Situational Quiz: Expanded Program on Immunization (EPI) in the Philippines

1. A mother brings her 2-month-old baby to the health center for a routine checkup. The
baby is due for the first dose of the DTP vaccine. What should the nurse do?

• A) Administer the vaccine without checking the baby's records

• B) Ask the mother to wait for a second opinion from the doctor
• C) Verify the baby’s immunization history and check for any contraindications before
giving the vaccine
• D) Delay the vaccination until the baby turns 3 months

Answer: C) Verify the baby’s immunization history and check for any contraindications before
giving the vaccine.
Rationale: It's important to confirm the baby's immunization history to ensure the child has not
missed any previous doses or experienced adverse reactions to prior vaccines. Checking for
contraindications ensures the baby is fit to receive the vaccine.

2. A 5-year-old child has not received his booster dose of measles-containing vaccine
(MCV) because his mother is concerned about the vaccine’s safety. What should the health
worker explain?

• A) Vaccines are not necessary for children who seem healthy.

• B) Measles vaccination is essential to prevent outbreaks and complications, and the
vaccine is safe.
• C) The child will automatically gain immunity by being exposed to the disease.
• D) The vaccine should only be administered if the child develops symptoms of measles.

Answer: B) Measles vaccination is essential to prevent outbreaks and complications, and the
vaccine is safe.
Rationale: Measles is a highly contagious disease that can cause severe complications. The
MCV is safe and effective in providing immunity, and vaccines prevent outbreaks, ensuring the
child's health and the community's protection.

3. A 3-month-old baby comes to the health center for his immunization schedule. The baby
is due for DTP, IPV, and Hib vaccines. What is the correct course of action?

• A) Only administer the DTP vaccine.

• B) Administer DTP, IPV, and Hib vaccines simultaneously, as per the recommended
schedule.
• C) Delay the vaccination until the baby turns 6 months old.
• D) Give the DTP and Hib vaccines but delay IPV until the baby is 6 months old.

Answer: B) Administer DTP, IPV, and Hib vaccines simultaneously, as per the recommended
schedule.
Rationale: According to the EPI schedule, DTP, IPV, and Hib vaccines are given at 2, 4, and 6
months. These vaccines can be administered simultaneously unless there are contraindications.
Delaying them would leave the baby vulnerable to preventable diseases.

4. A 12-month-old child is brought in for their MMR vaccine but has a fever. The child’s
mother is concerned about the fever’s effect on the vaccine. What is the best advice for the
nurse to give?

• A) Administer the vaccine only if the fever is completely gone.

• B) Postpone the vaccination until the child is completely healthy.
 • C) Proceed with vaccination, but advise the mother to monitor for any adverse reactions.
• D) Recommend that the vaccine be administered at a private clinic instead.

Answer: C) Proceed with vaccination, but advise the mother to monitor for any adverse
reactions.
Rationale: Mild fever is not a contraindication for vaccination. Vaccination can be given when
the child has a mild illness (like a low-grade fever), but the mother should monitor for any side
effects or worsening of symptoms.

5. A pregnant woman is worried about her newborn’s immunization schedule and asks the
midwife about the importance of immunization. What should the midwife explain?

• A) Immunization is important to prevent diseases and death, and it should start at birth.
• B) Immunization is optional, and she can decide when to start based on the baby's health.
• C) Immunization is only necessary if the baby develops symptoms of a disease.
• D) The baby will develop immunity naturally without vaccines.

Answer: A) Immunization is important to prevent diseases and death, and it should start at birth.
Rationale: Immunization is crucial for the newborn’s health, as vaccines protect against serious
diseases such as tuberculosis, polio, and hepatitis. Starting vaccinations early ensures the child is
protected before exposure to these diseases.

6. A 9-month-old baby missed the BCG vaccine at birth and is now brought in for
immunization. What should the health worker do?

• A) Administer the BCG vaccine as soon as possible.

• B) Advise the mother that it is too late for the BCG vaccine.
• C) Administer only the recommended vaccines for 9 months.
• D) Advise the mother to wait until the baby is 1 year old for all vaccines.

Answer: A) Administer the BCG vaccine as soon as possible.

Rationale: The BCG vaccine can still be given at any time in the first year of life if it was
missed at birth. It is crucial for protection against tuberculosis (TB), which can have serious
consequences in young children.

7. A 6-week-old infant has just been born, and the mother has concerns about the
newborn's vaccination schedule. What should the health worker recommend?

