NUR-521 ADVANCED PHARM EXAM 3 QUESTIONS AND ANSWERS 2025/2026 GUIDE
UPDATE - ALABAMA
A 12-month-old child arrives at the clinic for their routine MMR vaccine. The caregiver
reports the child had a mild cold with a low-grade fever earlier in the week but is now
asymptomatic. What is the best course of action?
A. Postpone the vaccine due to the recent illness
B. Administer the vaccine as scheduled
C. Defer the vaccine and recommend acetaminophen before administration
D. Avoid the vaccine because of a prior mild reaction to another vaccine
Answer: B. Administer the vaccine as scheduled Rationale: Mild, acute illnesses with or
without fever (e.g., a cold) are not contraindications for vaccination. The child can safely receive
the vaccine as scheduled. Routine NSAIDs or acetaminophen before vaccination are not
recommended, as they may decrease the immune response.
A mother of a 6-month-old baby is concerned about severe adverse effects after a DTaP
vaccine. Which of the following is the most serious adverse event associated with DTaP
administration?
A. Local soreness and mild fever
B. Transient thrombocytopenia
C. Anaphylaxis
D. Acute encephalopathy
Answer: D. Acute encephalopathy Rationale: Acute encephalopathy is a rare but severe
adverse effect of the DTaP vaccine. Mild reactions like local soreness and fever are more
common, while anaphylaxis is also rare but serious. Transient thrombocytopenia is associated
with MMR, not DTaP.
A 35-year-old woman of childbearing age is starting rifampin for tuberculosis treatment.
What should the nurse practitioner include in her patient education?
A. Rifampin has no interactions with hormonal birth control.
B. Rifampin can discolor bodily fluids but the effect is harmless.
C. Stop rifampin immediately if the patient notices any change in urine color.
D. Rifampin is safe to take during pregnancy without caution.
Answer: B. Rifampin can discolor bodily fluids but the effect is harmless. Rationale: Rifampin
can cause harmless discoloration (orange-red) of bodily fluids like urine, sweat, and tears. It
interacts with hormonal birth control, so women should use an additional non-hormonal
method. Rifampin should be used with caution during pregnancy only if the benefits outweigh
risks.
, A 15-month-old child had persistent crying lasting more than 3 hours within 48 hours of
their last DTaP dose. What is the correct action regarding their next DTaP dose?
A. Skip all future DTaP doses and use DT instead.
B. Delay the next dose until the child is 7 years old.
C. Administer the next dose with caution and monitor the child.
D. Discontinue pertussis vaccination entirely.
Answer: C. Administer the next dose with caution and monitor the child. Rationale:
Persistent crying after a previous DTaP dose is a precaution but not a contraindication. The child
can receive the next dose with careful monitoring. Severe events like anaphylaxis or
encephalopathy would contraindicate further pertussis vaccines.
Which of the following is a true contraindication to vaccine administration?
A. Mild acute illness with or without fever
B. Current antibiotic use
C. Anaphylactic reaction to a prior dose of the vaccine
D. History of localized swelling after a previous vaccine
Answer: C. Anaphylactic reaction to a prior dose of the vaccine Rationale: An anaphylactic
reaction to a vaccine or one of its components is a true contraindication. Conditions such as
mild illness, antibiotic use, or localized reactions are not contraindications.
A 5-year-old child is receiving IPV (inactivated poliovirus vaccine). What patient history
would contraindicate administration of the vaccine?
A. Local reaction to a previous vaccine
B. History of mild febrile seizures
C. Anaphylactic reaction to streptomycin
D. History of frequent ear infections
Answer: C. Anaphylactic reaction to streptomycin Rationale: IPV is contraindicated in patients
with an anaphylactic reaction to streptomycin, neomycin, or bacitracin, which are components
of the vaccine. Local reactions, febrile seizures, or unrelated medical conditions do not
contraindicate IPV administration.
Which of the following statements about the MMR vaccine is correct?
A. It contains inactivated virus components.
B. It is contraindicated in individuals with a history of thrombocytopenia.
C. It is 97% effective after a single dose.
D. Fever up to 103°F is considered a serious adverse effect.
,Answer: C. It is 97% effective after a single dose. Rationale: The MMR vaccine, a live-virus
vaccine, is highly effective (97%) after a single dose. Thrombocytopenia is a precaution but not
an absolute contraindication. Fever up to 103°F is considered mild and not serious.
