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1
While the infant is supine, if the head is turned to one side, the shoulder, trunk, and finally pelvis will turn toward that side. This reflex appears at 3 months, and persists until 24 to 36 months of age. Body righting is a modification of the neck-righting reflex in which turning hips and shoulders to one side causes all other body parts to follow; it appears at 6 months, and persists until 24 to 36 months of age. When the body of an erect infant is tilted, the head is returned to an upright, erect position; this is known as otolith righting, which appears at 7 to 12 months of age, and persists indefinitely. When an infant in prone or supine position is able to raise head, it is known as labyrinth righting. It appears at 2 months, and is strongest at 10 months of ag
Which of the following groups, ages 6-64, should receive Prevnar 13 followed by Pneumovax 23 at least 8 weeks later then Pneumovax 23 again 5 years after the first dose? (Select all that apply)
HIV infection
Multiple myeloma about to begin Tx
Chronic renal failure undergoing dialysis x3 weekly
HF
Organ transplant
HIV infection
Multiple myeloma about to begin Tx
Chronic renal failure undergoing dialysis x3 weekly
Organ transplant
A 20-year-old female has no evidence of immunity to varicella and is being vaccinated to prevent chickenpox. Which screening question must be asked prior to administering Varivax?
Has she ever has a life-threatening allergic reaction to eggs?
Has she ever had Guillan-Barre syndrome after the flu vaccine?
Has she ever had a bad reaction to gelatin?
Does she have a history of smoking?
Is she
receiving more than 5 mg prednisone per day for at least the past two months?
Has she ever had a bad reaction to gelatin?
Common live vaccines:
remember COZY IV RM
Cholera
Oral Typhoid
Zoster (Zostavax)
Yellow Fever
Intranasal Influenza
Varicella
Rotavirus
MMR
A mother asks if her 11-month-old son will receive thimerosal from vaccines. She is concerned that this mercury-containing perservative might increase the risk of autism in her son. How do you respond?
Thimerosal may be present in multi-dose influenza vaccines and can be avoided upon request.
A link between vaccines and autism has been shown to be invalid; pharmacists should promote vaccination to reduce disease spread.
Choose the correct
statements regarding SC administration of vaccines. (Select all that apply)
Zostavax, Varivax and MMR are administered SQ
FluMist, Fluzone and Vivotif are administered SQ
SC injxn are administered into the fatty tissue over the triceps.
SC injxns are administered using a needle that is 5/8 inch long
SC injxns are administered at a 45 degree angle.
Zostavax, Varivax and MMR are administered SQ
SC injxn are administered into the fatty tissue over the triceps.
SC injxns are administered using a needle that is 5/8 inch long
SC injxns are administered at a 45 degree angle.
Select the correct name for the chickenpox vaccine:
Valtrex
Zovirax
Varivax
Engerix-B
Zostavax
Varivax
JB is a 72-year-old male who is due for his tetanus vaccine. He lives in an apartment
with his daughter, a 3-month-old granddaughter and a 2-year-old grandson. He does not know if he ever received the pertussis vaccine. Which vaccine should JB receive?
Tdap
Td
Tetanus only
DtaP
TdP
Tdap
Children get DtaP (5 doses) and older children, adolescents and adults get TdaP. Tdap is recommended for adults because they can pass it along to children and infants who are at highest risk of severe illness and death.
An 14-month-old child was hospitalized two months ago for a dog bite injury. She was not on schedule with her tetanus vaccine series, so tetanus immune globulin was given. Which vaccine would be affected by this treatment?
Hep B vaccine
Polio vaccine
Influenza vaccine, inactivated
Measles-mumps-rubella-varicella (MMRV)
Pneumococcal conjugate
Measles-mumps-rubella-varicella (MMRV)
MMR and varicella vaccines are live virus vaccines that require replication. If antibody containing products have been administered, the vaccine should not be given for at least 3 months (required time of separation varies depending on the product received). If vaccine has been given, antibody products should be avoided for at least 2 weeks after MMR and varicella-containing vaccines to avoid interference with vaccine efficacy.
