# A nurse is preparing a 12-month-old for routine well-child immunizations per the CDC ACIP schedule. Which actions and statements reflect correct evidence-based practice? Select all that apply.

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> language: en  
> subject: Health Promotion and Maintenance  
> category: HPM

## Question

A nurse is preparing a 12-month-old for routine well-child immunizations per the CDC ACIP schedule. Which actions and statements reflect correct evidence-based practice? Select all that apply.

1

Anticipate routine 12-month vaccines: MMR (1st), varicella (1st), hepatitis A (1st), and PCV (4th dose typically given at 12 to 15 months).

2

Use the 5 Rights of medication and verify the patient with two identifiers; the parent or guardian signs the vaccine consent.

3

Hold all live virus vaccines if the child is on chronic high-dose corticosteroids or is severely immunocompromised.

4

Provide a Vaccine Information Statement (VIS) for each vaccine to the parent before administration as required by federal law.

5

Administer the varicella vaccine intramuscularly because it provides more rapid seroconversion than the subcutaneous route.

## Explanation

Option 1 is correct because routine vaccination at 12-15 months includes the first MMR, varicella, and hepatitis A doses and the indicated PCV dose. Option 2 is correct because the nurse verifies the child with two identifiers, follows medication-administration rights, and obtains the required consent. Option 3 is correct because live vaccines such as MMR and varicella are contraindicated with severe immunocompromise or immunosuppressive high-dose systemic corticosteroid therapy. Option 4 is correct because the appropriate Vaccine Information Statement must be given before vaccination. Option 5 is incorrect as written: current product guidance may permit intramuscular or subcutaneous administration for varicella-containing products, but intramuscular administration does not provide faster seroconversion; the nurse must follow the route specified for the product and current guidance.

## In-depth explanation

Common pediatric immunization NCLEX traps: (1) "live virus IV" — wrong, never IV; (2) "skip VIS to save time" — wrong, federally required; (3) "give all vaccines despite severe immunocompromise" — wrong, live virus contraindicated. Mild illness without fever is NOT a contraindication to vaccination.

## Clinical scenario

**Healthy 12-month-old at routine well-child visit**. Immunizations up to date through 6 months. The nurse reviews the **CDC ACIP schedule** for 12-month vaccines.

## Key concepts

- **12-month ACIP vaccines** — MMR, varicella, hepatitis A, PCV20 4th dose, plus catch-up if needed.
- **Vaccine Information Statement (VIS)** — Federally mandated handout describing benefits and risks of each vaccine; given before administration.
- **Live vaccine route** — MMR and varicella subcutaneously; rotavirus orally; never IV.

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