You are seeing a 9-month-old infant who is due for the Haemophilus influenzae type b (Hib)
vaccine. The parents ask about its benefits. Which of the following diseases does the Hib
vaccine primarily protect against?
A. Meningitis, pneumonia, epiglottitis, and septicemia
B. Chicken pox and shingles
C. Measles, mumps, and rubella
D. Hepatitis A and hepatitis B
Answer: A. Meningitis, pneumonia, epiglottitis, and septicemia Rationale: The Hib vaccine
provides protection against serious bacterial infections like meningitis, pneumonia, epiglottitis,
and septicemia. These diseases are caused by Haemophilus influenzae type b, which is
particularly dangerous for young children.
A mother is concerned about the effectiveness of the Hib vaccine her child is receiving. She
asks which preparation elicits the strongest immune response. You respond by saying:
A. ActHIB and Hiberix
B. PedvaxHIB and Comvax
C. ProQuad
D. Engerix-B and Recombivax
Answer: B. PedvaxHIB and Comvax Rationale: PedvaxHIB and Comvax are made with an outer
membrane protein (OMP) isolated from Neisseria meningitidis and elicit a stronger immune
response compared to ActHIB and Hiberix, which are made with tetanus toxoid.
A vaccinated child develops a mild fever and localized rash a few days after receiving the
varicella vaccine. What should you tell the parents?
A. This is an expected mild reaction to the vaccine.
B. The child likely has a breakthrough case of chicken pox.
C. These symptoms are concerning for an allergic reaction to gelatin or neomycin.
D. This reaction indicates a contraindication for future varicella vaccines.
Answer: A. This is an expected mild reaction to the vaccine. Rationale: Mild reactions, such as
local reactions, low-grade fever, and a mild varicella-like rash, are common and not a cause for
concern. Severe reactions to the varicella vaccine are rare.
A 10-year-old child arrives for their hepatitis B vaccine. The parent reports a history of
anaphylactic reaction to the child’s last hepatitis B vaccine. What is the next best
step?
A. Administer the vaccine with close monitoring.
, B. Substitute a live attenuated hepatitis B vaccine.
C. Avoid vaccination due to contraindication.
D. Test for hepatitis B immunity instead of vaccination.
Answer: C. Avoid vaccination due to contraindication. Rationale: A previous anaphylactic
reaction to the hepatitis B vaccine is a contraindication for further doses. Additionally, an
allergy to baker’s yeast is another contraindication.
You are counseling a pregnant patient who is concerned about the varicella vaccine. Which
of the following should you include in your recommendations?
A. The varicella vaccine is safe during pregnancy.
B. The patient should avoid the vaccine during pregnancy due to its live virus.
C. Varicella vaccination should be administered only in the third trimester.
D. Vaccination is safe, but the patient should avoid aspirin for 6 weeks.
Answer: B. The patient should avoid the vaccine during pregnancy due to its live virus.
Rationale: The varicella vaccine is contraindicated during pregnancy because it is a live
attenuated virus vaccine. Pregnant patients should avoid it to prevent potential harm to the
fetus.
A 3-year-old child is scheduled to receive the hepatitis A vaccine (HepA). Which of the
following individuals would also be a candidate for this vaccine?
A. A 40-year-old patient traveling to South America
B. A pregnant woman exposed to a child with hepatitis A
C. An adolescent who completed the hepatitis A series at age 2
D. An adult with an egg allergy
Answer: A. A 40-year-old patient traveling to South America Rationale: The hepatitis A
vaccine is recommended for individuals traveling to areas with high rates of hepatitis A, such as
South America. It is also recommended for at-risk populations but not routinely for individuals
already vaccinated.
Which precaution should be emphasized when a patient receives the varicella vaccine?
A. Avoid contact with aspirin for 6 weeks due to the risk of Reye syndrome.
B. Avoid high-risk activities for 72 hours to reduce systemic effects.
C. Do not administer during active viral illnesses.
D. Avoid dairy products 48 hours before administration.
Answer: A. Avoid contact with aspirin for 6 weeks due to the risk of Reye syndrome.
Rationale: The varicella vaccine requires caution against aspirin or salicylates for 6 weeks post-
vaccination to avoid Reye syndrome, which is strongly associated with ASA use in children.
A 3-year-old child with sickle cell anemia has not completed the pneumococcal vaccine
series. Which vaccine is most appropriate for this child?
