Screening, immunisation and health teaching

40 NCLEX-RN practice questions on Screening, immunisation and health teaching, part of Health Promotion and Maintenance. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard

   A 70-year-old man comes for his annual visit. He smoked 1 pack a day for 30 years and quit 20 years ago. A colonoscopy 3 years ago was normal. He has no symptoms. The screening test recommended for him now is:

   1. AAnnual low-dose chest CT scan
   2. BA repeat colonoscopy this year
   3. CAn annual PSA blood test
   4. DA one-time abdominal aortic ultrasound

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   Answer: D · A one-time abdominal aortic ultrasound

   The USPSTF recommends one-time ultrasound screening for abdominal aortic aneurysm in men aged 65 to 75 who have ever smoked. He is not eligible for lung cancer screening because he quit more than 15 years ago. After a normal colonoscopy the next one is due in 10 years, and the USPSTF recommends against routine PSA screening at 70 and older. This item tests analysing several cues to choose the right screening.

   • A: Low-dose CT is not advised when he quit more than 15 years ago.
   • B: A normal colonoscopy is repeated after 10 years, not 3.
   • C: Routine PSA screening is not recommended for men 70 and older.

2. Question 2 · Hard

   A 6-year-old is receiving chemotherapy for leukaemia. The parent asks whether the child's healthy 1-year-old sister can receive her MMR vaccine as planned. Which response is correct?

   1. A"Yes, but keep the two children apart for 6 weeks after."
   2. B"Yes, she should get it; MMR virus does not spread to others."
   3. C"No, she should have an inactivated measles vaccine."
   4. D"No, wait until your son has finished his chemotherapy."

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   Answer: B · "Yes, she should get it; MMR virus does not spread to others."

   Household contacts of immunocompromised people should be fully vaccinated, and MMR vaccine viruses are not transmitted to contacts. Vaccinating the sibling protects the child on chemotherapy from measles brought into the home. Separation after MMR is not needed, and no inactivated measles vaccine is available in the United States. This item tests generating solutions that protect a vulnerable family member.

   • A: MMR vaccine virus is not shed to contacts, so separation is not needed.
   • C: There is no inactivated measles vaccine in routine US use.
   • D: Delaying the sibling's vaccine increases the risk to the immunocompromised child.

3. Question 3 · Medium

   A 62-year-old man had shingles 3 years ago and asks whether he still needs the shingles vaccine. Which response by the nurse is correct?

   1. A"Yes, two doses of the recombinant zoster vaccine are advised."
   2. B"No, the vaccine is only for adults who are over 75."
   3. C"No, having had shingles gives you lifelong protection."
   4. D"Yes, but only once you have a blood test for immunity."

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   Answer: A · "Yes, two doses of the recombinant zoster vaccine are advised."

   The recombinant zoster vaccine is recommended as two doses for adults 50 and older, including those who have already had shingles, because shingles can recur. Testing for varicella immunity is not needed before vaccination. The vaccine is not live, so it can also be given to many immunocompromised adults. This item tests generating solutions using current immunisation guidance.

   • B: The vaccine is recommended from age 50, not only after 75.
   • C: Shingles can recur, so a past episode is not a reason to skip the vaccine.
   • D: No immunity test is needed before the recombinant zoster vaccine.

4. Question 4 · Hard

   A 60-year-old man at average risk, with no urinary symptoms, asks the nurse whether he should have a PSA blood test. Which response is best?

   1. A"Yes, every man over 50 should have a PSA test every year."
   2. B"No, PSA testing is only advised for men over 70."
   3. C"No, you only need it if you have trouble urinating."
   4. D"Let's talk with your provider about its benefits and harms, then decide together."

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   Answer: D · "Let's talk with your provider about its benefits and harms, then decide together."

   For men aged 55 to 69, the USPSTF (2018) advises an individual decision about PSA screening after discussing possible benefits and harms, such as false positives, biopsy complications and overtreatment. For men 70 and older it recommends against routine PSA screening. Urinary symptoms are not the trigger for screening, which is for men without symptoms. This item tests generating solutions that support informed, shared decision-making.

   • A: Routine annual PSA for all men over 50 is not recommended.
   • B: The USPSTF recommends against routine screening at 70 and older.
   • C: Screening is for men without symptoms; symptoms need diagnostic evaluation.

