Summary NR 222 NURSING Health and Wellness ACROSS
LIFE SPAN 2026 ACTUAL GUIDE - 149 Questions
Section 1: Health Promotion and Disease Prevention (Questions 1-15)
1 A community health initiative aims to reduce cardiovascular disease by promoting physical activity among
sedentary adults. Based on the Transtheoretical Model, which intervention strategy is most appropriate for
individuals who have been regularly walking for 20 minutes three times a week for the past month?
A) Provide information about the health risks of inactivity to reinforce the need for change
B) Encourage commitment to a long-term exercise plan and discuss relapse prevention
C) Help the individual set a date to start walking within the next 30 days
D) Offer praise and support for the current behavior without suggesting further increases
Answer: B
Rationale: Individuals in the action stage (regular activity for <6 months) benefit from commitment reinforcement
and relapse prevention. Option A targets precontemplation, C targets preparation, and D may stall progression to
maintenance.
2 A nurse is evaluating a school-based program to prevent childhood obesity. Which outcome measure best
reflects the program's effectiveness in addressing primary prevention?
A) Reduction in body mass index percentile among overweight children
B) Increase in the proportion of children who meet daily physical activity recommendations
C) Decrease in the incidence of type 2 diabetes diagnoses
D) Improvement in self-reported dietary habits among children with obesity
Answer: B
Rationale: Primary prevention aims to prevent onset of disease. Increased physical activity in a healthy population is
primary prevention. Option A and D involve secondary/tertiary prevention (overweight/obese), and C measures
tertiary prevention.
3 A health policy analyst is comparing two screening programs for cervical cancer: Program X offers Pap smears
every 3 years to women aged 21-65; Program Y offers HPV testing every 5 years to women aged 30-65. Which
statement best describes the trade-off between the two programs?
A) Program X has higher sensitivity but lower specificity than Program Y
B) Program Y has a lower false-positive rate but may miss some precancerous lesions in younger women
C) Program X is more cost-effective due to lower test costs per screening event
D) Program Y reduces overdiagnosis of transient HPV infections that would regress spontaneously
Answer: B
Rationale: HPV testing has higher sensitivity for CIN2+ but lower specificity, especially in younger women due to
transient infections. Program Y's longer interval and start at age 30 reduces false positives. Option A is reversed; C
ignores longer interval costs; D overstates overdiagnosis.
4 A nurse is designing a culturally tailored intervention to increase colorectal cancer screening among a
population with low health literacy and distrust of the healthcare system. Which approach is most likely to
improve screening uptake?
A) Distribute pamphlets with simplified language and graphic illustrations
B) Partner with community faith leaders to deliver screening messages during services
,C) Offer financial incentives for completing fecal immunochemical tests
D) Conduct a mass media campaign emphasizing the dangers of late-stage diagnosis
Answer: B
Rationale: Community-based participatory approaches that leverage trusted leaders address distrust and cultural
barriers more effectively than printed materials (A), incentives (C) which may not address distrust, or fear-based
messaging (D) which can increase avoidance.
5 A nurse educator is teaching a group of clinicians about the U.S. Preventive Services Task Force (USPSTF)
grades. Which statement correctly describes the implications of a 'B' grade recommendation?
A) The service should be offered only if the patient requests it after shared decision-making
B) There is high certainty that the net benefit is substantial
C) The service is recommended for all eligible individuals, and insurance must cover it without cost-sharing
D) The evidence is insufficient to assess the balance of benefits and harms
Answer: C
Rationale: USPSTF 'B' grade indicates moderate certainty of moderate net benefit; the Affordable Care Act requires
coverage without cost-sharing. Option A describes 'C' grade, B describes 'A', D describes 'I' statement.
6 A researcher is analyzing data from a cohort study on the association between sedentary behavior and
cardiovascular mortality. After adjusting for confounders, the hazard ratio is 1.15 (95% CI: 0.98-1.35). Which
interpretation is most accurate?
A) Sedentary behavior is associated with a 15% increased risk of cardiovascular mortality, but the result is not
statistically significant at the 0.05 level
B) There is a 15% increase in the hazard of cardiovascular death among sedentary individuals, and this is
clinically significant
C) The confidence interval includes 1, indicating no association between sedentary behavior and cardiovascular
mortality
D) The p-value is less than 0.05, so the association is statistically significant
Answer: A
Rationale: The HR of 1.15 suggests a 15% increase in hazard, but the 95% CI (0.98-1.35) includes 1, so the result is
not statistically significant at =0.05. Option C incorrectly claims no association (point estimate suggests increased
risk, but not significant).
