Delaware PN: Health Promotion and Maintenance Practice Test

Practice test questions — PN: Health Promotion and Maintenance

1. According to Erikson's theory, what is the primary developmental task of a toddler (ages 1-3)?

   • Trust vs. Mistrust
   • Autonomy vs. Shame and Doubt ✓
   • Initiative vs. Guilt
   • Industry vs. Inferiority

   Erik Erikson's psychosocial stages identify AUTONOMY vs. SHAME AND DOUBT as the primary conflict of toddlerhood (approximately ages 1-3). During this stage the child is developing a sense of personal control and independence. Key behaviors include: insisting on doing things independently ('me do it'…

2. A 2-month-old infant is brought in for a well-child visit. Which milestone is EXPECTED at this age?

   • Sits without support
   • Social smile and holds head up briefly when prone ✓
   • Pulls to a standing position
   • Walks independently

   By age 2 months, normal developmental milestones include: SOCIAL SMILE (smiling in response to a face or voice — a key early social milestone, distinct from the reflexive newborn smile); HOLDS HEAD UP briefly when placed on the abdomen (prone position); follows objects with eyes past midline; respon…

3. A nurse is teaching a newly pregnant client about early prenatal care. Which of the following instructions is MOST important to give regarding folic acid?

   • Start folic acid only in the third trimester
   • Take 400-800 mcg of folic acid daily, ideally beginning before conception and continuing through the first trimester to reduce the risk of neural tube defects ✓
   • Folic acid is optional and has no proven benefit
   • Take folic acid only if you have a family history of neural tube defects

   FOLIC ACID supplementation is one of the most strongly evidence-based prenatal interventions. Adequate folic acid intake reduces the risk of NEURAL TUBE DEFECTS (NTDs) — most critically spina bifida (incomplete closure of the spinal column) and anencephaly (absence of major brain structures). The NE…

4. During the immediate newborn period, which of the following interventions is given to prevent hemorrhagic disease of the newborn?

   • Vitamin C injection
   • Vitamin K (phytonadione) injection, given within 6 hours of birth to prevent bleeding caused by low vitamin K levels in newborns ✓
   • Erythromycin eye ointment
   • Hepatitis B vaccine

   VITAMIN K (phytonadione) is administered to all newborns within 6 hours of birth to prevent VITAMIN K DEFICIENCY BLEEDING (VKDB), formerly called hemorrhagic disease of the newborn. WHY NEWBORNS ARE AT RISK: (1) Vitamin K does not cross the placenta well; (2) Newborns have limited intestinal bacteri…

5. At a 12-month well-child visit, which vaccines are typically administered according to the CDC immunization schedule?

   • HPV only
   • MMR (measles, mumps, rubella), Varicella, Hepatitis A — along with any catch-up doses; this is a major immunization visit ✓
   • Only influenza vaccine
   • No vaccines are given at 12 months

   The 12-MONTH VISIT is one of the most vaccine-intensive well-child visits. The CDC Advisory Committee on Immunization Practices (ACIP) schedule typically includes at 12-15 months: MMR (Measles, Mumps, Rubella) — first dose; VARICELLA (chickenpox) — first dose; HEPATITIS A — first dose (series of 2 d…

6. Which screening test is recommended for ALL adults starting at age 45 (or earlier for high-risk individuals) to detect colorectal cancer?

   • Mammography
   • Colorectal cancer screening — options include colonoscopy every 10 years, fecal occult blood test (FOBT) or FIT annually, or stool DNA test every 1-3 years ✓
   • Prostate-specific antigen (PSA) test
   • Chest X-ray

   COLORECTAL CANCER SCREENING is recommended for all adults beginning at age 45 (the American Cancer Society updated their recommendation from 50 to 45 in 2018 due to rising rates in younger adults; the USPSTF now recommends starting at 45 as well). Earlier screening is recommended for HIGHER-RISK ind…

7. A client smokes 1.5 packs per day and wants to quit. Which approach is MOST evidence-based as first-line treatment?

   • Willpower alone, without any support
   • Combination therapy: nicotine replacement therapy (NRT) plus a medication (varenicline or bupropion) combined with behavioral counseling; combination has higher quit rates than any single approach ✓
   • Switching to e-cigarettes
   • Simply reducing number of cigarettes smoked

   Tobacco cessation is the single most impactful modifiable health behavior change for most smokers. EVIDENCE-BASED APPROACH: the 2008 USPHS Clinical Practice Guideline (updated) recommends COMBINATION of pharmacotherapy plus behavioral counseling as the most effective approach. PHARMACOTHERAPY OPTION…

8. A client asks how much moderate-intensity physical activity adults should get per week to maintain health. What is the current recommendation?

   • 10 minutes per week
   • At least 150 minutes (2.5 hours) of moderate-intensity aerobic activity per week, plus muscle-strengthening activities on 2 or more days per week ✓
   • No formal recommendation exists
   • 1 hour per year

   The U.S. Department of Health and Human Services PHYSICAL ACTIVITY GUIDELINES FOR AMERICANS (2nd edition) recommends for adults: AEROBIC ACTIVITY: at least 150-300 minutes per week of moderate-intensity activity (like brisk walking, casual biking, water aerobics) OR 75-150 minutes per week of vigoro…

9. A nurse is caring for a client who is 2 hours postpartum. The client reports feeling sad and crying without reason. Which postpartum mood disorder does this MOST likely represent?