Which of the following groups should receive the
pneumococcal polysaccharide vaccine (Pneumovax 23)? Select all that apply
68 y/o female with HTN but no other comorbities
50 y/o male with COPD
26 month old child with asthma receiving high-dose corticosteroids
6 y/o child receiving chemotherapy for lymphoma
8 month old baby with patent ductus arteriosus
68 y/o female with HTN but no other comorbities
50 y/o male with COPD
26 month old child with asthma receiving high-dose
corticosteroids
6 y/o child receiving chemotherapy for lymphoma
Select the correct administration site for Zostavax vaccine in an adult:
Biceps
Fatty tissue over the triceps
Anterolateral thigh
Deltoid muscle
Gluteus maximus
Fatty tissue over the triceps
KH approaches pharmacist about 7 y/o daughter getting influenza vaccine. How would you respond?
If this is the first time she is receiving the vaccine, she should receive two doses spaced 4 weeks apart
A small community pharmacy just received a delivery of influenza vaccine. The pharmacy has a small refrigerator with a freezer compartment within the refrigerator. The pharmacist tells the staff to make sure that the FluMist is kept in the refrigerator door to keep it separate for the influenza injections. Which of the following statements regarding vaccine storage is correct?
The influenza vaccine should be frozen, not refrigerated
Food can be kept in the same refrigerator but not on the same shelf as the vaccine (or any medication)
The influenza vials for injection should be kept in the door
The refrigerator in the pharmacy is acceptable if the door is not open and closed repeatedly.
This type of refrigerator is not acceptable.
This type of refrigerator is not acceptable.
It is very rare for a patient receiving an injection to experience anaphylaxis. However, if any serious reaction does occur to a vaccine, it must be reported to the following agency.
VAERS
Which of the following patients should receive Pneumovax 23 x1 before age 65?
A patient with heart failure
A
patient with a history of meningitis
A patient with diabetes
A patient who smokes
A patient with asthma
A patient with heart failure
A patient with diabetes
A patient who smokes
A patient with asthma
Which of the following is true regarding Zostavax: Select all that apply
The diluent must be stored in the refrigerator only
Once reconstituted the vaccine must be used within 30 minutes or
discarded
The vaccine can be administered IM or SQ
Store the unused vaccine vials (powder) in the refrigerator
Store the unused vaccine vials (powder) in the freezer
Once reconstituted the vaccine must be used within 30 minutes or discarded
Store the unused vaccine vials (powder) in the freezer
Which of the following patients should receive Bexsero?
19 y/o on a college campus during a meningitis
serogroup B out break
6 y/o with sickle cell disease
10 y/o with sickle cell disease
25 y/o lab worker exposed to N. meningitidis
38 y/o person traveling to the meningitis belt of Sub-Saharan Africa
19 y/o on a college campus during a meningitis serogroup B out break
10 y/o with sickle cell disease
25 y/o lab worker exposed to N. meningitidis
A pharmacy that is administering vaccines must be
prepared to administer the following medication in the event of an anaphylactic reaction:
Epinephrine injection
Dexamethasone injection
Hydroxyzine injection
Epinephrine injection
DV is a healthy 66 y/o female. Her PCP believes that she would benefit from receiving both Prevnar 13 and Pneumovax 23. How should the vaccines be sequenced?
Prevnar 13 today
Pneumovax 1
year from today
Which of the following vaccines can be given in the time interval as stated below?
Proquad and FluMist separated by 14 days
MMR and FluMist separated by 10 days
Varivax and FluMist separated by 28 days
MMR and the zoster vaccine (Zostavax) seperated by 14 days
MMR and the zoster vaccine (Zostavax) seperated by 7 days
Varivax and FluMist separated by 28 days
A community pharmacist who runs a vaccination clinic has run out of the vaccine information sheets (VIS) for one of the vaccines. To find a current VIS for copying, the pharmacist can use which recommended website? (select all that apply)
CDC
WHO
The Pharmacist Letter
The Immunization Action Coalition
The Medical letter
the center for disease control
the immunization action coalition
A community pharmacist who runs a vaccination clinic wants to review current vaccine administration recommendations. What source is best to obtain the current vaccine recommendations and other essential immunization information?
