Recommended Immunization Schedule for Persons

Aged 4-6 years.

 4-6 yr olds decided playing inside igloos may value house moms

DTAP (diphtheria,Tetanus, Pertussis)

PPSV (Pneumococcal)*High Risk group

IPV (Inactivated Poliovirus)

Influenza-Yearly

MMR (Measles, Mumps, Rubella)

Varicella

HepA series (Hepatitis A series)

MCV (Meningococcal)

True or False

All organs and systems in the body are subject to anaphylaxis.

TRUE

What is the appropriate dosage when administering epinephrine 1:2000 aqueous intramuscular via EpiPen Junior?

a. 0.15mL

b. 0.30mL

c. 0.50mL

d. 1.0mL

a. 0.15mL

Stimulation of which division of the autonomic nervous system causes the release of epinephrine?

a. Sypathetic division

b. Para-sypathetic division

a. Sypathetic division

Anthrax

Route: SC

# of Doses:5

Dose: 0.5mL

Schedule: 0,1,6,12,18

Age range: 18-65

*Booster annually 

Hepatitis A

Route: IM

# of Doses:2

Dose: 1.0mL

Schedule: 0,6

Age range: 19 and older

Hepatitis B

(19 and older)

Route: IM

# of Doses:3

Dose: 1.0 mL

Schedule: 0,1,6

Age range: 19 and older

What effect does epinephrine have on cardiac activity?

a. Epinephrine stimulates the receptor cells of the smooth cardiac

muscle causing the heart rate and blood pressure to decrease.

b. Epinephrine stimulates the receptor cells of the smooth cardiac

muscle causing the heart rate and blood pressure to increase.

b. Epinephrine stimulates the receptor cells of the smooth cardiac

muscle causing the heart rate and blood pressure to increase.

There are two types of syringe tips—plain and locking.

a. True

b. False

Epinephrine is referred to as adrenaline and causes____________?

a. Vasoconstriction/bronchodilation

b. Vasodialation/bronchoconstriction

What is the most dangerous aspect of a vasovagal episode?

a. Injuries obtained from the fall.

b. Reduced blood flow to the brain.

c. Seizure activity.

d. None of the above.

a. Injuries obtained from the fall.

What is the most common type of syringe used for administration of parenteral

injections?

a. Plastic

b. Insulin

c. Glass

d. Prepackaged inserts

a. Plastic

Syringe selection is based on ____________?

a. purpose of the injection

b. the volume of vaccine to be injected

c. the need for accuracy in dosage

d. All of the above

                d. All of the above

The most accurate size syringe is the _______________?

a. 1 mL

b. 3 mL

c. 5 mL

d. 10 mL

a. 1 mL

Prepackaged units ________________.

a. guarantee accuracy

b. are convenient for normal use

c. are especially convenient for emergency situations

d. all of the above

d. all of the above

The gauge of a needle is an inverse measurement of the diameter. As the

diameter increases, the gauge decreases.

a. True

b. False

Which of the following should be considered when selecting a needle for

administering injections?

a. Size of the individual

b. Route and site of injection

c. Viscosity and volume of the vaccine

d. All of the above

d. All of the above

Because vaccine administered parenterally is almost totally absorbed rather

than being partially destroyed by the digestive system, a smaller dosage will

achieve the same therapeutic effect.

a. True

b. False

Only the purpose and characteristics of the vaccine determine the route of

administration.

a. True

b. False

b. False

Of the different sites available for an intramuscular injection for an adult,

which site has the best blood supply and the most rapid response?

a. Gluteal Muscle

b. Deltoid Muscle

c. Rectus Femoris

d. Vastus Lateralis

What steps can you take to prevent nosocomial infections and associated

complications?

a. Hand washing

b. Maintain sterility of equipment.

c. Cleaning of the injection site.

d. All of the above.

                  d. All of the above.

When preparing a syringe for vaccine administration you notice the package

is partially open. What should you do?

a. Check the syringe for defects.

b. Make sure the plunger still has resistance.

c. Get a new syringe.

d. Use the syringe if it came from a locked and sterile area.

c. Get a new syringe.

The proper procedure for drawing vaccine from a vial is?

Remove the protective cap on the vial and clean off the diaphragm with an alcohol swab. Pull back the plunger to aspirate the needed amount of air and insert the needle in the center of the rubber diaphragm. Inject the air and aspirate

the vaccine.

