RN: Health Promotion and Maintenance Practice Test

Practice test questions — RN: Health Promotion and Maintenance

1. What is the expected developmental task for an adolescent (ages 12-18) according to Erikson's stages of psychosocial development?

   • Trust vs. mistrust
   • Identity vs. role confusion — adolescents work to form a personal identity and sense of self separate from family ✓
   • Integrity vs. despair
   • Industry vs. inferiority

   Erik Erikson's eight stages of psychosocial development describe normal developmental tasks across the lifespan. Stage 5 (12-18 years): Identity vs. Role Confusion — adolescents develop a sense of self and personal identity. Success leads to fidelity; failure to role confusion and weak sense of self…

2. At what age does an infant typically begin to develop separation anxiety from primary caregivers?

   • Birth
   • Around 6-8 months, peaking at 10-18 months ✓
   • 3 years
   • After 5 years

   Separation anxiety is a normal developmental milestone reflecting cognitive development. Around 6-8 months, infants develop 'object permanence' — understanding that objects (and people) continue to exist when out of sight. This enables them to miss caregivers, leading to anxiety when separated. Sepa…

3. What is the recommended weight gain during pregnancy for a woman with a normal pre-pregnancy BMI (18.5-24.9)?

   • 5-10 pounds
   • 25-35 pounds total ✓
   • 50-60 pounds
   • No weight gain

   Recommended pregnancy weight gain depends on pre-pregnancy BMI (Institute of Medicine guidelines): (1) Underweight (BMI <18.5): 28-40 pounds; (2) Normal weight (BMI 18.5-24.9): 25-35 pounds; (3) Overweight (BMI 25-29.9): 15-25 pounds; (4) Obese (BMI ≥30): 11-20 pounds. Twin pregnancies: higher recom…

4. What is the APGAR score and when is it assessed?

   • A diabetes screening
   • A standardized assessment of newborn well-being performed at 1 minute and 5 minutes after birth, scoring 0-2 points each in five categories (Appearance, Pulse, Grimace, Activity, Respirations) for a total of 0-10 ✓
   • A pregnancy test
   • A nutritional assessment

   APGAR (developed by Virginia Apgar in 1952) is the standard newborn assessment at 1 and 5 minutes after birth. Five categories scored 0-2 each: A — Appearance (color): 0 = blue/pale all over, 1 = pink body with blue extremities (acrocyanosis), 2 = pink all over; P — Pulse (heart rate): 0 = absent, 1…

5. What is the recommended infant feeding for the first 6 months of life?

   • Cow's milk only
   • Exclusive breastfeeding (or iron-fortified infant formula if breastfeeding is not chosen or possible) — no water, juice, or solid foods needed ✓
   • Solid foods at 2 months
   • Whole milk and cereal

   AAP recommendation: exclusive breastfeeding for the first 6 months, then continued breastfeeding with appropriate complementary foods through at least 12 months and longer as mutually desired. WHO recommends continued breastfeeding through 2 years. If breastfeeding is not chosen or possible, iron-fo…

6. What is the CDC recommended childhood vaccination schedule for the MMR (measles, mumps, rubella) vaccine?

   • Birth and 6 months
   • First dose at 12-15 months, second dose at 4-6 years ✓
   • Only at age 2
   • Adult only

   MMR (measles, mumps, rubella) is a combination live attenuated vaccine. CDC recommended schedule: First dose at 12-15 months; Second dose at 4-6 years. Two doses provide approximately 97% effectiveness for measles, 88% for mumps, 97% for rubella. MMRV (also contains varicella) is available as an alt…

7. Which adult vaccinations does the CDC recommend?

   • None for adults
   • Annual influenza, Tdap (then Td booster every 10 years), Shingles (50+), Pneumococcal (65+ or risk factors), HPV (through age 26), and others based on age and risk factors ✓
   • Only childhood vaccinations
   • Only travel vaccinations

   Standard adult vaccination recommendations (CDC ACIP): (1) Influenza — annually for all adults, especially essential for healthcare workers, elderly, pregnant women, immunocompromised; (2) Tdap (tetanus, diphtheria, pertussis) — at least once for all adults; then Td or Tdap booster every 10 years; T…

8. What are the main components of a healthy lifestyle that nurses should teach for disease prevention?

   • Only diet
   • Balanced nutrition, regular physical activity (150 minutes moderate or 75 minutes vigorous per week), avoiding tobacco, limiting alcohol, adequate sleep, stress management, social connections, regular preventive care ✓
   • Only exercise
   • Avoiding all activities

   Comprehensive lifestyle teaching addresses major modifiable risk factors for chronic disease. (1) Nutrition: balanced diet emphasizing fruits, vegetables, whole grains, lean protein, healthy fats; limit added sugars, refined carbs, sodium, saturated/trans fats; Mediterranean or DASH diets show stron…

9. What is the recommended age and frequency for colorectal cancer screening in average-risk adults?

   • Never
   • Begin at age 45, with various options (colonoscopy every 10 years, FIT annually, FIT-DNA every 1-3 years, sigmoidoscopy every 5 years, CT colonography every 5 years) through age 75 ✓
   • Only after age 80
   • Daily testing