   • Postpartum psychosis
   • Postpartum blues (baby blues) — a very common, self-limiting mood change in the first 2 weeks after birth affecting up to 80% of new mothers ✓
   • Postpartum depression
   • Postpartum anxiety disorder

   POSTPARTUM BLUES ('baby blues') is the MOST COMMON postpartum mood change, affecting up to 70-80% of new mothers. Characteristics: onset within 1-3 days after delivery; peaks around day 3-5; resolves on its own within 10-14 days; symptoms include tearfulness, emotional lability, irritability, anxiet…

10. Which of the following is a NORMAL physiological change of aging rather than a pathological finding?

    • Complete loss of short-term memory
    • Decreased skin turgor, slower wound healing, reduced visual acuity, and longer reaction times — these are normal aging changes ✓
    • New-onset urinary incontinence
    • Severe confusion and disorientation at all times

    Distinguishing NORMAL AGING from PATHOLOGY is essential nursing knowledge. NORMAL PHYSIOLOGICAL CHANGES OF AGING include: SKIN — decreased turgor (pinch test not reliable for dehydration in elderly), thinning, dryness, increased bruising, slower wound healing, age spots (lentigines), decreased subcu…

11. Which of the following is a major risk factor for FALLS in older adults that nurses should assess?

    • Having too much energy
    • Polypharmacy (taking 4+ medications), especially medications that cause dizziness, orthostatic hypotension, or sedation (such as antihypertensives, diuretics, sedatives, and opioids) ✓
    • Being too young
    • Having perfect vision

    FALLS are the leading cause of injury death and one of the most common causes of injury in adults aged 65 and older. FALL RISK ASSESSMENT is a key PN nursing responsibility. MAJOR FALL RISK FACTORS: (1) POLYPHARMACY — taking multiple medications increases interaction risks; medications contributing …

12. A nurse teaches a 50-year-old client about the shingles (herpes zoster) vaccine. Which statement is CORRECT?

    • The shingles vaccine is only for people who have never had chickenpox
    • The Shingrix vaccine is recommended for adults 50 and older as two doses given 2-6 months apart, even if the person has had shingles before or received the older Zostavax vaccine ✓
    • Only one dose of the shingles vaccine is needed
    • Shingles vaccines are not recommended for people over 80

    SHINGLES (herpes zoster) is caused by reactivation of the varicella-zoster virus (VZV) — the same virus that causes chickenpox — which remains dormant in nerve tissue after initial infection. As people age, immunity wanes and VZV can reactivate, causing the painful shingles rash along a dermatome, a…

13. A parent is concerned that her 4-year-old still has occasional nighttime bedwetting. What is the MOST appropriate response?

    • Immediately refer for kidney evaluation
    • Reassure the parent that nighttime dryness is typically not expected until age 5-6; primary nocturnal enuresis is common in children up to age 6 and is not abnormal ✓
    • Restrict all fluids after noon
    • Start the child on medication immediately

    NOCTURNAL ENURESIS (bedwetting) is very common in young children. Expected timeline for toilet training: DAYTIME DRYNESS — most children achieve by ages 2-3; NIGHTTIME DRYNESS — typically not expected until ages 5-6; NORMAL VARIATION — many children are not consistently dry at night until age 6-7; a…

14. A nurse is counseling a client about safe alcohol use. Which statement about alcohol is CORRECT?

    • Light drinking has no health effects at all
    • Moderate drinking is defined as up to 1 drink per day for women and up to 2 drinks per day for men; heavy or binge drinking is associated with liver disease, cancer, cardiovascular problems, and addiction ✓
    • Alcohol is safe in any amount during pregnancy
    • Drinking more alcohol helps with sleep quality

    MODERATE ALCOHOL USE — per NIAAA and USDA Dietary Guidelines for Americans: up to 1 standard drink per day for women; up to 2 standard drinks per day for men. A STANDARD DRINK = 14 grams of pure alcohol = 12 oz regular beer (5% ABV); 5 oz wine (12% ABV); 1.5 oz distilled spirits (40% ABV). NOTE: the…

15. A client at 28 weeks gestation asks about warning signs that should prompt her to call her provider immediately. Which of the following is a WARNING SIGN of preterm labor?

    • Mild back discomfort from uterine stretching
    • Regular contractions (4 or more per hour), pelvic pressure, low backache, vaginal discharge or bleeding, or fluid leaking from vagina before 37 weeks gestation ✓
    • Increased appetite
    • Occasional Braxton-Hicks contractions

    PRETERM LABOR is defined as regular uterine contractions resulting in cervical change before 37 weeks gestation. It is a major cause of neonatal morbidity and mortality. WARNING SIGNS of preterm labor (teach clients to report IMMEDIATELY if they experience before 37 weeks): (1) Regular uterine CONTR…

16. When teaching a parent about nutrition for a school-age child (ages 6-12), which of the following is MOST important to emphasize?

