NLE Community Health Nursing — Communicable Disease Control & ImmunizationExam Answer Templates

Marks

1

Topic

EPI — BCG Vaccine

Difficulty

easy

Template Id

T1

Examiner Tip

The 1-mark VSA question tests exact recall. For BCG, the three non-negotiable details are: intradermal / 0.05 mL / right deltoid. Pack all three into one sentence.

Model Answer

BCG is administered via the intradermal route at a dose of 0.05 mL into the right deltoid region of the upper arm.

Question Type

very_short_answer

Answer Structure

• State the route (intradermal), dose (0.05 mL), and site (right upper arm/deltoid) — all three elements together earn the 1 mark.

Scoring Breakdown

Common Mark Deductions

• Writing 'subcutaneous' instead of 'intradermal' — wrong route, no mark.
• Writing '0.1 mL' instead of '0.05 mL' — this is the dose for older children, not infants.
• Omitting the site — answer is incomplete.

Key Phrases To Include

• intradermal
• 0.05 mL
• right deltoid
• upper arm

Marks

1

Topic

EPI — Legal Basis

Difficulty

easy

Template Id

T2

Examiner Tip

Philippine nursing law questions are frequently tested. Know RA 10152 (immunization), PD 996 (original EPI mandate), and RA 9173 (nursing practice) by heart.

Model Answer

Republic Act 10152, known as the Mandatory Infants and Children Health Immunization Act of 2011, mandates free routine immunization for infants and children in the Philippines.

Question Type

very_short_answer

Answer Structure

• State the RA number (10152), the law's short title, and the year (2011) — this earns the mark.

Scoring Breakdown

Common Mark Deductions

• Citing 'RA 9173' (which is the Philippine Nursing Act of 2002) instead of RA 10152.
• Citing 'PD 996' only — PD 996 is the older compulsory immunization decree; RA 10152 is the current mandate.
• Omitting the year or law number.

Key Phrases To Include

• RA 10152
• Mandatory Infants and Children Health Immunization Act
• 2011
• free routine immunization

Marks

2

Topic

Immunity Concepts

Difficulty

easy

Template Id

T3

Examiner Tip

For a 2-mark differentiation question, the examiner allocates 1 mark per concept. Always pair definition + characteristic + example for each type to guarantee full marks.

Model Answer

Active immunity occurs when the body produces its own antibodies in response to an antigen; it is long-lasting. Example: A child who receives the MMR vaccine develops active artificial immunity against measles, mumps, and rubella. Passive immunity occurs when ready-made antibodies are transferred from an external source; it is immediate but temporary. Example: A newborn receives natural passive immunity through maternal antibodies crossing the placenta.

Question Type

short_answer

Answer Structure

• Line 1–2: Define active immunity + state it is long-lasting [0.5 mark]
• Line 3: Give a correct example of active immunity [0.5 mark]
• Line 4–5: Define passive immunity + state it is immediate but temporary [0.5 mark]
• Line 6: Give a correct example of passive immunity [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Defining active immunity correctly but giving a passive example (e.g., 'breastfeeding') — mismatched example loses the mark.
• Forgetting to mention the duration characteristic (long-lasting vs. temporary) — this is the key differentiator.
• Using the wrong term: writing 'antibodies' for active immunity as if they are received, not produced.

Key Phrases To Include

• active immunity
• passive immunity
• long-lasting
• immediate but temporary
• antibodies
• antigen
• vaccine
• maternal antibodies
• placenta

Marks

2

Topic

EPI — Vaccine Schedule

Difficulty

medium

Template Id

T4

Examiner Tip

The '6–10–14 week' schedule is one of the most tested facts in EPI. Memorize it as a unit: Pentavalent + OPV + PCV all follow 6–10–14 weeks.

Model Answer

Pentavalent vaccine (DPT–HepB–Hib): Given at 6 weeks, 10 weeks, and 14 weeks of age — a total of 3 doses, administered intramuscularly at 0.5 mL per dose in the vastus lateralis. OPV (Oral Polio Vaccine): Given at 6 weeks, 10 weeks, and 14 weeks of age — a total of 3 doses, administered orally as 2–3 drops per dose. The minimum interval between doses is 4 weeks.