   Colorectal cancer screening guidelines updated by ACS in 2018 and USPSTF in 2021 to lower age from 50 to 45 due to increased CRC incidence in younger adults. Screening options for average-risk adults age 45-75: (1) Colonoscopy every 10 years — gold standard; can identify and remove polyps in one pro…

10. What teaching is most important for a client newly diagnosed with hypertension?

    • Avoid all activity
    • Lifestyle modifications (DASH diet, sodium reduction, weight loss, exercise, alcohol moderation, stress management); medication adherence; home blood pressure monitoring; when to seek care ✓
    • Take medication only when symptomatic
    • Diet doesn't matter

    Hypertension is often asymptomatic ('silent killer'); patient education is critical because behavior change drives outcomes. Key teaching: (1) DASH Diet (Dietary Approaches to Stop Hypertension) — emphasizes fruits, vegetables, whole grains, low-fat dairy, lean protein; limits saturated fat, total f…

11. What are common normal physical changes associated with aging that the nurse should expect in elderly clients?

    • No changes
    • Decreased visual and hearing acuity, slower reaction time, decreased muscle mass and strength, decreased bone density, reduced kidney function (decreased GFR), slower metabolism, skin thinning, decreased thirst sensation, decreased gastric acid ✓
    • Stronger senses
    • Faster healing

    Normal aging changes affect every body system and influence care: (1) Vision: presbyopia (near vision decline starting ~40), cataracts, glaucoma risk, decreased adaptation to dark and glare; (2) Hearing: presbycusis (high-frequency hearing loss); (3) Cardiovascular: decreased cardiac output, increas…

12. At what age can children typically be safely placed in forward-facing car seats?

    • From birth
    • Most pediatric recommendations: rear-facing as long as possible (until age 2 minimum, ideally until they reach the rear-facing seat's height/weight limit), then forward-facing with harness until reaching that seat's limit, then booster ✓
    • After age 8
    • Never use car seats

    Car seat recommendations (AAP and NHTSA): (1) Rear-Facing: as long as possible; until the child reaches the rear-facing seat's maximum height or weight limit (typically 40-50 pounds in convertible seats); minimum until age 2; rear-facing significantly reduces injury in crashes by 5x compared to forw…

13. What is the recommended prenatal screening for gestational diabetes?

    • Never screened
    • Glucose Challenge Test (GCT) at 24-28 weeks gestation; if abnormal (typically >140 mg/dL at 1 hour), confirmatory 3-hour Glucose Tolerance Test (GTT) ✓
    • Daily glucose testing from conception
    • Only after birth

    Gestational Diabetes Mellitus (GDM) screening: standard one-step or two-step approach. Two-step (US standard): (1) Glucose Challenge Test (GCT) at 24-28 weeks: drink 50g glucose, check blood glucose 1 hour later; cutoff typically 130-140 mg/dL; if abnormal, proceed to confirmatory test; (2) 3-hour G…

14. What is the proper sleep position for infants to reduce SIDS risk?

    • On the stomach
    • On the back (supine), in a safety-approved crib with firm mattress, no soft objects, blankets, or bumpers in the crib — the 'Back to Sleep' or 'Safe to Sleep' campaign ✓
    • On the side
    • Sleeping with parents

    Sudden Infant Death Syndrome (SIDS) — sudden unexplained death of infants <1 year — was reduced by 50%+ through the AAP 'Back to Sleep' campaign (now 'Safe to Sleep'). Recommendations: (1) Supine (back) sleep position for every sleep until age 1 — significantly reduces SIDS risk; the position with s…

15. What are the contraindications to giving live attenuated vaccines (MMR, varicella, MMRV)?

    • None
    • Pregnancy (defer until after delivery), severe immunocompromise (HIV with severe immunosuppression, hematologic malignancy, high-dose immunosuppressants), anaphylactic reaction to vaccine components ✓
    • Any cold
    • Age over 65

    Live attenuated vaccines contain weakened pathogens that replicate in the body; while safe for healthy individuals, they can cause disease in vulnerable groups. Contraindications: (1) Pregnancy — defer live vaccines until after delivery; advise women to avoid pregnancy for 4 weeks after live vaccine…

16. What are the recommended steps for proper hand hygiene?

    • Quick rinse with cold water
    • Wet hands with warm water, apply soap, scrub all surfaces (palms, backs, between fingers, under nails, wrists) for at least 20 seconds, rinse thoroughly with running water, dry with paper towel or air dryer, use paper towel to turn off faucet ✓
    • Only use sanitizer
    • Wipe with cloth

    Proper hand washing technique (CDC guidelines): (1) Wet hands with clean, running water (warm preferred for comfort and better lather); (2) Apply enough soap to cover all hand surfaces; (3) Scrub all surfaces for at least 20 seconds — palms, backs of hands, between fingers, under nails, including wr…

17. What teaching is most important for a client beginning a new exercise program?

    • Exercise at maximum intensity from day one
    • Start gradually, progress slowly (10% per week guideline), warm up and cool down, stay hydrated, use proper form, listen to the body, choose enjoyable activities, set realistic goals, address contraindications ✓
    • Only exercise daily for hours
    • Avoid all exertion