    • Children this age don't need regular meals
    • A balanced diet with fruits, vegetables, whole grains, lean protein, and dairy supports growth, brain development, and energy; limit added sugars, sodium, and saturated fats; breakfast is particularly important for school performance ✓
    • Fast food several times a week is acceptable as a primary diet
    • School-age children only need two meals per day

    SCHOOL-AGE NUTRITION is foundational to healthy growth, cognitive function, and lifelong dietary patterns. Key principles: BALANCED DIET: use MyPlate as a visual guide — half the plate fruits and vegetables; one quarter whole grains; one quarter lean protein; dairy on the side; BREAKFAST: research c…

17. A nurse provides teaching about the HPV vaccine. Which statement is ACCURATE?

    • The HPV vaccine is only for females
    • The HPV vaccine is recommended for all preteens at ages 11-12 (may start at age 9), with catch-up vaccination through age 26; males and females both benefit from vaccination ✓
    • The vaccine protects against all cancers
    • The HPV vaccine eliminates the need for Pap smears

    HUMAN PAPILLOMAVIRUS (HPV) is the most common sexually transmitted infection in the US. Certain HPV strains cause: cervical cancer, vaginal and vulvar cancer, anal cancer, oropharyngeal cancer, penile cancer, and genital warts. HPV VACCINE (Gardasil 9): protects against 9 HPV strains (including type…

18. A client with type 2 diabetes asks what blood glucose level range is generally recommended before meals for adults. Which is CORRECT?

    • Less than 60 mg/dL
    • 80-130 mg/dL before meals (and less than 180 mg/dL two hours after meals) for most non-pregnant adults with diabetes, per ADA guidelines ✓
    • Less than 200 mg/dL at all times
    • 300-400 mg/dL

    BLOOD GLUCOSE TARGETS for adults with diabetes are established by the American Diabetes Association (ADA) in annual Standards of Medical Care in Diabetes. For most NON-PREGNANT ADULTS with diabetes: PREPRANDIAL (before meals): 80-130 mg/dL; POSTPRANDIAL (2 hours after the start of a meal): less than…

19. Which medication consideration is MOST important when administering drugs to an older adult?

    • Older adults always need higher doses
    • Renal and hepatic clearance decreases with age; drug distribution, metabolism, and elimination change — older adults often need LOWER doses, and are more sensitive to side effects and drug interactions (polypharmacy risk) ✓
    • Age has no effect on drug metabolism
    • Older adults absorb all oral drugs faster

    PHARMACOKINETICS IN OLDER ADULTS is altered in multiple ways, creating significant medication management considerations. ABSORPTION: generally less affected; gastric motility may be slowed (delayed peak effect); some medications requiring acidic environment may be affected by reduced gastric acid. D…

20. According to Piaget's theory of cognitive development, what is characteristic of the preoperational stage (ages 2-7)?

    • Ability to think abstractly and hypothetically
    • Egocentric thinking — inability to take another's perspective; magical thinking; difficulty understanding that quantity stays the same even if appearance changes (lack of conservation) ✓
    • Fully logical and systematic thinking
    • Understanding of abstract moral philosophy

    Jean PIAGET's theory describes four stages of cognitive development. The PREOPERATIONAL STAGE (approximately ages 2-7) is characterized by: EGOCENTRISM — the child cannot take another's perspective; believes others see, think, and feel exactly as they do; demonstrated by Piaget's 'three mountains' t…

21. An older adult client is prescribed a new blood pressure medication. Which teaching point is MOST important for this population?

    • Take the medication at bedtime only
    • Rise slowly from sitting or lying positions (orthostatic precautions) because antihypertensives can cause orthostatic hypotension — a sudden drop in blood pressure when standing — that is more pronounced in older adults due to decreased baroreceptor sensitivity ✓
    • Skip doses if feeling well
    • Take double doses if the blood pressure reads high

    ORTHOSTATIC HYPOTENSION is defined as a drop in systolic blood pressure of 20 mmHg or more (or diastolic 10 mmHg or more) within 3 minutes of standing from a sitting or lying position. OLDER ADULTS ARE AT HIGHER RISK because: baroreceptors (pressure sensors in blood vessels) become less sensitive wi…

22. A nurse is teaching a 55-year-old client about pneumococcal vaccination. Which statement is ACCURATE?

    • Pneumococcal vaccines are only for children under 2
    • Adults 65 and older should receive pneumococcal vaccination; adults 19-64 with high-risk conditions (immunocompromise, chronic heart/lung/liver/kidney disease, diabetes, smoking) should also receive it; multiple formulations exist (PCV15, PCV20, PPSV23) and the combination depends on prior vaccination history ✓
    • One dose of any pneumococcal vaccine provides lifetime protection
    • Pneumococcal vaccines are the same as the flu shot

    PNEUMOCOCCAL VACCINATION protects against Streptococcus pneumoniae, which causes pneumonia, meningitis, and bacteremia — conditions with high mortality especially in elderly and immunocompromised individuals. CURRENT CDC RECOMMENDATIONS (as of most recent guidelines): Adults 65 and older: pneumococc…

23. A parent asks when their child should receive the first MMR (measles, mumps, rubella) vaccine. What is the correct response?

