Page 1 of 79
APHA IMMUNIZATION EXAM 350 QUESTIONS AND
WELL ELABORATED ANSWERS LATEST UPDATE THIS
YEAR
Question: Which of the following best describes how to administer MMR vaccine to an adult
patient weighing 210 lb? - CORRECT ANSWER✔✔Inject subcutaneously at a 45° angle in the
outer aspect of the upper arm.
LO 4.10; Module 4— General Injection Principles The MMR vaccine is administered
subcutaneously at a 45 degree angle into the outer aspect of the upper arm. Vaccines that are
given intramuscularly are administered into the deltoid muscle at a 90 degree angle. The weight
of the patient does not matter with regard to route of administration.
Question: The presence of fever, diffuse maculopapular rash, and Koplik spots are characteristic
of which of the following diseases? - CORRECT ANSWER✔✔Measles
Module 3—Measles, Mumps, Rubella. MeaslesThe classic symptoms of measles include fever,
cough, coryza (runny nose), conjunctivitis, Koplik spots (a bluish-white rash on mucous
membranes, especially the mouth), followed by the development of a maculopapular rash
approximately 14 days after exposure. Individuals infected with mumps may not have
symptoms. Others may have nonspecific symptoms, such as headache, fever, myalgia, and
malaise. About 30% to 40% of individuals may experience inflammation of the parotid glands.
Rubella symptoms tend to be relatively mild and may present as a maculopapular rash that
occurs approximately 14 days after exposure. Others may experience arthritis and arthralgia.
Varicella presents as a generalized vesicular rash.
Question: Which entity determines the specific vaccines that a pharmacist may administer? -
CORRECT ANSWER✔✔State and yada
Module 1—Expanding Vaccination Offerings
A pharmacist's scope of practice and immunization authority are determined by the
pharmacist's state practice act. As such the laws and regulations for pharmacists as immunizers
vary by state. The U.S. Food and Drug Administration provides the regulatory oversight for the
approval of vaccines. The Advisory Committee on Immunization Practices is the leading
, Page 2 of 79
authority in the U.S. that provides comprehensive vaccination recommendations and guidelines.
These recommendations are reviewed and approved by the CDC. The local health departments
do not have any oversight regarding a pharmacist's immunization practices. However,
pharmacists often work with their local health departments to provide vaccines and public
health services.
Question: Kyle is a 5-year-old boy who is up to date with his vaccinations. He has never
experienced any adverse effects from vaccinations. At his next well-child check-up, Kyle will be
receiving the following vaccines: IPV, MMR, varicella vaccine, and a tetanus-containing vaccine.
Which of the following tetanus-containing vaccines would be appropriate for him? - CORRECT
ANSWER✔✔DTaP
LO 3.4; Module 3—Target Groups for Vaccination. DTaP VaccineDTaP is a five-dose series given
at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years. Kyle is due for his 5th and final
dose of DTaP. DTaP is appropriate for children less than 7 years of age. DT is only reserved for
children who have a contraindication to the pertussis component in DTaP. Children, adolescents,
and adults 7 years of age and older who require protection against tetanus, diphtheria, and
pertussis would receive Tdap. Following the one-time dose of Tdap, a Td booster should be
given every 10 years.
Question: Which of the following documents must be given to every patient or patient's
caregiver before administration of a vaccine covered under the National Childhood Vaccine
Injury Act (NCVIA)? - CORRECT ANSWER✔✔VIS
Module 4— Providing Vaccine Information StatementsVaccine information statemetns (VISs) are
standardized forms that provide an overview of the risks and benefits of vaccines. Health care
providers who administer vaccines are required by law to provide patients with the most up-to-
date version of the VIS for any vaccine covered under the National Childhood Vaccine Injury Act
(NCVIA). The CMS-1500 and CMS-855B are forms required by the Centers for Medicare and
Medicaid Services (CMS) for billing and enrolling as a Medicare provider, respectively. The PHS-
731 is now the CDC 731 form and is the International Certificate of Vaccination or Prophylaxis as
Approved by the World Health Organization (the Yellow Card).
