APHA IMMUNIZATION ACTUAL EVALUATION EXAM
QUESTION WITH ANSWERS 2025/2026 GRADED A+
Why should refrigerated vaccines be stored in the middle of the refrigerator? - There are
fewer temperature fluctuations.
Feedback for both Full, Partial, and Incorrect Credit:LO 5.4; Module 5— Vaccine
Storage and HandlingVaccines should be stored in the middle of the refrigerator, not in
the door or on the bottom shelf, because the temperature in the middle does not
fluctuate as much.
Which of the following statements would be accurate when responding to a patient's
concerns about the safety of vaccines? - The immune system is capable of stimulating
an immune response to multiple vaccines administered at the same time.
LO 4.7; Module 4— Countering Myths and Misperceptions About Vaccines Injectable
influenza vaccine is inactivated (i.e., killed), thus it is impossible for this vaccine to
cause influenza. The intranasal influenza vaccine is a live vaccine, but the virus has
been modified so that it cannot cause disease. No vaccine is 100% effective and
efficacy varies depending on the vaccine. Furthermore, if illness does occur in someone
vaccinated, it is often less severe. Thimerosal is a mercury-containing compound that
has been used for decades as a preservative in vaccines to prevent bacterial
contamination. There is no scientific evidence showing any short- or long-term harm
from exposure to thimerosal in vaccines. One myth that has circulated about vaccines is
that some manufacturer lots are associated with higher incidences of adverse events
reported to VAERS (i.e., hot lots). To date, no vaccine lot in the modern era has been
found to be unsafe on the basis of VAERS reports. There is a misperception that giving
several vaccines on the same day overloads the patient's immune system. 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.
A health care provider who has not been vaccinated against hepatitis B is stuck by a
contaminated needle after administering an immunization to a hepatitis B-positive
patient. In addition to hepatitis B vaccine, the health care provider also should receive
hepatitis B Immunoglobulin (HBIG) as postexposure prophylaxis because the HBIG
provides: - Prompt immunity
LO 2.1; Module 2—Passive and Active Immunity Can Be ComplementaryGiving both
the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) allows for active and
passive immunity. Active immunity occurs when the antigen from the vaccine triggers
the immune system to respond. The vaccine will provide long-term protection but it
takes the body about two weeks to develop immunity. Passive immunity happens when
antibodies are provided from another source, such as immunoglobulin. Passive
immunity is short-live, but it provides protection right away.
,What is the type of immunity that occurs when a pregnant woman is vaccinated with
Tdap to protect the infant from pertussis after birth? - Passive immunity
LO2. 1; Module 2—Passive vs. Active Immunity: Acquired immunity involves
immunological memory. It is something the body develops upon exposure to pathogens
or antigens and results in antigen-antibody complex formation. Cell-mediated immunity
is a component of acquired immunity and destroys pathogens that have entered cells.
Acquired immunity can be active or passive. Active immunity occurs when an antigen
from an invading pathogen or a vaccine triggers the immune system to respond.
Passive immunity happens when antibodies are provided from another source, such as
or upon receipt of blood products or immunoglobulin when maternal antibodies are
transferred to the fetus. This is the reason Tdap is given with every pregnancy—the
maternal antibodies passed to the fetus protect the newborn from pertussis.
What is the standard dose of epinephrine for managing anaphylaxis? - 0.01 mg per kg
body weight, up to a maximum of 0.5 mg
LO 4.11; Module 4—AnaphylaxisPreferably, 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. The
dose of epinephrine can be repeated every 5-15 minutes (according to the patient's
response), up to three doses.
What is the minimum needle length recommended for administering HepB vaccine to an
adult patient weighing 130 lb? - 1 inch
LO 4.10; Module 4— General Injection PrinciplesThe hepatitis B vaccine is
administered intramuscularly into the deltoid muscle in individuals three years of age
and older. The needle must be long enough to reach deep into the muscle. Fixed 1-inch
needles are acceptable for patients weighing 60 kg (132 lb) or less.
Justin is a healthy 16-year-old boy who has no documentation of varicella vaccine or
history of the disease. He should receive: - 2 doses of varicella vaccine separated by at
least 4 weeks.
LO 3.4; Module 3—Varicella Vaccine Recommendations
Anyone aged 7 years and older without evidence of immunity to varicella should receive
2 doses of varicella vaccine. Children aged 7 through 12 years should receive 2 doses 3
months apart. However, if the second dose was administered at least 4 weeks after the
first dose, it can be considered valid. Individuals aged 13 years and older should receive
2 doses at least 4 weeks apart.