    • At birth, with the Hepatitis B vaccine
    • At 12-15 months of age for the first dose; the second dose is given at 4-6 years before school entry; MMR is a live attenuated vaccine and should not be given before 12 months due to interference from maternal antibodies ✓
    • Only if the child has been exposed to measles
    • MMR is given annually like the flu vaccine

    MMR VACCINE SCHEDULE (CDC ACIP recommended): FIRST DOSE: 12-15 months of age; SECOND DOSE: 4-6 years of age (school entry); CATCH-UP: Children who did not receive MMR on schedule should be vaccinated as soon as possible; adults born after 1957 who lack evidence of immunity should receive 1-2 doses. …

24. A client with hypertension asks which dietary change would have the GREATEST impact on blood pressure reduction. What is evidence-based?

    • Eliminating all fats from the diet
    • Reducing sodium intake to 2,300 mg/day or less (ideally 1,500 mg for higher-risk individuals); adopting the DASH diet pattern — high in fruits, vegetables, whole grains, lean protein, low-fat dairy, and low in saturated fat and sodium — can reduce systolic blood pressure by 8-14 mmHg ✓
    • Increasing protein intake only
    • Eliminating all carbohydrates

    HYPERTENSION DIETARY MANAGEMENT evidence supports sodium reduction and the DASH (Dietary Approaches to Stop Hypertension) pattern as primary dietary interventions. SODIUM: Sodium causes water retention, increasing blood volume and blood pressure; the current recommendation is <2,300 mg/day for most …

25. A nurse is assessing a client at 34 weeks gestation who reports a severe headache, visual disturbances, and has a blood pressure of 158/104 mmHg. What condition is MOST concerning?

    • Normal third-trimester discomforts
    • Preeclampsia — a pregnancy-specific hypertensive disorder that can progress to eclampsia (seizures), HELLP syndrome, or stroke; requires urgent evaluation and possible preterm delivery ✓
    • Dehydration
    • Gestational diabetes only

    PREECLAMPSIA is a serious obstetric emergency defined as: new onset hypertension (BP ≥140/90 mmHg on two separate occasions 4 hours apart) after 20 weeks gestation PLUS one of: proteinuria; other severe features. SEVERE FEATURES (indicating severe preeclampsia): BP ≥160/110 mmHg; severe headache unr…

26. At which gestational age should a pregnant patient receive the Tdap vaccine?

    • First trimester
    • Between 27 and 36 weeks of each pregnancy — ideally the earlier part of this window ✓
    • After delivery only
    • Only if not vaccinated in childhood

    TDAP IN PREGNANCY: The ACIP (Advisory Committee on Immunization Practices) recommends Tdap between 27-36 weeks of every pregnancy, regardless of prior Tdap vaccination history. RATIONALE: Tdap given during pregnancy maximises maternal antibody transfer to the fetus — the newborn cannot receive their…

27. What is the recommended starting age for colorectal cancer screening in average-risk adults?

    • 40 years
    • 45 years (updated recommendation — lowered from 50 in 2021 by the USPSTF and ACS due to increasing rates in younger adults) ✓
    • 55 years
    • Only if symptoms present

    COLORECTAL CANCER SCREENING: In 2021, the USPSTF lowered the recommended starting age from 50 to 45 years for average-risk adults, in response to rising colorectal cancer rates in the 45-54 age group. SCREENING OPTIONS at 45: Colonoscopy every 10 years (gold standard — can both detect and remove pol…

28. At what age does a healthy child typically begin walking independently?

    • 6-9 months
    • 12-15 months — walking alone (supported) often begins around 9-12 months; independent walking (without support) by 12-15 months is typical; not walking by 18 months warrants evaluation ✓
    • 18-24 months
    • 24-30 months

    GROSS MOTOR MILESTONES for walking: SITTING independently: 6-8 months; PULLING TO STAND: 8-10 months; CRUISING (walking while holding furniture): 9-12 months; STANDING ALONE briefly: 10-12 months; FIRST INDEPENDENT STEPS: 9-12 months (range); WALKING WELL: 12-15 months (most children); RED FLAG: Not…

29. What key health teaching should the nurse provide about skin cancer prevention?

    • Sun exposure is healthy and doesn't need to be limited
    • Use sunscreen SPF 30+ and reapply every 2 hours when outdoors; seek shade 10 AM - 4 PM; wear protective clothing and hat; avoid tanning beds; perform monthly skin self-examination; annual skin exam by a provider for high-risk individuals ✓
    • Only use sunscreen at the beach
    • Skin cancer only affects people with light skin tones

    SKIN CANCER PREVENTION: Skin cancer is the most common cancer in the US — over 5 million cases annually. PREVENTION TEACHING: SUNSCREEN: SPF 30 or higher; reapply every 2 hours (not just once in the morning); broad-spectrum (UVA + UVB protection); apply 15-30 minutes before sun exposure; don't forge…

30. Which of the following is a NORMAL physiological change associated with aging?

    • Decreased blood pressure in all older adults
    • Decreased renal clearance — kidney function declines progressively with age, affecting drug elimination and making older adults more susceptible to medication toxicity ✓
    • Increased muscle mass
    • Improved balance and faster reaction time

    NORMAL PHYSIOLOGICAL CHANGES WITH AGING: RENAL: GFR decreases approximately 1% per year after age 40; reduced creatinine clearance means medications eliminated renally accumulate to higher levels at the same dose — dosage adjustments are often required; MUSCULOSKELETAL: Muscle mass decreases (sarcop…