, Page 3 of 79
Question: Which vaccine does ACIP recommend for all college freshmen, aged 21 years or
younger, living in dormitories, who have not been previously vaccinated? - CORRECT
ANSWER✔✔MCV4,
LO 3.4; Module 3— Meningococcal Disease, Target Groups for Vaccination Routine vaccination
with the quadrivalent meningococcal conjugate vaccine (MenACWY or MCV4) is one dose at
ages 11 to 12 years and a booster dose at age 16 years. A first-year college student aged 21
years or younger living in residential housing who has not been previously vaccinated with
MCV4 is considered high-risk for meningococcal disease. One dose should be administered.
Living in dormitories on a college campus is not considered a risk factor for pneumococcal
disease, HPV, or varicella.
Question: When Mary turned 64, she was diagnosed with type 2 diabetes. At that time, she
received PPSV23. Which of the following represents appropriate pneumococcal coverage for
Mary. - CORRECT ANSWER✔✔Administer PCV13 at age 65, then PPSV23 at age 69.
LO 3.4; Module 3— Pneumococcal Disease, Vaccine Recommendations Immunocompetent
adults aged 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13)
followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year after
PCV13. However, if an individual is a candidate for PPSV23 prior to age 65 due to high-risk
conditions (in this case diabetes), then another dose of PPSV23 would be recommended after
the individual turns 65, but should be given 5 years after the 1st dose. Since Mary received
PPSV23 prior to PCV13, then PCV13 should be administered at least one year after PPSV23.
Question: According to ACIP recommendations, HZV is indicated for the prevention of herpes
zoster in adults aged: - CORRECT ANSWER✔✔60
LO 3.2; Module 3—
Herpes Zoster, Target Groups for VaccinationEven though the herpes zoster vaccine (Zostavax) is
FDA approved for individuals aged 50 and older, the ACIP recommends this vaccine for
individuals aged 60 and older. There are concerns about waning immunity with this vaccine. If
given too soon (before age 60), it may not afford protection in older individuals who are at
higher risk of herpes zoster.
Question: In which publication does the CDC initially publish new or updated vaccine
recommendations? - CORRECT ANSWER✔✔Morbidity and Mortality Weekly Report (MMWR)
, Page 4 of 79
LO 1.6; Module 1—Vaccine Recommendation SourcesThe Advisory Committee on Immunization
Practices (ACIP) develops vaccine recommendations and guidelines. These are reviewed and
approved by the CDC Director and the U.S. Department of Health and Human Services. Once
approved, they are published in the CDC's Morbidity and Mortality Weekly Report (MMWR).
The Epidemiology and Prevention of Vaccine-Preventable Diseases (commonly referred to as the
Pink Book) provides comprehensive information about vaccines and the diseases they prevent.
Content published in the MMWR regarding vaccines is often incorporated into this resource.
Needle Tips is a newsletter published multiple times throughout the year by the Immunization
Action Coalition. It provides timely updates and answers to frequently asked questions. Vaccine
is a journal affiliated with the Edward Jenner Society and The Japanese Society for Vaccinology.
It is a forum for the publication of research, reviews, and commentaries related to vaccines.
Question: Which of the following tetanus booster vaccines would be most appropriate for
administration to a 12-year-old boy who has completed a primary series with DTaP and has no
known allergies? - CORRECT ANSWER✔✔Tdap
LO 3.4; Module 3— Pertussis. Target Groups for Vaccination. Tdap Vaccine
One dose of Tdap is routinely recommended for all adolescents who have completed the
primary series of DTaP. This should be given at 11 to 12 years of age. DTaP contains higher
amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years
of age to avoid injection site reactions in adolescents and adults. Following the one-time dose of
Tdap, a Td booster should be given every 10 years. DT, which has a higher amount of diphtheria
toxin is only reserved for children who have a contraindication to the pertussis component in
DTaP.
Question: Which of these vaccines is a live attenuated vaccine? - CORRECT ANSWER✔✔Zoster
The live attenuated vaccines include cholera, herpes zoster, live attenuated influenza vaccine
(LAIV), MMR, MMRV, rotavirus, tuberculosis (BCG), typhoid (Ty21a), vaccinia (smallpox),
varicella, and yellow fever. All other vaccines are inactivated.