Koda Kimble: Applied therapeutics
A website he found by searching with Google
The vaccine manufacturer's product package inserts
Center for Disease Control website
His pharmacy school notes
Center for Disease Control website
The shingrix vaccine is recommended for which of the following patient groups?
Adults 60 years and older and children at 2-3 months and 10-11 years old
adults 40 years and older
Adults 50 years and older and children at 2-3 months and 10-11 years old
Adults 60 years and older and college students who live in dormitories
Adults 50 years and older
Adults 50 years and older
Which vaccine is contraindicated with a severe allergy to eggs or gelatin?
yellow fever
Which of the following, if taken, would qualify as a steroid-induced immune suppressive state? (select all that apply)
a patient who recently infected HIV
an 11.6 kg child receiving 30 mg prednisolone for the past 22 days
the use of a beclomethasone inhaler twice daily for at least 4 weeks
an elderly female who received a triamcinolone intra-articular injection for gout x1 two days ago
an adult who received 4 mg of dexamethasone daily for the past 3 weeks
an 11.6 kg child receiving 30 mg prednisolone for the past 22 days
an adult who received 4 mg of dexamethasone daily for the past 3 weeks
Which of the following statements about the Shingrix vaccine is correct? (select all that apply)
it prevents infections caused by the herpes simplex virus
it should be administered even if the patient has a history of shingles
antivirals (ex. acyclovir) can interfere with vaccine response
it is administered SQ in the fatty tissue above the triceps
it should be injected into the deltoid muscle
it should be administered even if the patient has a history of shingles
it should be injected into the deltoid muscle
a 67 year old patient at your pharmacy has diabetes and heart disease. She states that she has not received any immunization in the past 10 years except for her annual flu shot. Which vaccine should the patient receive today?
MMR
DTaP
Havrix
Hib
Pneumovax 23
Pneumovax 23
LM, a 29 year-old female, is getting her first job as a hospital pharmacist since completing school. Her first day of work is September 15. She completed her hepatitis B vaccine series (three doses, with evidence of immunity) during pharmacy school. Her mother reports that she was the only child in the family who did not contract chickenpox. What other vaccines should LM receive now? (Select ALL that apply.)
RotaTeq
Tdap vaccine, if no record of previous booster with a perussis-containing
tetanus vaccine
Varivax
The influenza vaccine, seasonally
Hib vaccine
Tdap vaccine, if no record of previous booster with a perussis-containing tetanus vaccine
Varivax
The influenza vaccine, seasonally
Select the correct statement concerning active and passive immunity:
The MMR vaccine provides active immunity
Active immunity is weaker than passive immunity
Immune globulin provides active immunity
One way to get passive immunity is to survive an infection
Breast milk, during the early days of a baby's life, provides active immunity
The MMR vaccine provides active immunity
Select the correct group of patients for whom hepatitis B vaccine is recommended:
39 y/o patient with cirrhosis and an 18 y/o leaving for college next month
66 y/o with HF and 35 y/o with hx of drug abuse
58 y/o with diabetes, 39 y/o dialysis patient and an infant born 12 hours ago
44 y/o patient with HIV, a 31 y/o surgery resident and a 27 y/o patient with G6PD deficiency
52 y/o patient who is status post-splenectomy and a 28 y/o patient with multiple sex partners
58 y/o with diabetes, 39 y/o dialysis patient and an infant born 12 hours ago
WD is a 13 y/o female. Her mother is upset that the pediatrician wants to administer the HPV vaccine. Which of the following statements concerning HPV are correct?
