COMPREHENSIVE NURSING BOARD REVIEW EXAM
PEDIATRIC IMMUNIZATIONS & CLINICAL
JUDGMENT
200 Clinical Practice Questions with In-Depth Evidence-Based
Rationales
Focus: MMR Immunization, Safety, Contraindications, Administration,
and Toddler Development
Question 1: A nurse is providing education to the parent of a toddler
who is about to receive her first dose of the measles, mumps, and rubella
(MMR) immunization. Which statement by the parent indicates an
understanding of the teaching?
A. 'My child will receive her second dose next week.'
B. 'I should expect my child to develop a mild fever and rash in
about 1 to 2 weeks.'
C. 'This vaccine is given intramuscularly in the thigh.'
D. 'My child cannot receive any other vaccines until age 4.'
Correct Answer: B
Rationale: Mild fever and transient rash commonly occur 7-12 days
post-MMR due to viral replication. Dose 2 is at 4-6 years. MMR is
given subcutaneously.
,Question 2: A nurse evaluates a parent whose 15-month-old child
received the first dose of MMR yesterday. Which statement
demonstrates correct comprehension?
A. 'I will give aspirin immediately for fever.'
B. 'I should apply warm compresses every hour.'
C. 'I will monitor my child for a mild, non-contagious rash and low-
grade fever.'
D. 'I must isolate my toddler from her newborn sibling for 30 days.'
Correct Answer: C
Rationale: Fever and maculopapular rash are expected mild adverse
effects 1-2 weeks post-MMR. Aspirin is contraindicated (Reye's
syndrome). MMR is non-contagious person-to-person.
Question 3: A parent expresses concern about autism linked to the
MMR vaccine. What is the nurse's best response?
A. 'There is a proven correlation, but benefits outweigh risks.'
B. 'Extensive scientific research involving millions of children has
conclusively shown no link between MMR and autism.'
C. 'We can split the MMR vaccine into three separate injections.'
D. 'Let's delay the vaccine until school entry.'
Correct Answer: B
Rationale: Extensive epidemiological studies have conclusively
disproven any link between MMR and autism. Splitting the vaccine is
not recommended.
,Question 4: A nurse is counseling a mother regarding potential side
effects of MMR. Which finding is normal and self-limiting?
A. High fever (105°F) within 2 hours
B. Parotitis and mild transient lymphadenopathy 1 to 2 weeks post-
vaccination
C. Immediate anaphylaxis with wheezing
D. Persistent purpura for 3 months
Correct Answer: B
Rationale: Mild parotitis (mumps component) and transient
lymphadenopathy or rash can occur 1-2 weeks post-MMR.
Question 5: A parent asks why MMR is not routinely given at 6 months.
What is the nurse's best explanation?
A. 'Maternal antibodies transferred during pregnancy can neutralize
vaccine antigens.'
B. 'Infants' kidneys are too immature before 12 months.'
C. 'The risk of autism is higher before the first birthday.'
D. 'Infants do not possess lymphatic tissue.'
Correct Answer: A
Rationale: Maternally acquired passive immunity (IgG) persists up
to 12 months and can neutralize live vaccine viruses.
, Question 6: A nurse teaches a parent about the MMR schedule. Which
statement indicates correct understanding?
A. 'Dose 1 at 12-15 months, and Dose 2 at 4-6 years.'
B. 'Dose 1 at 2 months, Dose 2 at 4 months.'
C. 'Dose 1 at 6 months, Dose 2 at 12 months.'
D. 'Only one lifetime dose is required.'
Correct Answer: A
Rationale: Routine schedule recommends Dose 1 at 12-15 months
and Dose 2 at 4-6 years.
Question 7: A parent asks if MMR can be given if the toddler has a mild
upper respiratory infection with a temperature of 99.2°F. How should
the nurse respond?
A. 'No, any illness requires postponing for 4 weeks.'
B. 'Yes, mild acute illnesses with or without low-grade fever are not
contraindications.'
C. 'Only if the physician prescribes antibiotics.'
D. 'We must perform a complete blood count first.'
Correct Answer: B
Rationale: Mild acute illnesses with or without low-grade fever are
NOT contraindications to vaccination.
