Page 1 of 87
APhA Immunization Self-Study Assessment Exam
ALL 300 QUESTIONS AND VERIFIED SOLUTIONS
LATEST UPDATE THIS YEAR
QUESTION: In which publication does the CDC initially publish new or updated vaccine
recommendations? - ANSWER-Morbidity and Mortality Weekly Report (MMWR)
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.
1
, Page 2 of 87
QUESTION: Which of the following best describes how to administer MMR vaccine to an adult
patient weighing 210 lb? - 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? - 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.
2
, Page 3 of 87
Q; 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. -
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: - 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
3
, Page 4 of 87
given too soon (before age 60), it may not afford protection in older individuals who are at
higher risk of herpes zoster.
QUESTION: Which entity determines the specific vaccines that a pharmacist may administer? -
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
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.
4
APhA Immunization Self-Study Assessment Exam
ALL 300 QUESTIONS AND VERIFIED SOLUTIONS
LATEST UPDATE THIS YEAR
QUESTION: In which publication does the CDC initially publish new or updated vaccine
recommendations? - ANSWER-Morbidity and Mortality Weekly Report (MMWR)
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.
1
, Page 2 of 87
QUESTION: Which of the following best describes how to administer MMR vaccine to an adult
patient weighing 210 lb? - 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? - 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.
2
, Page 3 of 87
Q; 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. -
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: - 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
3
, Page 4 of 87
given too soon (before age 60), it may not afford protection in older individuals who are at
higher risk of herpes zoster.
QUESTION: Which entity determines the specific vaccines that a pharmacist may administer? -
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
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.
4