• A) The baby should not be vaccinated until 1 year old.

• B) The baby should receive the first dose of BCG, Hepatitis B, and OPV (oral polio
vaccine) as soon as possible.
• C) The baby should only receive vaccinations for Hepatitis B at birth.
• D) The baby should start vaccination at 6 months old.

Answer: B) The baby should receive the first dose of BCG, Hepatitis B, and OPV (oral polio
vaccine) as soon as possible.
Rationale: Newborns should receive their first vaccines at birth, including BCG for tuberculosis,
Hepatitis B, and OPV for polio, as part of the national immunization program. This ensures
timely protection against critical diseases.

8. A mother asks if vaccines can be administered during breastfeeding. What is the health
worker's correct response?
 • A) Vaccines should not be given while the baby is breastfeeding.
• B) Vaccines can be safely administered while breastfeeding.
• C) Only oral vaccines can be given during breastfeeding.
• D) Vaccines should be delayed until the baby stops breastfeeding.

Answer: B) Vaccines can be safely administered while breastfeeding.

Rationale: Vaccines are safe for breastfeeding infants. There is no contraindication to
administering vaccines while the baby is breastfeeding, and in fact, breastfeeding offers
additional immune protection for the infant.

9. A mother is concerned about the cost of immunization and asks if vaccines are free.
What should the health worker tell her?

• A) Vaccines are not free, and the mother will need to pay at the health center.
• B) Vaccines are free under the Expanded Program on Immunization (EPI) at government
health facilities.
• C) The vaccines are free, but the mother must purchase the syringes and other materials.
• D) Vaccines are free only for children below 1 year old.

Answer: B) Vaccines are free under the Expanded Program on Immunization (EPI) at
government health facilities.
Rationale: Under the EPI, vaccines are provided free of charge at government health facilities to
ensure that all children, regardless of socioeconomic status, receive essential immunization.

10. A 3-year-old child is due for a booster dose of the MMR vaccine. However, the mother
insists that the child already had a mild case of measles and is immune. What should the
health worker advise?

• A) Skip the MMR vaccine because the child is already immune.

• B) Administer the MMR booster dose to ensure full protection.
• C) Only give the vaccine if the child develops a more severe case of measles.
• D) Recommend a blood test to check for immunity before giving the vaccine.

Answer: B) Administer the MMR booster dose to ensure full protection.

Rationale: A child who has had a mild case of measles may not have sufficient immunity, and
the MMR vaccine is needed for lasting protection. Booster doses are part of the recommended
schedule to ensure continued immunity.

11. A community health worker is preparing for a vaccination campaign. What is the best
way to increase participation in rural areas?

• A) Offer financial incentives to parents for bringing their children for vaccination.
 • B) Conduct home visits, educate families, and address concerns about vaccination.
• C) Focus on vaccinating only in urban areas.
• D) Set up vaccination clinics in schools only.

Answer: B) Conduct home visits, educate families, and address concerns about vaccination.
Rationale: Community-based education, including home visits, is effective in rural areas to
overcome misconceptions and increase vaccination uptake. Personal interactions can help
address specific concerns and build trust with the community.

12. A mother asks if vaccines can cause autism. How should the health worker respond?

• A) Vaccines are safe and do not cause autism, as proven by multiple studies.
• B) Vaccines should be avoided because they are known to cause autism.
• C) Vaccines cause autism in some children, and the government has not addressed this
issue.
• D) It is better not to vaccinate if there is a family history of autism.

Answer: A) Vaccines are safe and do not cause autism, as proven by multiple studies.
Rationale: Extensive research has shown that vaccines, including the MMR vaccine, do not
cause autism. The claim linking vaccines to autism has been discredited, and vaccines remain
safe and critical for preventing disease.

13. A child is due for a second dose of the polio vaccine. What is the correct schedule for
this dose?

• A) At 3 months of age.
• B) At 6 months of age.
• C) At 4-6 years of age.
• D) At 12-18 months of age.

Answer: D) At 12-18 months of age.

Rationale: The second dose of the polio vaccine is administered at 12-18 months, according to
the EPI schedule, to ensure the child is fully protected against polio.

14. A mother arrives with her 5-year-old child who has not received any previous
vaccinations. What should the health worker do?

• A) Start the child’s immunization with the most recent vaccines.