    Exercise initiation guidance for previously sedentary clients: (1) Medical clearance — recommended for adults 45+ starting vigorous exercise, those with chronic conditions, or those with cardiovascular risk factors; ECG stress test for some; (2) Start gradually — '10% rule' for runners (don't increa…

18. What teaching points should a nurse include for a client newly diagnosed with type 2 diabetes?

    • Diabetes cannot be managed
    • Disease pathophysiology, blood glucose monitoring, signs of hypoglycemia and hyperglycemia, medication administration and side effects, diet and exercise, foot care, when to seek medical attention, regular follow-up ✓
    • Only diet matters
    • Medication only

    Diabetes self-management education is comprehensive and ongoing. Core teaching: (1) Disease overview — type 2 diabetes is insulin resistance plus relative insulin deficiency; can be progressive but well-managed; (2) Blood glucose monitoring — proper meter use, when to check (fasting, before meals, 2…

19. What are signs of newborn jaundice that require evaluation?

    • Mild yellowing in the first week
    • Yellow skin and sclera; jaundice appearing in the first 24 hours of life, lasting >2 weeks in full-term infants, with serum bilirubin >15 mg/dL, with poor feeding, lethargy, irritability, or fever — requires evaluation; severe cases need phototherapy or exchange transfusion ✓
    • Just normal skin variation
    • Only adult condition

    Neonatal jaundice (hyperbilirubinemia) is common — 60% of full-term and 80% of preterm infants develop visible jaundice. Most cases are physiologic and benign. Pathologic jaundice (warrants evaluation): (1) Onset in first 24 hours of life — suggests hemolysis, sepsis, or other serious cause; (2) Rap…

20. What is the recommended schedule for breast cancer screening in average-risk women?

    • Never screen
    • Mammograms typically beginning between ages 40-50 (USPSTF recommends starting at 50, ACS suggests options starting at 40, with annual screening 45-54, then biennial 55+); clinical breast exam often performed at annual physical; breast self-awareness encouraged ✓
    • Only after age 80
    • Daily testing

    Breast cancer screening guidelines vary by organization but generally include: (1) Average-risk women: USPSTF 2024 update recommends biennial screening mammograms starting at age 40 (lowered from 50 in 2024 update); ACS recommends annual screening starting at 45, with option to start at 40, then bie…

21. A nurse counsels a client about sodium reduction to manage hypertension. Which food is HIGHEST in hidden sodium?

    • Fresh apple
    • Processed deli meat and canned soup ✓
    • Plain oatmeal
    • Fresh chicken breast

    SODIUM AND HYPERTENSION: dietary sodium contributes to elevated blood pressure by increasing fluid retention and vascular resistance. The American Heart Association recommends less than 2,300 mg sodium/day for most adults; less than 1,500 mg for those with hypertension, heart failure, or kidney dise…

22. Which assessment finding in a 6-year-old child would require referral to a healthcare provider for developmental evaluation?

    • Occasional difficulty tying shoes independently
    • Inability to write their own name, persistent inability to follow two-step instructions, or significant difficulty with peer relationships at age 6 — these may indicate developmental delays requiring evaluation ✓
    • Preferring to play with one friend at a time
    • Occasional difficulty with losing games

    At AGE 6 (school-age entry), certain developmental skills are expected. RED FLAGS warranting referral include: LANGUAGE: difficulty following two-step directions; very limited vocabulary for age; significant articulation problems that make speech hard to understand; COGNITIVE: inability to recognize…

23. A client asks whether they need a tetanus booster. They received a tetanus shot 8 years ago and have not had any wounds since. What is the recommendation?

    • Tetanus boosters are never needed after the primary series
    • Td (tetanus-diphtheria) booster every 10 years for adults; if more than 5 years since last tetanus immunization and a dirty wound occurs, a booster should be given at the time of injury ✓
    • Tetanus requires a new series from scratch every year
    • Tetanus boosters are only for children

    TETANUS (Clostridium tetani) vaccine recommendations for adults: Td BOOSTER: every 10 YEARS throughout adulthood; this maintains adequate immunity against tetanus and diphtheria; TDAP (tetanus, diphtheria, acellular pertussis): adults should receive one TDAP instead of a regular Td booster (ideally …

24. A nurse is assessing a client at 38 weeks gestation who reports reduced fetal movement today compared to usual. What is the PRIORITY nursing action?

    • Reassure her that decreased movement is normal near term
    • Immediately notify the provider and initiate fetal monitoring — decreased fetal movement is a potential sign of fetal compromise requiring urgent evaluation ✓
    • Tell her to come back in two days if it continues
    • Have her drink orange juice and recount kicks in a week

    DECREASED FETAL MOVEMENT (DFM) is a significant obstetric concern that requires PROMPT assessment. Fetal movement is an indicator of fetal wellbeing — the fetus moves in response to stimuli and as a sign of adequate oxygenation. NORMAL FETAL MOVEMENT: increases from about 28 weeks; most mothers noti…

25. A nurse is performing a skin assessment on a 70-year-old client and notes a new asymmetric lesion on the client's back with irregular borders, multiple colors (brown, black, and red), and a diameter of 7 mm. What is the priority nursing action?