Question Type

short_answer

Answer Structure

• Line 1: Pentavalent — ages (6, 10, 14 weeks), number of doses (3), route/dose [1 mark]
• Line 2: OPV — ages (6, 10, 14 weeks), number of doses (3), route (oral, 2–3 drops), minimum interval [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing '2, 4, 6 months' — this is the American CDC schedule, NOT the Philippine EPI schedule.
• Confusing OPV (oral) with IPV (intramuscular) — wrong route loses the mark.
• Forgetting to state the minimum 4-week interval.

Key Phrases To Include

• 6 weeks
• 10 weeks
• 14 weeks
• 3 doses
• intramuscular
• vastus lateralis
• oral
• 2–3 drops
• minimum interval 4 weeks

Marks

2

Topic

EPI — FIC and CIC

Difficulty

medium

Template Id

T5

Examiner Tip

Always distinguish FIC from CIC when this question appears. The key difference is the time frame: FIC = before 12 months; CIC = 12–23 months. State both if the question asks for FIC criteria.

Model Answer

A Fully Immunized Child (FIC) is a child who has received all of the following vaccines before reaching 12 months (1 year) of age: • 1 dose of BCG • 3 doses of OPV • 3 doses of Pentavalent (DPT–HepB–Hib) • At least 1 dose of measles-containing vaccine (MCV1) Note: A Completely Immunized Child (CIC) completes the same antigens but between 12–23 months of age.

Question Type

short_answer

Answer Structure

• Line 1: Define FIC — all required antigens received BEFORE 12 months [1 mark]
• Line 2–5: List the four antigen groups correctly: BCG ×1, OPV ×3, Pentavalent ×3, MCV1 ×1 [1 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing FIC (before 12 months) with CIC (12–23 months) — wrong age criterion.
• Omitting the measles-containing vaccine from the list.
• Listing Hepatitis B birth dose as a separate antigen — in FIC criteria, HepB is counted within Pentavalent.

Key Phrases To Include

• Fully Immunized Child
• before 12 months
• BCG
• OPV
• Pentavalent
• measles-containing vaccine
• 1 dose
• 3 doses

Marks

3

Topic

EPI — Cold Chain

Difficulty

medium

Template Id

T6

Examiner Tip

Cold chain questions often come with a scenario (e.g., power outage, vaccine left at room temperature). Always bring your answer back to nursing action: what does the nurse do? Check VVM, use shake test, report to supervisor.

Model Answer

The cold chain is the system of storing and transporting vaccines within safe temperature ranges from the manufacturer to the recipient, in order to maintain vaccine potency and effectiveness. At the health center or Rural Health Unit (RHU) level, vaccines are stored in a refrigerator at +2°C to +8°C. Key principles of cold chain management: 1. Heat-sensitive vaccines (OPV, measles, BCG) must be stored in the coldest part of the refrigerator (near the freezer compartment). 2. Freeze-sensitive vaccines (DPT, Hepatitis B, Td, and Pentavalent) must NOT be frozen; freezing destroys their potency. The shake test is used to detect freeze-damaged vaccines. 3. Stock rotation follows the FEFO (First Expiry, First Out) principle. 4. The Vaccine Vial Monitor (VVM) on each vial provides a visual indicator of cumulative heat exposure. Nursing responsibility: The community nurse must monitor refrigerator temperatures twice daily (morning and afternoon) and document readings to ensure the cold chain is never broken.

Question Type

short_answer

Answer Structure

• Sentence 1: Define the cold chain [1 mark]
• Sentence 2: State the correct temperature at health center level: +2°C to +8°C [1 mark]
• Points 1–4: State at least 2 key principles (heat-sensitive vs. freeze-sensitive vaccines, FEFO, VVM, shake test) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing '0°C to 8°C' instead of '+2°C to +8°C' — the positive sign matters to avoid freezing.
• Confusing heat-sensitive and freeze-sensitive vaccines — putting DPT in the coldest spot (will freeze it).
• Forgetting to mention the VVM or shake test as cold chain monitoring tools.
• Not mentioning FEFO for stock rotation.

