APHA Administration Techniques & Routes 3 — Questions and Answers
Question 1: Intradermal vaccine administration requires the needle to be inserted at approximately what angle?
- 90 degrees
- 45 degrees
- 10–15 degrees (Correct answer)
- 30 degrees
Correct answer: 10–15 degrees
Intradermal injections are given at a 10–15 degree angle, nearly parallel to the skin surface, to deposit vaccine within the dermis.
Question 2: Which characteristic confirms a correctly placed intradermal injection?
- Absence of any resistance during injection
- Formation of a pale wheal (bleb) at the injection site (Correct answer)
- Visible bleeding at the needle insertion point
- Patient reports sharp burning pain
Correct answer: Formation of a pale wheal (bleb) at the injection site
A pale raised wheal (bleb) appearing under the skin confirms the vaccine was deposited correctly within the dermis.
Question 3: When administering vaccines to a patient who weighs more than 130 kg (obese adult), what needle length adjustment is recommended for deltoid IM injection?
- Use a 5/8-inch needle
- Use a 1-inch needle
- Use a 1.5-inch needle (Correct answer)
- Use the same 1-inch needle but inject faster
Correct answer: Use a 1.5-inch needle
For adults weighing more than 130 kg, a 1.5-inch needle is recommended to ensure the vaccine reaches deltoid muscle through increased subcutaneous tissue.
Question 4: Which of the following is the correct technique for stretching skin during an IM deltoid injection in an adult?
- Pinch up a fold of tissue and inject into the fold
- Spread the skin taut at the injection site (Correct answer)
- No skin preparation is needed before injecting
- Apply firm downward pressure with two fingers around the site
Correct answer: Spread the skin taut at the injection site
For IM injections, the skin should be spread taut (not bunched) to allow the needle to penetrate cleanly into the muscle.
Question 5: Oral polio vaccine (OPV) is no longer used in the United States. If a patient from another country received OPV, how should their immunization history be recorded?
- OPV doses are not valid and must be repeated with IPV
- OPV doses count as valid polio vaccine doses toward U.S. schedules (Correct answer)
- OPV must be followed by a booster IPV dose regardless of age
- OPV history requires serologic testing to confirm immunity
Correct answer: OPV doses count as valid polio vaccine doses toward U.S. schedules
OPV doses received outside the U.S. are counted as valid polio immunization doses when evaluating a patient's vaccination history.
Question 6: After preparing a vaccine injection, air bubbles are present in the syringe. What is the recommended action?
- Expel air bubbles before administration to ensure accurate dosage (Correct answer)
- Leave small air bubbles in; they have no effect on vaccine delivery
- Discard the syringe and prepare a new dose
- Tap the syringe until bubbles rise, then inject without expelling
Correct answer: Expel air bubbles before administration to ensure accurate dosage
Air bubbles should be expelled from the syringe before injection to ensure the patient receives the full intended vaccine dose.
Question 7: A clinician is giving Gardasil 9 (HPV vaccine) to a 16-year-old. Which site and route should be used?
- Subcutaneous in the upper arm
- Intramuscular in the anterolateral thigh
- Intramuscular in the deltoid (Correct answer)
- Intradermal in the forearm
Correct answer: Intramuscular in the deltoid
HPV vaccine (Gardasil 9) is administered intramuscularly, with the deltoid muscle of the upper arm preferred for adolescents and adults.
APHA Administration Techniques & Routes 3
Intradermal vaccine administration requires the needle to be inserted at approximately what angle?