A 2-year-old has had cough for 3 days. She is alert and drinking well, with no vomiting or convulsions. Her respiratory rate is 46 per minute on two counts, with no chest indrawing and no stridor when calm. What is her IMNCI classification?

Severe pneumonia or very severe disease

At an outreach session, one MR vial was reconstituted in the morning and used for all infants through the day. That evening, three of those infants develop high fever, vomiting and watery diarrhoea, and one becomes floppy. What is the most likely cause?

Toxic shock from a contaminated reconstituted vial

Expected mild fever and rash after measles vaccine

Anaphylaxis to a component of the MR vaccine

Reduced potency from a vial exposed to freezing

Once a vial of measles-rubella vaccine has been reconstituted at a session site, it must be discarded:

Four hours after reconstitution or at session end

Twenty-four hours after it is reconstituted

Only when its vaccine vial monitor turns dark

Twenty-eight days after the vial is opened

A 10-week-old is due for the second pentavalent dose. The mother says the baby has had a runny nose since yesterday, and the axillary temperature is 37.8°C. The baby is feeding well. What is the most appropriate action?

Give the due vaccines as scheduled

Give OPV only and defer pentavalent

Postpone all vaccines for two weeks

Give paracetamol and vaccinate tomorrow

Immunisation schedule and IMNCI

22 AIIMS NORCET (Nursing Officer) practice questions on Immunisation schedule and IMNCI, part of Paediatric Nursing. The first 22 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A 2-year-old has had cough for 3 days. She is alert and drinking well, with no vomiting or convulsions. Her respiratory rate is 46 per minute on two counts, with no chest indrawing and no stridor when calm. What is her IMNCI classification?
1. ANo pneumonia: cough or cold
2. BPneumonia
3. CVery severe febrile disease
4. DSevere pneumonia or very severe disease
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Answer: B · Pneumonia
At 2 years the fast-breathing cut-off is 40 per minute, so a rate of 46 is fast breathing. With no general danger sign, no chest indrawing and no stridor, fast breathing alone classifies as pneumonia, a yellow row. She is treated with oral amoxicillin, the mother is taught to soothe the throat, and she is followed up in 2-3 days. A common error is applying the infant cut-off of 50.
- A: This would apply only if the rate were below 40; the infant cut-off of 50 was wrongly used.
- C: This classification is for fever with a danger sign or stiff neck, not cough with fast breathing.
- D: The severe class needs a danger sign, chest indrawing or stridor in a calm child, none of which she has.
Question 2 · Hard
At an outreach session, one MR vial was reconstituted in the morning and used for all infants through the day. That evening, three of those infants develop high fever, vomiting and watery diarrhoea, and one becomes floppy. What is the most likely cause?
1. AExpected mild fever and rash after measles vaccine
2. BAnaphylaxis to a component of the MR vaccine
3. CToxic shock from a contaminated reconstituted vial
4. DReduced potency from a vial exposed to freezing
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Answer: C · Toxic shock from a contaminated reconstituted vial
This cluster of severe illness within hours, all from one reconstituted vial, points to a programme error. A preservative-free reconstituted vaccine kept beyond 4 hours lets bacteria multiply, causing toxic shock syndrome. It is a serious AEFI and must be reported at once, and the vial and diluent are kept for investigation. The 4-hour discard rule prevents it.
- A: Fever and rash after measles vaccine appear 5-12 days later and are mild.
- B: Anaphylaxis starts within minutes of injection, not hours later, with urticaria and stridor.
- D: Lost potency means failed protection, not acute illness, and MR is not freeze-sensitive.
Question 3 · Easy
Once a vial of measles-rubella vaccine has been reconstituted at a session site, it must be discarded:
1. ATwenty-four hours after it is reconstituted
2. BFour hours after reconstitution or at session end
3. COnly when its vaccine vial monitor turns dark
4. DTwenty-eight days after the vial is opened
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Answer: B · Four hours after reconstitution or at session end
Reconstituted live vaccines such as MR, BCG and JE contain no preservative. If contaminated, bacteria multiply in them within hours, which has caused fatal toxic shock in infants. The UIP therefore discards them 4 hours after reconstitution or at the end of the session, whichever comes first. The time of reconstitution is written on the vial label.
- A: Twenty-four hours is far longer than the safe limit for a preservative-free reconstituted vaccine.
- C: A VVM tracks heat damage before use and gives no protection against contamination.
- D: The 28-day open vial policy covers liquid vaccines such as pentavalent, not reconstituted MR.
Question 4 · Medium
Under India's open vial policy, which opened multidose vial may be kept and used at later sessions for up to 28 days if the other conditions are met?
1. APentavalent vaccine
2. BMeasles-rubella vaccine
3. CBCG vaccine
4. DJapanese encephalitis vaccine
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Answer: A · Pentavalent vaccine
The open vial policy applies to liquid vaccines that contain a preservative, such as pentavalent, DPT, Td, hepatitis B, OPV, PCV and IPV. An opened vial may be reused for up to 28 days if it is within expiry, the VVM has not reached the discard point, it has been kept at +2°C to +8°C, the septum was never submerged in water, and aseptic technique was used. The date of opening is written on the vial. Reconstituted vaccines are excluded.
- B: MR is reconstituted and discarded after 4 hours or at session end.
- C: BCG is reconstituted and has the same 4-hour limit.
- D: JE vaccine is reconstituted and is not covered by the open vial policy.
Question 5 · Medium
A 10-week-old is due for the second pentavalent dose. The mother says the baby has had a runny nose since yesterday, and the axillary temperature is 37.8°C. The baby is feeding well. What is the most appropriate action?
1. AGive OPV only and defer pentavalent
2. BGive the due vaccines as scheduled
3. CPostpone all vaccines for two weeks
4. DGive paracetamol and vaccinate tomorrow