Key Phrases To Include

• +2°C to +8°C
• cold chain
• heat-sensitive
• freeze-sensitive
• OPV
• DPT
• FEFO
• First Expiry First Out
• VVM
• Vaccine Vial Monitor
• shake test
• potency

Marks

3

Topic

EPI — Tetanus Immunization for Women

Difficulty

medium

Template Id

T7

Examiner Tip

A useful memory trick: 'Td2 = 4 Weeks = 3 Years protection.' The intervals increase (4 weeks → 6 months → 1 year → 1 year) and so do the durations (3 → 5 → 10 → lifetime). Write these as a table in your exam for clarity.

Model Answer

Tetanus-diphtheria (Td) immunization is given to women of childbearing age and pregnant women to protect both the mother and the newborn from tetanus (neonatal tetanus) and diphtheria. The schedule is as follows: • Td1: Given as early as possible in pregnancy. Does NOT yet confer protection on its own. • Td2: Given at least 4 weeks after Td1. Protects the newborn from neonatal tetanus; gives approximately 3 years of protection to the mother. • Td3: Given at least 6 months after Td2. Provides approximately 5 years of protection. • Td4: Given at least 1 year after Td3. Provides approximately 10 years of protection. • Td5: Given at least 1 year after Td4. Provides lifetime protection. Nursing priority: The nurse must ensure the patient receives at least Td2 during pregnancy, as it is the dose that protects the newborn from neonatal tetanus. A newborn protected through maternal immunization is considered a 'Child Protected at Birth' (CPAB).

Question Type

short_answer

Answer Structure

• Introduction sentence: Purpose of Td in pregnancy (maternal and neonatal protection) [0.5 mark]
• Table/list of Td1–Td5 with timing and duration of protection for each [1.5 marks]
• Nursing implication: Importance of Td2 and the concept of CPAB [1 mark]

Scoring Breakdown

Common Mark Deductions

• Mixing up the intervals (e.g., saying Td2 is given 6 months after Td1 instead of 4 weeks).
• Forgetting Td1 confers no protection by itself — students often say Td1 gives '1 year' protection.
• Not mentioning neonatal tetanus protection or CPAB — omitting the clinical significance loses a mark.
• Confusing the old 'TT' (tetanus toxoid) schedule with the current 'Td' schedule.

Key Phrases To Include

• Td1
• Td2
• Td3
• Td4
• Td5
• 4 weeks
• 6 months
• 1 year
• 3 years
• 5 years
• 10 years
• lifetime
• neonatal tetanus
• Child Protected at Birth
• CPAB

Marks

3

Topic

Immunity Concepts — Herd Immunity

Difficulty

medium

Template Id

T8

Examiner Tip

Concept questions at the 3-mark level reward three elements: definition, significance, and nursing application. Structure your answer in exactly three parts to maximize marks.

Model Answer

Herd immunity (also called community immunity) is the indirect protection that occurs when a sufficiently high proportion of a population is immune to an infectious disease (through vaccination or prior infection), thereby reducing the likelihood of transmission and indirectly protecting susceptible (unimmunized) individuals. Significance in the Philippine community setting: 1. Protection of vulnerable groups: Infants too young for vaccination (e.g., a 2-week-old too young for BCG), immunocompromised individuals (e.g., those with HIV), and elderly persons who cannot receive live vaccines are indirectly protected when the surrounding population is highly immunized. 2. Disease elimination and eradication: High EPI coverage rates support DOH goals for measles elimination and polio eradication. Sustained herd immunity interrupts the chain of transmission. 3. Community health nursing implication (RA 9173): Under their mandate, nurses promote community immunization coverage through health education, outreach immunization activities, and defaulter tracking to maintain herd immunity thresholds. The community nurse's role is to achieve and maintain high vaccination coverage rates — the foundation of herd immunity.