31. A patient is prescribed warfarin (Coumadin). What dietary teaching is most important?

    • Eliminate all vitamin K from the diet
    • Maintain a CONSISTENT intake of vitamin K-rich foods — do not drastically increase or decrease them; sudden large changes in vitamin K intake affect INR control ✓
    • Take warfarin with meals only
    • Avoid all green vegetables

    WARFARIN AND VITAMIN K: Warfarin works by blocking Vitamin K-dependent clotting factors (II, VII, IX, X). DIET TEACHING: DO NOT abruptly increase vitamin K-rich foods (leafy greens — kale, spinach, collards, broccoli): this will decrease INR (more clotting, less anticoagulation — risk of clot); DO N…

32. What is the recommended frequency for cervical cancer screening (Pap smear) for average-risk women aged 21-65?

    • Annually
    • Every 3 years for women 21-65 (Pap alone); OR every 5 years for women 30-65 (Pap + HPV co-testing or hrHPV alone) — per current USPSTF guidelines ✓
    • Every 10 years
    • Only when symptomatic

    CERVICAL CANCER SCREENING (USPSTF 2018 Guidelines): Ages 21-29: Pap smear every 3 years (no HPV testing recommended in this age group — HPV is common and transient in this group); Ages 30-65: Pap alone every 3 years; OR Pap + high-risk HPV (hrHPV) co-test every 5 years; OR hrHPV alone every 5 years;…

33. Which vaccine is recommended annually for all adults?

    • MMR
    • Influenza (flu) vaccine — recommended annually for everyone 6 months and older, because the flu virus changes each year and immunity from the prior year's vaccine declines ✓
    • Hepatitis B (once only)
    • Varicella (once in adulthood if not immune)

    ANNUAL INFLUENZA VACCINATION: Recommended for: EVERYONE 6 months and older, annually; SPECIAL PRIORITY GROUPS (higher risk of severe flu): Adults 65+; Pregnant women; People with chronic conditions (heart disease, diabetes, asthma, kidney disease, immunocompromise); Healthcare workers (to protect th…

34. Which of the following is a characteristic of Erikson's stage of 'Initiative vs Guilt' (ages 3-6)?

    • Trust building with caregivers
    • Children begin to assert power through directing play and taking on new activities — when encouraged, they develop initiative; when over-controlled or criticised, they develop guilt about their desires and initiative ✓
    • Teens forming personal identity
    • Adults finding life purpose

    ERIKSON'S STAGES OF PSYCHOSOCIAL DEVELOPMENT: INITIATIVE vs GUILT (ages 3-6, preschool): Children begin to assert themselves — taking initiative in play, pretend play, asking questions, directing activities. When adults encourage initiative, the child develops the virtue of PURPOSE. When adults cons…

35. A patient is being discharged after a myocardial infarction (MI). Which lifestyle modification is the highest priority?

    • Start a high-protein diet
    • Cessation of smoking — if the patient smokes, this is the single most impactful lifestyle modification for preventing a second MI; smoking is an independent, modifiable risk factor for coronary artery disease ✓
    • Eliminate all physical activity
    • Stop all saturated fat immediately

    CARDIAC RISK REDUCTION AFTER MI — PRIORITY ORDER: SMOKING CESSATION: Smoking is one of the strongest modifiable risk factors for CAD — doubles the risk; cessation reduces recurrent MI risk by up to 50% within 1 year. This is the highest priority single lifestyle intervention. MEDICATION ADHERENCE: A…

36. At what age should colorectal cancer screening begin for average-risk adults according to current guidelines?

    • 40
    • 45 ✓
    • 50
    • 60

    ACS updated its guideline in 2018 to recommend colorectal cancer screening beginning at age 45 for average-risk adults (previously 50). Options include annual FIT/FOBT, every 3-year FIT-DNA (Cologuard), every 5-year CT colonography or sigmoidoscopy, or colonoscopy every 10 years. Early detection dra…

37. A parent asks what the maximum safe temperature for a water heater should be to prevent childhood scalding injuries. What does the nurse recommend?

    • 140°F (60°C)
    • 130°F (54°C)
    • 120°F (49°C) ✓
    • 110°F (43°C)

    120°F (49°C) is the recommended maximum water heater setting to prevent scalding burns in children. At 140°F, scalding occurs in 5 seconds; at 120°F, it takes approximately 5 minutes — providing time to react. Young children have thinner, more sensitive skin and cannot react as quickly as adults. Th…

38. A client asks about foods high in iron to prevent anaemia. Which combination provides the most absorbable (heme) iron?