    • Document the finding and reassess in 6 months
    • Report the finding to the provider immediately for evaluation — this lesion has multiple characteristics of potential melanoma using the ABCDE rule (Asymmetry, Border irregularity, Color variation, Diameter >6 mm, Evolution); early detection is critical for melanoma survival ✓
    • Apply sunscreen to the lesion
    • Tell the client it is probably just an age spot

    The ABCDE RULE is the standard skin cancer screening tool for identifying lesions suspicious for MELANOMA — the most dangerous form of skin cancer: A — ASYMMETRY: one half doesn't match the other (normal moles are symmetrical); B — BORDER: irregular, ragged, notched, or blurred edges (normal moles h…

26. At what age does the American Cancer Society recommend women with average risk begin annual mammography screening?

    • 35
    • 40
    • 45 ✓
    • 50

    ACS MAMMOGRAPHY GUIDELINES (2023): Women at AVERAGE RISK should have the OPTION to start annual mammography at age 40; should START annual mammography at age 45; can TRANSITION to every other year at age 55 if they choose; should CONTINUE screening as long as they are in good health and have a 10+ y…

27. A client has a fasting blood glucose of 112 mg/dL. How should the nurse interpret this result?

    • Normal — no follow-up needed
    • Prediabetes range — normal fasting glucose is 70-99 mg/dL; 100-125 mg/dL indicates prediabetes; this result warrants counseling on lifestyle modifications to prevent progression to type 2 diabetes ✓
    • Type 2 diabetes diagnosis
    • Hypoglycemia

    FASTING GLUCOSE INTERPRETATION: Normal: 70-99 mg/dL; Prediabetes: 100-125 mg/dL (impaired fasting glucose); Diabetes: 126 mg/dL or above on two separate occasions. The client's 112 mg/dL falls squarely in the PREDIABETES range. NURSING IMPLICATIONS: Education on lifestyle modifications: 5-7% weight …

28. At what age should a child be able to walk independently without support?

    • 6 months
    • 9 months
    • 12 months ✓
    • 18 months

    GROSS MOTOR MILESTONE — independent walking: Most children walk independently by 12 MONTHS (9-15 months is the normal range). RELATED MILESTONES: 6 months: sits with support; 9 months: pulls to stand, cruises (walks holding furniture); 12 months: stands alone briefly, takes first independent steps; …

29. A pregnant client at 28 weeks asks about the gestational diabetes screening. What is the standard screening test?

    • Fasting blood glucose only
    • 1-hour glucose challenge test (GCT): the client drinks a 50g glucose solution and blood glucose is measured 1 hour later; a result of 130-140 mg/dL or above (threshold varies by institution) requires follow-up with a 3-hour glucose tolerance test for diagnosis ✓
    • HbA1c only
    • Fasting insulin level

    GESTATIONAL DIABETES MELLITUS (GDM) SCREENING: WHEN: 24-28 weeks gestation for all pregnant women (earlier if high-risk factors: prior GDM, obesity, family history, prior macrosomic infant); SCREENING TEST: 1-hour GCT (Glucose Challenge Test): 50g oral glucose load; no fasting required; glucose draw…

30. Which vaccine requires special handling because it must be stored in an ultra-cold freezer (approximately -80°C to -60°C)?

    • Influenza vaccine
    • mRNA COVID-19 vaccines (Pfizer-BioNTech original formulation) — these required ultra-cold storage due to the lipid nanoparticle delivery system; updated formulations may have different storage requirements ✓
    • MMR vaccine
    • Hepatitis B vaccine

    VACCINE COLD CHAIN is a critical nursing responsibility — improper storage destroys vaccine efficacy. ULTRA-COLD STORAGE: Original mRNA COVID-19 vaccines (specifically Pfizer-BioNTech BNT162b2) required storage at -80°C to -60°C (ultra-cold freezers) for long-term storage; they could be stored in st…

31. The nurse is conducting a community health fair. Which screening test is most appropriate to offer for colorectal cancer to average-risk adults aged 50+?

    • Annual PSA test
    • Annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT) — a non-invasive, inexpensive screening tool that detects blood in stool that may indicate colorectal cancer; colonoscopy every 10 years is the gold standard but requires bowel prep and sedation ✓
    • Annual chest X-ray
    • Annual upper endoscopy

    COLORECTAL CANCER SCREENING GUIDELINES: ACS recommends beginning at age 45 for average risk (lowered from 50 in 2018). OPTIONS range from non-invasive to invasive: STOOL TESTS: Annual FIT (fecal immunochemical test) — most practical for community screening; FOBT (guaiac-based) — less specific; FIT-D…

32. What is the most common cause of maternal mortality in the United States in the postpartum period?

    • Infection
    • Hemorrhage — postpartum hemorrhage (blood loss exceeding 1,000 mL within 24 hours after delivery) is a leading cause of maternal morbidity and mortality; it is largely preventable with active management of the third stage of labor ✓
    • Preeclampsia
    • Pulmonary embolism

    POSTPARTUM HEMORRHAGE (PPH) DEFINITION: Blood loss ≥1,000 mL (or any amount with signs of hypovolemia) within 24 hours of delivery. LEADING CAUSES — the 4 Ts: TONE (uterine atony — most common; 70-80% of PPH); TRAUMA (lacerations, uterine rupture, hematoma); TISSUE (retained placenta/products of con…

33. A 3-year-old patient refuses to cooperate with a physical examination. Which play strategy is most developmentally appropriate?

