MCQ Quiz: Immunizations

Welcome, PharmD students, to this MCQ quiz on Immunizations! As medication experts and accessible healthcare providers, pharmacists play an increasingly vital role in public health through immunization services. A comprehensive understanding of vaccine types, immunization schedules, administration techniques, patient screening, and the management of adverse events is essential. This quiz will test your knowledge on these critical aspects, helping you prepare to confidently and competently provide immunization services and contribute to preventing vaccine-preventable diseases. Let’s get started!

1. Which type of immunity is acquired when a person receives antibodies produced by another person or animal?

• a) Active natural immunity
• b) Active artificial immunity
• c) Passive natural immunity
• d) Passive artificial immunity

Answer: d) Passive artificial immunity

2. Live attenuated vaccines are generally NOT recommended for which patient population due to the risk of causing disease?

• a) Healthy adults
• b) Adolescents
• c) Immunocompromised individuals
• d) Healthcare workers

Answer: c) Immunocompromised individuals

3. The Advisory Committee on Immunization Practices (ACIP) provides recommendations for:

• a) The manufacturing standards of vaccines.
• b) The routine administration of vaccines to the pediatric and adult populations in the United States.
• c) The pricing of vaccines.
• d) Only travel-related immunizations.

Answer: b) The routine administration of vaccines to the pediatric and adult populations in the United States.

4. Which of the following is an example of an inactivated vaccine?

• a) Measles, Mumps, Rubella (MMR) vaccine
• b) Varicella (chickenpox) vaccine
• c) Inactivated Influenza Vaccine (IIV)
• d) Rotavirus vaccine

Answer: c) Inactivated Influenza Vaccine (IIV)

5. When screening a patient for vaccination eligibility, which of the following would be considered a valid contraindication to receiving an influenza vaccine?

• a) Mild cold symptoms
• b) Egg allergy not involving hives
• c) A history of a severe allergic reaction (e.g., anaphylaxis) to a previous dose of influenza vaccine or one of its components.
• d) Concurrent antibiotic therapy

Answer: c) A history of a severe allergic reaction (e.g., anaphylaxis) to a previous dose of influenza vaccine or one of its components.

6. The recommended route of administration for the intramuscular (IM) influenza vaccine in adults is typically the:

• a) Deltoid muscle.
• b) Gluteal muscle.
• c) Vastus lateralis muscle.
• d) Forearm.

Answer: a) Deltoid muscle.

7. The “cold chain” refers to the temperature-controlled environment required for:

• a) Manufacturing vaccines.
• b) Administering vaccines.
• c) Storing and transporting vaccines to maintain their potency.
• d) Disposing of used vaccine vials.

Answer: c) Storing and transporting vaccines to maintain their potency.

8. A Vaccine Information Statement (VIS) must be provided to a patient (or parent/guardian):

• a) Only if they ask for it.
• b) After the vaccine has been administered.
• c) Before each dose of a vaccine is administered.
• d) Only for live attenuated vaccines.

Answer: c) Before each dose of a vaccine is administered.

9. For an intramuscular injection in an adult, what is a commonly appropriate needle length for the deltoid muscle?

• a) 1/2 inch
• b) 5/8 inch
• c) 1 to 1.5 inches (depending on patient size)
• d) 2 inches

Answer: c) 1 to 1.5 inches (depending on patient size)

10. Which type of vaccine is made from the inactivated toxins produced by bacteria?

• a) Live attenuated vaccine
• b) Subunit vaccine
• c) Toxoid vaccine
• d) mRNA vaccine

Answer: c) Toxoid vaccine (e.g., tetanus, diphtheria)

11. The ability of a vaccinated individual to protect unvaccinated individuals in a community due to reduced disease transmission is known as:

• a) Passive immunity
• b) Herd immunity (community immunity)
• c) Attenuated immunity
• d) Acquired immunity

Answer: b) Herd immunity (community immunity)

12. A common local reaction to a vaccine includes:

• a) Anaphylaxis
• b) Fever and malaise
• c) Pain, swelling, and redness at the injection site
• d) Generalized rash

Answer: c) Pain, swelling, and redness at the injection site

13. Before administering any vaccine, it is essential to screen for precautions and contraindications. A precaution:

• a) Means the vaccine should never be given.
• b) Is a condition that might increase the risk of an adverse reaction or compromise the ability of the vaccine to produce immunity; vaccination may proceed if benefits outweigh risks.
• c) Only applies to live vaccines.
• d) Is the same as an allergy to a vaccine component.