APHA IMMUNIZATION EXAM 350 QUESTIONS AND
WELL ELABORATED ANSWERS LATEST UPDATE THIS
YEAR
Question: Which of the following best describes how to administer MMR vaccine to an adult
patient weighing 210 lb? - CORRECT ANSWER✔✔Inject subcutaneously at a 45° angle in the
outer aspect of the upper arm.
LO 4.10; Module 4— General Injection Principles The MMR vaccine is administered
subcutaneously at a 45 degree angle into the outer aspect of the upper arm. Vaccines that are
given intramuscularly are administered into the deltoid muscle at a 90 degree angle. The weight
of the patient does not matter with regard to route of administration.
Question: The presence of fever, diffuse maculopapular rash, and Koplik spots are characteristic
of which of the following diseases? - CORRECT ANSWER✔✔Measles
Module 3—Measles, Mumps, Rubella. MeaslesThe classic symptoms of measles include fever,
cough, coryza (runny nose), conjunctivitis, Koplik spots (a bluish-white rash on mucous
membranes, especially the mouth), followed by the development of a maculopapular rash
approximately 14 days after exposure. Individuals infected with mumps may not have
symptoms. Others may have nonspecific symptoms, such as headache, fever, myalgia, and
malaise. About 30% to 40% of individuals may experience inflammation of the parotid glands.
Rubella symptoms tend to be relatively mild and may present as a maculopapular rash that
occurs approximately 14 days after exposure. Others may experience arthritis and arthralgia.
Varicella presents as a generalized vesicular rash.
Question: Which entity determines the specific vaccines that a pharmacist may administer? -
CORRECT ANSWER✔✔State and yada
Module 1—Expanding Vaccination Offerings
A pharmacist's scope of practice and immunization authority are determined by the
pharmacist's state practice act. As such the laws and regulations for pharmacists as immunizers
vary by state. The U.S. Food and Drug Administration provides the regulatory oversight for the
approval of vaccines. The Advisory Committee on Immunization Practices is the leading
, Page 2 of 79
authority in the U.S. that provides comprehensive vaccination recommendations and guidelines.
These recommendations are reviewed and approved by the CDC. The local health departments
do not have any oversight regarding a pharmacist's immunization practices. However,
pharmacists often work with their local health departments to provide vaccines and public
health services.
Question: Kyle is a 5-year-old boy who is up to date with his vaccinations. He has never
experienced any adverse effects from vaccinations. At his next well-child check-up, Kyle will be
receiving the following vaccines: IPV, MMR, varicella vaccine, and a tetanus-containing vaccine.
Which of the following tetanus-containing vaccines would be appropriate for him? - CORRECT
ANSWER✔✔DTaP
LO 3.4; Module 3—Target Groups for Vaccination. DTaP VaccineDTaP is a five-dose series given
at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years. Kyle is due for his 5th and final
dose of DTaP. DTaP is appropriate for children less than 7 years of age. DT is only reserved for
children who have a contraindication to the pertussis component in DTaP. Children, adolescents,
and adults 7 years of age and older who require protection against tetanus, diphtheria, and
pertussis would receive Tdap. Following the one-time dose of Tdap, a Td booster should be
given every 10 years.
Question: Which of the following documents must be given to every patient or patient's
caregiver before administration of a vaccine covered under the National Childhood Vaccine
Injury Act (NCVIA)? - CORRECT ANSWER✔✔VIS
Module 4— Providing Vaccine Information StatementsVaccine information statemetns (VISs) are
standardized forms that provide an overview of the risks and benefits of vaccines. Health care
providers who administer vaccines are required by law to provide patients with the most up-to-
date version of the VIS for any vaccine covered under the National Childhood Vaccine Injury Act
(NCVIA). The CMS-1500 and CMS-855B are forms required by the Centers for Medicare and
Medicaid Services (CMS) for billing and enrolling as a Medicare provider, respectively. The PHS-
731 is now the CDC 731 form and is the International Certificate of Vaccination or Prophylaxis as
Approved by the World Health Organization (the Yellow Card).