    • Restrain the child and proceed quickly
    • Allow the child to handle the stethoscope before using it, listen to a stuffed animal first, and narrate each step in simple terms before doing it — preschoolers aged 3-5 understand and respond well to play-based preparation and simple explanation ✓
    • Tell the parent to force the child to cooperate
    • Skip non-essential parts of the exam

    PRESCHOOLER (3-5 years) DEVELOPMENTAL CHARACTERISTICS: Significant fear of bodily harm and intrusive procedures; concrete thinking (only understand what they can directly experience); animistic thinking (toys can 'feel' things — listening to a stuffed animal first removes the fear that it hurts); be…

34. What is 'secondary prevention' in mental health care?

    • Preventing mental illness from occurring through societal changes
    • Early detection and intervention — identifying mental health conditions at their earliest stage through screening and initiating treatment before the condition becomes severe or chronic ✓
    • Rehabilitation and restoration of function for individuals with established mental illness
    • Only applicable to substance use disorders

    LEVELS OF PREVENTION IN HEALTH: PRIMARY: Prevent the condition from occurring — reducing risk factors, health promotion activities (smoking cessation, stress management, social connectedness); SECONDARY: Early detection and prompt treatment — screening tools (PHQ-9 for depression, CAGE for alcohol u…

35. Using the TEACH-BACK METHOD, a nurse asks a client: 'Can you show me how you will check your blood sugar at home?' The client correctly demonstrates the technique. What should the nurse document?

    • 'Client verbalized understanding of blood glucose monitoring'
    • 'Client accurately demonstrated blood glucose monitoring technique using teach-back — correctly identified lancet use, meter operation, recording, and target glucose range; able to describe what to do if result is out of range' ✓
    • 'Education provided regarding blood glucose monitoring'
    • 'Client understands blood glucose monitoring'

    TEACH-BACK DOCUMENTATION must reflect what the client DEMONSTRATED, not just that teaching occurred or that the client 'verbalized understanding.' WHY THE DETAIL MATTERS: Generic documentation ('education provided', 'verbalized understanding') provides no evidence that the client actually learned an…

36. A nurse teaches a client with risk factors for cardiovascular disease about the DASH diet. Which of the following is a core principle of the DASH diet?

    • High protein, low carbohydrate intake
    • Emphasis on fruits, vegetables, whole grains, and low-fat dairy; limited saturated fat, sodium (<2,300 mg/day ideally <1,500 mg/day), and added sugars; adequate potassium, calcium, and magnesium ✓
    • Unlimited fat intake if it comes from animal sources
    • Eliminate all carbohydrates

    DASH DIET (Dietary Approaches to Stop Hypertension): Developed specifically to reduce blood pressure. KEY COMPONENTS: Fruits: 4-5 servings/day; Vegetables: 4-5 servings/day; Whole grains: 6-8 servings/day; Low-fat dairy: 2-3 servings/day; Lean meats, poultry, fish: ≤6 oz/day; Nuts, seeds, legumes: 4…

37. A 50-year-old male client asks about lung cancer screening. The nurse explains that he is a candidate if he meets which criteria?

    • Anyone over age 50 regardless of smoking history
    • Current or former smokers aged 50-80 who have a 20 pack-year history and currently smoke or quit within the past 15 years — these are the USPSTF low-dose CT (LDCT) screening criteria ✓
    • Only current smokers over age 65
    • Anyone with a family history of lung cancer

    LUNG CANCER SCREENING — USPSTF 2021 RECOMMENDATION: Annual low-dose CT (LDCT) screening for adults aged 50-80 who: currently smoke OR quit within the past 15 years AND have a 20+ pack-year history. PACK-YEAR: (packs per day) × (years smoked) = 20 pack-years = 1 pack/day × 20 years = 2 packs/day × 10…

38. During a newborn assessment at 24 hours of life, the nurse notes the baby has jaundice visible below the umbilicus. How should the nurse prioritise this finding?

    • This is expected and normal for all newborns — document and continue
    • This is a significant finding — jaundice appearing below the umbilicus (zones 3-5) suggests potentially high bilirubin requiring immediate serum bilirubin level measurement and provider notification ✓
    • Jaundice only matters if the baby is visibly orange
    • Jaundice below the umbilicus is less serious than facial jaundice

    NEONATAL JAUNDICE ZONATION (Kramer's Rule): Zone 1 — head and neck: suggests lower bilirubin (<5-6 mg/dL); Zone 2 — to umbilicus: approximately 5-12 mg/dL; Zone 3 — below umbilicus to knees: approximately 8-16 mg/dL; Zone 4 — below knees to ankles: approximately 11-18 mg/dL; Zone 5 — palms and soles…

39. A client who smokes 2 packs per day expresses interest in quitting. Using the 5 A's framework, what is the nurse's FIRST step?