• B) Administer all missed vaccines according to the schedule, starting with the earliest
missed dose.
• C) Refuse to vaccinate as the child is too old.
• D) Ask the mother to return after the child turns 6 years old.

Answer: B) Administer all missed vaccines according to the schedule, starting with the earliest
missed dose.
Rationale: It is important to catch up on missed vaccines as soon as possible, even if the child is
older. The vaccination schedule should be followed, starting with the earliest missed doses and
catching up to the current schedule.

15. A child is found with a severe allergic reaction (anaphylaxis) shortly after receiving the
vaccine. What is the immediate action the health worker should take?

• A) Monitor the child for the next few hours and call the mother later.
• B) Administer an antihistamine and continue the vaccination program.
• C) Provide emergency medical care, administer epinephrine, and transfer the child to a
hospital immediately.
• D) Discontinue all vaccinations for the day.

Answer: C) Provide emergency medical care, administer epinephrine, and transfer the child to a
hospital immediately.
Rationale: Anaphylaxis is a life-threatening allergic reaction that requires immediate emergency
treatment, including the administration of epinephrine and quick transfer to a medical facility for
further care.

This version includes not only the correct answers but also the rationale behind each choice to
reinforce understanding of the Expanded Program on Immunization and its proper
implementation.

16. A community health worker is conducting a vaccination outreach, and a child refuses
vaccination due to fear of needles. What should the health worker do?

• A) Force the child to receive the vaccine to ensure full coverage.

• B) Respect the child’s decision and do not vaccinate.
• C) Use age-appropriate communication to explain the benefits of vaccination and
alleviate the child’s fears.
• D) Offer a reward for the child to receive the vaccine.

Answer: C) Use age-appropriate communication to explain the benefits of vaccination and

alleviate the child’s fears.
Rationale: It's important to respect the child’s feelings while also providing information that can
help reduce fear. Using simple, comforting language and explaining why vaccination is
important can help alleviate anxiety. Coercion should be avoided, as it can cause more distress.
17. A mother brings her 10-month-old baby who has missed several immunizations. What
should the health worker do?

• A) Start the immunization schedule from the beginning.

• B) Administer the vaccines that are due and follow the catch-up schedule.
• C) Delay the vaccination until the baby reaches 1 year old.
• D) Only administer the vaccines for diseases that the child has symptoms of.

Answer: B) Administer the vaccines that are due and follow the catch-up schedule.
Rationale: The child should receive all missed vaccinations based on the catch-up schedule,
even if the child is older than the usual age for those vaccines. This ensures the child is protected
from preventable diseases, as missing vaccines puts the child at risk.

18. A mother asks if her baby can receive vaccines after being sick with a cold. What
should the health worker advise?

• A) Delay vaccinations until the baby is completely healthy.

• B) Proceed with vaccination unless the baby has a high fever.
• C) Only vaccinate if the baby is receiving antibiotics.
• D) Postpone all vaccinations for the baby until after the cold passes.

Answer: B) Proceed with vaccination unless the baby has a high fever.
Rationale: Mild illnesses like a cold are not contraindications for vaccination. However, if the
child has a high fever or severe illness, vaccination should be postponed until the child is better.
Vaccinating during a mild illness will not interfere with the efficacy of the vaccine.

19. A mother expresses concerns about her child’s reaction to the DTP vaccine, fearing it
might cause complications. How should the health worker respond?

• A) Tell the mother that there is no risk of complications from the DTP vaccine.
• B) Explain that while the DTP vaccine can cause mild side effects, the benefits far
outweigh the risks.
• C) Advise the mother to delay the vaccine until the child is older.
• D) Suggest alternative vaccination options instead of DTP.

Answer: B) Explain that while the DTP vaccine can cause mild side effects, the benefits far
outweigh the risks.
Rationale: The DTP vaccine may cause mild side effects, such as a low-grade fever or fussiness,
but these are temporary and generally resolve on their own. The protection the vaccine offers
against diseases like diphtheria, tetanus, and pertussis is crucial for the child's health. Informing
parents of the common side effects and reassuring them is important for maintaining trust in the
vaccination process.

20. A child has a severe allergic reaction (anaphylaxis) after receiving the vaccine. What is
the first step the health worker should take?

• A) Wait for the symptoms to resolve on their own.

• B) Administer epinephrine and call for immediate medical assistance.
• C) Monitor the child for 30 minutes and then administer the second dose of the vaccine.
• D) Ask the mother to take the child to the nearest hospital after a few hours.