UPDATE - ALABAMA
A 12-month-old child arrives at the clinic for their routine MMR vaccine. The caregiver
reports the child had a mild cold with a low-grade fever earlier in the week but is now
asymptomatic. What is the best course of action?
A. Postpone the vaccine due to the recent illness
B. Administer the vaccine as scheduled
C. Defer the vaccine and recommend acetaminophen before administration
D. Avoid the vaccine because of a prior mild reaction to another vaccine
Answer: B. Administer the vaccine as scheduled Rationale: Mild, acute illnesses with or
without fever (e.g., a cold) are not contraindications for vaccination. The child can safely receive
the vaccine as scheduled. Routine NSAIDs or acetaminophen before vaccination are not
recommended, as they may decrease the immune response.
A mother of a 6-month-old baby is concerned about severe adverse effects after a DTaP
vaccine. Which of the following is the most serious adverse event associated with DTaP
administration?
A. Local soreness and mild fever
B. Transient thrombocytopenia
C. Anaphylaxis
D. Acute encephalopathy
Answer: D. Acute encephalopathy Rationale: Acute encephalopathy is a rare but severe
adverse effect of the DTaP vaccine. Mild reactions like local soreness and fever are more
common, while anaphylaxis is also rare but serious. Transient thrombocytopenia is associated
with MMR, not DTaP.
A 35-year-old woman of childbearing age is starting rifampin for tuberculosis treatment.
What should the nurse practitioner include in her patient education?
A. Rifampin has no interactions with hormonal birth control.
B. Rifampin can discolor bodily fluids but the effect is harmless.
C. Stop rifampin immediately if the patient notices any change in urine color.
D. Rifampin is safe to take during pregnancy without caution.
Answer: B. Rifampin can discolor bodily fluids but the effect is harmless. Rationale: Rifampin
can cause harmless discoloration (orange-red) of bodily fluids like urine, sweat, and tears. It
interacts with hormonal birth control, so women should use an additional non-hormonal
method. Rifampin should be used with caution during pregnancy only if the benefits outweigh
risks.
, A 15-month-old child had persistent crying lasting more than 3 hours within 48 hours of
their last DTaP dose. What is the correct action regarding their next DTaP dose?
A. Skip all future DTaP doses and use DT instead.
B. Delay the next dose until the child is 7 years old.
C. Administer the next dose with caution and monitor the child.
D. Discontinue pertussis vaccination entirely.
Answer: C. Administer the next dose with caution and monitor the child. Rationale:
Persistent crying after a previous DTaP dose is a precaution but not a contraindication. The child
can receive the next dose with careful monitoring. Severe events like anaphylaxis or
encephalopathy would contraindicate further pertussis vaccines.
Which of the following is a true contraindication to vaccine administration?
A. Mild acute illness with or without fever
B. Current antibiotic use
C. Anaphylactic reaction to a prior dose of the vaccine
D. History of localized swelling after a previous vaccine
Answer: C. Anaphylactic reaction to a prior dose of the vaccine Rationale: An anaphylactic
reaction to a vaccine or one of its components is a true contraindication. Conditions such as
mild illness, antibiotic use, or localized reactions are not contraindications.
A 5-year-old child is receiving IPV (inactivated poliovirus vaccine). What patient history
would contraindicate administration of the vaccine?
A. Local reaction to a previous vaccine
B. History of mild febrile seizures
C. Anaphylactic reaction to streptomycin
D. History of frequent ear infections
Answer: C. Anaphylactic reaction to streptomycin Rationale: IPV is contraindicated in patients
with an anaphylactic reaction to streptomycin, neomycin, or bacitracin, which are components
of the vaccine. Local reactions, febrile seizures, or unrelated medical conditions do not
contraindicate IPV administration.
Which of the following statements about the MMR vaccine is correct?
A. It contains inactivated virus components.
B. It is contraindicated in individuals with a history of thrombocytopenia.
C. It is 97% effective after a single dose.
D. Fever up to 103°F is considered a serious adverse effect.
,Answer: C. It is 97% effective after a single dose. Rationale: The MMR vaccine, a live-virus
vaccine, is highly effective (97%) after a single dose. Thrombocytopenia is a precaution but not
an absolute contraindication. Fever up to 103°F is considered mild and not serious.
