Chapter 20 -Immunizations Flashcards

Which tetanus-containing vaccine requires five doses to be given as a part of the routine childhood vaccine series?

A patient is undergoing a pre-operative evaluation for a splenectomy. Which vaccine is specifically indicated in a patient without a spleen?

Exposure to which of the following commonly requires administration of immune globulin at the time of vaccination?

History of Present Illness: this is a 65-year-old male who presents to the emergency department with altered mental status. According to the patient's daughter, he has been confused since yesterday and is now dragging his right side. The patient does not recognize his daughter and he is unable to answer questions related to recent events. He denies chest pain or shortness of breath. The daughter also noticed some blood in the patient's urine this morning.
Past Medical History:

HypertensionPeripheral vascular diseaseCOPDTobacco use (1 PPD)DyslipidemiaDiabetes Chronic kidney disease, stage 2

At discharge, the nurse screens the patient to determine if he is a candidate for any vaccinations. The patient states that he only recently established care with a healthcare provider and cannot recall receiving any vaccinations in the past 20 years. Based on his medical profile, which vaccines would be indicated in this patient? (Select ALL that apply)

Which of the following statements concerning the recombinant vaccine Flublok are correct? (Select ALL that apply.)

A small community pharmacy just received a delivery of influenza vaccines. The pharmacy owner needs to instruct the staff on storage requirements. He should include the following information:

Which vaccine is contraindicated in patients with a severe allergy to eggs or gelatin?

History of Present Illness: TH is a 57-year-old male who presents to the ED on February 5 with a decreased level of consciousness. He was found unresponsive on the bathroom floor by his daughter, who came to check on him after a call from the dialysis center that he had missed 2 sessions. She had spoken to him 2 days prior, when he told her he had been to the doctor and gotten prescriptions for Tamiflu and a cough syrup after a positive influenza swab.

Past Medical History: end stage renal disease (anuric), hemodialysis on MWF for 3.5 hours each session, hypertension, osteoarthritis (knees), restless legs syndrome, hypothyroidism

Which vaccinations are indicated for this patient if not otherwise up-to-date? (Select ALL that apply)

**case above**

When questioned, TH states that he declined the influenza vaccine offered at his dialysis center in the fall because he felt like he was getting a cold. Which of the following is true regarding the influenza vaccine in this patient?

A 12-month-old child 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? (Select ALL that apply.)

History of Present Illness: SM is a 36-year-old male who presents to the HIV clinic for a routine appointment. He is doing well and has no major complaints at this time. He states that he uses his albuterol inhaler 4 days per week (about 6 puffs on each of those days) and has been trying over-the-counter medications to manage occasional heartburn.Allergies: sulfa (hives)

Past Medical History: HIV (no history of opportunistic infections)Asthma, Dyslipidemia

Immunization History: annual influenza vaccine (up-to-date), Recombivax-HB (up-to-date), no history of pneumococcal vaccination

Which pneumococcal vaccination recommendation is most appropriate for SM?

**case above**

Which vaccine is indicated for SM based on his medical profile?

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.)

Which of the following vaccines must be stored in the freezer and require reconstitution with a diluent prior to administration? (Select ALL that apply.)

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 before administering Varivax?

LM, a 29-year-old female, is starting her first job as a hospital pharmacist in September. She completed the hepatitis B vaccine series during pharmacy school but states that she did not receive most childhood vaccines and cannot recall any other vaccinations during adulthood. What vaccines should LM receive today? (Select ALL that apply.)

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 the following statements is true?

Select the correct name for the chickenpox vaccine:

Referring to the figure, which choice best represents the appropriate location for administering the Tdap vaccine?

On January 20th, a 4-year-old child was hospitalized for 7 days with Kawasaki disease. During the hospitalization, she received 80 mg/kg/day of oral aspirin, 30 mg/kg/day of IV methylprednisolone and IV immune globulin (Privigen). She is scheduled for a visit with her pediatrician on March 10th for routine vaccinations. Which vaccine should not be administered on March 10th given the treatments received during her hospitalization?

HS is a healthy 67-year-old female who presents to her PCP in October. Which vaccine should the pharmacist recommend for HS today?

A 52-year-old male comes to his primary care provider for his annual physical examination.

Past Medical History: gout, hypothyroidism

Immunization History:
Hepatitis B series (5 years ago)
Tdap (5 years ago)
Influenza (1 month ago)

Medications: allopurinol 100 mg PO daily, levothyroxine 50 mcg PO daily

Vital Signs: BP 108/70 mmHg, HR 72 bpm, RR 16 bpm, T 98.2°F (36.8°C), Ht 5′ 10″, Wt 80 kg

Laboratory Tests (Fasting):
Glucose 85 mg/dL
Serum creatinine 0.9 mg/dL
Aspartate aminotransferase 16 units/L
Alanine aminotransferase 12 units/L
White blood cells 6,000 cells/mm³
Thyroid-stimulating hormone 1.4 mIU/L
Total cholesterol 180 mg/dL
Low-density lipoprotein 77 mg/dL
High-density lipoprotein 85 mg/dL
Triglycerides 110 mg/dL

Which of the following vaccinations is recommended for this patient at this time?