5. Question 5 · Easy

   Which statement by the nurse uses the teach-back method correctly?

   1. A"Do you have any questions before I leave you to rest?"
   2. B"Do you understand everything I just told you about how to use your inhaler?"
   3. C"To check that I explained it well, show me how you will use your inhaler."
   4. D"Here is a handout about your inhaler to read at home."

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   Answer: C · "To check that I explained it well, show me how you will use your inhaler."

   Teach-back asks the client to explain or demonstrate in their own words what they were taught, and frames it as a check on the nurse's teaching rather than a test of the client. Yes-or-no questions such as "Do you understand?" do not show real understanding. Handouts support teaching but do not confirm it. This item tests evaluating outcomes of health teaching.

   • A: Asking for questions does not confirm what the client learned.
   • B: A yes-or-no question often gets a polite yes without real understanding.
   • D: A handout supports teaching but does not evaluate it.

6. Question 6 · Hard

   The nurse teaches a client with heart failure to weigh himself daily and call if he gains more than 3 lb (1.4 kg) in 2 days. During teach-back he says, "I'll weigh myself when I feel puffy." What should the nurse do next?

   1. ADocument that the teaching was completed and understood
   2. BTeach the point again in plain words, then repeat teach-back
   3. CGive him a written handout and complete the discharge
   4. DTeach his daughter instead, as he did not understand

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   Rotavirus vaccine should not be given to an infant with a history of:

   1. AIntussusception
   2. BAtopic eczema
   3. CBreastfeeding
   4. DPremature birth

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8. Question 8 · Hard

   After FIT teaching, a 52-year-old client makes four statements about his home colorectal screening kit. Which statement shows the teaching needs to be repeated?

   1. A"I will mail the sample back as the instructions say."
   2. B"I will repeat this test every year if it is negative."
   3. C"If the test is positive, I won't need any other tests."
   4. D"If the test is positive, I will need a colonoscopy."

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9. Question 9 · Medium

   In January, a family of four reports that everyone has had headaches and nausea for a week. The symptoms improve when they are away from home all day. The home has a gas furnace. Which question by the nurse is most important?

   1. A"Has anyone in the family had a recent cold?"
   2. B"Do you have a working carbon monoxide detector?"
   3. C"Have you changed the brand of food you buy?"
   4. D"How many hours of sleep is each person getting?"

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10. Question 10 · Hard

    A 4-year-old with nephrotic syndrome has taken prednisone 2 mg/kg/day (above 20 mg/day) for the past 3 weeks. He is due for his MMR, varicella, DTaP and IPV boosters. What should the nurse do?

    1. AGive DTaP and IPV, and defer MMR and varicella
    2. BGive MMR and varicella, and defer DTaP and IPV
    3. CDefer all four vaccines until steroids stop
    4. DGive all four vaccines as scheduled today

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11. Question 11 · Medium

    A 35-year-old client with normal past cervical screening results asks how often she needs to be screened. Which option follows the USPSTF recommendation?

    1. AHPV testing alone every 5 years
    2. BNo further screening after age 30
    3. CCytology (Pap test) every year
    4. DCytology (Pap test) every 10 years

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12. Question 12 · Easy

    In a household with toddlers, the hot water heater should be kept at a maximum of:

    1. A130°F (54°C)
    2. B120°F (49°C)
    3. C140°F (60°C)
    4. D150°F (66°C)

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13. Question 13 · Medium

    A 34-year-old client says she gets hives after eating eggs and asks whether she can have the influenza vaccine. Which response by the nurse is correct?

    1. A"You will need an allergy skin test before the vaccine."
    2. B"Only the nasal spray flu vaccine is safe for you."
    3. C"People with egg allergy should not have flu vaccines."
    4. D"You can have any flu vaccine suitable for your age."

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14. Question 14 · Hard

    Ten minutes after a vaccine injection, a 28-year-old client reports throat tightness. The nurse notes hives on the chest, wheezing and a blood pressure of 88/50 mm Hg. Which action should the nurse take first?