    • Spinach and orange juice
    • Red meat and poultry — these provide heme iron, which is absorbed at 15-35% efficiency vs 2-20% for non-heme iron from plant sources ✓
    • Beans and fortified cereal
    • Dairy products and eggs

    IRON TYPES — HEME vs NON-HEME: Heme iron (from meat, poultry, fish): absorbed at 15-35% efficiency regardless of other foods; best dietary source. Non-heme iron (from plants, fortified foods): absorbed at 2-20%; absorption enhanced by vitamin C and inhibited by calcium, tannins (tea/coffee), and phy…

39. A client has a blood pressure reading of 138/88 mmHg. How should the LPN classify this finding?

    • Normal
    • Elevated (previously 'prehypertension') — systolic 120-129 and diastolic <80; or Stage 1 hypertension — systolic 130-139 OR diastolic 80-89 ✓
    • Stage 2 hypertension
    • Hypertensive crisis

    ACC/AHA 2017 BLOOD PRESSURE CATEGORIES: Normal: <120/<80; Elevated: 120-129/<80; Stage 1 HTN: 130-139 OR 80-89; Stage 2 HTN: ≥140 OR ≥90; Hypertensive Crisis: >180/>120. 138/88 = Stage 1 hypertension (systolic 130-139, diastolic 80-89). NURSING IMPLICATIONS: Report to RN/provider; reinforce lifestyl…

40. At what age should a child have their first dental visit?

    • When all baby teeth have come in (around age 3)
    • When the first tooth erupts or by age 1 — whichever comes first; the American Academy of Pediatric Dentistry recommends establishing a 'dental home' by age 1 ✓
    • Only when the child has a dental problem
    • Starting school age (5-6 years)

    AAPD RECOMMENDATION: First dental visit by age 1 or within 6 months of the first tooth eruption. WHY EARLY: Dental caries (cavities) is the most common chronic childhood disease; early dental visits establish preventive care habits, identify early caries risk, provide fluoride varnish application, a…

41. A nurse is educating a factory worker about hearing protection. At what noise level (dB) does the Occupational Safety and Health Administration (OSHA) require hearing protection?

    • 70 dB or above
    • 85 dB or above for 8 hours — OSHA permissible exposure limit (PEL) is 90 dB for 8 hours; action level requiring hearing conservation program is 85 dB (TWA over 8 hours) ✓
    • 95 dB or above
    • 100 dB or above

    OSHA NOISE STANDARDS: Action Level: 85 dB time-weighted average over 8 hours — triggers hearing conservation programme (audiometric testing, hearing protection training, noise monitoring); Permissible Exposure Limit (PEL): 90 dB TWA 8 hours; at higher decibels, permitted exposure time decreases (95 …

42. A nurse is conducting a depression screen at a primary care visit. Which validated tool is the most widely used for depression screening?

    • Hamilton Depression Rating Scale
    • Patient Health Questionnaire-9 (PHQ-9) — a 9-item self-report screening tool that aligns with DSM-5 diagnostic criteria; scores 0-27; widely used in primary care; validated in multiple populations ✓
    • Beck Depression Inventory (BDI)
    • Columbia Suicide Severity Rating Scale (C-SSRS)

    PHQ-9 (Patient Health Questionnaire-9): 9 questions about depressive symptoms over the past 2 weeks; each scored 0-3 (not at all to nearly every day); SCORES: 0-4 none/minimal; 5-9 mild; 10-14 moderate; 15-19 moderately severe; 20-27 severe; VALIDATED: Multiple clinical settings, populations, langua…

43. Which population has the HIGHEST documented risk for suicide in the United States?

    • Adolescent females
    • Middle-aged white males
    • Elderly white males — men aged 75 and above have the highest suicide rate of any demographic group in the United States; older white males who are recently widowed, socially isolated, or have chronic illness are at particularly elevated risk ✓
    • Military veterans only

    SUICIDE RISK BY DEMOGRAPHIC (CDC data): Overall highest rate: men (4× higher than women); By age and race: White men have the highest rates across most age groups; Elderly white males 75+ have the highest absolute rate of any demographic group; RISK FACTORS: Social isolation; recent loss (spouse, in…

44. A pregnant client asks which fish are safe to eat during pregnancy. What is the nurse's best response?

    • Avoid all fish during pregnancy
    • Most fish are safe and beneficial — fish provides DHA (omega-3 fatty acids important for fetal brain development); the FDA advises 2-3 servings per week of low-mercury fish (salmon, sardines, trout, tilapia, shrimp, catfish); avoid high-mercury fish (shark, swordfish, king mackerel, bigeye tuna) ✓
    • Only canned tuna is safe
    • All seafood is prohibited

    FDA/EPA FISH ADVISORY FOR PREGNANCY: SAFE (2-3 servings/week): Salmon, sardines, trout, tilapia, catfish, pollock, canned light tuna, shrimp, crab, oysters, clams; LIMIT (1 serving/week): White/albacore tuna, snapper, lobster, mahi-mahi; AVOID: Shark, swordfish, king mackerel, tilefish from Gulf of …

45. Which vaccine is recommended annually for all adults?

    • Pneumococcal vaccine (Pneumovax)
    • Influenza vaccine — recommended annually for all persons 6 months and older; the vaccine formulation changes each year based on predicted circulating strains; peak flu season is October-March in the Northern Hemisphere; vaccination is most effective before the season begins (September-October) ✓
    • Hepatitis B vaccine
    • Tdap vaccine

    ANNUAL INFLUENZA VACCINATION: Universal recommendation for all persons ≥6 months without contraindication; TIMING: September-October before flu season begins; still beneficial if received later in the season; FORMULATION: Quadrivalent (protects against 4 strains: 2 influenza A, 2 influenza B); CONTR…

46. A pregnant client asks about recommended weight gain during pregnancy. The nurse explains that recommended weight gain is primarily based on:

    • The client's height only
    • The client's pre-pregnancy body mass index (BMI) ✓
    • The baby's gender
    • The client's age only

    Recommended pregnancy WEIGHT GAIN is based primarily on the client's PRE-PREGNANCY BMI (body mass index). General guidelines: NORMAL BMI (18.5-24.9): gain about 25-35 lbs; UNDERWEIGHT (BMI <18.5): gain more (about 28-40 lbs); OVERWEIGHT (BMI 25-29.9): gain less (about 15-25 lbs); OBESE (BMI ≥30): ga…

47. A nurse is teaching parents about childhood immunizations. Which statement reflects accurate health-promotion teaching?