Question Type

short_answer

Answer Structure

• Sentence 1–2: Define herd immunity with the key elements (threshold, indirect protection, susceptible individuals) [1 mark]
• Points 1–2: Explain at least 2 community health significance points (protection of vulnerable groups, disease elimination) [1 mark]
• Sentence: Nursing implication linked to RA 9173 or Philippine context [1 mark]

Scoring Breakdown

Common Mark Deductions

• Defining herd immunity as 'the entire community is immune' — incorrect; herd immunity requires a threshold, not 100% immunity.
• Not explaining WHY unimmunized individuals are protected — missing the mechanism loses a mark.
• Failing to contextualize to the Philippine setting or connect to nursing practice.

Key Phrases To Include

• herd immunity
• community immunity
• indirect protection
• susceptible individuals
• vaccination coverage
• immunocompromised
• chain of transmission
• disease elimination
• RA 9173

Marks

3

Topic

National TB Control Program — DOTS

Difficulty

medium

Template Id

T9

Examiner Tip

Mnemonics help here. Try 'PCSUR': Political commitment, Case detection, Standardized treatment, Uninterrupted supply, Recording system. Write the mnemonic lightly in your answer sheet margin as a checklist.

Model Answer

The five elements of DOTS as implemented in the Philippine National TB Control Program (NTP) are: 1. Political commitment with sustained financing — government support and allocation of funds for the TB program. 2. Case detection through quality-assured bacteriology — use of GeneXpert (Xpert MTB/RIF) as the primary diagnostic tool and Direct Sputum Smear Microscopy (DSSM) for follow-up monitoring. 3. Standardized treatment regimen with direct observation — a health worker or trained treatment partner observes the patient swallowing every dose of anti-TB medication. 4. Uninterrupted supply of quality-assured anti-TB drugs — ensuring that isoniazid, rifampicin, pyrazinamide, and ethambutol are always available at no cost. 5. A standardized recording and reporting system — to monitor treatment outcomes, track defaulters, and evaluate program performance.

Question Type

short_answer

Answer Structure

• Introduction line: Name the program (Philippine NTP/DOTS) [0 marks — contextual]
• List all 5 DOTS elements with brief explanations [3 marks — 0.5 mark per element, minimum 5 elements needed for full marks]

Scoring Breakdown

Common Mark Deductions

• Listing only 3–4 elements — must identify all 5 for full marks.
• Describing DOTS as only 'watching the patient take medicine' — this is only the third element; the full concept has 5 elements.
• Confusing Xpert MTB/RIF with the old sputum smear as the primary diagnostic — under current NTP, GeneXpert is now first-line.

Key Phrases To Include

• political commitment
• quality-assured bacteriology
• GeneXpert
• Xpert MTB/RIF
• direct observation
• treatment partner
• standardized treatment
• uninterrupted drug supply
• recording and reporting

Marks

5

Topic

National TB Control Program — DOTS Treatment

Difficulty

hard

Template Id

T10

Examiner Tip

For 5-mark long answers, the examiner uses a detailed marking rubric. Write in numbered sections or labeled paragraphs (e.g., '1. Direct Observation:') — this makes it easy for the examiner to award each mark and demonstrates organized, professional-level thinking aligned with RA 9173 nursing scope of practice.