It prevents cervical, vaginal, and orophryngeal cancers, as well as genital warts
It has been associated with fainting after vaccination and should be administered while the patient is lying down
It should only be administered to males; females are not candidates for the vaccine
If the patient receives the vaccine today, only two doses are required
It should only be administered in males and females who are sexually active
It prevents cervical, vaginal, and orophryngeal cancers, as well as genital warts
If the patient receives the vaccine today, only two doses are require
Select the correct information about Zostavax and Varivax vaccines.
the diluent must be stored in the freezer and the vaccine is refregerated
both the diluent and the vaccines are kept frozen until needed
the vaccines are ready to use, no reconstitution required
Once drawn up in a syringe, the vaccine must be used quickly, do not store reconstituted vaccine
Only Zostavax (not Varivax) can be given during pregnancy
Once drawn up in a syringe, the vaccine must be used quickly, do not store reconstituted vaccine
A 64 y/o female is in the pharmacy to pick up her meloxicam prescription and some throat lozenges on August 24. The pharmacist notices that she is congested, with sneezing and she mentions a sore throat. Upon questioning, she states that she has not received her influenza vaccine yet this season. Which of the following is correct?
She should not receive the influenza vaccine today because of an interaction with her medication
She should not receive the vaccine today as she is too ill
She should receive the vaccine today
She will need to receive 2 doses of influenza this year, 1 dose today and 1 dose in 4 weeks
She should not receive the vaccine until after Oct. 1, to avoid the immunity waning before the end of the influenza season
She should receive the vaccine today
Which vaccine can cause a false positive reaction to the Tuberculin Skin Test (TST)?
Varivax
Bexsero
Bacille
Calmette-Guerin
FluBlok
Human papillomavirus
Bacille Calmette-Guerin
A 62-year-old male underwent a splenectomy secondary to refractory thrombocytopenia. Which vaccine should he receive at least 2 weeks before this procedure?
Hepatitis B
Menactra
Menhibrix
Boostrix
Twinrix
Menactra
Splenectomy patients should receive the meningococcal and Hib vaccines, however, Menhibrix is used only in children age 6 weeks to 18 months. Menactra and Menveo are quadrivalent conjugate vaccines containing the ACW and Y serogroups.
General Rules for all Vaccines:
Vaccines can usually be given at the same time (same visit on same day)
Multiple live vaccines can be given on the same or (if not given on the same day) spaced 4 weeks apart.
If a vaccine series requires > 1 dose, the intervals
between doses can be extended without restarting the series, but they cannnot be shortened in most cases.
Live Vaccines and Antibody:
MMR and Varicella-containing vaccines (not zoster) require separation form antibody-containing products (ie blood transfusions, IVIG). The recommended spacing is:
-Vaccine -> 2 weeks -> antibody-containing product
-Antibody-containing product -> 3 months or longer ->vaccine
Simultaneous administration of vaccine and antibody (in the form of immunoglobuliin) is recommended for post-exposure prophylaxis for certain diseases (ex. hepatitis A and B, rabies and tetanus).
...
PPD =
purified protein derivative
Patient should be monitored post immunization for at least _____minutes (watch for allergic reactions, syncope, dizziness or falls)
15
HY is a 77 y/o female with diabetes, HF and rheumatoid arthritis. She would like to get a flu vaccine while her prescriptions are filled. Which of the following formulations would not be appropriate for her?
FluMist
Flublok Quadrivalent
Fluzone High-Dose
Fluad
Fluarix Quadrivalent
FluMist
Which of the following is incorrect regarding vaccine storage:
MMR vaccine can be stored in the freezer
Cholera vaccine must be stored in the refrigerator
MMRV vaccine must be stored in the freezer
MMR vaccine can be stored in the refrigerator
Vivotif must be stored in the refrigerator
Cholera vaccine must be stored in the refrigerator
A pharmacist is working in a hospital that requires hepatitis B vaccination. She received her 1st dose of a 3-dose series. She did not return for the 2nd dose, which was due one month later. It is now four months after the 1st dose. Select the correct recommendation:
The first dose provided adequate protection, the second doses are optional
She is more than 30 days late with the 2nd dose; she must start the series over
She should get the 2nd dose now and return the 3rd dose at the proper time
She should receive a double dose of hepatitis B vaccination to make up for the late dose.