When reconstituting a vaccine you should ?

a. Label the vial with the date and time mixed

b. Swirl the mixture gently

c. Agitate the mixture until foamy

d. Roll in your hands to warm the vaccine

a. Label the vial with the date and time mixed

What steps should you take before administering a vaccine?

a. Ask the patient to tell you which vaccine is required, and give the vaccine

requested

b. Review available documents and refer patient to a Doctor.

c. Follow the 6 rights of medication administration

d. Review the Doctors orders and verify you have that vaccine in stock

c. Follow the 6 rights of medication administration

What is the most commonly used area for the administration of Intradermal injections?

a. Top of thighs

b. Middle of back

c. Ventral surface of forearms

d. Chest

17) The most common site for subcutaneous injections is the

a. Deltoid

b. Abdomen

c. Triceps

d. None of the above

Which intramuscular injection site presents the most risk because of

proximity to the large sciatic nerve?

a. Femoral sites

b. Deltoid sites

c. Gluteal sites

d. Brachial sites

c. Gluteal sites

Choose the correct intramuscular injection needle angle when

administering an injection into the deltoid muscle.

a. 45 degrees

b. 60 degrees

c. 90 degrees

d. 15 degrees

20) Vaccines can be given in the gluteal area to pediatric patients

a. True

b. False

b. False

The #1 thing to know about most immunizations is that more often than not they are 0.5 ml and given IM. (Intramuscularly).

The only 1ml Vaccines are: HHJRT – Hep A (when given to adults 19 and older) Hep B (when given to adults 20 yo) JEV (Japenese Encephalitis Virus) Rabies and Twinrix (a combination vaccine of Hep A and Hep B that’s is given at 18 yrs.

Most of the time hepatitis is given to individuals when they are kids and in that case they get 0.5ml when 17 and under.

-         For Twinrix, Hep A and Hep B try to remember TAB and that stands for Twinrix at 18yo, Hep A at 19yo and Hep B at 20 yo when they can receive the 1 ml.

Hep A vaccines are:

Hep B vaccines are:

The only vaccines given subcutaneously are:

(the ones mostly used are in bold)

MMR, MMRV, Varicella (Chicken Pox), Yellow Fever, Zoster (Shingles), Menomune (a type of meningococcal)

MMR, Small pox, varicella, zoster, yellow fever, rotavirus (oral vaccine), Flumist (LAIV)

What is the difference between Passive and Active Immunity.

Passive Immunity: immunity acquired by transfer of antibodies (as by injection

of serum from an individual with active immunity).

Active Immunity: usually long-lasting immunity that is acquired through

production of antibodies within the organism in response to the presence of

antigens

 Differentiate

Anaphylaxis/ Vasovagal Reactions

IN

Respiratory

Anaphylaxis:                     Vasovagal Reaction:

*Shortness of breath                          *Hyperventilation

*Hoarse, lump in throat

difficulty swallowing

*Wheezing, chest tightness

*Nasal congestion, rhinorrhea

 Differentiate

Anaphylaxis/ Vasovagal Reactions

IN

Cardiovascular

Anaphylaxis:                  Vasovagal Reactions:

*Tachycardia                 *Normal or bradycardia

*Hypotensive Systolic               *Nomrmotensive or       

HIGH/LOW                                         Hypotensive

Diastolic LOW

 Differentiate

Anaphylaxis/ Vasovagal Reactions

IN

Skin

Anaphylaxis:                   Vasovagal Reactions:

*Flushing                                          * Pallor

* Urticaria (hives)                          *Cool, clammy

angiedema                                        diaphoresis

Differentiate

Anaphylaxis/ Vasovagal Reactions

IN

CNS

Anaphylaxis:

Feeling of impending doom

Vasovagal Reactions:

Anxious, tense, fearful

Differentiate

Anaphylaxis/ Vasovagal Reactions

IN

GI

Anaphylaxis:

*Nausea/vomiting

*Abdominal cramps/diarrhea

Vasovagal Reactions:

*Nausea/vomiting

Pediatric shots:

2/4/6 months

DtaP, IPV, Hep B, HIB, Prevnar, Rotavirus

Pediatric shots:

12 months (they start to get their live vaccines)

– MMR, Varicella, Hep A, Prevnar, HIB

Pediatric shots:

18 months

Pediatric shots:

4-6 yo

Pediatric shots:

11-12 yo

TdaP, Meningococcal (Menactra), HPV (suggested at this age)  over the age of 11 adults only receive 1 Tetanus with pertussis –TdaP. and you receive a tetanus booster (Td) every 10 years.