Model Answer

Category I Treatment Regimen (New TB Cases): Category I is for newly diagnosed TB cases including new smear-positive pulmonary TB, new smear-negative pulmonary TB, and new extrapulmonary TB cases. The regimen is: 2HRZE / 4HR • Intensive Phase (2 months): Daily administration of Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), and Ethambutol (E) — four drugs for 2 months. • Continuation Phase (4 months): Daily administration of Isoniazid (H) and Rifampicin (R) — two drugs for 4 months. Total duration: 6 months. Nursing Responsibilities under DOTS: 1. Direct Observation of Treatment: The nurse directly observes the patient swallowing every dose of anti-TB medication during the intensive phase and arranges for a trained treatment partner (family member or community volunteer) to continue direct observation during the continuation phase. This is the cornerstone of DOTS and the primary nursing role. 2. Patient Education and Adherence Counseling: • Explain the importance of completing the full 6-month regimen; stopping early leads to drug resistance (MDR-TB). • Inform the patient that Rifampicin causes orange-red discoloration of urine, sweat, and tears — this is normal and expected, not an adverse reaction. • Teach cough etiquette: cover mouth and nose when coughing or sneezing, use tissues, and dispose of sputum properly. • Encourage proper ventilation at home (open windows) to reduce airborne transmission. 3. Monitoring for Drug Side Effects: • Isoniazid (H): peripheral neuropathy, hepatotoxicity • Rifampicin (R): hepatotoxicity, orange-red urine (normal) • Pyrazinamide (Z): hepatotoxicity, hyperuricemia (gout symptoms) • Ethambutol (E): optic neuritis (advise patient to report any changes in vision immediately) 4. Contact Tracing and Screening: The nurse conducts a home visit to identify and screen all household contacts (especially children under 5 and immunocompromised individuals) for TB symptoms; refer symptomatic contacts for GeneXpert testing. 5. Documentation and Reporting: Accurately document treatment dates, doses observed, sputum examination results, and any adverse reactions in the NTP treatment card and register. Report outcomes through the standardized DOH recording and reporting system. Nursing Diagnosis (NANDA): • Ineffective Health Maintenance related to lack of knowledge of the TB treatment regimen and consequences of non-adherence. • Risk for Infection (secondary) related to inadequate primary defenses and airborne transmission. Goal: The patient will complete the full 6-month DOTS regimen without treatment interruption, as evidenced by negative sputum smear at the end of the intensive phase.

Question Type

long_answer

Answer Structure

• Paragraph 1: Identify Category I (who it applies to) [0.5 mark]
• Paragraph 2: State the regimen 2HRZE/4HR with correct drug names and phases [1 mark]
• Paragraph 3: DOTS nursing responsibility #1 — Direct Observation [1 mark]
• Paragraph 4: DOTS nursing responsibility #2 — Patient Education (adherence, side effects, cough etiquette) [1 mark]
• Paragraph 5: DOTS nursing responsibility #3 — Contact Tracing [0.5 mark]
• Closing: State a relevant nursing diagnosis (NANDA) and goal/evaluation criterion [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing the regimen as '2HRZE/6HR' — wrong continuation phase duration (should be 4 months, not 6).
• Describing direct observation without mentioning the treatment partner — incomplete DOTS concept.
• Not linking orange-red urine specifically to Rifampicin — generic statement loses the mark.
• Omitting the nursing diagnosis/goal — a 5-mark long answer in nursing must include nursing process elements.
• Not mentioning MDR-TB as the consequence of non-adherence — missed opportunity for a high-value key phrase.

Key Phrases To Include

• 2HRZE/4HR
• Category I
• intensive phase
• continuation phase
• Directly Observed Treatment
• treatment partner
• adherence
• orange-red urine
• Rifampicin
• Ethambutol
• optic neuritis
• contact tracing
• MDR-TB
• cough etiquette
• NANDA nursing diagnosis

Marks

5

Topic

Dengue Control — DOH 4-S Strategy

Difficulty

hard

Template Id

T11

Examiner Tip

The most common error on dengue questions is confusing Aedes (day-biting, clean water breeder) with Anopheles (night-biting, malaria vector). Make this distinction explicit in your answer to show the examiner you know the difference.