    • Vaccines should be delayed until age 5
    • Following the recommended immunization schedule protects the child and the community through herd immunity ✓
    • Vaccines are unnecessary if the child is healthy
    • Only one vaccine is ever needed

    Accurate immunization teaching: following the RECOMMENDED IMMUNIZATION SCHEDULE protects the individual child AND the community through HERD IMMUNITY (when enough people are immune, disease spread is limited, protecting those who can't be vaccinated). NCLEX-PN health promotion/immunizations. Vaccine…

48. A nurse is counseling an older adult on health promotion. Which dietary recommendation helps prevent osteoporosis?

    • Avoid all dairy products
    • Ensure adequate calcium and vitamin D intake, along with weight-bearing exercise ✓
    • Increase sodium intake
    • Eliminate all protein

    To help PREVENT OSTEOPOROSIS, recommend ADEQUATE CALCIUM and VITAMIN D intake (vitamin D aids calcium absorption) plus WEIGHT-BEARING EXERCISE (walking, resistance training stimulate bone density). NCLEX-PN health promotion/nutrition. Other measures: avoid smoking and excessive alcohol; fall prevent…

49. A nurse is providing health-promotion education about cancer screening. Which is an example of a recommended screening for early detection?

    • Screening is unnecessary for everyone
    • Mammography for breast cancer and colonoscopy for colorectal cancer at recommended ages/intervals ✓
    • Screening only after symptoms appear
    • Avoiding all medical tests

    Recommended CANCER SCREENINGS for early detection include: MAMMOGRAPHY (breast cancer); COLONOSCOPY (colorectal cancer); Pap smear/HPV testing (cervical cancer); and others, performed at recommended AGES and INTERVALS based on guidelines and risk factors. NCLEX-PN health promotion/screening. The PUR…

50. A nurse is performing health-promotion teaching with the parent of a 6-month-old infant. Which is an appropriate developmental expectation to discuss?

    • The infant should be walking independently
    • The infant can typically sit with support and may begin sitting without support, and starts introducing solid foods around this age ✓
    • The infant should be toilet trained
    • The infant should be speaking in sentences

    At about 6 MONTHS, typical development includes: SITTING with support (and beginning to sit without support around 6-7 months); rolling over; transferring objects between hands; babbling; and introducing SOLID FOODS (around 6 months, complementary to breast milk/formula). NCLEX-PN health promotion/g…

51. What is the general purpose of immunization as a health-promotion measure?

    • To treat an existing infection
    • To stimulate the body's immune system to develop protection against specific diseases before exposure, preventing illness ✓
    • To replace the need for all other health care
    • To diagnose disease

    Immunization is a primary prevention measure that works by stimulating the body's immune system to develop protection (immunity) against specific diseases before the person is exposed, thereby preventing the illness or reducing its severity. Vaccines do not treat existing infections, diagnose diseas…

52. What is the general purpose of health 'screening' tests?

    • To cure diseases
    • To detect disease or risk factors early — often before symptoms appear — so that earlier intervention is possible ✓
    • To replace a physical exam
    • To immunize the client

    Screening tests are a secondary prevention measure intended to detect disease or risk factors early, often before symptoms appear, so that earlier diagnosis and intervention become possible and outcomes can be improved. Examples include blood pressure checks and various recommended screenings approp…

53. Which is a general principle of effective client health teaching?

    • Use complex medical jargon
    • Assess the client's readiness and understanding, use clear language, and confirm comprehension (for example, by teach-back) ✓
    • Teach everything at once regardless of the client's state
    • Avoid letting the client ask questions

    Effective health teaching involves assessing the client's readiness to learn and current understanding, using clear, plain language at the client's level, breaking information into manageable pieces, and confirming comprehension — for example, by asking the client to restate or demonstrate the infor…

54. What are the three commonly described levels of disease prevention?

    • Early, middle, and late
    • Primary, secondary, and tertiary prevention ✓
    • Acute, chronic, and terminal
    • Inpatient, outpatient, and home

    Prevention is commonly described at three levels. Primary prevention aims to prevent disease before it occurs (e.g., immunization, healthy lifestyle, education). Secondary prevention aims to detect and treat disease early (e.g., screening tests). Tertiary prevention aims to manage established diseas…

55. According to commonly taught developmental theory, which is a general characteristic of toddler (approximately 1–3 years) development?