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Answer: B · Give the due vaccines as scheduled
A minor illness such as a cold or low-grade fever is not a reason to delay vaccination. Delaying leaves the infant unprotected and adds to drop-outs, since many children do not return. Vaccination is deferred only for a severe illness, such as a child needing admission. True contraindications to pentavalent are rare, such as anaphylaxis or encephalopathy after an earlier dose.
- A: There is no reason to split the vaccines for a mild cold.
- C: A two-week delay is a missed opportunity, not good practice.
- D: Paracetamol is not needed before vaccination, and waiting a day risks the child not returning.
Question 6 · Medium
The pentavalent vaccine used in India protects against:
1. ADiphtheria, pertussis, tetanus, hepatitis B and Hib
2. BDiphtheria, pertussis, tetanus, measles and Hib
3. CDiphtheria, tetanus, hepatitis B, Hib and polio
4. DDiphtheria, pertussis, tetanus, polio and hepatitis B
Answer and explanation in LearnFree account
Question 7 · Medium
Under IMNCI, a young infant aged 3 weeks has fast breathing when the respiratory rate, counted for one minute, is:
1. A50 breaths per minute or more
2. B40 breaths per minute or more
3. C60 breaths per minute or more
4. D70 breaths per minute or more
Answer and explanation in LearnFree account
Question 8 · Easy
Under IMNCI, a child aged 12 months up to 5 years has fast breathing when the respiratory rate is:
1. A60 breaths per minute or more
2. B50 breaths per minute or more
3. C30 breaths per minute or more
4. D40 breaths per minute or more
Answer and explanation in LearnFree account
Question 9 · Medium
After vaccination at an outreach session, the UIP advises that the child should stay near the session site for:
1. A2 hours
2. B24 hours
3. C30 minutes
4. D5 minutes
Answer and explanation in LearnFree account
Question 10 · Medium
A 14-month-old has had diarrhoea for 2 days. He is restless and irritable, his eyes are sunken, he drinks eagerly when offered ORS, and a skin pinch goes back slowly. He has no general danger sign. How should the nurse classify his hydration?
1. APersistent diarrhoea
2. BNo dehydration
3. CSevere dehydration
4. DSome dehydration
Answer and explanation in LearnFree account
Question 11 · Hard
A 2-year-old weighing 10 kg is classified as having some dehydration. How much ORS should the nurse plan to give in the first 4 hours under Plan B?
1. A1000 mL
2. B750 mL
3. C300 mL
4. D500 mL
Answer and explanation in LearnFree account
Question 12 · Easy
On a vaccine vial monitor, the inner square is lighter than the outer circle. What does this mean?
1. AThe vaccine has reached its discard point
2. BThe vaccine may be used if it is within expiry
3. CThe vaccine has been frozen and must be discarded
4. DThe vial must be shaken and checked again
Answer and explanation in LearnFree account
Question 13 · Hard
An 8-month-old weighing 6 kg has severe dehydration and an IV line is in place. Using IMNCI Plan C with Ringer lactate, what should the nurse give first?
1. A180 mL over 30 minutes
2. B600 mL over 1 hour
3. C180 mL over 1 hour
4. D420 mL over 1 hour
Answer and explanation in LearnFree account
Question 14 · Easy
In the IMNCI chart booklet, a classification placed in a pink row tells the health worker to:
1. AGive specific treatment at the facility and advise
2. BAdmit only if the child fails to improve in two days
3. CAdvise home care and follow up in five days
4. DRefer the child urgently after pre-referral treatment
Answer and explanation in LearnFree account
Question 15 · Hard
Five minutes after a pentavalent injection, a 14-week-old infant develops generalised urticaria, noisy breathing and pallor, and the pulse is weak and rapid. What is the nurse's first action?
1. AGive an oral antihistamine syrup at once
2. BGive hydrocortisone intravenously as a slow bolus
3. CGive adrenaline 1:1000 intramuscularly in the thigh
4. DGive nebulised salbutamol through a face mask
Answer and explanation in LearnFree account
Question 16 · Medium
Before a session, a nurse is preparing to reconstitute BCG vaccine. Which diluent practice is correct?
1. AUse normal saline drawn from a ward stock vial
2. BUse the diluent of any brand if within expiry
3. CUse the same manufacturer's diluent, cooled with it
4. DUse any sterile water kept at room temperature
Answer and explanation in LearnFree account
Question 17 · Medium
For an 8-month-old with acute diarrhoea, the IMNCI dose of zinc is:
1. A10 mg once daily for 14 days
2. B20 mg once daily for 5 days
3. C20 mg once daily for 14 days
4. D10 mg twice daily for 7 days
Answer and explanation in LearnFree account
Question 18 · Hard
An 18-month-old with watery diarrhoea is lethargic, has very sunken eyes, drinks poorly, and a skin pinch goes back very slowly. He has no other severe classification, and the facility can give IV fluids. What is the nurse's priority?
1. AGive ORS 75 mL/kg over 4 hours by Plan B
2. BGive zinc and ORS packets for home use
3. CGive a first dose of oral antibiotic
4. DStart Ringer lactate 100 mL/kg by Plan C
Answer and explanation in LearnFree account
Question 19 · Medium
A 9-month-old child who has completed all earlier doses comes to the immunisation session. Which vaccine is due at this visit under the UIP?
1. AFirst booster dose of DPT vaccine
2. BSecond dose of measles-rubella vaccine
3. CFourth dose of pentavalent vaccine
4. DFirst dose of measles-rubella vaccine
Answer and explanation in LearnFree account
Question 20 · Easy
Under India's Universal Immunization Programme, the birth dose of hepatitis B vaccine should be given:
1. AWithin 15 days of birth
2. BAt any time before 6 weeks
3. CAlong with the first pentavalent dose
4. DWithin 24 hours of birth
Answer and explanation in LearnFree account
Question 21 · Medium
At morning check, the nurse finds that the PHC ice-lined refrigerator thermometer reads -3°C after the thermostat was turned too low overnight. Which stored vaccine is most likely to have been damaged?
1. AMeasles-rubella vaccine
2. BHepatitis B vaccine
3. CBCG vaccine
4. DOral polio vaccine
Answer and explanation in LearnFree account
Question 22 · Easy
The temperature range that must be maintained inside an ice-lined refrigerator storing vaccines at a primary health centre is:
1. A-15°C to -25°C
2. B+8°C to +15°C
3. C+2°C to +8°C
4. D0°C to +4°C
Answer and explanation in LearnFree account