    1. ACall the provider to ask whether a steroid is needed
    2. BGive oral diphenhydramine and observe for 30 minutes
    3. CPlace the client upright and offer a glass of water
    4. DGive intramuscular epinephrine per the clinic protocol

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15. Question 15 · Medium

    A client at 20 weeks' gestation asks about the Tdap vaccine. The nurse explains that Tdap is recommended:

    1. AOnly after delivery, before going home
    2. BDuring every pregnancy, ideally at 27 to 36 weeks
    3. COnce in a lifetime, so a past dose is enough
    4. DIn the first trimester, before 12 weeks

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16. Question 16 · Medium

    A 44-year-old woman at average risk for breast cancer asks about mammograms. According to the USPSTF (2024), the nurse should explain that screening is recommended:

    1. AOnly after a lump is found
    2. BEvery 2 years from age 50 to 74
    3. CEvery 2 years from age 40 to 74
    4. DEvery year from age 50 to 74

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17. Question 17 · Medium

    The nurse is screening a 16-year-old for substance use during a private part of the visit. Which question is most appropriate?

    1. A"Why would you want to use drugs at your age?"
    2. B"You don't drink or use drugs, do you?"
    3. C"Do your parents know whether you drink alcohol or vape?"
    4. D"Many teens try alcohol or vaping. What have you tried?"

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18. Question 18 · Easy

    Which finding is a true contraindication to giving a dose of a vaccine?

    1. ACurrent treatment with an oral antibiotic
    2. BA low-grade fever with a mild cold
    3. CAnaphylaxis after an earlier dose of the same vaccine
    4. DRecent exposure to a classmate who has chickenpox at school

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19. Question 19 · Hard

    The nurse reviews four clients for lung cancer screening with yearly low-dose CT (USPSTF 2021: age 50 to 80, at least 20 pack-years, and currently smoking or quit within 15 years). Which client is eligible?

    1. AA 58-year-old who smoked 1 pack a day for 22 years and quit 8 years ago
    2. BA 72-year-old who has smoked half a pack a day for 30 years
    3. CA 47-year-old who smokes 2 packs a day and has smoked for 15 years
    4. DA 66-year-old who smoked 1 pack a day for 30 years and quit 20 years ago

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20. Question 20 · Medium

    A client was diagnosed with type 2 diabetes yesterday. The nurse comes to teach blood glucose monitoring and finds the client rating abdominal incision pain at 8 on a 0 to 10 scale. What should the nurse do first?

    1. ALeave a handout for the client to read
    2. BTeach the client's spouse in the hallway
    3. CTeach the steps while the client listens
    4. DTreat the pain and return to teach later

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21. Question 21 · Easy

    For adults at average risk, the USPSTF (2021) recommends that colorectal cancer screening begin at age:

    1. A45 years
    2. B55 years
    3. C40 years
    4. D50 years

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22. Question 22 · Medium

    A 13-month-old receives MMR vaccine today but the varicella vaccine is not available. The varicella vaccine may be given:

    1. AOnly once the child turns 4
    2. BAny day once the MMR is given
    3. CAt least 6 months after the MMR
    4. DAt least 28 days after the MMR

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23. Question 23 · Medium

    The nurse teaches fall prevention to a 79-year-old who lives alone. Which statement by the client indicates a need for further teaching?

    1. A"I stand up slowly and sit for a moment on the bed edge first."
    2. B"I walk around the house in socks at night to stay quiet."
    3. C"I keep a night-light on between my bed and the bathroom."
    4. D"I had grab bars put in next to the toilet and in the shower."

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24. Question 24 · Medium

    An infant born at 32 weeks' gestation is now 8 weeks old, weighs 3.2 kg and is healthy. The parent asks whether the 2-month vaccines should be delayed. The nurse explains that the infant should receive them:

    1. AWhen the infant reaches 2 months corrected age
    2. BNow, by chronological age, at the usual doses
    3. COnly after the infant reaches 5 kg
    4. DNow, but each at half the usual dose

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25. Question 25 · Hard · Select all that apply

    A client who is hepatitis B surface antigen (HBsAg) positive has just given birth to a term newborn. Which actions should the nurse plan?

    1. ASupport breastfeeding
    2. BGive hepatitis B vaccine within 12 hours of birth
    3. CPlan HBsAg and anti-HBs testing after the vaccine series
    4. DGive the two injections at different sites
    5. EGive formula only until the vaccine series is complete
    6. FGive hepatitis B immune globulin within 12 hours of birth

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