7 A nurse is implementing a population-based smoking cessation program using the 5 A's framework. Which
action is most appropriate for the 'Assist' step?
A) Advise the patient to quit in a clear, strong, and personalized manner
B) Arrange follow-up contact to prevent relapse within the first week
C) Provide pharmacotherapy and counseling resources tailored to the patient's readiness
D) Ask every patient about tobacco use at every visit
Answer: C
Rationale: The 5 A's: Ask, Advise, Assess, Assist, Arrange. Assist involves helping the patient with a quit plan,
including pharmacotherapy and counseling. Option A is Advise, B is Arrange, D is Ask.
8 A health department is evaluating a needle exchange program to reduce HIV transmission among people who
inject drugs. Which ethical principle is most directly supported by this intervention?
A) Beneficence, by reducing harm to the individual and community
B) Nonmaleficence, by avoiding the imposition of moral judgments
C) Justice, by ensuring equitable access to sterile equipment
,D) Autonomy, by respecting the individual's choice to use drugs
Answer: A
Rationale: Needle exchange programs are harm reduction strategies that primarily aim to prevent disease
(beneficence). While they also involve justice (access) and nonmaleficence (non-judgmental), the core ethical
justification is preventing harm.
9 A nurse is developing a community intervention to increase influenza vaccination rates among healthcare
workers. Based on the Health Belief Model, which factor is most strongly associated with vaccine uptake?
A) Perceived susceptibility to influenza and perceived severity of the disease
B) Perceived benefits of vaccination and perceived barriers to receiving it
C) Cues to action, such as reminders from supervisors
D) Self-efficacy to get vaccinated
Answer: B
Rationale: The Health Belief Model posits that perceived benefits minus perceived barriers is the strongest predictor
of behavior. While all components contribute, the balance of benefits and barriers is most influential. Option A is
necessary but insufficient without benefits outweighing barriers.
10 A public health official is interpreting a systematic review of randomized controlled trials on the effectiveness
of home visitation programs for at-risk families. The review reports a number needed to treat (NNT) of 20 for
preventing child maltreatment. Which interpretation is correct?
A) 20% of families who receive home visitation will experience prevention of child maltreatment
B) For every 20 families enrolled in home visitation, one case of child maltreatment is prevented
C) The odds of preventing maltreatment are 20 times higher in the intervention group
D) The risk of maltreatment in the control group is 20 per 1000
Answer: B
Rationale: NNT is the number of patients who need to be treated to prevent one adverse outcome. An NNT of 20
means that treating 20 families prevents one case of maltreatment. Option A confuses percentage, C is odds ratio, D
is baseline risk.
11 A community health initiative aims to reduce the incidence of type 2 diabetes in a population with high rates of
obesity and sedentary lifestyle. The program includes screening for prediabetes using HbA1c, followed by a
lifestyle intervention based on the Diabetes Prevention Program (DPP). Which of the following best describes
the level of prevention and the evidence-based rationale for this approach?
A) Primary prevention, because screening identifies at-risk individuals before disease onset.
B) Secondary prevention, because the intervention targets early disease detection and reversal of prediabetes.
C) Tertiary prevention, because the program aims to prevent complications in those already diagnosed.
D) Quaternary prevention, because it avoids overmedicalization in low-risk populations.
Answer: B
Rationale: Screening for prediabetes and intervening with lifestyle changes is secondary prevention—it detects
early, asymptomatic disease (prediabetes) and aims to prevent progression to type 2 diabetes. The DPP trial
demonstrated that lifestyle intervention reduced diabetes incidence by 58% in individuals with impaired glucose
tolerance, supporting this approach. Primary prevention would target the entire population before any risk factor
develops, while tertiary prevention manages established disease.
12 A nurse is counseling a client with a family history of colorectal cancer. The client asks about the
recommended screening schedule. Based on current guidelines from the U.S. Preventive Services Task Force
(USPSTF), which of the following is the most appropriate recommendation?
, A) Begin screening at age 40 with colonoscopy every 10 years.
B) Begin screening at age 45 with colonoscopy every 10 years or fecal immunochemical test annually.
C) Begin screening at age 50 with flexible sigmoidoscopy every 5 years.