Answer: b) Is a condition that might increase the risk of an adverse reaction or compromise the ability of the vaccine to produce immunity; vaccination may proceed if benefits outweigh risks.

14. Subcutaneous (SC) injections are typically administered at what angle to the skin?

• a) 15 degrees
• b) 45 degrees
• c) 90 degrees
• d) Parallel to the skin

Answer: b) 45 degrees

15. Which of the following is a key component of the APhA Pharmacy-Based Immunization Delivery program?

• a) Training on prescribing antibiotics.
• b) Education on vaccine-preventable diseases, immunization schedules, administration techniques, and emergency procedures.
• c) How to manufacture vaccines.
• d) Only pediatric immunizations.

Answer: b) Education on vaccine-preventable diseases, immunization schedules, administration techniques, and emergency procedures.

16. The Tdap vaccine protects against:

• a) Measles, Mumps, Rubella
• b) Tetanus, Diphtheria, Pertussis
• c) Polio, Hepatitis B, Influenza
• d) Varicella, Zoster, Pneumonia

Answer: b) Tetanus, Diphtheria, Pertussis

17. Pneumococcal vaccines (e.g., PCV13, PCV15, PCV20, PPSV23) are particularly important for:

• a) All healthy teenagers.
• b) Only international travelers.
• c) Young children and older adults, as well as individuals with certain underlying medical conditions.
• d) Exclusively for healthcare providers.

Answer: c) Young children and older adults, as well as individuals with certain underlying medical conditions.

18. What is the primary reason for annual influenza vaccination?

• a) The vaccine provides lifelong immunity.
• b) Influenza viruses are constantly changing (antigenic drift/shift), and vaccine formulations are updated annually.
• c) The vaccine is only effective for 6 months.
• d) It is required by law for all citizens.

Answer: b) Influenza viruses are constantly changing (antigenic drift/shift), and vaccine formulations are updated annually.

19. After administering a vaccine, how long should a patient typically be observed for immediate adverse reactions, including syncope or anaphylaxis?

• a) 1-2 minutes
• b) 5 minutes
• c) 15-30 minutes
• d) 1 hour

Answer: c) 15-30 minutes

20. The Vaccine Adverse Event Reporting System (VAERS) is a national surveillance system used for:

• a) Compensating individuals for vaccine injuries.
• b) Tracking vaccine inventory.
• c) Collecting and analyzing reports of adverse events that occur after vaccination.
• d) Approving new vaccines for market.

Answer: c) Collecting and analyzing reports of adverse events that occur after vaccination.

21. Which of the following is an example of a live attenuated vaccine?

• a) Hepatitis B vaccine
• b) Inactivated poliovirus vaccine (IPV)
• c) Measles, Mumps, Rubella (MMR) vaccine
• d) Tetanus toxoid vaccine

Answer: c) Measles, Mumps, Rubella (MMR) vaccine

22. For subcutaneous injections, the needle is typically inserted into the:

• a) Muscle layer.
• b) Adipose tissue layer beneath the skin.
• c) Dermal layer of the skin.
• d) Vein.

Answer: b) Adipose tissue layer beneath the skin.

23. The Herpes Zoster vaccine (e.g., Shingrix) is recommended by ACIP for adults aged:

• a) 18 years and older
• b) 30 years and older
• c) 50 years and older
• d) 65 years and older only

Answer: c) 50 years and older

24. When reconstituting a vaccine that requires it, the pharmacist should use:

• a) Any sterile diluent available.
• b) Only the specific diluent supplied by the manufacturer for that vaccine.
• c) Sterile water for injection only.
• d) Normal saline only.

Answer: b) Only the specific diluent supplied by the manufacturer for that vaccine.

25. What is the appropriate first-line treatment for anaphylaxis following vaccination?

• a) Oral antihistamine
• b) Intramuscular epinephrine
• c) Intravenous corticosteroids
• d) Oxygen via nasal cannula

Answer: b) Intramuscular epinephrine

26. Proper documentation of an administered vaccine should include all of the following EXCEPT:

• a) Vaccine manufacturer and lot number.
• b) Date of administration and site/route of administration.
• c) Name and title of the person administering the vaccine.
• d) The patient’s preferred pharmacy for future vaccinations.

Answer: d) The patient’s preferred pharmacy for future vaccinations.