    • Formal abstract reasoning
    • Developing autonomy and beginning to assert independence ✓
    • Retirement planning
    • Choosing a career

    Commonly taught developmental theory (such as Erikson's stages) describes the toddler period (approximately ages 1–3) as a time of developing autonomy — the child begins to assert independence, explore, and do things for themselves ('autonomy versus shame and doubt'). Abstract reasoning develops muc…

56. Which is a general principle of providing age-appropriate care across the lifespan?

    • Treat all clients identically regardless of age
    • Adapt communication, teaching, and care to the client's developmental stage and abilities ✓
    • Use only written instructions for everyone
    • Ignore developmental differences

    A general principle of care across the lifespan is to adapt communication, teaching, and interventions to the client's developmental stage, abilities, and needs — for example, using play and simple language with young children, and respecting autonomy and addressing sensory or cognitive changes with…

57. Which is a general, expected change associated with normal aging that the nurse should account for in care and teaching?

    • Complete loss of all cognitive ability is normal
    • Some gradual changes such as slower processing and certain sensory changes can occur, but significant confusion is not a normal part of aging and should be evaluated ✓
    • Aging stops all learning ability
    • All older adults are the same

    Normal aging can involve some gradual changes, such as slower information processing and certain sensory changes (vision, hearing), which the nurse accommodates in communication and teaching. Importantly, significant or sudden confusion is NOT a normal part of aging and should be evaluated rather th…

58. What is a general health-promotion principle for supporting older adults' safety at home?

    • Encourage clutter to keep items handy
    • Promote a safe environment by reducing fall hazards (such as good lighting and clear walkways) and supporting the client's independence ✓
    • Discourage all physical activity
    • Remove all support and assistance

    A general health-promotion principle for older adults is to promote a safe home environment while supporting independence — for example, reducing fall hazards through adequate lighting, clear walkways, and removing tripping hazards, and encouraging appropriate activity. Falls are a significant safet…

59. What is a general purpose of prenatal (antepartum) care?

    • To replace the need for delivery
    • To monitor the health of the pregnant client and the developing fetus, provide education, and identify and address concerns early ✓
    • To diagnose unrelated diseases only
    • To avoid all health teaching

    Prenatal (antepartum) care is health-promotion care during pregnancy whose general purposes include monitoring the health of the pregnant client and the developing fetus, providing education and anticipatory guidance, promoting healthy behaviors, and identifying and addressing potential concerns ear…

60. Which is a general newborn-care teaching principle nurses commonly reinforce with new parents?

    • Newborns need no safety precautions
    • Reinforce safe practices such as safe sleep positioning and supporting the newborn's head, and provide education tailored to the family ✓
    • Discourage parents from asking questions
    • Provide no guidance on feeding

    General newborn-care teaching commonly includes reinforcing safe practices — such as safe sleep recommendations and supporting the newborn's head and neck — and providing individualized education and support to new parents, including encouraging their questions. Newborns require careful safety preca…

61. Which is a general principle of promoting a healthy lifestyle that the nurse can teach most clients?

    • Avoid all physical activity
    • Encourage balanced nutrition, regular appropriate physical activity, adequate sleep, and avoidance of tobacco, tailored to the individual ✓
    • Recommend skipping meals to lose weight quickly
    • Discourage any preventive care

    General healthy-lifestyle teaching includes encouraging balanced nutrition, regular and appropriate physical activity, adequate sleep, stress management, and avoidance of tobacco and excessive alcohol — always tailored to the individual's needs, abilities, and any medical conditions. The nurse promo…

62. What is a general principle when teaching a client about a new self-care skill, such as a dressing change they will do at home?

    • Tell them once and assume they understand
    • Demonstrate the skill, allow the client to practice (return demonstration), and confirm they can perform it safely before discharge ✓
    • Use only verbal explanation with no practice
    • Discourage the client from performing self-care

    When teaching a psychomotor self-care skill, an effective general principle is to demonstrate the skill, then have the client perform a return demonstration so the nurse can confirm they can do it safely and correctly, providing feedback and reinforcement. Telling the client once, using only verbal …

63. What is the general nursing principle regarding client education about recommended screenings and immunizations?

    • Withhold information from clients
    • Provide accurate, understandable information about recommended preventive measures so clients can make informed decisions, and refer to current authoritative guidelines ✓
    • Tell clients preventive care is unnecessary
    • Make decisions for the client without explanation

    The general nursing principle is to provide clients with accurate, understandable information about recommended preventive measures — such as screenings and immunizations appropriate to their age and risk — so they can make informed decisions, while relying on and referring to current authoritative …

64. According to commonly taught developmental theory, a major developmental task of adolescence is:

    • Developing trust as an infant
    • Establishing a sense of identity ✓
    • Learning to walk
    • Retirement adjustment

    Commonly taught developmental theory (such as Erikson's) describes adolescence as the period in which a major developmental task is establishing a sense of identity ('identity versus role confusion') — exploring who one is and one's values and roles. Developing trust is the task of infancy, learning…

65. What is a general communication adaptation a nurse may use for an older adult who has mild hearing changes?

    • Shout loudly from across the room
    • Face the client, speak clearly at a moderate pace, reduce background noise, and confirm understanding ✓
    • Avoid speaking to the client
    • Use only written notes regardless of the client's literacy

    For an older adult with mild hearing changes, helpful general communication adaptations include facing the client so they can see your face, speaking clearly at a normal-to-slightly-slower pace and lower pitch, reducing background noise, and confirming the client understood. Shouting can distort spe…