D) Begin screening at age 50 with CT colonography every 5 years.
Answer: B
Rationale: The USPSTF recommends screening for colorectal cancer starting at age 45 for average-risk adults.
Options include colonoscopy every 10 years or annual FIT. The age was lowered from 50 to 45 in 2021 due to
increasing incidence in younger adults. Option A is too early for average risk; options C and D reflect outdated age
thresholds.
13 A public health department is evaluating the effectiveness of a population-based intervention to reduce
cardiovascular disease. The intervention includes a media campaign promoting physical activity, a community
walking program, and free blood pressure screenings at pharmacies. Which of the following measures would
best assess the success of this intervention at the population level?
A) Change in the prevalence of hypertension among participants.
B) Reduction in the incidence of myocardial infarction over 5 years.
C) Proportion of participants achieving 150 minutes of moderate physical activity per week.
D) Increase in the number of individuals who report knowing their blood pressure numbers.
Answer: B
Rationale: The ultimate goal of a cardiovascular disease prevention program is to reduce disease occurrence.
Incidence of myocardial infarction is a direct measure of morbidity reduction. While intermediate outcomes like
physical activity levels (C) or knowledge (D) are important, they do not directly reflect disease prevention.
Hypertension prevalence (A) is a risk factor, not disease outcome.
14 A nurse is designing a health promotion program for employees at a corporate office. The program aims to
reduce sedentary behavior. Which theoretical model would best guide an intervention that targets both
individual motivation and environmental restructuring?
A) Health Belief Model, focusing on perceived susceptibility to chronic diseases.
B) Transtheoretical Model, focusing on stages of change for physical activity.
C) Social Ecological Model, addressing intrapersonal, interpersonal, organizational, and community factors.
D) Theory of Planned Behavior, focusing on attitudes, subjective norms, and perceived behavioral control.
Answer: C
Rationale: The Social Ecological Model recognizes that behavior is influenced by multiple levels: individual, social,
organizational, and environmental. For reducing sedentary behavior, it can incorporate individual motivation, peer
support, and workplace policies (e.g., standing desks, walking meetings). The Health Belief Model (A) and Theory
of Planned Behavior (D) are individual-level theories, while the Transtheoretical Model (B) focuses on readiness to
change but does not explicitly address environmental factors.
15 A nurse is reviewing evidence-based recommendations for immunizations in adults. According to the Advisory
Committee on Immunization Practices (ACIP) 2023-2024 schedule, which of the following vaccines is
recommended for all adults aged 19-26 years, regardless of other risk factors?
A) Human papillomavirus (HPV) vaccine.
B) Influenza vaccine annually.
C) Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine once.
D) Hepatitis B vaccine for those at risk.
Answer: A
Rationale: The ACIP recommends routine HPV vaccination for all persons through age 26 years if not adequately
LIFE SPAN 2026 ACTUAL GUIDE - 149 Questions
Section 1: Health Promotion and Disease Prevention (Questions 1-15)
1 A community health initiative aims to reduce cardiovascular disease by promoting physical activity among
sedentary adults. Based on the Transtheoretical Model, which intervention strategy is most appropriate for
individuals who have been regularly walking for 20 minutes three times a week for the past month?
A) Provide information about the health risks of inactivity to reinforce the need for change
B) Encourage commitment to a long-term exercise plan and discuss relapse prevention
C) Help the individual set a date to start walking within the next 30 days
D) Offer praise and support for the current behavior without suggesting further increases
Answer: B
Rationale: Individuals in the action stage (regular activity for <6 months) benefit from commitment reinforcement
and relapse prevention. Option A targets precontemplation, C targets preparation, and D may stall progression to
maintenance.
2 A nurse is evaluating a school-based program to prevent childhood obesity. Which outcome measure best
reflects the program's effectiveness in addressing primary prevention?
A) Reduction in body mass index percentile among overweight children
B) Increase in the proportion of children who meet daily physical activity recommendations
C) Decrease in the incidence of type 2 diabetes diagnoses
D) Improvement in self-reported dietary habits among children with obesity
Answer: B
Rationale: Primary prevention aims to prevent onset of disease. Increased physical activity in a healthy population is
primary prevention. Option A and D involve secondary/tertiary prevention (overweight/obese), and C measures
tertiary prevention.
3 A health policy analyst is comparing two screening programs for cervical cancer: Program X offers Pap smears
every 3 years to women aged 21-65; Program Y offers HPV testing every 5 years to women aged 30-65. Which
statement best describes the trade-off between the two programs?