Model Answer

Introduction: Dengue is a viral hemorrhagic fever transmitted by the Aedes aegypti mosquito (with Aedes albopictus as a secondary vector). There are four dengue serotypes (DENV 1, 2, 3, and 4). Infection with one serotype provides lifetime immunity to that serotype but only temporary cross-immunity to others; a subsequent infection with a different serotype is associated with more severe disease (Dengue Hemorrhagic Fever or Dengue Shock Syndrome). Vector Characteristics: • Species: Aedes aegypti — a domestic, day-biting mosquito (most active during early morning and late afternoon). • Breeding site: Breeds in clean, stagnant water in artificial containers (water drums, pails, flower vases, discarded tires, clogged gutters). • This breeding behavior is the target of the DOH 4-S strategy. The DOH '4-S' Strategy Against Dengue: 1. Search and Destroy mosquito breeding sites: Conduct weekly inspection of the home and surroundings; overturn, cover, or discard water-holding containers. Drain, scrub, or apply larvicide to water storage containers that cannot be removed. 2. Self-protection measures: Use insect repellent (DEET-based), wear long-sleeved clothing and long pants especially during peak mosquito activity hours, install window and door screens, and use mosquito nets. 3. Seek early consultation: Teach the community to recognize dengue warning signs that require immediate medical attention: severe abdominal pain, persistent vomiting, bleeding (gums, skin petechiae, epistaxis), sudden drop in temperature with signs of shock (cold clammy skin, restlessness), and rapid breathing. Early consultation prevents mortality. 4. Support fogging/spraying only in hotspot areas during outbreaks: Community members are educated that fogging kills only adult mosquitoes and is NOT effective for preventing dengue during non-outbreak periods. Fogging is reserved as a reactive measure for confirmed outbreak hotspots, coordinated by the local health unit (LGU/RHU). Nursing Responsibilities in Community Dengue Control: • Conduct community health education using the 4-S framework in schools, barangay health centers, and home visits. • Teach the community to monitor and record platelet count trends for febrile patients and seek care at the RHU or hospital if platelet count drops below 100,000/µL. • Emphasize adequate oral hydration for dengue patients at home. • Coordinate with the barangay health workers (BHWs) for house-to-house vector surveillance and larval source reduction. • Report confirmed and suspected dengue cases to the RHU/city epidemiology office as per PIDSR guidelines (dengue is a weekly notifiable disease under the Philippine Integrated Disease Surveillance and Response system). Nursing Diagnosis (NANDA): Deficient Knowledge regarding dengue prevention and warning signs, related to inadequate information, as evidenced by inability to identify breeding sites and danger signs. Goal: The family/community members will verbalize and demonstrate at least 3 of the 4-S strategies within one week of health education.

Question Type

long_answer

Answer Structure

• Introduction: Identify the vector (Aedes aegypti), its biting time (day-biting), and the 4 serotypes [1 mark]
• Body Part 1: Breeding characteristics — clean stagnant water, artificial containers, domestic mosquito [0.5 mark]
• Body Part 2: Enumerate and explain each of the 4-S strategies with specific examples [2 marks — 0.5 per S]
• Body Part 3: Nursing responsibilities in community education — BHWs, PIDSR reporting, hydration [1 mark]
• Closing: NANDA nursing diagnosis and measurable goal [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Stating Aedes aegypti is a 'night-biting' mosquito — it is a DAY-biting mosquito (Anopheles is the night-biter/malaria vector).
• Stating dengue breeding sites include 'dirty stagnant water' — Aedes aegypti breeds in CLEAN stagnant water.
• Recommending fogging as a routine preventive measure — fogging is only for outbreak hotspots, not routine prevention.
• Not listing the dengue warning signs when discussing 'Seek early consultation' — warning signs are high-yield NLE content.
• Confusing dengue serotypes: 'immunity to all 4 serotypes after first infection' — wrong; immunity is TYPE-SPECIFIC.

Key Phrases To Include

• Aedes aegypti
• day-biting
• clean stagnant water
• 4 serotypes
• DENV 1–4
• 4-S strategy
• Search and Destroy
• Self-protection
• Seek early consultation
• Support fogging
• warning signs
• platelet count
• PIDSR
• weekly notifiable
• NANDA nursing diagnosis

Marks

2

Topic

Levels of Prevention — TB

Difficulty

easy

Template Id

T12

Examiner Tip

Think of the three levels as a timeline: Primary = BEFORE disease, Secondary = EARLY disease, Tertiary = AFTER disease complications. Apply this framework to any communicable disease question.