You are seeing a 9-month-old infant who is due for the Haemophilus influenzae type b (Hib)
vaccine. The parents ask about its benefits. Which of the following diseases does the Hib
vaccine primarily protect against?
A. Meningitis, pneumonia, epiglottitis, and septicemia
B. Chicken pox and shingles
C. Measles, mumps, and rubella
D. Hepatitis A and hepatitis B
Answer: A. Meningitis, pneumonia, epiglottitis, and septicemia Rationale: The Hib vaccine
provides protection against serious bacterial infections like meningitis, pneumonia, epiglottitis,
and septicemia. These diseases are caused by Haemophilus influenzae type b, which is
particularly dangerous for young children.
A mother is concerned about the effectiveness of the Hib vaccine her child is receiving. She
asks which preparation elicits the strongest immune response. You respond by saying:
A. ActHIB and Hiberix
B. PedvaxHIB and Comvax
C. ProQuad
D. Engerix-B and Recombivax
Answer: B. PedvaxHIB and Comvax Rationale: PedvaxHIB and Comvax are made with an outer
membrane protein (OMP) isolated from Neisseria meningitidis and elicit a stronger immune
response compared to ActHIB and Hiberix, which are made with tetanus toxoid.
A vaccinated child develops a mild fever and localized rash a few days after receiving the
varicella vaccine. What should you tell the parents?
A. This is an expected mild reaction to the vaccine.
B. The child likely has a breakthrough case of chicken pox.
C. These symptoms are concerning for an allergic reaction to gelatin or neomycin.
D. This reaction indicates a contraindication for future varicella vaccines.
Answer: A. This is an expected mild reaction to the vaccine. Rationale: Mild reactions, such as
local reactions, low-grade fever, and a mild varicella-like rash, are common and not a cause for
concern. Severe reactions to the varicella vaccine are rare.
A 10-year-old child arrives for their hepatitis B vaccine. The parent reports a history of
anaphylactic reaction to the child’s last hepatitis B vaccine. What is the next best
step?
A. Administer the vaccine with close monitoring.
, B. Substitute a live attenuated hepatitis B vaccine.
C. Avoid vaccination due to contraindication.
D. Test for hepatitis B immunity instead of vaccination.
Answer: C. Avoid vaccination due to contraindication. Rationale: A previous anaphylactic
reaction to the hepatitis B vaccine is a contraindication for further doses. Additionally, an
allergy to baker’s yeast is another contraindication.
You are counseling a pregnant patient who is concerned about the varicella vaccine. Which
of the following should you include in your recommendations?
A. The varicella vaccine is safe during pregnancy.
B. The patient should avoid the vaccine during pregnancy due to its live virus.
C. Varicella vaccination should be administered only in the third trimester.
D. Vaccination is safe, but the patient should avoid aspirin for 6 weeks.
Answer: B. The patient should avoid the vaccine during pregnancy due to its live virus.
Rationale: The varicella vaccine is contraindicated during pregnancy because it is a live
attenuated virus vaccine. Pregnant patients should avoid it to prevent potential harm to the
fetus.
A 3-year-old child is scheduled to receive the hepatitis A vaccine (HepA). Which of the
following individuals would also be a candidate for this vaccine?
A. A 40-year-old patient traveling to South America
B. A pregnant woman exposed to a child with hepatitis A
C. An adolescent who completed the hepatitis A series at age 2
D. An adult with an egg allergy
Answer: A. A 40-year-old patient traveling to South America Rationale: The hepatitis A
vaccine is recommended for individuals traveling to areas with high rates of hepatitis A, such as
South America. It is also recommended for at-risk populations but not routinely for individuals
already vaccinated.
Which precaution should be emphasized when a patient receives the varicella vaccine?
A. Avoid contact with aspirin for 6 weeks due to the risk of Reye syndrome.
B. Avoid high-risk activities for 72 hours to reduce systemic effects.
C. Do not administer during active viral illnesses.
D. Avoid dairy products 48 hours before administration.
Answer: A. Avoid contact with aspirin for 6 weeks due to the risk of Reye syndrome.
Rationale: The varicella vaccine requires caution against aspirin or salicylates for 6 weeks post-
vaccination to avoid Reye syndrome, which is strongly associated with ASA use in children.
A 3-year-old child with sickle cell anemia has not completed the pneumococcal vaccine
series. Which vaccine is most appropriate for this child?
