Health Promotion and Maintenance — Questions and Answers
Question 1: A nurse is teaching a 45-year-old male client with a family history of colorectal cancer about cancer screening. Which recommendation is most appropriate?
- Begin colonoscopy screening at age 50, which is standard for all adults
- Start colonoscopy screening at age 40, ten years before the youngest affected relative (Correct answer)
- Obtain a fecal occult blood test annually and defer colonoscopy until symptoms appear
- Colorectal cancer screening is only necessary if the client develops rectal bleeding
Correct answer: Start colonoscopy screening at age 40, ten years before the youngest affected relative
For individuals with a first-degree relative diagnosed with colorectal cancer, guidelines recommend beginning colonoscopy screening at age 40 or 10 years before the earliest diagnosis in the family, whichever comes first. Early screening detects precancerous polyps.
Question 2: A nurse is providing anticipatory guidance to parents of a 12-month-old child. Which developmental milestone should the nurse expect at this age?
- Speaking in complete 3-word sentences
- Walking independently without support most of the time (Correct answer)
- Drawing simple geometric shapes
- Identifying colors by name
Correct answer: Walking independently without support most of the time
By 12 months, most children are pulling to stand and beginning to take independent steps. Some walk independently by this age. Language typically consists of a few words (mama, dada). Drawing shapes and identifying colors are skills that develop later in toddlerhood.
Question 3: A nurse is counseling a pregnant client in the first trimester about nutrition. Which supplement is most critical to prevent neural tube defects?
- Iron, to prevent anemia during pregnancy
- Calcium, to support fetal bone development
- Folic acid, ideally begun before conception and continued through the first trimester (Correct answer)
- Vitamin D, to enhance calcium absorption
Correct answer: Folic acid, ideally begun before conception and continued through the first trimester
Folic acid (400-800 mcg/day) is essential before and during the first trimester to prevent neural tube defects such as spina bifida and anencephaly. The neural tube closes within the first 28 days, often before a woman knows she is pregnant.
Question 4: A nurse is teaching a group of older adults about fall prevention at home. Which instruction is most important?
- Avoid physical activity to prevent exertion-related falls
- Install grab bars in the bathroom and remove loose rugs throughout the home (Correct answer)
- Wear socks without shoes indoors to protect floors
- Limit fluid intake after 6 PM to reduce nighttime bathroom trips
Correct answer: Install grab bars in the bathroom and remove loose rugs throughout the home
Environmental modifications are one of the most effective fall prevention strategies. Grab bars in bathrooms provide stability during transfers, and removing loose rugs eliminates a common tripping hazard. Exercise programs that improve balance and strength are also strongly recommended.
Question 5: A nurse is performing a health history on a 55-year-old woman during a wellness visit. The client smokes half a pack per day. The nurse's priority health promotion intervention is to:
- Respect the client's autonomy and avoid discussing smoking unless she brings it up
- Provide brief cessation counseling and offer referral to a smoking cessation program (Correct answer)
- Inform the client that she will develop lung cancer if she does not quit immediately
- Prescribe nicotine replacement therapy without further assessment
Correct answer: Provide brief cessation counseling and offer referral to a smoking cessation program
Brief smoking cessation counseling at every clinical encounter is an evidence-based intervention (the '5 A's' model: Ask, Advise, Assess, Assist, Arrange). Nurses should provide counseling and connect clients with cessation resources, not prescribe medications independently.
Question 6: A school nurse is conducting a vision screening for a group of first-grade students. Which finding warrants referral to an ophthalmologist?
- Visual acuity of 20/20 in both eyes
- Visual acuity of 20/40 in both eyes, which is normal for children age 6
- Visual acuity of 20/50 in one eye and 20/20 in the other (Correct answer)
- The child squints slightly when looking at the chart from a distance
Correct answer: Visual acuity of 20/50 in one eye and 20/20 in the other
A two-line or greater difference in visual acuity between the two eyes (e.g., 20/50 vs. 20/20) suggests amblyopia (lazy eye) and requires prompt ophthalmology referral. Early intervention during the critical visual development period prevents permanent vision loss.
Health Promotion and Maintenance
A nurse is teaching a 45-year-old male client with a family history of colorectal cancer about cancer screening.
Which recommendation is most appropriate?