23 are recommended for all patients when they turn age 65. PPSV23 is also recommended for patients with heart disease. Larry will need to receive PCV13 now and PPSV23 in 12 months. Tdap is recommended for all adults who have not previously received Tdap. Adults ages 60 and older need herpes zoster vaccine. Since he was born before 1980, he does not need varicella vaccine. 33 1 point Five minutes after receiving a vaccine, a patient tells you that his face "feels funny" and he is starting to feel itchy all over. You notice that his lips are swollen. Which of the following would be the most appropriate action to take? Feedback If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Prepare your staff for a potential emergency situation. If you suspect anaphylaxis, then you instruct a staff member to call 911. You would then prepare and administer epinephrine. The patient should not take him or herself to the emergency department. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. While diphenhydramine is sometimes used in conjunction with epinephrine, it is typically given intravenously. Epinephrine remains first-line treatment for anaphylaxis. 34 1 point Vaccines evoke an immune response because they contain: Feedback Vaccines contain antigens that stimulate an immune response and result in immunologic memory. B cells are activated in this process. Except for pure polysaccharide vaccines, T cells are also activated and are able to generate additional B cells. B cells express unique receptors that recognize and bind to only one particular antigen. B cells are the major cells involved in the creation of antibodies that circulate in blood plasma and lymph. This is referred to as humoral immunity. B cells mature to plasma cells and antibodies that help the body eliminate the antigen are formed. 35 1 point Which of the following statements best describes recommendations for vaccine administration during pregnancy? Feedback There are two vaccines recommended during pregnancy. Tdap should be given with each pregnancy in the beginning of the third trimester (27 to 36 weeks gestation). Influenza vaccine is recommended if the woman is pregnant during flu season. It can be given in any trimester. Live vaccines are a temporary contraindication during pregnancy. They should be administered after the woman gives birth. There is no risk to a pregnant woman wh
o is in close contact with someone who received a live vaccine. There is also no risk if pregnant providers administer live vaccines. 36 1 point Hugh, a 56-year-old health care worker, has no laboratory evidence of immunity to measles or mumps and cannot confirm that he had either disease. How many doses of MMR vaccine should Hugh receive? Feedback At age 56, Hugh would have been born after 1957. Health care personnel born in or after 1957 without evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease should receive two doses of MMR. Evidence of immunity includes laboratory evidence or documentation of vaccination. Provider diagnosis is not adequate evidence of immunity. 37 1 point Which of the following is the minimum needle length recommended for intramuscular administration of the influenza vaccine to an adult woman weighing 215 lbs? Feedback When giving intramuscular injections to adults, the ACIP provides recommendations for needle length based on gender and weight. This is to help ensure the vaccine is injected into muscle tissue. Women who weigh more than 200 lbs and men who weigh more than 260 pounds should use a 1.5 inch needle. A 1 inch needle is used for men and women who weigh less than 152 lbs. Those with weights in between these parameters would use either a 1 or 1.5 inch needle. A 5/8 inch needle is used for subcutaneous injections. A ½ inch needle should never be used for vaccine administration. 38 1 point The majority of cases of vasovagal syncope occur within which of the following time frames following vaccination? Feedback Fainting, or vasovagal syncope, is a brief loss of consciousness. Although it is not that common, if fainting occurs following vaccination, it is usually within 5 to 15 minutes. It is important to vaccinate patients while they are seated or lying down and observe them for at least 15 minutes following vaccination. 39 1 point Which of the following is the youngest age at which a child should receive inactivated influenza vaccine? Feedback Influenza vaccination is universally recommended for all individuals beginning at 6 months of age. The vaccines recommended prior to 6 months include hepatitis B (given at birth), rotavirus, DTaP, Hib, PCV13, and IPV. 40 1 point Which of the following is a symptom of a true allergic reaction? Feedback An allergic response to a vaccine is considered an immediate (or type I) hypersensitivity reaction. It typically occurs within minutes to an hour of vaccination. Such an allergic reaction can include itching, erythema, hives, urticarial, and anaphylaxis. Fever, headache, and GI distress are not considered allergic reactions to vaccines. 41 1 point What could potentially happen if an intramuscular vaccine is administered too high? Feedback If a vaccine is injected into or around the bursa, which surrounds the shoulder joint, severe, persistent shoulder pain and lack of function may occur. In fact, Shoulder Injury Related to Vaccine Administration (SIRVA) has now been added to the Vaccine Injury Table in accordance with the National Vaccine Injury Compensation Program (VICP). Proper injection technique is important to avoid this type of injury. Intramuscular vaccines should be administered in the thickest, most central portion of the deltoid muscle. 42 1 point If a patient experiences symptoms of anaphylaxis, which of the following would be the first action to take? Feedback If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Prepare your staff for a potential emergency situation. If you suspect anaphylaxis, then you instruct a staff member to call 911. You would then prepare and administer epinephrine. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. While diphenhydramine is sometimes used in conjunction with epinephrine, it is typically given intravenously. Epinephrine remains first-line treatment for anaphylaxis. 43 0 points Albert is a 61-year-old man who wants to receive the herpes zoster vaccine. He is up to date on his other immunizations and reports receiving his inactivated influenza vaccine two weeks ago. Which of the following would be the best recommendation to make regarding the herpes zoster vaccine for Albert? Feedback The herpes zoster vaccine is a live vaccine and is recommended for those ages 60 and older. Inactivated vaccines do not interfere with the immune response to other vaccines, live or inactivated. There is no need to observe any minimum interval between doses of two different inactivated vaccines, nor between combinations of inactivated and live vaccines. The concern is when two live vaccines are not administered at the same clinic visit. If two live vaccines are not given simultaneously, at least 4 weeks must pass before giving the other live vaccine. 44 1 point A patient who reports an allergy to eggs but is able to eat lightly cooked eggs (e.g., scrambled eggs) without a reaction could receive which of the following influenza vaccines? Feedback Someone who is able to eat lightly cooked egg without a reaction is not likely to be allergic to eggs. Any recommended influenza vaccine can be administered. Furthermore, individuals with a history of egg allergy who have experienced only urticaria (hives) after exposure to egg should receive any recommended influenza vaccine. A person with a more severe reaction to egg can also receive any recommended influenza vaccine, but it should be administered by a health care provider who is trained and equipped to manage a severe allergic reaction. 45 1 point Within a few minutes after receiving a vaccine, a patient reports not feeling well and would like a drink of water. Which of the following would be the most appropriate action to take? Feedback If a patient begins to experience an adverse reaction after receiving a vaccine, have the patient sit down and observe the patient. Assess the patient’s symptoms and vital signs. Do not give the patient water or anything else by mouth. If the patient loses consciousness, this could result in aspiration or asphyxiation. Prepare your staff for a potential emergency situation. If the condition worsens and you suspect anaphylaxis, then you would prepare and administer epinephrine. A sugar-containing beverage would only be warranted if the patient was experiencing hypoglycemia.

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