Model Answer

Primary Prevention of TB aims to prevent the disease from occurring in the first place. Examples include: BCG vaccination of newborns (specific protection), health education on TB transmission and cough etiquette, improving nutrition and housing conditions, and ensuring adequate ventilation to reduce airborne exposure. Secondary Prevention of TB involves early detection and prompt treatment to limit the spread of disease and prevent complications. Examples include: active case-finding through community sputum microscopy and GeneXpert testing, contact tracing of household members of known TB patients, and prompt initiation of DOTS therapy once TB is confirmed.

Question Type

short_answer

Answer Structure

• Line 1–2: Define primary prevention in TB context with at least 2 specific examples [1 mark]
• Line 3–4: Define secondary prevention in TB context with at least 2 specific examples [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing BCG vaccination under secondary prevention — BCG is a primary prevention measure (specific protection).
• Defining the levels correctly but providing examples from the wrong level.
• Confusing tertiary prevention (rehabilitation) with secondary prevention.

Key Phrases To Include

• primary prevention
• secondary prevention
• BCG vaccination
• health education
• case-finding
• contact tracing
• GeneXpert
• DOTS
• early detection
• prompt treatment

Marks

2

Topic

EPI — Cold Chain (Freeze-sensitive Vaccines)

Difficulty

medium

Template Id

T13

Examiner Tip

A simple memory hook: 'DPT, HepB, Td, and Pentavalent — Don't Put Them in the Freezer.' For OPV, BCG, and measles, the opposite applies — store them in the coldest part of the refrigerator because they are heat-sensitive.

Model Answer

The freeze-sensitive vaccines under the Philippine EPI that must NOT be frozen are: DPT (diphtheria-pertussis-tetanus), Hepatitis B (including the birth dose), Td (tetanus-diphtheria), and the Pentavalent vaccine (DPT–HepB–Hib). Freezing destroys their potency and renders them ineffective. The nurse detects a freeze-damaged vaccine using the Shake Test: 1. Take one vial of the suspect vaccine and one control vial of the same vaccine that was previously frozen and then allowed to thaw (a 'freeze control'). 2. Shake both vials vigorously for 10–15 seconds. 3. Allow both to stand for 30 minutes. 4. If the suspect vial remains cloudy/flocculated (like the frozen control), the vaccine has been freeze-damaged and must be DISCARDED. If it clears (becomes uniform) like a good vaccine, it is safe to use.

Question Type

short_answer

Answer Structure

• Line 1–2: List all 4 freeze-sensitive vaccines correctly [1 mark]
• Line 3–6: Describe the shake test procedure in correct sequence [1 mark]

Scoring Breakdown

Common Mark Deductions

• Including OPV or BCG in the freeze-sensitive list — these are heat-sensitive, not freeze-sensitive.
• Describing the shake test without mentioning the freeze control vial — the test requires a comparison.
• Forgetting to state the outcome criteria: discard if flocculated/cloudy.

Key Phrases To Include

• freeze-sensitive
• DPT
• Hepatitis B
• Td
• Pentavalent
• shake test
• freeze control
• flocculation
• discard
• potency

Marks

1

Topic

EPI — History and Target Diseases

Difficulty

easy

Template Id

T14

Examiner Tip

Memory trick for the classic six: 'TP DTP M' — Tuberculosis, Pertussis, Diphtheria, Tetanus, Polio, Measles. Or 'The Disease: TB, DPT (3), Polio, Measles.' These six form the core of EPI history questions.

Model Answer

The EPI was launched in 1976. The original six target diseases were: tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, and measles.

Question Type

very_short_answer

Answer Structure

• State the year: 1976 [0.5 mark]
• List all 6 diseases correctly: TB, diphtheria, pertussis, tetanus, polio, measles [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Missing one or more of the six diseases — must list all six for full marks.
• Adding Hepatitis B to the original six — HepB was added later; the classic six does not include it.
• Stating the wrong year (e.g., 1979, 1986) — the correct year is 1976.