With the exception of rotavirus, the routinely recommended live vaccines are
contraindicated in a patient who: - Is immunosuppressed
,The majority of live vaccines are contraindicated in patients who are
immunocompromised. Immunosuppression may reduce vaccine efficacy as well as
pose a risk for disseminated infection with the normally attenuated pathogen in the live
vaccine. However, some exceptions have been made depending on the level of
immunosuppression. In the case of the rotavirus vaccine, severe combined
immunodeficiency (SCID) is a contraindication but other immunocompromising
conditions are precautions. The interval that should be observed between one or more
live vaccines is four weeks. Ppsv2 Antibiotics can interfere with the oral typhoid and
cholera vaccines but should be fine with all other vaccines.
Which of the following best describes an opportunity for pharmacists to use diagnosis-
based screening to identify people at risk for vaccine-preventable diseases? -
Performing a medication review for a patient who has diabetes.
LO 4.2; Module 4—Identifying People at Risk for Vaccine-Preventable Disease
There are two main approaches for determining who needs a vaccine: universal
immunization and high-risk targeting. Three screening strategies can be used to identify
people at high-risk: diagnosis-based screening, procedure-based screening, and
occurrence-based screening. Diagnosis-based screening identifies patients in need of
vaccines based on the presence of a particular diagnosis (in this case, diabetes).
Procedure-based screening involves assessing vaccine needs based on a patient's
receipt of a surgical, medical, or pharmacy-based procedure (in this case, a
splenectomy). Occurrence-based screening takes advantage of an event, such as a
hospital admission, clinic visit, or emergency department visit to identify people who
need to be vaccinated (in this case, discharge counseling).
According to ACIP recommendations, what is the maximum number of doses of
PPSV23 a patient should receive in his or her lifetime? - 3 doses
LO 3.4; Module 3— Pneumococcal Disease, Vaccine
RecommendationsImmunocompromised individuals and those with asplenia should
receive two doses of PPSV23 five years apart. If the second dose was administered
prior to age 65, then a third dose would be given after the individual turns 65 (and five
years after the previous dose). It is possible for these individuals to receive up to three
doses of PPSV23. However, there are no circumstances in which more than three
doses would be recommended.
RotaTeq (RV5) should be administered as a: - 3-dose series to infants at 2, 4, and 6
months of age.
.LO 3.4; Module 3—Rotavirus, Vaccine Recommendations There are two live, oral
vaccines available to prevent rotavirus. However, the dosing differs between the two.
RotaTeq (RV5) is administered orally in a 3-dose series, with doses administered at
ages 2, 4, and 6 months. Rotarix (RV1) is administered orally in a 2-dose series, with
doses administered at ages 2 and 4 months.
, If pharmacists are called upon to assist with vaccination efforts following a natural
disaster, which vaccine is likely to be needed by many of the victims? - Tetanus
LO 1.5; Module 1—Emergency Preparedness and Vaccines Natural disasters, such as
hurricanes, earthquakes, and floods, may increase the risk for tetanus infections due to
environmental microbes, such as the contamination of wounds from bacteria in the soil.
Therefore, it is important to provide Td or Tdap vaccination for victims in disaster-
affected areas. Natural disasters have not been found to increase risk for pneumococcal
disease, measles, mumps, rubella, or meningococcal B.
For which age group is the adjuvanted inactivated influenza vaccine approved? - 65
years and older
LO 3.2; Module 3—Influenza. Influenza Vaccines.In November 2015, the FDA approved
the first trivalent, adjuvanted inactivated influenza vaccine for persons aged 65 years
and older.
A history of anaphylaxis caused by gelatin would be a contraindication to receiving
which of the following vaccines? - Varicella
LO 3.3; Module 3—Varicella, Contraindications and Precautions The vaccines that
contain gelatin include live attenuated influenza vaccine (Flumist), MMR, MMRV, rabies
(RabAvert), typhoid (Vivotif Ty21a), varicella, yellow fever, and zoster (Zostavax).
Appendix B (Vaccine Excipient & Media Summary) of CDC's Epidemiology and
Prevention of Vaccine-Preventable Diseases is a great resource to identify the various
components in each vaccine.
Which of the following statements about live attenuated vaccines is true? - Live and
inactivated vaccines can be given at the same time
Module 2—Live vs. Inactivated Vaccines Live attenuated vaccines are produced by
weakening the virus or bacteria to reduce the likelihood that it can cause disease.
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). 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. If given to a patient with a compromised immune system, there is a
chance they could replicate in an uncontrolled fashion and cause disease. Circulating
antibodies may interfere with a live attenuated vaccine's ability to replicate.
During which step of the Pharmacists' Patient Care Process would a pharmacist
analyze a patient's need for certain vaccines? - Assess
LO4.1; Module 4— Applying the Pharmacists' Patient Care Process to Immunization
ServicesThe Pharmacists' Patient Care Process incorporates five steps to providing
patient-centered care (collect, assess, plan, implement, and follow-up). Each of these
can be applied to immunization services. Collect: the pharmacist collects the information
QUESTION WITH ANSWERS 2025/2026 GRADED A+
Why should refrigerated vaccines be stored in the middle of the refrigerator? - There are
fewer temperature fluctuations.