27. “Cocooning” is a vaccination strategy that involves:

• a) Vaccinating only the infant.
• b) Vaccinating close contacts of a vulnerable individual (e.g., an infant too young to be vaccinated) to protect them.
• c) Administering multiple vaccines in a single visit.
• d) Delaying all vaccinations until adulthood.

Answer: b) Vaccinating close contacts of a vulnerable individual (e.g., an infant too young to be vaccinated) to protect them.

28. mRNA vaccines (e.g., some COVID-19 vaccines) work by:

• a) Introducing a weakened form of the live virus into the body.
• b) Using inactivated viral particles to stimulate an immune response.
• c) Providing cells with instructions (mRNA) to produce a specific viral protein (antigen), which then triggers an immune response.
• d) Containing pre-formed antibodies against the virus.

Answer: c) Providing cells with instructions (mRNA) to produce a specific viral protein (antigen), which then triggers an immune response.

29. A “precaution” to vaccination differs from a “contraindication” in that a precaution:

• a) Is an absolute reason not to give the vaccine.
• b) Indicates a condition where the vaccine might have reduced efficacy or increased risk of an adverse reaction, and the benefits vs. risks must be carefully considered.
• c) Means the vaccine is only given in a hospital setting.
• d) Applies only to live vaccines.

Answer: b) Indicates a condition where the vaccine might have reduced efficacy or increased risk of an adverse reaction, and the benefits vs. risks must be carefully considered.

30. The Hepatitis B vaccine series is recommended for:

• a) Only healthcare workers.
• b) Infants starting at birth, and other individuals at risk.
• c) Only adults over 65 years.
• d) Only international travelers to specific regions.

Answer: b) Infants starting at birth, and other individuals at risk.

31. Which of the following conditions is a general contraindication for ALL vaccines?

• a) Mild upper respiratory tract infection.
• b) Current immunosuppressive therapy (contraindication for live vaccines, precaution for others).
• c) A history of severe allergic reaction (anaphylaxis) to a previous dose of that vaccine or to a component of that vaccine.
• d) Family history of seizures.

Answer: c) A history of severe allergic reaction (anaphylaxis) to a previous dose of that vaccine or to a component of that vaccine.

32. When administering multiple vaccines at the same visit, if using the same limb for IM injections, how far apart should the injection sites be?

• a) They can be given at the same exact spot.
• b) At least 1 inch apart.
• c) At least 3 inches apart.
• d) In different muscle groups only.

Answer: b) At least 1 inch apart.

33. A key role of pharmacists in immunization is to:

• a) Diagnose vaccine-preventable diseases.
• b) Advocate for, educate about, and administer vaccines according to current guidelines.
• c) Only dispense vaccines, not administer them.
• d) Develop new vaccine formulations.

Answer: b) Advocate for, educate about, and administer vaccines according to current guidelines.

34. Viral vector vaccines (e.g., some COVID-19 vaccines) use:

• a) Only the viral antigen itself.
• b) A harmless virus (the vector) to deliver genetic material from the target pathogen into host cells to elicit an immune response.
• c) Pre-formed antibodies.
• d) Inactivated toxins.

Answer: b) A harmless virus (the vector) to deliver genetic material from the target pathogen into host cells to elicit an immune response.

35. The purpose of an adjuvant in a vaccine is to:

• a) Preserve the vaccine during storage.
• b) Enhance the immune response to the antigen.
• c) Make the injection less painful.
• d) Act as the primary antigen.

Answer: b) Enhance the immune response to the antigen.

36. Which of the following is a crucial step in proper vaccine administration technique for IM injections?

• a) Massaging the site vigorously after injection.
• b) Administering the vaccine very slowly over 5 minutes.
• c) Ensuring the needle is inserted at a 90-degree angle into the muscle.
• d) Re-capping the needle after use.

Answer: c) Ensuring the needle is inserted at a 90-degree angle into the muscle.

37. The Human Papillomavirus (HPV) vaccine is recommended to prevent:

• a) Influenza
• b) Chickenpox
• c) Cancers caused by HPV (e.g., cervical, anal, oropharyngeal) and genital warts.
• d) Hepatitis B

Answer: c) Cancers caused by HPV (e.g., cervical, anal, oropharyngeal) and genital warts.

38. What is the minimum interval usually recommended between two doses of the same live attenuated vaccine if not administered simultaneously?