PEDIATRIC IMMUNIZATIONS & CLINICAL
JUDGMENT
200 Clinical Practice Questions with In-Depth Evidence-Based
Rationales
Focus: MMR Immunization, Safety, Contraindications, Administration,
and Toddler Development
Question 1: A nurse is providing education to the parent of a toddler
who is about to receive her first dose of the measles, mumps, and rubella
(MMR) immunization. Which statement by the parent indicates an
understanding of the teaching?
A. 'My child will receive her second dose next week.'
B. 'I should expect my child to develop a mild fever and rash in
about 1 to 2 weeks.'
C. 'This vaccine is given intramuscularly in the thigh.'
D. 'My child cannot receive any other vaccines until age 4.'
Correct Answer: B
Rationale: Mild fever and transient rash commonly occur 7-12 days
post-MMR due to viral replication. Dose 2 is at 4-6 years. MMR is
given subcutaneously.
,Question 2: A nurse evaluates a parent whose 15-month-old child
received the first dose of MMR yesterday. Which statement
demonstrates correct comprehension?
A. 'I will give aspirin immediately for fever.'
B. 'I should apply warm compresses every hour.'
C. 'I will monitor my child for a mild, non-contagious rash and low-
grade fever.'
D. 'I must isolate my toddler from her newborn sibling for 30 days.'
Correct Answer: C
Rationale: Fever and maculopapular rash are expected mild adverse
effects 1-2 weeks post-MMR. Aspirin is contraindicated (Reye's
syndrome). MMR is non-contagious person-to-person.
Question 3: A parent expresses concern about autism linked to the
MMR vaccine. What is the nurse's best response?
A. 'There is a proven correlation, but benefits outweigh risks.'
B. 'Extensive scientific research involving millions of children has
conclusively shown no link between MMR and autism.'
C. 'We can split the MMR vaccine into three separate injections.'
D. 'Let's delay the vaccine until school entry.'
Correct Answer: B
Rationale: Extensive epidemiological studies have conclusively
disproven any link between MMR and autism. Splitting the vaccine is
not recommended.
,Question 4: A nurse is counseling a mother regarding potential side
effects of MMR. Which finding is normal and self-limiting?
A. High fever (105°F) within 2 hours
B. Parotitis and mild transient lymphadenopathy 1 to 2 weeks post-
vaccination
C. Immediate anaphylaxis with wheezing
D. Persistent purpura for 3 months
Correct Answer: B
Rationale: Mild parotitis (mumps component) and transient
lymphadenopathy or rash can occur 1-2 weeks post-MMR.
Question 5: A parent asks why MMR is not routinely given at 6 months.
What is the nurse's best explanation?
A. 'Maternal antibodies transferred during pregnancy can neutralize
vaccine antigens.'
B. 'Infants' kidneys are too immature before 12 months.'
C. 'The risk of autism is higher before the first birthday.'
D. 'Infants do not possess lymphatic tissue.'
Correct Answer: A
Rationale: Maternally acquired passive immunity (IgG) persists up
to 12 months and can neutralize live vaccine viruses.
, Question 6: A nurse teaches a parent about the MMR schedule. Which
statement indicates correct understanding?
A. 'Dose 1 at 12-15 months, and Dose 2 at 4-6 years.'
B. 'Dose 1 at 2 months, Dose 2 at 4 months.'
C. 'Dose 1 at 6 months, Dose 2 at 12 months.'
D. 'Only one lifetime dose is required.'
Correct Answer: A
Rationale: Routine schedule recommends Dose 1 at 12-15 months
and Dose 2 at 4-6 years.
Question 7: A parent asks if MMR can be given if the toddler has a mild
upper respiratory infection with a temperature of 99.2°F. How should
the nurse respond?
A. 'No, any illness requires postponing for 4 weeks.'
B. 'Yes, mild acute illnesses with or without low-grade fever are not
contraindications.'
C. 'Only if the physician prescribes antibiotics.'
D. 'We must perform a complete blood count first.'
Correct Answer: B
Rationale: Mild acute illnesses with or without low-grade fever are
NOT contraindications to vaccination.