Immunisation schedule and IMNCI

A 2-year-old has had cough for 3 days. She is alert and drinking well, with no vomiting or convulsions. Her respiratory rate is 46 per minute on two counts, with no chest indrawing and no stridor when calm. What is her IMNCI classification?

At an outreach session, one MR vial was reconstituted in the morning and used for all infants through the day. That evening, three of those infants develop high fever, vomiting and watery diarrhoea, and one becomes floppy. What is the most likely cause?

Once a vial of measles-rubella vaccine has been reconstituted at a session site, it must be discarded:

Under India's open vial policy, which opened multidose vial may be kept and used at later sessions for up to 28 days if the other conditions are met?

A 10-week-old is due for the second pentavalent dose. The mother says the baby has had a runny nose since yesterday, and the axillary temperature is 37.8°C. The baby is feeding well. What is the most appropriate action?

The pentavalent vaccine used in India protects against:

Under IMNCI, a young infant aged 3 weeks has fast breathing when the respiratory rate, counted for one minute, is:

Under IMNCI, a child aged 12 months up to 5 years has fast breathing when the respiratory rate is:

After vaccination at an outreach session, the UIP advises that the child should stay near the session site for:

A 14-month-old has had diarrhoea for 2 days. He is restless and irritable, his eyes are sunken, he drinks eagerly when offered ORS, and a skin pinch goes back slowly. He has no general danger sign. How should the nurse classify his hydration?

A 2-year-old weighing 10 kg is classified as having some dehydration. How much ORS should the nurse plan to give in the first 4 hours under Plan B?

On a vaccine vial monitor, the inner square is lighter than the outer circle. What does this mean?

An 8-month-old weighing 6 kg has severe dehydration and an IV line is in place. Using IMNCI Plan C with Ringer lactate, what should the nurse give first?

In the IMNCI chart booklet, a classification placed in a pink row tells the health worker to:

Five minutes after a pentavalent injection, a 14-week-old infant develops generalised urticaria, noisy breathing and pallor, and the pulse is weak and rapid. What is the nurse's first action?

Before a session, a nurse is preparing to reconstitute BCG vaccine. Which diluent practice is correct?

For an 8-month-old with acute diarrhoea, the IMNCI dose of zinc is:

An 18-month-old with watery diarrhoea is lethargic, has very sunken eyes, drinks poorly, and a skin pinch goes back very slowly. He has no other severe classification, and the facility can give IV fluids. What is the nurse's priority?

A 9-month-old child who has completed all earlier doses comes to the immunisation session. Which vaccine is due at this visit under the UIP?

Under India's Universal Immunization Programme, the birth dose of hepatitis B vaccine should be given:

At morning check, the nurse finds that the PHC ice-lined refrigerator thermometer reads -3°C after the thermostat was turned too low overnight. Which stored vaccine is most likely to have been damaged?

The temperature range that must be maintained inside an ice-lined refrigerator storing vaccines at a primary health centre is: