# Situation: A public health nurse runs adolescent-friendly health services on weekend afternoons at a Rural Health Unit (RHU). Adolescents from the municipality come for counseling, immunization, and reproductive health services. A mother at the RHU asks which vaccines her children will receive under the school-based immunization of the National Immunization Program (NIP): measles-rubella (MR), tetanus-diphtheria (Td), and human papillomavirus (HPV) vaccines. Which schedule is CORRECT?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627065  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A public health nurse runs adolescent-friendly health services on weekend afternoons at a Rural Health Unit (RHU). Adolescents from the municipality come for counseling, immunization, and reproductive health services.

A mother at the RHU asks which vaccines her children will receive under the school-based immunization of the National Immunization Program (NIP): measles-rubella (MR), tetanus-diphtheria (Td), and human papillomavirus (HPV) vaccines. Which schedule is CORRECT?

## 보기

1. Grade 1: MR and Td; Grade 7 girls: HPV
2. Grade 4: MR and Td; Grade 7 girls: HPV
3. Grades 1 and 7: MR and HPV; Grade 4 girls: Td
4. Grades 1 and 7: MR and Td; Grade 4 girls: HPV **✔ 정답**

**정답: 4**

## 해설

Under the NIP school-based immunization, learners in Grade 1 and Grade 7 receive MR and Td. HPV vaccine is given to girls in Grade 4 in school, or at 9 years of age in the community, as 2 doses 1 year apart. The distractors mix up the vaccines and the grade levels.

## 심화 해설

School-based immunization in the NIP
The National Immunization Program (NIP) extends beyond infancy through school-based immunization, delivered with the Department of Education. The schedule asked about here has two parts. Learners in Grade 1 and Grade 7 receive the measles-rubella (MR) vaccine and the tetanus-diphtheria (Td) vaccine. Girls in Grade 4 receive the human papillomavirus (HPV) vaccine in school, or at 9 years of age in the community if they are not in school, as 2 doses given about 1 year apart. The pairing to remember is MR with Td in Grades 1 and 7, and HPV for Grade 4 girls.

Why these vaccines at these grades
MR and Td in school are booster doses. Protection from infant measles-containing and tetanus-containing vaccines can wane, and some children missed infant doses, so school entry in Grade 1 and the start of junior high school in Grade 7 are convenient points to reach almost every child. HPV vaccine is timed differently because its purpose is to protect against the cancer-causing HPV types before any exposure through sexual activity. Giving it at around 9 years of age, before adolescence, gives the best immune response and the widest protection against later cervical cancer.

| Grade level | Vaccines | Purpose |
| --- | --- | --- |
| Grade 1 | MR and Td | Booster against measles, rubella, tetanus, diphtheria |
| Grade 4 (girls) | HPV, 2 doses about 1 year apart | Prevent HPV infection and cervical cancer |
| Grade 7 | MR and Td | Second school booster |

How the distractors mix things up
One option keeps MR and Td in Grade 1 but places HPV in Grade 7, which misses both the Grade 7 booster and the correct HPV grade. Another moves MR and Td to Grade 4 and HPV to Grade 7, shifting every vaccine to the wrong level. A third swaps HPV and Td, pairing MR with HPV in Grades 1 and 7 and giving Td only to Grade 4 girls; that would give HPV to boys and first graders and remove the tetanus booster from most learners. Watch out! Each wrong option contains real grade levels and real vaccines, so read each pairing carefully rather than recognizing single words.

Counseling the mother
The nurse can explain that her children will be offered MR and Td in Grade 1 and again in Grade 7, and that a daughter will be offered HPV vaccine in Grade 4. She should keep the children's immunization records, since the school team checks them, and she should know that the HPV vaccine protects against infection that can lead to cervical cancer later in life. Knowing the school schedule also helps the nurse identify children who missed doses and catch them up at the health center.

## 임상 시나리오

NIP School-Based ImmunizationWhich vaccine at which grade
Learners in Grade 1 and Grade 7 receive MR and Td as school boosters.

Girls in Grade 4 receive HPV vaccine, or at 9 years of age in the community, as 2 doses about 1 year apart.

Ask parents to keep immunization records and use the school schedule to find and catch up learners who missed doses.

CautionHPV is for Grade 4 girls, not for Grade 1 or Grade 7. MR and Td always go together in Grades 1 and 7.

## 핵심 개념

- **School-based immunization** — Vaccination of learners in school by health workers, part of the NIP, to give boosters and adolescent vaccines.
- **MR vaccine** — A combined measles and rubella vaccine used for booster doses in school.
- **HPV vaccine** — A vaccine against human papillomavirus types that cause most cervical cancers, given to girls before exposure.
- **Booster dose** — An additional vaccine dose given after the primary series to restore or strengthen protection.

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