Health Promotion and Maintenance
Screening, Immunization, and Anticipatory Guidance
Health promotion questions ask you to match a person's age, risk profile, and stage of life to the right screening, teaching, or preventive service. Know the well-child visit rhythm: frequent visits in infancy, then annual visits through childhood, with vision and hearing screening, lead screening for at-risk children, and developmental surveillance at every visit. Immunization timing is high-yield - birth hepatitis B, two-month combination series, and adolescent HPV and Tdap boosters. Adult screening includes blood pressure at every visit, colorectal cancer screening beginning at 45, mammography shared decision-making in the 40s, cervical screening starting at 21, and osteoporosis screening for older women.
Traps to Watch
Questions often test the difference between screening (asymptomatic, early detection) and diagnostic testing (symptoms present). Another trap is the vaccine that is contraindicated in pregnancy (live vaccines such as MMR and varicella) versus those recommended (Tdap each pregnancy, influenza). Do not confuse primary prevention (immunization, counseling), secondary prevention (screening), and tertiary prevention (rehabilitation, support groups). Read the stem for the person's actual risk factors rather than answering from the general population.
Rule of Thumb
When a question asks "what should the nurse teach," choose the answer that is specific to that person's developmental stage and stated risk. Teaching a new parent about car seat safety is the correct answer over generic nutrition advice. For a 50-year-old with a family history of colon cancer, earlier or more frequent colonoscopy outranks routine screening at 45. Match the intervention to the individual, not the average.
Worked Example
A 68-year-old woman with no symptoms asks what she should do about bone health. The best answer is to discuss bone mineral density screening, because she is over 65 and screening is recommended regardless of symptoms. A DEXA scan is screening; an X-ray after a fall would be diagnostic.