Feedback for both Full, Partial, and Incorrect Credit:LO 5.4; Module 5— Vaccine
Storage and HandlingVaccines should be stored in the middle of the refrigerator, not in
the door or on the bottom shelf, because the temperature in the middle does not
fluctuate as much.
Which of the following statements would be accurate when responding to a patient's
concerns about the safety of vaccines? - The immune system is capable of stimulating
an immune response to multiple vaccines administered at the same time.
LO 4.7; Module 4— Countering Myths and Misperceptions About Vaccines Injectable
influenza vaccine is inactivated (i.e., killed), thus it is impossible for this vaccine to
cause influenza. The intranasal influenza vaccine is a live vaccine, but the virus has
been modified so that it cannot cause disease. No vaccine is 100% effective and
efficacy varies depending on the vaccine. Furthermore, if illness does occur in someone
vaccinated, it is often less severe. Thimerosal is a mercury-containing compound that
has been used for decades as a preservative in vaccines to prevent bacterial
contamination. There is no scientific evidence showing any short- or long-term harm
from exposure to thimerosal in vaccines. One myth that has circulated about vaccines is
that some manufacturer lots are associated with higher incidences of adverse events
reported to VAERS (i.e., hot lots). To date, no vaccine lot in the modern era has been
found to be unsafe on the basis of VAERS reports. There is a misperception that giving
several vaccines on the same day overloads the patient's immune system. 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.
A health care provider who has not been vaccinated against hepatitis B is stuck by a
contaminated needle after administering an immunization to a hepatitis B-positive
patient. In addition to hepatitis B vaccine, the health care provider also should receive
hepatitis B Immunoglobulin (HBIG) as postexposure prophylaxis because the HBIG
provides: - Prompt immunity
LO 2.1; Module 2—Passive and Active Immunity Can Be ComplementaryGiving both
the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) allows for active and
passive immunity. Active immunity occurs when the antigen from the vaccine triggers
the immune system to respond. The vaccine will provide long-term protection but it
takes the body about two weeks to develop immunity. Passive immunity happens when
antibodies are provided from another source, such as immunoglobulin. Passive
immunity is short-live, but it provides protection right away.
,What is the type of immunity that occurs when a pregnant woman is vaccinated with
Tdap to protect the infant from pertussis after birth? - Passive immunity
LO2. 1; Module 2—Passive vs. Active Immunity: Acquired immunity involves
immunological memory. It is something the body develops upon exposure to pathogens
or antigens and results in antigen-antibody complex formation. Cell-mediated immunity
is a component of acquired immunity and destroys pathogens that have entered cells.
Acquired immunity can be active or passive. Active immunity occurs when an antigen
from an invading pathogen or a vaccine triggers the immune system to respond.
Passive immunity happens when antibodies are provided from another source, such as
or upon receipt of blood products or immunoglobulin when maternal antibodies are
transferred to the fetus. This is the reason Tdap is given with every pregnancy—the
maternal antibodies passed to the fetus protect the newborn from pertussis.
What is the standard dose of epinephrine for managing anaphylaxis? - 0.01 mg per kg
body weight, up to a maximum of 0.5 mg
LO 4.11; Module 4—AnaphylaxisPreferably, 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. The
dose of epinephrine can be repeated every 5-15 minutes (according to the patient's
response), up to three doses.
What is the minimum needle length recommended for administering HepB vaccine to an
adult patient weighing 130 lb? - 1 inch
LO 4.10; Module 4— General Injection PrinciplesThe hepatitis B vaccine is
administered intramuscularly into the deltoid muscle in individuals three years of age
and older. The needle must be long enough to reach deep into the muscle. Fixed 1-inch
needles are acceptable for patients weighing 60 kg (132 lb) or less.
Justin is a healthy 16-year-old boy who has no documentation of varicella vaccine or
history of the disease. He should receive: - 2 doses of varicella vaccine separated by at
least 4 weeks.
LO 3.4; Module 3—Varicella Vaccine Recommendations
Anyone aged 7 years and older without evidence of immunity to varicella should receive
2 doses of varicella vaccine. Children aged 7 through 12 years should receive 2 doses 3
months apart. However, if the second dose was administered at least 4 weeks after the
first dose, it can be considered valid. Individuals aged 13 years and older should receive
2 doses at least 4 weeks apart.
