Clinical High-Yield · 9 min read · April 28, 2026
Immunization questions are among the most reliably tested content on the FNP boards. They are also among the most learnable — the schedule is fixed, the contraindications are specific, and the boards ask the same types of questions year after year. Here is the complete high-yield guide.
Before memorizing the schedule, understand the fundamental distinction that drives most contraindication questions.
Live attenuated vaccines contain weakened but replicating organisms. They produce strong, long-lasting immunity but carry a small risk of causing disease in immunocompromised hosts. Live vaccines: MMR, Varicella (chickenpox), MMRV (ProQuad), Zoster (Zostavax — the older shingles vaccine), LAIV (live attenuated influenza vaccine, the nasal spray), rotavirus, yellow fever, oral typhoid, BCG.
Inactivated vaccines contain killed organisms or protein subunits. They are safe in immunocompromised patients but generally require booster doses. Inactivated vaccines: influenza (injectable), IPV (inactivated polio), hepatitis A, hepatitis B, DTaP/Tdap, Hib, PCV, PPSV23, HPV, meningococcal, zoster (Shingrix — the newer recombinant shingles vaccine), COVID-19 (mRNA and protein subunit).
Board Pearl: The boards love to ask about live vaccine contraindications. Live vaccines are contraindicated in: pregnancy (all live vaccines), severe immunocompromise (HIV with CD4 <200, active chemotherapy, high-dose corticosteroids), and severe combined immunodeficiency (SCID). Inactivated vaccines are safe in all of these populations.
Influenza: Annual vaccination for all persons ≥6 months. Inactivated influenza vaccine (IIV) is preferred for immunocompromised patients, pregnant women, and adults ≥50 years. LAIV (nasal spray) is an option for healthy non-pregnant adults 2–49 years but is contraindicated in immunocompromised patients, pregnant women, and those with severe asthma or active wheezing.
Tdap/Td: All adults should receive a one-time Tdap (if not previously vaccinated), then Td booster every 10 years. Tdap is recommended during every pregnancy (27–36 weeks gestation) regardless of prior vaccination — this protects the newborn through passive antibody transfer before the infant can be vaccinated.
Pneumococcal vaccines: PCV15 or PCV20 for all adults ≥65 years. If PCV15 is used, follow with PPSV23 at least 1 year later. For immunocompromised adults and those with certain chronic conditions, vaccination is recommended starting at age 19. The boards test that PPSV23 alone is no longer the standard — PCV is now preferred as the initial vaccine.
Zoster (shingles): Recombinant zoster vaccine (Shingrix) is recommended for all immunocompetent adults ≥50 years, given as 2 doses 2–6 months apart. Shingrix is preferred over Zostavax (which is no longer available in the US). Shingrix is also recommended for adults who previou...