She is no longer a candidate for hepatitis B vaccination
She should get the 2nd dose now and return the 3rd dose at the proper time
Which of the following vaccines comes as a powder that is stored in the freezer and requires reconstitution with the supplied diluent? Select all that apply
Varivax
Zostavax
Vivotif
Pentacel
MMR with Varicella (MMRV,
ProQuad)
Varivax
Zostava
MMR with Varicella (MMRV, ProQuad)
Which of the following statements concerning the recombinant vaccine Flublok are correct? Select all that apply
Flublok is approved for use in patients 18 years and older
Flublok is given SQ
Flublok is produced with recombinant DNA techniques and is completely free of egg products
Flublok is preferred in children < 8 y/o
If a patient wishes to receive Flublok and they have had a severe reaction to eggs (anaphylaxis they cannot receive Flublok in the pharmacy
Flublok is approved for use in patients 18 years and older
Flublok is produced with recombinant DNA techniques and is completely free of egg products
With flu ages 6 months to 8 years (not previously vaccinated) give 2 doses ____ weeks apart
4
Which of the following patients is the measles-mumps-rubella vaccine CI?
56 y/o female that lives with elderly mother who takes methotrexate for RA
27 y/o patient currently on 5-7 day of amoxicillin Rx for tooth abscess
23 y/o with head cold + fever of 100.1 the previous evening
31 y/o female who is 31 weeks pregnant
51 y/o with HIV and CD4 count of 292
31 y/o female who is 31 weeks pregnant
Normal interval between Prevnar 13 and Pneumovax 23 is 12 months unless patient is immunocompromised then ___ weeks
8
Which vaccines contain hepatitis B vaccine only?
Pediarix
Recombivax-HB
Engerix-B
Havrix
Twinrix
Recombivax-HB
Engerix-B
Havrix - hep A
Twinrix - hep A,
B
Pediarix - DTaP-hep B - IPV
A pharmacist is preparing an injxn for a 63 y/o male, who weighs 280 lbs. The pharmacist is going to administer the Zostavax vaccine. Which of the following statements concerning Zostavax injxns is correct?
Zostavax will help protect the patient against developing a herpes zoster outbreak
Use a needle at least 1.5 inches long
This vaccine is administered SQ in the fatty tissue over the triceps
The vaccine must be reconstituted prior to use with sterile or bacteriostatic water
Zostavax is reommended in patients woh have had shingles before
Zostavax will help protect the patient against developing a herpes zoster outbreak
This vaccine is administered SQ in the fatty tissue over the triceps
Zostavax is reommended in patients woh have had shingles before
Which of the following is not a
live vaccine?
Yellow fever
RotaTeq
Typhim Vi
Flumist
Vaxchora
Typhim Vi
Exposure to which of the following requires administration of immune globulin at the time of vaccination?
Eppstein-Barr virus
Cholera
Pertussis
HPV
Rabies
Rabies
Which of the following could interfere with the effectiveness
of a dose of Zostavax? (select all that apply)
Denavir
Valtrex
Oseltamivir
Acyclovir
MMR given 2 weeks prior to Zostavax
Valtrex
Acyclovir
MMR given 2 weeks prior to Zostavax
SC only vaccines (4)
MMR
MMRV
Zostavax
Yellow Fever
The CDC does not recommend using acetaminophen before or at vaccination as it may decrease immune response; it can be used afterwards if needed for mild pain/or fever. T or F
True
PJ is 13 month old male who presents to the pediatrician for a routine check up. hea has never received influenza vaccine. How will he get vaccinated?
One dose to prime the immune system plus a second dose 28 days later.
6 months - 8 years
-2 doses 4 weeks apart
When at the health clinic to get influenza vaccines for herself and her 13 month old daughter, a mother noted on the screening form that her daughter received Vaqta earlier that month, which of following is True?