Which of the following patients are eligible to receive the pneumococcal conjugate vaccinePrevnar 20? (Select ALL that apply)

FM is a 16-year-old female who presents to the clinic for a follow-up visit with her psychiatrist. She was diagnosed with ADHD as a small child but stopped taking her medications 2-3 years ago. She now feels like she needs to be started back on medication to help her focus with school work.

Allergies: sulfa
VitalsHeight: 5'4" Weight: 120 lbsBP: 110/64 mm Hg, HR: 65 BPM, RR: 18 BPM, Temp: 98.6 F
Past Medical HistoryADHDMajor depressive disorderInsomnia
Medications Prozac 20 mg QHS
Plan Vyvanse 30 mg each morningCatapres 0.1 mg QHSFollow-up in 1 month

It is discovered that FM has not received any doses of the human papillomavirus vaccine. If a dose of Gardasil 9 is administered today, how many additional doses will need to be administered to complete the series?

History of Present Illness: TP is a 52-year-old African American female who was admitted to the hospital 5 days ago for resection of an abdominal mass.

Allergies: Accupril (cough), cefepime (anaphylaxis)

Past Medical History:
Hypertension
Kidney transplant (cadaveric donor) 6 years ago

Immunization History:
Prevnar 13 and Pneumovax 23 (6 years ago)
Influenza (up-to-date)

During her hospitalization, TP has an immunization screening. Which of the following vaccines should be administered to TP?

KH approaches the pharmacist in January and asks if her 7-year-old daughter should receive the seasonal influenza vaccination. She notes that her daughter has a severe allergy to eggs. Which statement regarding the administration of an influenza vaccine for KH's daughter is correct?

Choose the correct statements regarding SC administration of vaccines. (Select ALL that apply.)

A small community pharmacy just received a delivery of influenza vaccines. The pharmacist tells the staff to place the FluMist in the refrigerator door to keep it separate from the influenza injections.

Which of the following statements regarding vaccine storage is correct?

The manager at a pharmacy ordered 100 single-dose vials of Afluria. He found them stored in the pharmacy's freezer. Choose the correct course of action:

Which statements regarding vaccine administration timing and spacing are true? (Select ALL that apply.)

HY is a 77-year-old female with diabetes, heart failure 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?

On October 14th, a 13-month-old child was hospitalized for 4 days for a flare of polyarticular juvenile rheumatoid arthritis. During the hospitalization, her rheumatologist administered IV steroids, nonsteroidal anti-inflammatory drugs and Gammagard (intravenous immunoglobulin) to manage the flare. The child is now scheduled for a visit with her pediatrician to catch up on several vaccinations, including Varivax. What is the earliest date that Varivax should be administered to this child?

JK is a 21-year-old male who presents to the urgent care clinic on June 22 with a puncture wound in his left foot after stepping on a nail when he walked outside barefoot. He remembers getting a tetanus shot at age 14 (it made his arm very sore) but has only gotten a flu shot every year since then. Which of these vaccines would be an appropriate selection to administer at this time? (Select ALL that apply.)

VR is 20 weeks pregnant with her second child. She is unsure what childhood vaccines she received and is certain that she has not been vaccinated for anything in at least fifteen years. Which vaccines are recommended for VR during her pregnancy? (Select ALL that apply.)

A 62-year-old female patient came into the pharmacy to get an influenza shot. It was her first time receiving the annual vaccine. Three days later, she came back complaining of a hacking cough, mild weakness, stuffy nose and a sore throat. She is afebrile and reports no muscle aches or pains. She states the shot gave her the flu. What is the most likely reason for the patient's illness?

Select the correct information for the Varivax vaccine.

Chief Complaint: "I'm here for my flu vaccine but my stomach hurts"
History of Present Illness: ZB is a 66-year-old white female who presents to her PCP with a 2-week history of gastric pain that is worse at night and in between meals. She describes a burning pain that goes from a "9 out of 10" to a "5 out of 10" when she eats.
Allergies: penicillin (swollen tongue)
Past Medical History: hypertension, type 2 diabetes, dyslipidemia, osteoporosis, anxiety, chronic pain
Social History: quit smoking 20 years ago (previous 15-year pack history), drinks 1 vodka and soda each night while playing cards with friends at the retirement home

Select the correct administration instructions for the vaccine that ZB is scheduled to receive today.

ZB will be receiving two pneumococcal vaccines. Which of the following regimens represents the correct vaccines, sequence and interval?

The Shingrix vaccine is recommended for which of the following patients?

Which vaccine can cause a false-positive reaction to the Tuberculin Skin Test (TST)?