    • Prescribe nicotine replacement therapy
    • Ask — assessing tobacco use status is the first of the 5 A's and must precede any other intervention ✓
    • Assist with cessation — provide resources
    • Advise to quit

    THE 5 A'S OF TOBACCO CESSATION COUNSELLING: (1) ASK: Systematically ask about tobacco use at every visit — establishes smoking status as a vital sign; (2) ADVISE: Clearly, firmly, and personally advise quitting — brief, direct advice (1-3 minutes) from a clinician increases quit rates; (3) ASSESS: A…

40. A pregnant client at 10 weeks is found to have HIV. Which medication is most important to initiate immediately?

    • Azithromycin prophylaxis
    • Antiretroviral therapy (ART) — all pregnant women with HIV should receive ART regardless of CD4 count or viral load; the goal is an undetectable viral load at delivery to reduce perinatal transmission to <1% ✓
    • Fluconazole for Candida prevention
    • Aspirin for preeclampsia prevention only

    HIV IN PREGNANCY — NURSING PRIORITY: INITIATE ART IMMEDIATELY: All pregnant women with HIV should start antiretroviral therapy regardless of CD4 count; the primary goal is viral suppression to undetectable levels (<20-40 copies/mL) by delivery; PERINATAL TRANSMISSION: Without ART, transmission risk …

41. A nurse is teaching a community group about mental health. Which statement best describes mental health?

    • Mental health is the absence of mental illness
    • Mental health is a state of well-being in which an individual can realise their potential, cope with normal stresses of life, work productively, and contribute to their community — it is possible to have good mental health even while managing a mental health condition ✓
    • Only people without stress have good mental health
    • Mental health is determined by genetics alone

    WHO DEFINITION OF MENTAL HEALTH: 'A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or her community.' KEY CONCEPTS: Mental health is a POSITIVE STATE, n…

42. A parent is concerned because their 4-year-old child engages in 'imaginary friend' play. How should the nurse respond?

    • Refer immediately for a psychiatric evaluation
    • This is normal developmental behaviour for preschoolers — children aged 2-7 engage in symbolic and fantasy play (Piaget's preoperational stage); imaginary friends are common in preschool years and reflect normal cognitive and social development, not psychopathology ✓
    • Tell the parent to discourage the behaviour
    • Evaluate for schizophrenia

    PRESCHOOL DEVELOPMENTAL NORMS: Imaginary friends are common and normal in 2-7 year olds; research suggests 65% of children have imaginary friends at some point; PIAGET'S PREOPERATIONAL STAGE (2-7 years): Symbolic thinking develops (objects can represent other things); magical and animistic thinking …

43. A 13-year-old is seen for a well-child visit. Which vaccine should be initiated at this visit if not previously given?

    • MMR booster
    • HPV vaccine (Human Papillomavirus) — the CDC recommends starting the HPV vaccine series at age 11-12, with catch-up vaccination through age 26 for those not previously vaccinated; 2-dose series if started before age 15, 3-dose series if started at 15 or older ✓
    • Hepatitis A vaccine series
    • DTaP booster (4th dose)

    HPV VACCINE RECOMMENDATIONS: Routine: age 11-12 (can start at age 9); Catch-up: 13-26 for females; 13-26 for males; 27-45: shared clinical decision-making (less benefit as likely prior exposure); DOSING SCHEDULE: Age 9-14 at initiation: 2 doses (0, 6-12 months); Age 15+ at initiation: 3 doses (0, 1-…

44. A 68-year-old female client asks about bone density screening. What does the nurse explain?

    • Bone density screening is not recommended after age 65
    • DEXA (dual-energy X-ray absorptiometry) scan is recommended for all women aged 65 and older by the USPSTF — for younger postmenopausal women, screening is recommended if risk factors are present (family history, low body weight, smoking, alcohol use, long-term corticosteroids) ✓
    • Bone density is only tested when fractures occur
    • DEXA scan is only for men

    BONE DENSITY SCREENING (OSTEOPOROSIS): USPSTF RECOMMENDATION: Screen ALL women age 65 and older with DEXA; Screen younger postmenopausal women under 65 whose 10-year fracture risk is equal to or greater than that of a 65-year-old white woman with no risk factors (calculated using FRAX tool); WHO T-S…

45. A nurse is teaching a 45-year-old woman about cervical cancer screening. Which schedule is currently recommended?

    • Annual Pap smear starting at age 21
    • Pap smear every 3 years (ages 21-65) OR Pap smear with HPV co-testing (co-test) every 5 years (ages 30-65); no Pap needed before age 21 regardless of sexual history ✓
    • Monthly self-examination
    • Pap smear only when symptoms occur

    CERVICAL CANCER SCREENING GUIDELINES (USPSTF/ASCCP): Ages 21-29: Pap smear (cytology) alone every 3 years; HPV testing not recommended in this age group (HPV is common and usually clears spontaneously in younger women); Ages 30-65: OPTION 1: Pap smear every 3 years; OPTION 2: Pap + HPV co-test every…

