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NCLEX-RN · Health Promotion and Maintenance

NCLEX-RN: Health Screening and Disease Prevention Concepts

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Overview

This chapter is about keeping people healthy before illness starts or catching it early. It covers vaccines, health screening, risk factors and how to teach clients so they can care for themselves.

Prevention has three levels. Primary prevention stops a disease from starting, such as a vaccine or quitting smoking. Secondary prevention finds disease early through screening, such as a mammogram or a blood pressure check. Tertiary prevention limits harm from a disease the person already has, such as rehabilitation after a stroke.

Live vaccines, such as MMR and varicella, are generally avoided in pregnancy and in people with a badly weakened immune system. Good teaching starts by checking whether the client is ready to learn, then uses plain words, short sessions and the teach-back method.

Key concepts

  • Primary prevention

    Actions that stop a disease from starting in a healthy person, such as vaccines, seat belts, a healthy diet, exercise and stopping smoking.

    Memory tipPrimary = before the disease exists.

  • Secondary prevention

    Screening and early detection to find a disease before it causes symptoms, such as blood pressure checks, mammograms and colon cancer screening.

    Memory tipSecondary = finding it early.

  • Tertiary prevention

    Care that limits damage and prevents problems from a disease the person already has, such as cardiac rehabilitation or foot care teaching for diabetes.

    Memory tipTertiary = living as well as possible with the disease.

  • Live vaccines

    Vaccines made from weakened live germs, such as MMR and varicella. They are generally not given during pregnancy or to people with a severely weakened immune system.

    Memory tipAsk about pregnancy and immune problems before giving a live vaccine.

  • Readiness to learn

    Before teaching, check that the client is comfortable, not in severe pain or anxiety, and interested. Teaching a client who is not ready rarely works.

    Memory tipTreat pain and calm fear first, then teach.

  • Teach-back

    Ask the client to explain or show, in their own words, what you just taught. It checks understanding without making the client feel tested.

    Memory tipSay 'Show me how you will check your blood sugar at home,' not 'Do you understand?'

Often tested

  • Sort actions into primary, secondary or tertiary prevention; most screening is secondary prevention.
  • Check for pregnancy and immune problems before giving a live vaccine.
  • Assess readiness and remove barriers such as pain before teaching.
  • Use teach-back to confirm learning instead of yes-or-no questions.
  • Use plain language and short sessions, and include family when the client agrees.

Easy to confuse: Three levels of prevention

LevelGoalExample
PrimaryStop disease from startingVaccines, quitting smoking
SecondaryFind disease earlyMammogram, blood pressure check
TertiaryLimit harm from existing diseaseStroke rehabilitation

3 sample questions

Verified practice questions from this unit.

Practice questionReviewedHealth Promotion and Maintenance › Health Screening and Disease Prevention★★★★☆

Question 1. A pregnant client asks which vaccines are safe during pregnancy. Which vaccine should NOT be given during pregnancy?

  1. ① Measles, mumps, and rubella (MMR)
  2. ② Hepatitis B
  3. ③ Tdap (tetanus, diphtheria, and pertussis)
  4. ④ Inactivated influenza (flu shot)
▼ Show answer and explanation▲ Hide answer and explanation

Answer: ① Measles, mumps, and rubella (MMR)

Key point: Live vaccines such as MMR are not given during pregnancy

MMR is a live vaccine (it contains weakened live virus). Live vaccines are not given during pregnancy because of a possible risk to the baby. A client who is not immune to rubella is usually given MMR after the baby is born.

Wrong choices

  • "Tdap" is an inactivated vaccine and is recommended during each pregnancy to protect the newborn from whooping cough.
  • "Inactivated influenza (flu shot)" is recommended during pregnancy because flu can be serious for pregnant clients.
  • "Hepatitis B" is not a live vaccine; certain hepatitis B vaccine brands are recommended during pregnancy for clients at risk.
Practice questionReviewedHealth Promotion and Maintenance › Health Screening and Disease Prevention★★★★☆

Question 2. The nurse has taught a client how to draw up and inject insulin. Which action best shows that the client has learned the skill?

  1. ① The client says, "Yes, I understand."
  2. ② The client watches a video about insulin
  3. ③ The client takes home a printed handout
  4. ④ The client shows the nurse how to draw up and inject the insulin
▼ Show answer and explanation▲ Hide answer and explanation

Answer: ④ The client shows the nurse how to draw up and inject the insulin

Key point: Return demonstration best confirms learning of a skill

For a hands-on skill, the best way to check learning is a return demonstration: the client does the skill while the nurse watches. The nurse can see mistakes and correct them before the client goes home.

Wrong choices

  • "Yes, I understand" does not prove the client can do the skill. Many people say yes even when they are unsure.
  • "Takes home a printed handout" is a helpful extra but does not show the client can do it.
  • "Watches a video about insulin" is a teaching method, not a way to check learning.
Practice questionReviewedHealth Promotion and Maintenance › Health Screening and Disease Prevention★★★★☆

Question 3. The nurse reviews foot care with a client who has diabetes. Which statement by the client requires further teaching?

  1. ① "I will dry well between my toes after washing."
  2. ② "I will soak my feet in hot water every night."
  3. ③ "I will look at my feet every day, using a mirror for the bottoms."
  4. ④ "I will wear shoes or slippers, even inside the house."
▼ Show answer and explanation▲ Hide answer and explanation

Answer: ② "I will soak my feet in hot water every night."

Key point: Diabetes foot care: no hot soaks; check feet daily

Diabetes can cause nerve damage, so the client may not feel heat or injury in the feet. Hot water can burn the skin without the client noticing, and long soaking dries and cracks the skin, which lets infection in. Clients should wash feet in warm (not hot) water, test the water with an elbow or thermometer, and avoid long soaks. All the other statements are correct.

Wrong choices

  • "I will look at my feet every day" is correct. Daily checks find small cuts or sores early.
  • "I will dry well between my toes" is correct. Moisture between toes can lead to fungal infection and skin breakdown.
  • "I will wear shoes or slippers, even inside" is correct. This protects the feet from injuries the client may not feel.
Practice 5 questions from this unit →