A) Program X has higher sensitivity but lower specificity than Program Y
B) Program Y has a lower false-positive rate but may miss some precancerous lesions in younger women
C) Program X is more cost-effective due to lower test costs per screening event
D) Program Y reduces overdiagnosis of transient HPV infections that would regress spontaneously
Answer: B
Rationale: HPV testing has higher sensitivity for CIN2+ but lower specificity, especially in younger women due to
transient infections. Program Y's longer interval and start at age 30 reduces false positives. Option A is reversed; C
ignores longer interval costs; D overstates overdiagnosis.
4 A nurse is designing a culturally tailored intervention to increase colorectal cancer screening among a
population with low health literacy and distrust of the healthcare system. Which approach is most likely to
improve screening uptake?
A) Distribute pamphlets with simplified language and graphic illustrations
B) Partner with community faith leaders to deliver screening messages during services
,C) Offer financial incentives for completing fecal immunochemical tests
D) Conduct a mass media campaign emphasizing the dangers of late-stage diagnosis
Answer: B
Rationale: Community-based participatory approaches that leverage trusted leaders address distrust and cultural
barriers more effectively than printed materials (A), incentives (C) which may not address distrust, or fear-based
messaging (D) which can increase avoidance.
5 A nurse educator is teaching a group of clinicians about the U.S. Preventive Services Task Force (USPSTF)
grades. Which statement correctly describes the implications of a 'B' grade recommendation?
A) The service should be offered only if the patient requests it after shared decision-making
B) There is high certainty that the net benefit is substantial
C) The service is recommended for all eligible individuals, and insurance must cover it without cost-sharing
D) The evidence is insufficient to assess the balance of benefits and harms
Answer: C
Rationale: USPSTF 'B' grade indicates moderate certainty of moderate net benefit; the Affordable Care Act requires
coverage without cost-sharing. Option A describes 'C' grade, B describes 'A', D describes 'I' statement.
6 A researcher is analyzing data from a cohort study on the association between sedentary behavior and
cardiovascular mortality. After adjusting for confounders, the hazard ratio is 1.15 (95% CI: 0.98-1.35). Which
interpretation is most accurate?
A) Sedentary behavior is associated with a 15% increased risk of cardiovascular mortality, but the result is not
statistically significant at the 0.05 level
B) There is a 15% increase in the hazard of cardiovascular death among sedentary individuals, and this is
clinically significant
C) The confidence interval includes 1, indicating no association between sedentary behavior and cardiovascular
mortality
D) The p-value is less than 0.05, so the association is statistically significant
Answer: A
Rationale: The HR of 1.15 suggests a 15% increase in hazard, but the 95% CI (0.98-1.35) includes 1, so the result is
not statistically significant at =0.05. Option C incorrectly claims no association (point estimate suggests increased
risk, but not significant).
7 A nurse is implementing a population-based smoking cessation program using the 5 A's framework. Which
action is most appropriate for the 'Assist' step?
A) Advise the patient to quit in a clear, strong, and personalized manner
B) Arrange follow-up contact to prevent relapse within the first week
C) Provide pharmacotherapy and counseling resources tailored to the patient's readiness
D) Ask every patient about tobacco use at every visit
Answer: C
Rationale: The 5 A's: Ask, Advise, Assess, Assist, Arrange. Assist involves helping the patient with a quit plan,
including pharmacotherapy and counseling. Option A is Advise, B is Arrange, D is Ask.
8 A health department is evaluating a needle exchange program to reduce HIV transmission among people who
inject drugs. Which ethical principle is most directly supported by this intervention?
A) Beneficence, by reducing harm to the individual and community
B) Nonmaleficence, by avoiding the imposition of moral judgments
C) Justice, by ensuring equitable access to sterile equipment
,D) Autonomy, by respecting the individual's choice to use drugs
Answer: A
Rationale: Needle exchange programs are harm reduction strategies that primarily aim to prevent disease
(beneficence). While they also involve justice (access) and nonmaleficence (non-judgmental), the core ethical
justification is preventing harm.
9 A nurse is developing a community intervention to increase influenza vaccination rates among healthcare
workers. Based on the Health Belief Model, which factor is most strongly associated with vaccine uptake?