46. A nurse is teaching a pregnant client about preventing neural tube defects. Which supplement is most important?

    • Vitamin C
    • Folic acid (folate) ✓
    • Vitamin E
    • Calcium

    FOLIC ACID (folate) is most important for preventing NEURAL TUBE DEFECTS (such as spina bifida and anencephaly). NCLEX-RN health promotion/prenatal care. Recommendations: women of childbearing age should take about 400 mcg of folic acid daily, and pregnant women typically 600 mcg — IDEALLY STARTING …

47. A nurse is counseling a client on primary prevention of cardiovascular disease. Which recommendation is appropriate?

    • Begin taking cardiac medications immediately
    • Adopt lifestyle measures: regular physical activity, a heart-healthy diet, smoking cessation, and maintaining a healthy weight ✓
    • Avoid all physical activity
    • Increase saturated fat intake

    PRIMARY PREVENTION of cardiovascular disease (preventing it before it develops) focuses on LIFESTYLE: REGULAR PHYSICAL ACTIVITY (e.g., ~150 min/week moderate); a HEART-HEALTHY DIET (fruits, vegetables, whole grains, lean protein; limit saturated/trans fats, sodium, added sugars); SMOKING CESSATION; …

48. When teaching an older adult about health promotion, which age-related change should the nurse consider?

    • Older adults need no health screenings
    • Older adults experience normal changes such as decreased skin elasticity, slower metabolism, and possible sensory changes, requiring tailored teaching and safety measures ✓
    • Aging stops all body function changes
    • Older adults cannot learn new health behaviors

    Health-promotion teaching for OLDER ADULTS must account for normal AGE-RELATED CHANGES: decreased SKIN elasticity and thinning (skin care, fall/injury risk); slower METABOLISM (nutrition/medication considerations); SENSORY changes (vision, hearing — adapt teaching with large print, clear speech); de…

49. A community flu vaccination clinic is an example of which level of prevention?

    • Tertiary prevention
    • Primary prevention ✓
    • Quaternary prevention
    • Diagnostic prevention

    A FLU VACCINATION clinic is an example of PRIMARY PREVENTION — measures taken to PREVENT a disease before it occurs. NCLEX-RN health promotion/levels of prevention. THE LEVELS: PRIMARY prevention prevents disease onset (immunizations, healthy lifestyle, health education, safety measures); SECONDARY …

50. A nurse is teaching a client about recommended adult health screenings. Blood pressure screening is important because hypertension is often:

    • Accompanied by obvious symptoms
    • Asymptomatic ('the silent killer'), so screening detects it before complications occur ✓
    • Only found in older adults
    • Harmless if untreated

    Blood pressure screening is important because HYPERTENSION is often ASYMPTOMATIC — called 'the SILENT KILLER' because people frequently have no symptoms while the elevated pressure silently damages the heart, brain, kidneys, and blood vessels, increasing the risk of heart attack, stroke, and kidney …

51. According to commonly taught developmental theory, which is the primary psychosocial task of infancy (approximately birth to 1 year)?

    • Identity formation
    • Developing trust ✓
    • Career achievement
    • Generativity

    Commonly taught developmental theory (such as Erikson's stages) identifies the primary psychosocial task of infancy (approximately birth to 1 year) as developing trust versus mistrust — the infant learns to trust caregivers when their basic needs are met consistently and lovingly. Identity formation…

52. Which is a general principle of providing developmentally appropriate care to a preschool-age child (approximately 3–5 years)?

    • Use detailed abstract explanations
    • Use simple language, allow choices when possible, and incorporate play, recognizing the child's developmental level ✓
    • Treat the preschooler exactly like an adult
    • Avoid involving the parents

    Developmentally appropriate care for a preschool-age child includes using simple, concrete language, offering choices when appropriate to support their growing autonomy, incorporating play (a key way young children learn and cope), and involving the parents. Preschoolers cannot process detailed abst…

53. What general immunization principle should the nurse understand regarding community (herd) immunity?

    • It has no relationship to vaccination rates
    • When a sufficient proportion of a population is immune, the spread of a contagious disease is reduced, offering some protection even to those not immune ✓
    • It means no one ever needs vaccination
    • It applies only to adults

    Community (herd) immunity is the general principle that when a sufficiently high proportion of a population is immune to a contagious disease — typically through vaccination — the disease spreads less easily, which provides some indirect protection even to people who are not immune (such as those wh…

54. What is a general nursing responsibility related to immunizations?

    • Decide vaccine policy independently
    • Provide accurate education, follow current authoritative recommendations and provider orders, and document according to policy ✓
    • Discourage all vaccination
    • Ignore documentation requirements

    General nursing responsibilities related to immunizations include providing clients and families with accurate education about the purpose and importance of recommended immunizations, following current authoritative recommendations and provider orders, and documenting administration according to pol…

55. What is the purpose of the 'teach-back' method in client education?

    • To test how smart the client is
    • To confirm the client's understanding by having them explain or demonstrate the information in their own words, so the nurse can correct gaps ✓
    • To replace all written materials
    • To speed through teaching