Key Phrases To Include

• 1976
• tuberculosis
• diphtheria
• pertussis
• tetanus
• poliomyelitis
• measles

Marks

5

Topic

EPI — Complete Infant Immunization Schedule

Difficulty

hard

Template Id

T15

Examiner Tip

For a 5-mark schedule question, use a table format — it is faster to write, easier for the examiner to check, and clearly demonstrates that you know each vaccine's specific parameters. A well-organized table earns more marks than a disorganized prose answer covering the same content.

Model Answer

The Philippine Expanded Program on Immunization (EPI) routine infant schedule from birth to 12 months (per current DOH guidelines under RA 10152) is as follows: | Vaccine | Age Given | No. of Doses | Route | Dose Volume | Site | |---|---|---|---|---|---| | BCG | At birth | 1 | Intradermal | 0.05 mL | Right deltoid/upper arm | | Hepatitis B (birth dose) | Within 24 hours of birth | 1 | Intramuscular | 0.5 mL | Vastus lateralis | | Pentavalent (DPT–HepB–Hib) | 6, 10, 14 weeks | 3 | Intramuscular | 0.5 mL | Vastus lateralis | | OPV (Oral Polio Vaccine) | 6, 10, 14 weeks | 3 | Oral | 2–3 drops | — | | IPV (Inactivated Polio Vaccine) | 14 weeks and 9 months | 2 | Intramuscular | 0.5 mL | Vastus lateralis | | PCV (Pneumococcal Conjugate) | 6, 10, 14 weeks | 3 | Intramuscular | 0.5 mL | Vastus lateralis | | MCV1 (Measles-containing / MMR) | 9 months | 1 | Subcutaneous | 0.5 mL | Outer upper arm | | MCV2 (MMR) | 12 months | 1 | Subcutaneous | 0.5 mL | Outer upper arm | Key Points for the Nurse to Remember: 1. BCG and Hepatitis B birth dose are given at birth (HepB within 24 hours). 2. Pentavalent, OPV, and PCV all follow the 6–10–14 week schedule with a minimum 4-week interval between doses. 3. Polio immunization uses both OPV (oral, at 6–10–14 weeks) AND IPV (intramuscular, at 14 weeks and 9 months) — this combination strategy (sequential schedule) maximizes protection and supports polio eradication. 4. Measles vaccines are given subcutaneously (not intramuscularly) — MCV1 at 9 months and MCV2 (MMR) at 12 months. 5. A child who completes BCG ×1, OPV ×3, Pentavalent ×3, and MCV1 before 12 months of age is classified as a Fully Immunized Child (FIC). Nursing Responsibility: Under RA 9173 and the EPI mandate, the community nurse ensures that every child receives vaccines at the scheduled age, that missed doses are caught up promptly, and that vaccination status is accurately recorded on the child's immunization card and the RHU register. The nurse must never miss a vaccination opportunity for a child with only mild illness.

Question Type

long_answer

Answer Structure

• Table: List all 8 vaccines with correct age, doses, route, and dose volume [3 marks — 0.5 per vaccine row]
• Key Points 1–3: Highlight the 6–10–14 week co-administration, OPV+IPV combination, and subcutaneous route for measles [1 mark]
• Closing: FIC classification criteria and nursing responsibility [1 mark]

Scoring Breakdown

Common Mark Deductions

• Using the American schedule (2, 4, 6 months) instead of the Philippine schedule (6, 10, 14 weeks).
• Stating measles vaccine is given intramuscularly — it is SUBCUTANEOUS.
• Omitting IPV from the polio vaccine section — many students only write OPV.
• Stating BCG dose as 0.1 mL — this is for older children; for infants it is 0.05 mL.
• Not distinguishing MCV1 (at 9 months) from MCV2/MMR (at 12 months).
• Failing to state the Fully Immunized Child (FIC) definition in the conclusion.

Key Phrases To Include

• BCG
• 0.05 mL
• intradermal
• Hepatitis B
• within 24 hours
• Pentavalent
• 6–10–14 weeks
• OPV
• oral
• IPV
• intramuscular
• PCV
• MCV1
• MCV2
• subcutaneous
• 9 months
• 12 months
• Fully Immunized Child
• FIC
• minimum 4-week interval
• RA 9173