# Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS). At the 9-month visit, how should the nurse give the MMR vaccine?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627054  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).

At the 9-month visit, how should the nurse give the MMR vaccine?

## 보기

1. 0.5 mL intramuscularly in the anterolateral thigh
2. 0.5 mL subcutaneously in the upper arm **✔ 정답**
3. 0.05 mL intradermally in the upper arm
4. 0.5 mL intramuscularly in the deltoid muscle

**정답: 2**

## 해설

In the NIP, MMR is given at 9 and 12 months as 0.5 mL subcutaneously in the upper arm. The other routes belong to other vaccines: pentavalent, PCV, and IPV are intramuscular in the thigh, and BCG is 0.05 mL intradermal.

## 심화 해설

MMR at the 9-month visit
Under the National Immunization Program (NIP), the measles, mumps, and rubella (MMR) vaccine is given in two doses, at 9 months and 12 months of age. Each dose is 0.5 mL given subcutaneously in the upper arm. MMR is a live attenuated viral vaccine given by the subcutaneous route, and this is the detail that separates it from the other infant injections.

Why the subcutaneous route
Live attenuated vaccines such as MMR replicate after deposit in the subcutaneous tissue and produce a strong immune response with few local reactions. Many inactivated vaccines, such as the pentavalent vaccine and the pneumococcal conjugate vaccine (PCV), are given intramuscularly, which reduces local reactions to their components. The anterolateral thigh is the preferred intramuscular site in infants because the vastus lateralis is well developed at this age, while the deltoid is still small. The upper arm is used for MMR because the subcutaneous tissue there is easy to pinch up and the site is well separated from the thigh injections given at the same age.

| Vaccine | Dose | Route and site |
| --- | --- | --- |
| BCG | 0.05 mL | Intradermal, upper arm |
| Pentavalent, PCV, IPV | 0.5 mL | Intramuscular, anterolateral thigh |
| MMR | 0.5 mL | Subcutaneous, upper arm |

How the distractors were built
Each wrong option is the correct technique for a different vaccine or a mix of two. 0.5 mL intramuscularly in the anterolateral thigh is how the nurse gives pentavalent vaccine and PCV, not MMR. 0.05 mL intradermally in the upper arm is the dose and route of BCG given at birth. 0.5 mL intramuscularly in the deltoid combines the right dose with the wrong route and an unsuitable infant site: MMR is not intramuscular, and the intramuscular infant vaccines of the NIP are given in the thigh, not the deltoid. Watch out! Questions on vaccine technique often offer the correct dose with the wrong route, so check route, site, and dose together.

Exam takeaway
Remember MMR as 0.5 mL, subcutaneous, upper arm, at 9 and 12 months. After giving it, the nurse records the dose in the child's immunization record and the target client list, schedules the second dose at 12 months, and advises the mother about common mild reactions such as fever. Keeping the vaccine in the cold chain and reconstituting it only with the diluent supplied are also part of correct administration.

## 임상 시나리오

MMR AdministrationDose, route, and site at the 9-month visit
Give MMR as 0.5 mL subcutaneously in the upper arm. The first dose is due at 9 months and the second at 12 months.

MMR is a live attenuated vaccine and is given subcutaneously. Pentavalent, PCV, and IPV are intramuscular in the anterolateral thigh, and BCG is 0.05 mL intradermal.

Reconstitute only with the diluent supplied, keep the vaccine in the cold chain, record the dose, and schedule the 12-month dose.

CautionCheck dose, route, and site together. The deltoid is not the intramuscular site for infants, and MMR is never given intramuscularly in the NIP.

## 핵심 개념

- **MMR vaccine** — A live attenuated vaccine against measles, mumps, and rubella given in two doses in infancy under the NIP.
- **Subcutaneous injection** — An injection into the fatty tissue just below the skin, the route used for MMR.
- **Anterolateral thigh** — The outer front of the thigh over the vastus lateralis muscle, the preferred intramuscular site in infants.
- **Live attenuated vaccine** — A vaccine containing a weakened living organism that produces immunity without causing disease in healthy people.

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