Active immunity _____________?

a) is a reaction that stimulates antibody production

b) appears following exposure to an antigen

c) is a direct result of an immune response

d) all of the above

d) all of the above

2. Artificially acquired passive immunity results from the administration of a specific

____________?

a. pathogen

b. antigen

c. antibody

d. microorganism

The prescribed dosage and route for anthrax vaccine is _________ with a possible

mild ______ reaction.

a. 0.5 mL SQ; systemic

b. 0.5 mL IM; systemic

c. 0.5 mL SQ; local, systemic

d. 0.5 mL IM; local, systemic

d. 0.5 mL IM; local, systemic

The recommended booster dose for the Anthrax vaccine is _____________.

a. Every 6 months if continued immunity is needed for epidemic area.

b. Annually if continued immunity is needed.

c. Every 6 months while on deployment status.

d. None of the above.

5. What is the routine schedule for Hepatitis-B vaccination?

a. Day–45, day–90, day 180

b. Day–30, day–60, day 180

c. Day–0, day–30, day 180

b. Day–30, day–60, day 180

A patient with a history of an anaphylactic reaction after ingestion of eggs should not

receive a (n) ___________ vaccination before they are skin tested.

a. Hepatitis-B

b. Influenza

c. Adenovirus

The Td booster dose is administered ____________.

a. Annually throughout lifetime

b. every 5 years throughout lifetime

c. every 10 years throughout lifetime

c. every 10 years throughout lifetime

7. What is the dosage requirement for a child for Recombivax (Hepatitis-B) vaccine?

a. 0.50mL IM Deltoid muscle (< 20 years of age).

b. 0.50mL IM Deltoid muscle (< 12 years of age).

c. 0.50mL IM Gluteus Maximus muscle (> 19 years of age).

d. 0.50mL IM Gluteus Maximus muscle (< 12 years of age).

a. 0.50mL IM Deltoid muscle (< 20 years of age).

A 6-month-old healthy child presents for routine immunizations. Child is up to date

through 4 months of age. What vaccines are required?

a. DPT, MMR, OPV, Lyme

b. DTaP, HiB, Prevnar, IPV

c. DTaP, MMR, Prevnar

d. DTaP, HiB, IPV, Varivax

a. DPT, MMR, OPV, Lyme

An 8-week healthy child presents for routine immunization. The child has no

immunizations to date. What vaccines are required?

a. Typhoid, Td, Yellow fever

b. DT, OPV, HiB, Hep B, Prevnar

c. Comvax, Prevnar, IPV, DTaP

d. None because children do not start immunization until 2 months of age.

b. DT, OPV, HiB, Hep B, Prevnar

Primary immunization series for the Pediarix vaccine is?

a. 2,4, and 6 months

b. 2,4,6, and 12 months

C. 2 and 4 months

d. Can only be given at 15 months of age

Smallpox vaccine (ACAM2000) is administered________ route.

a. Intranasal(IN)

b. Percutaneous

c. Intradermal

d. Subcutaneous

How many jabs does an individual receive if receiving the Smallpox vaccine for the first time?

a. 3

b. 10

c. 15

d. None ofthe above

TB test are administered intradermally on the volor aspect of either forearm.

About how far below the bend in the elbow should it be placed?

a. 1inch

b. 2 inches

c. 3 inches

d. 4 inches

International health threat assessments are conducted by which governing

agency?

a. Center for Disease Control

b. World Health Organization

c. Department of Defense

d. Defense Intelligence Agency Armed Forces Medical Intelligence Center (AFMIC)

d. Defense Intelligence Agency Armed Forces Medical Intelligence Center (AFMIC)

AFJI 44-102 outlines immunization guidelines for active duty personnel on alert

status?

a. True

b. False

Can waivers for religious reasons be revoked if the mission is compromised?

a. Yes

b. No

Who has the responsibility for ensuring that military and nonmilitary personnel

who are subject to rapid deployment, receive all required immunizations?

a. Immediate supervisor

b. First Sergeant

c. Individual

d. Commander

d. Commander

Which of the following questions should you ask the patient prior to

administering a medication or vaccine?

a. Do you have allergies to any medications, foods, or vaccines?

b. Are you or a family member immunocompromised/deficient due to

medication, treatment, or disease (chemotherapy, radiation therapy, longterm

steroids, HIV, etc)?