With the exception of rotavirus, the routinely recommended live vaccines are
contraindicated in a patient who: - Is immunosuppressed
,The majority of live vaccines are contraindicated in patients who are
immunocompromised. Immunosuppression may reduce vaccine efficacy as well as
pose a risk for disseminated infection with the normally attenuated pathogen in the live
vaccine. However, some exceptions have been made depending on the level of
immunosuppression. In the case of the rotavirus vaccine, severe combined
immunodeficiency (SCID) is a contraindication but other immunocompromising
conditions are precautions. The interval that should be observed between one or more
live vaccines is four weeks. Ppsv2 Antibiotics can interfere with the oral typhoid and
cholera vaccines but should be fine with all other vaccines.
Which of the following best describes an opportunity for pharmacists to use diagnosis-
based screening to identify people at risk for vaccine-preventable diseases? -
Performing a medication review for a patient who has diabetes.
LO 4.2; Module 4—Identifying People at Risk for Vaccine-Preventable Disease
There are two main approaches for determining who needs a vaccine: universal
immunization and high-risk targeting. Three screening strategies can be used to identify
people at high-risk: diagnosis-based screening, procedure-based screening, and
occurrence-based screening. Diagnosis-based screening identifies patients in need of
vaccines based on the presence of a particular diagnosis (in this case, diabetes).
Procedure-based screening involves assessing vaccine needs based on a patient's
receipt of a surgical, medical, or pharmacy-based procedure (in this case, a
splenectomy). Occurrence-based screening takes advantage of an event, such as a
hospital admission, clinic visit, or emergency department visit to identify people who
need to be vaccinated (in this case, discharge counseling).
According to ACIP recommendations, what is the maximum number of doses of
PPSV23 a patient should receive in his or her lifetime? - 3 doses
LO 3.4; Module 3— Pneumococcal Disease, Vaccine
RecommendationsImmunocompromised individuals and those with asplenia should
receive two doses of PPSV23 five years apart. If the second dose was administered
prior to age 65, then a third dose would be given after the individual turns 65 (and five
years after the previous dose). It is possible for these individuals to receive up to three
doses of PPSV23. However, there are no circumstances in which more than three
doses would be recommended.
RotaTeq (RV5) should be administered as a: - 3-dose series to infants at 2, 4, and 6
months of age.
.LO 3.4; Module 3—Rotavirus, Vaccine Recommendations There are two live, oral
vaccines available to prevent rotavirus. However, the dosing differs between the two.
RotaTeq (RV5) is administered orally in a 3-dose series, with doses administered at
ages 2, 4, and 6 months. Rotarix (RV1) is administered orally in a 2-dose series, with
doses administered at ages 2 and 4 months.
, If pharmacists are called upon to assist with vaccination efforts following a natural
disaster, which vaccine is likely to be needed by many of the victims? - Tetanus
LO 1.5; Module 1—Emergency Preparedness and Vaccines Natural disasters, such as
hurricanes, earthquakes, and floods, may increase the risk for tetanus infections due to
environmental microbes, such as the contamination of wounds from bacteria in the soil.
Therefore, it is important to provide Td or Tdap vaccination for victims in disaster-
affected areas. Natural disasters have not been found to increase risk for pneumococcal
disease, measles, mumps, rubella, or meningococcal B.
For which age group is the adjuvanted inactivated influenza vaccine approved? - 65
years and older
LO 3.2; Module 3—Influenza. Influenza Vaccines.In November 2015, the FDA approved
the first trivalent, adjuvanted inactivated influenza vaccine for persons aged 65 years
and older.
A history of anaphylaxis caused by gelatin would be a contraindication to receiving
which of the following vaccines? - Varicella
LO 3.3; Module 3—Varicella, Contraindications and Precautions The vaccines that
contain gelatin include live attenuated influenza vaccine (Flumist), MMR, MMRV, rabies
(RabAvert), typhoid (Vivotif Ty21a), varicella, yellow fever, and zoster (Zostavax).
Appendix B (Vaccine Excipient & Media Summary) of CDC's Epidemiology and
Prevention of Vaccine-Preventable Diseases is a great resource to identify the various
components in each vaccine.
Which of the following statements about live attenuated vaccines is true? - Live and
inactivated vaccines can be given at the same time
Module 2—Live vs. Inactivated Vaccines Live attenuated vaccines are produced by
weakening the virus or bacteria to reduce the likelihood that it can cause disease.
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). 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. If given to a patient with a compromised immune system, there is a
chance they could replicate in an uncontrolled fashion and cause disease. Circulating
antibodies may interfere with a live attenuated vaccine's ability to replicate.
During which step of the Pharmacists' Patient Care Process would a pharmacist
analyze a patient's need for certain vaccines? - Assess
LO4.1; Module 4— Applying the Pharmacists' Patient Care Process to Immunization
ServicesThe Pharmacists' Patient Care Process incorporates five steps to providing
patient-centered care (collect, assess, plan, implement, and follow-up). Each of these
can be applied to immunization services. Collect: the pharmacist collects the information