    The teach-back method is used to confirm a client's understanding by asking them to explain the information or demonstrate the skill in their own words, allowing the nurse to identify and correct any gaps or misunderstandings and re-teach as needed. It is not a test of intelligence, a replacement fo…

56. Which is a general principle for promoting client self-care and autonomy?

    • Do everything for the client
    • Encourage and support the client to participate in their own care to the extent of their ability, providing education and resources ✓
    • Withhold information to maintain control
    • Make all decisions on the client's behalf

    A general principle of health promotion is to support client autonomy and self-care by encouraging clients to participate in their own care to the extent of their abilities, providing the education, resources, and support they need to do so safely. Doing everything for a capable client, withholding …

57. When helping a client set a health-behavior goal, which approach reflects good general practice?

    • Set the goal for the client without their input
    • Collaborate with the client to set realistic, individualized, and measurable goals that the client is motivated to pursue ✓
    • Set an extreme goal to maximize results
    • Avoid setting any goals

    Good general practice in health-behavior change is to collaborate with the client to set goals that are realistic, individualized, and measurable, and that the client is genuinely motivated to pursue — increasing the likelihood of success and sustained change. Setting goals for the client without in…

58. Which is a general principle of culturally competent health promotion?

    • Apply one standard approach to everyone
    • Respect and incorporate the client's cultural beliefs, values, and practices into care and teaching when safe and feasible ✓
    • Ignore cultural factors
    • Assume all members of a culture are identical

    Culturally competent health promotion means respecting the client's cultural beliefs, values, and practices and incorporating them into care and teaching when it is safe and feasible, while avoiding stereotyping (recognizing that individuals within any culture differ). Applying a single standard app…

59. What is a general purpose of prenatal health teaching during pregnancy?

    • To discourage prenatal visits
    • To promote healthy behaviors during pregnancy, prepare the client for childbirth and newborn care, and support early identification of concerns ✓
    • To replace medical care entirely
    • To avoid involving the client in decisions

    Prenatal health teaching during pregnancy generally aims to promote healthy behaviors (such as appropriate nutrition, activity, and avoidance of harmful substances), prepare the client for childbirth and newborn care, encourage attendance at prenatal visits, and support early identification and mana…

60. Which is a general newborn safety teaching point nurses commonly reinforce with new parents?

    • Newborns can be left unsupervised on high surfaces
    • Never leave a newborn unattended on an elevated surface, and follow current safe-sleep recommendations ✓
    • Car seats are unnecessary
    • Supervision is not important

    A general newborn safety teaching point is to never leave a newborn unattended on an elevated surface (such as a changing table or bed) because of the fall risk, along with following current safe-sleep recommendations and using appropriate car-seat safety. These are core anticipatory-guidance points…

61. Which is a general principle when assessing growth and development in children?

    • All children develop at exactly the same rate
    • Development generally follows predictable sequences, but the rate varies among individuals, so findings are interpreted in context ✓
    • Development is unpredictable and cannot be assessed
    • Only weight matters

    A general principle of growth and development is that development tends to follow predictable sequences and directions (for example, head-to-toe and center-outward progression in motor development), but the rate of development varies among individual children. Therefore, findings are interpreted in …

62. What is the general role of patient education in chronic disease management as a form of tertiary prevention?

    • It has no role
    • To help clients understand and manage their condition, follow their plan of care, and prevent or limit complications ✓
    • To replace all treatment
    • To discourage self-management

    In chronic disease management — a form of tertiary prevention — patient education plays a central role in helping clients understand their condition, participate in and adhere to their plan of care, recognize warning signs, and adopt behaviors that prevent or limit complications and maintain functio…

63. Which is a general principle of health promotion related to physical activity for most adults?

    • Adults should avoid all physical activity
    • Regular, appropriate physical activity — individualized to the person's health status and abilities — supports overall health ✓
    • Only competitive athletes benefit from activity
    • Activity should be discouraged after a certain age

    A general health-promotion principle is that regular, appropriate physical activity supports overall physical and mental health for most adults, and it should be individualized to the person's health status, abilities, and any medical considerations. Activity benefits people across the lifespan, not…

64. What is a general principle of effective health promotion at the community level?

    • Focus only on individuals, never groups
    • Address the needs of populations through education, access to resources, and programs that support healthy behaviors ✓
    • Ignore community needs
    • Provide no health information to the public

    Community-level health promotion addresses the health needs of populations and groups — through public education, improving access to resources and care, and programs and policies that support healthy behaviors and environments — in addition to caring for individuals. Focusing only on individuals, i…

65. Before administering any immunization, what is a general nursing safety practice?

    • Skip checking for allergies
    • Verify the order, follow the rights of medication administration, screen for contraindications such as known allergies per policy, and provide appropriate information ✓
    • Never check the client's history
    • Administer without any verification

    A general nursing safety practice before administering any immunization is to verify the provider's order, follow the rights of medication administration, screen for contraindications (such as a known allergy to a vaccine component) according to policy and current guidance, provide the client or fam…