c. Are you pregnant or have the intention of becoming pregnant in the next

three months?

d. All of the above

d. All of the above

When annotating immunization records, using a signature stamp is authorized.

a. True

b. False

b. False

When transcribing an adult’s immunization record, only transcribe

immunizations that are ____________.

a. once in a lifetime

b. current

c. last in a series

d. all of the above

d. all of the above

IAW WHO Article 80, what document is considered adequate proof of

vaccination for armed forces personnel?

a. DD Form 2766C, Vaccine Administration Record

b. SF 600, Chronological Record of Medical Care

c. AF Form 1480, Summary of Care

d. AF Form 3992, Adult Prevention Care Flow Sheet

a. DD Form 2766C, Vaccine Administration Record

At the time of initial immunization of Air Force non-military personnel, a DD

Form 2766C is established. Which other form can you use to document the

immunization?

a. Form 3922, Adult Preventive Care—Flow Sheet

b. SF 4700, Health Record—Chronological Record

c. Inernational Certificate of Vaccination or Prophylaxis (ICVP)

d. b and c only

c. Inernational Certificate of Vaccination or Prophylaxis (ICVP)

Influenza

Route: IM

# of Doses: 1 dose 

Dose: 0.5mL

Schedule:Annually

Age range:>35

Flu Mist

Route:IN

# of Doses: 1

Dose: 0.2 mL

Schedule:Annually

Age range:<49

Gardasil

(Cervical Cancer/Genital Herpes)

Route:IM

# of Doses:3

Dose: 0.5 mL

Schedule:0,2,6

Age range:9-26

IPV(Polio)

Route: IM or SC

# of Doses:3 doses

Dose: 0.5 ml

Schedule:0,(1-2),6, 12

Age range: >18

JEV(Encephalitis)

Route:SC

# of Doses:1 or 2 doses

Dose:0.5mL

Schedule:0,7,30 days *booster every 2 yrs

Age range:2-55

MMR

Route:SC

# of Doses:1-2

Dose: 0.5mL

Schedule: 1 month apart

Age range:>1

Menomune (MPSV)

(Menigitis)

Route: SC

# of Doses: 1 dose

Dose: 0.5mL

Schedule:

Age range: All

Menactra (MCV4)

(Menigitis)

Route:IM

# of Doses:1

Dose: 0.5mL

Schedule: *booster q 5 yrs

Age range: 2-55

Pneumococcal

(PPV23)

(must be >2 yo)

Route: IM or SC

# of Doses:1

Dose: 0.5 mL

Schedule: *If vaccinated prior to G5 booster q 5 yrs

Age range: At risk (19-64)other>65

Rabies

Route:IM

# of Doses:3/5

Dose: 1.0mL

Schedule:0,7,21,/0,3,7,14,28

*booster q 5 yrs

Age range: All

Smallpox(Dryvax)

Route: Percutaneous

Dose: 3-15 jabs(pre 3 and post 15)  

*booster 10 yrs

Age range:> 1

Smallpox

(ACAM2000)

Route: Percutaneous

Dose: 15 Jabs

Schedule: booster q 10yrs

Age range:>1

Route:IM

# of Doses: 3

Dose: 0,1-2,6-12,

Schedule: *booster q 10 yrs

Age range:>7

Tdap (Adacel)

Route:IM

# of Doses:3

Dose: 0.5mL

Schedule:*booster q 10 yrs

Age range:11-64

Typhim-VI (Typhoid)

Route:IM

# of Doses:1

Dose:0.5 mL

Schedule:*booster 3 yrs

Age range:>2

Twinrix (Hep A&B)

Route:IM

# of Doses:3

Dose: 1.0mL

Schedule:0,1,6

Age range:>6

TY21a (Typhoid)

Route:Oral

# of Doses:4 capsules

Dose: 4 caps

Schedule:0,2,4,6, days *booster 5 yrs

Age range:>6

Varicella (chickenpox)

Route:SC

# of Doses:2

Dose: 0.5mL

Schedule:1 month apart

Age range:>1

Yellow fever

Route:SC

# of Doses: 1

Dose: 0.5mL

Schedule:*booster 10yr

Age range:>9

Zoster (Shingles)

Route:SC

# of Doses:1

Dose: 0.65mL

Schedule:

Age range:>60

Tdap

Route:IM

# of Doses:

Dose: 0.50mL

Schedule:*booster >5 yrs

Age range:10-18