• a) 1 week
• b) 2 weeks
• c) 4 weeks (28 days)
• d) 6 months

Answer: c) 4 weeks (28 days)

39. If a patient experiences syncope (fainting) after vaccination, the immediate action should be to:

• a) Administer another dose of the vaccine.
• b) Help the patient lie down or sit with their head between their knees to prevent injury.
• c) Tell them to walk it off.
• d) Administer epinephrine.

Answer: b) Help the patient lie down or sit with their head between their knees to prevent injury.

40. The term “immunogenicity” refers to a vaccine’s ability to:

• a) Cause disease.
• b) Induce an immune response (e.g., antibody production).
• c) Be stored at room temperature.
• d) Be administered orally.

Answer: b) Induce an immune response (e.g., antibody production).

41. A common misconception about vaccines is that:

• a) They undergo rigorous testing for safety and efficacy before approval.
• b) They can cause the disease they are meant to prevent (especially for inactivated vaccines).
• c) They are a cost-effective public health intervention.
• d) Mild local reactions are common and expected.

Answer: b) They can cause the disease they are meant to prevent (especially for inactivated vaccines). (This is a misconception; inactivated vaccines cannot cause disease. Live vaccines can cause a mild form in rare cases, but not the full disease in healthy individuals).

42. Which of the following is a polysaccharide vaccine?

• a) MMR vaccine
• b) PPSV23 (Pneumovax 23)
• c) Varicella vaccine
• d) Inactivated influenza vaccine

Answer: b) PPSV23 (Pneumovax 23)

43. Conjugate vaccines (e.g., PCV13, Hib) are designed to improve the immune response to polysaccharide antigens, especially in:

• a) Elderly adults
• b) Young children (infants) whose immune systems do not respond well to plain polysaccharides.
• c) Immunocompromised adults.
• d) Pregnant women.

Answer: b) Young children (infants) whose immune systems do not respond well to plain polysaccharides.

44. The “grace period” for vaccine administration refers to:

• a) Administering vaccines much later than recommended.
• b) A short period (e.g., up to 4 days) before the minimum interval or age when a vaccine dose can be administered and still be considered valid.
• c) The time to observe for adverse reactions.
• d) The expiration date of the vaccine.

Answer: b) A short period (e.g., up to 4 days) before the minimum interval or age when a vaccine dose can be administered and still be considered valid.

45. Proper needle disposal after vaccination involves:

• a) Recapping the needle and placing it in a regular trash can.
• b) Immediately placing the uncapped needle and syringe into a designated sharps disposal container.
• c) Bending or breaking the needle before disposal.
• d) Giving the used needle to the patient to take home.

Answer: b) Immediately placing the uncapped needle and syringe into a designated sharps disposal container.

46. To become “Certified to Immunize” in many jurisdictions, pharmacists often need to complete:

• a) A medical degree.
• b) An accredited immunization training program (like APhA’s) and maintain CPR certification.
• c) A residency in infectious diseases.
• d) Only an online quiz.

Answer: b) An accredited immunization training program (like APhA’s) and maintain CPR certification.

47. If a multi-dose vial of vaccine is used, it is important to record which of the following on the vial after the first puncture?

• a) The patient’s name who received the first dose.
• b) The date and time it was first opened (or a beyond-use date according to manufacturer/policy).
• c) The pharmacist’s favorite color.
• d) The current room temperature.

Answer: b) The date and time it was first opened (or a beyond-use date according to manufacturer/policy).

48. A key element of patient counseling before administering a vaccine includes discussing:

• a) The cost of vaccine development.
• b) The specific vaccine(s) being given, common side effects, and when to seek medical attention for serious reactions.
• c) Only the benefits and not potential risks.
• d) The pharmacist’s personal vaccination history.

Answer: b) The specific vaccine(s) being given, common side effects, and when to seek medical attention for serious reactions.

49. Which vaccine is particularly recommended during each pregnancy to protect the newborn from pertussis?

• a) MMR
• b) Varicella
• c) Tdap
• d) HPV

Answer: c) Tdap

50. The ultimate goal of immunization programs is to:

• a) Increase pharmaceutical sales.
• b) Reduce the incidence, morbidity, and mortality of vaccine-preventable diseases in the population.
• c) Test new vaccine technologies.
• d) Make sure everyone gets at least one injection per year.

Answer: b) Reduce the incidence, morbidity, and mortality of vaccine-preventable diseases in the population.