Vaqta is a hepatitis A vaccine
Vaqta is a conbination of hepatitis B and A
Vaqta is a varicella vaccine
Vaqta is a tetanus, diptheria and pertussis vaccine
Vaqta is a hepatitis C vaccine
Vaqta is a hepatitis A vaccine
A child with sickle cell disease has not been vaccinated for meningococcal disease. Which of the following is true regarding meningococcal disease/vaccine? (select all that apply(
This patient should receive Trumenba or Bexsero once he turns y/o
Meningococcal vaccine is a routine childhood series given to all infants
Under current recommendations, this patient will require repeated vaccinations (boosters) every 5 years
Quadrivalent meningococcal vaccines include Menactra and Menveo
The damage of the spleen caused by sickle cell disease puts this patient at risk for meningococcal disease
This patient should receive Trumenba or Bexsero once he turns y/o
Under current recommendations, this patient will require repeated vaccinations (boosters) every 5 years
Quadrivalent meningococcal vaccines include Menactra and Menveo
The damage of the spleen caused by sickle cell disease puts this patient at risk for meningococcal disease
Live vaccines can cause false-negative on tuberculin test. T or F
True
Children get 5 doses of what tetanus-containing vaccine?
DTaP
Prevention of Typhoid:
Typhoid vaccine comes as oral capsule or as an IM injection
Vivotif is a capsule formulation and requires refrigeration
...
Which of the following vaccine names is not correctly matched?
Adacel = tetanus diptheria pertussis vaccine
Fluad = influenza vaccine
Hiberix = hepatitis B vaccine
Vaxchora = Cholera vaccine
Trumenba = Meningococcal serogroup B vaccine
Hiberix = hepatitis B vaccine
It is a Haemophilus influenza type B vaccine
In which of the following patients can Fluad be used for influenza prevention?
patient who had a severe rxn 30 minutes after a dose of Flublok
patient who wants quadrivalent vaccine
patient who want egg free vaccine
patient who had Guillain-Barre 2 weeks after receiving a flu vacccine 6 years prior
67 y/o female with hx of hypothyroidism
67 y/o female with hx of hypothyroidism
Choose correct statement concerning HPV:
They should be given in children who are sexually active
A series of 3 IM injxn required for 16 y/o female receiving 1st dose
A series of 2 IM injxns for 12 y/o female receiving her 1st dose
A series of 3 IM injxns required in a 24 y/o male with HIV receiving 1st dose
HPV vaccination is considered optional, not recommended for patients age 9-26 years
A series of 3 IM injxn required for 16 y/o female receiving 1st dose
A series of 2 IM injxns for 12 y/o female receiving her 1st dose
A series of 3 IM injxns required in a 24 y/o male with HIV receiving 1st dose
AD is a 12 month female with sickle cell disease who is at the clinic for a routine visit. She will receive her 4th dose of pneumococcal vaccine. Which of the following statements is/are accurate regarding the vaccine she will receive today? (select all that apply)
She will receive Pneumovax 23
She will receive Prevnar 23
She will receive pneumococcal conjugate vaccine, 13 valent
She will receive Prevnar 13
She will receive pneumococcal polysaccharide vaccine, 23-valent
...
Which vaccine contains antigens for both hep A and B?
Twinrix
62 y/o female patient came into the pharmacy to get flu shot. It was her 1st time getting annual vaccine. 3 days later, she comes back with hacking cough, mild weakness, stuffy nose and sore throat. She is afebrile and reports no muscle pain. She state the shot gave her the flu. What is most likely the reason?
she has a cold
12 month old was hospitalized two months ago and received immune globulin for Kawasaki disease. Which vaccine/s would be adversely affected by this treatment if administered today?
Inactivated polio vaccine
Influenza vaccine, inactivated
Varicella vaccine
Pneumococcal conjugate vaccine
MMR
Varicella vaccine
MMR
Some vaccines contain gelatin, however the dietary regulations for most religions that do not consume animal products approve of vaccine use since the end product has been rendered pure. A few other vaccines contain egg products and can be avoided.
...
The "a" in DTaP stand for Acellular, meaning that the pertussis component of the vaccine only part of the organism
...