Answer: B) Administer epinephrine and call for immediate medical assistance.

Rationale: Anaphylaxis is a medical emergency that requires immediate treatment with
epinephrine and transfer to a healthcare facility. Quick intervention is essential to prevent life-
threatening consequences. Vaccination sites must be prepared to handle such emergencies with
trained staff and emergency medications.
21. A health worker notices that a child’s immunization record is incomplete, and the child
has missed several doses of vaccines. What is the best course of action?

• A) Do nothing and wait for the next scheduled vaccination date.

• B) Administer the missed vaccines according to the catch-up immunization schedule.
• C) Advise the parent to wait until the child is older and then administer the vaccines.
• D) Skip the missed vaccines and only administer the vaccines for the current age group.

Answer: B) Administer the missed vaccines according to the catch-up immunization schedule.
Rationale: The child should receive the missed doses according to the catch-up schedule to
ensure proper protection against vaccine-preventable diseases. The EPI provides guidelines for
catching up on missed vaccines, even if the child is older than the usual age for vaccination.

22. A 2-year-old child comes in for a scheduled MMR vaccine, but the mother is concerned
about the child’s fever and refuses vaccination. What is the best advice to provide?

• A) Delay vaccination until the child’s fever subsides completely.

• B) Recommend that the vaccine be postponed until the child turns 3 years old.
• C) Administer the vaccine anyway, as the fever will not affect its efficacy.
• D) Advise the mother to consult a pediatrician before proceeding with the vaccine.

Answer: A) Delay vaccination until the child’s fever subsides completely.

Rationale: While mild illness is usually not a contraindication for vaccination, a fever may
indicate an underlying infection or an active condition that could interfere with the child’s ability
to respond to the vaccine. It’s best to wait until the fever subsides and the child is in a stable
condition before proceeding with vaccination.

23. A parent asks if it is safe to vaccinate their child who has a mild cough and runny nose.
What should the health worker advise?

• A) Postpone vaccination until the child recovers fully.

• B) Proceed with vaccination, as mild respiratory symptoms are not a contraindication.
• C) Only vaccinate if the child is prescribed antibiotics for the symptoms.
• D) Advise the parent to take the child to the hospital before vaccination.

Answer: B) Proceed with vaccination, as mild respiratory symptoms are not a contraindication.
Rationale: A mild cold or respiratory symptoms are not typically contraindications for
vaccination. Vaccines can be administered as long as the child does not have a severe illness
(such as a fever above 38°C or a systemic infection) that could interfere with the vaccination
process.

24. During a vaccination campaign, a health worker notices that some parents are hesitant
about immunizing their children due to misinformation about vaccines. What should the
health worker do?

• A) Ignore the concerns and proceed with the vaccinations.

 • B) Engage the parents in a conversation, provide accurate information, and address their
concerns respectfully.
• C) Discontinue the vaccination campaign for the day.
• D) Only vaccinate those who do not express any concerns.

Answer: B) Engage the parents in a conversation, provide accurate information, and address
their concerns respectfully.
Rationale: Addressing vaccine hesitancy involves respectful, empathetic communication.
Providing accurate, evidence-based information can help parents make informed decisions. It is
essential to build trust in the vaccination program to increase coverage and prevent the spread of
preventable diseases.

25. A health worker is conducting an immunization program in a remote area. What

should the health worker prioritize to ensure the vaccines are effective and safe?

• A) Ensure proper cold chain management, such as keeping vaccines at the correct
temperature.
• B) Focus on vaccinating as many children as possible without worrying about storage.
• C) Administer the vaccines quickly, even if the cold chain is not guaranteed.
• D) Only vaccinate children who are visibly healthy.

Answer: A) Ensure proper cold chain management, such as keeping vaccines at the correct
temperature.
Rationale: The effectiveness of vaccines depends on proper storage and handling, especially in
rural or remote areas where maintaining the cold chain (keeping vaccines at the correct
temperature) is essential. Without this, vaccines can lose their potency, rendering them
ineffective and compromising the health of those vaccinated.

This concludes the full continuation of the situational quiz, complete with correct answers and
rationales. The aim is to help healthcare providers in the Philippines, or in similar contexts,
understand not only the correct actions to take but also the reasoning behind them. This approach
encourages a deeper understanding of immunization practices and improves the quality of care
provided to children.

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