, Page 3 of 79
Question: Which vaccine does ACIP recommend for all college freshmen, aged 21 years or
younger, living in dormitories, who have not been previously vaccinated? - CORRECT
ANSWER✔✔MCV4,
LO 3.4; Module 3— Meningococcal Disease, Target Groups for Vaccination Routine vaccination
with the quadrivalent meningococcal conjugate vaccine (MenACWY or MCV4) is one dose at
ages 11 to 12 years and a booster dose at age 16 years. A first-year college student aged 21
years or younger living in residential housing who has not been previously vaccinated with
MCV4 is considered high-risk for meningococcal disease. One dose should be administered.
Living in dormitories on a college campus is not considered a risk factor for pneumococcal
disease, HPV, or varicella.
Question: When Mary turned 64, she was diagnosed with type 2 diabetes. At that time, she
received PPSV23. Which of the following represents appropriate pneumococcal coverage for
Mary. - CORRECT ANSWER✔✔Administer PCV13 at age 65, then PPSV23 at age 69.
LO 3.4; Module 3— Pneumococcal Disease, Vaccine Recommendations Immunocompetent
adults aged 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13)
followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year after
PCV13. However, if an individual is a candidate for PPSV23 prior to age 65 due to high-risk
conditions (in this case diabetes), then another dose of PPSV23 would be recommended after
the individual turns 65, but should be given 5 years after the 1st dose. Since Mary received
PPSV23 prior to PCV13, then PCV13 should be administered at least one year after PPSV23.
Question: According to ACIP recommendations, HZV is indicated for the prevention of herpes
zoster in adults aged: - CORRECT ANSWER✔✔60
LO 3.2; Module 3—
Herpes Zoster, Target Groups for VaccinationEven though the herpes zoster vaccine (Zostavax) is
FDA approved for individuals aged 50 and older, the ACIP recommends this vaccine for
individuals aged 60 and older. There are concerns about waning immunity with this vaccine. If
given too soon (before age 60), it may not afford protection in older individuals who are at
higher risk of herpes zoster.
Question: In which publication does the CDC initially publish new or updated vaccine
recommendations? - CORRECT ANSWER✔✔Morbidity and Mortality Weekly Report (MMWR)
, Page 4 of 79
LO 1.6; Module 1—Vaccine Recommendation SourcesThe Advisory Committee on Immunization
Practices (ACIP) develops vaccine recommendations and guidelines. These are reviewed and
approved by the CDC Director and the U.S. Department of Health and Human Services. Once
approved, they are published in the CDC's Morbidity and Mortality Weekly Report (MMWR).
The Epidemiology and Prevention of Vaccine-Preventable Diseases (commonly referred to as the
Pink Book) provides comprehensive information about vaccines and the diseases they prevent.
Content published in the MMWR regarding vaccines is often incorporated into this resource.
Needle Tips is a newsletter published multiple times throughout the year by the Immunization
Action Coalition. It provides timely updates and answers to frequently asked questions. Vaccine
is a journal affiliated with the Edward Jenner Society and The Japanese Society for Vaccinology.
It is a forum for the publication of research, reviews, and commentaries related to vaccines.
Question: Which of the following tetanus booster vaccines would be most appropriate for
administration to a 12-year-old boy who has completed a primary series with DTaP and has no
known allergies? - CORRECT ANSWER✔✔Tdap
LO 3.4; Module 3— Pertussis. Target Groups for Vaccination. Tdap Vaccine
One dose of Tdap is routinely recommended for all adolescents who have completed the
primary series of DTaP. This should be given at 11 to 12 years of age. DTaP contains higher
amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years
of age to avoid injection site reactions in adolescents and adults. Following the one-time dose of
Tdap, a Td booster should be given every 10 years. DT, which has a higher amount of diphtheria
toxin is only reserved for children who have a contraindication to the pertussis component in
DTaP.
Question: Which of these vaccines is a live attenuated vaccine? - CORRECT ANSWER✔✔Zoster
The live attenuated vaccines include cholera, herpes zoster, live attenuated influenza vaccine
(LAIV), MMR, MMRV, rotavirus, tuberculosis (BCG), typhoid (Ty21a), vaccinia (smallpox),
varicella, and yellow fever. All other vaccines are inactivated.