A) Perceived susceptibility to influenza and perceived severity of the disease
B) Perceived benefits of vaccination and perceived barriers to receiving it
C) Cues to action, such as reminders from supervisors
D) Self-efficacy to get vaccinated
Answer: B
Rationale: The Health Belief Model posits that perceived benefits minus perceived barriers is the strongest predictor
of behavior. While all components contribute, the balance of benefits and barriers is most influential. Option A is
necessary but insufficient without benefits outweighing barriers.
10 A public health official is interpreting a systematic review of randomized controlled trials on the effectiveness
of home visitation programs for at-risk families. The review reports a number needed to treat (NNT) of 20 for
preventing child maltreatment. Which interpretation is correct?
A) 20% of families who receive home visitation will experience prevention of child maltreatment
B) For every 20 families enrolled in home visitation, one case of child maltreatment is prevented
C) The odds of preventing maltreatment are 20 times higher in the intervention group
D) The risk of maltreatment in the control group is 20 per 1000
Answer: B
Rationale: NNT is the number of patients who need to be treated to prevent one adverse outcome. An NNT of 20
means that treating 20 families prevents one case of maltreatment. Option A confuses percentage, C is odds ratio, D
is baseline risk.
11 A community health initiative aims to reduce the incidence of type 2 diabetes in a population with high rates of
obesity and sedentary lifestyle. The program includes screening for prediabetes using HbA1c, followed by a
lifestyle intervention based on the Diabetes Prevention Program (DPP). Which of the following best describes
the level of prevention and the evidence-based rationale for this approach?
A) Primary prevention, because screening identifies at-risk individuals before disease onset.
B) Secondary prevention, because the intervention targets early disease detection and reversal of prediabetes.
C) Tertiary prevention, because the program aims to prevent complications in those already diagnosed.
D) Quaternary prevention, because it avoids overmedicalization in low-risk populations.
Answer: B
Rationale: Screening for prediabetes and intervening with lifestyle changes is secondary prevention—it detects
early, asymptomatic disease (prediabetes) and aims to prevent progression to type 2 diabetes. The DPP trial
demonstrated that lifestyle intervention reduced diabetes incidence by 58% in individuals with impaired glucose
tolerance, supporting this approach. Primary prevention would target the entire population before any risk factor
develops, while tertiary prevention manages established disease.
12 A nurse is counseling a client with a family history of colorectal cancer. The client asks about the
recommended screening schedule. Based on current guidelines from the U.S. Preventive Services Task Force
(USPSTF), which of the following is the most appropriate recommendation?
, A) Begin screening at age 40 with colonoscopy every 10 years.
B) Begin screening at age 45 with colonoscopy every 10 years or fecal immunochemical test annually.
C) Begin screening at age 50 with flexible sigmoidoscopy every 5 years.
D) Begin screening at age 50 with CT colonography every 5 years.
Answer: B
Rationale: The USPSTF recommends screening for colorectal cancer starting at age 45 for average-risk adults.
Options include colonoscopy every 10 years or annual FIT. The age was lowered from 50 to 45 in 2021 due to
increasing incidence in younger adults. Option A is too early for average risk; options C and D reflect outdated age
thresholds.
13 A public health department is evaluating the effectiveness of a population-based intervention to reduce
cardiovascular disease. The intervention includes a media campaign promoting physical activity, a community
walking program, and free blood pressure screenings at pharmacies. Which of the following measures would
best assess the success of this intervention at the population level?
A) Change in the prevalence of hypertension among participants.
B) Reduction in the incidence of myocardial infarction over 5 years.
C) Proportion of participants achieving 150 minutes of moderate physical activity per week.
D) Increase in the number of individuals who report knowing their blood pressure numbers.
Answer: B
Rationale: The ultimate goal of a cardiovascular disease prevention program is to reduce disease occurrence.
Incidence of myocardial infarction is a direct measure of morbidity reduction. While intermediate outcomes like
physical activity levels (C) or knowledge (D) are important, they do not directly reflect disease prevention.
Hypertension prevalence (A) is a risk factor, not disease outcome.
14 A nurse is designing a health promotion program for employees at a corporate office. The program aims to
reduce sedentary behavior. Which theoretical model would best guide an intervention that targets both
individual motivation and environmental restructuring?
A) Health Belief Model, focusing on perceived susceptibility to chronic diseases.
B) Transtheoretical Model, focusing on stages of change for physical activity.
C) Social Ecological Model, addressing intrapersonal, interpersonal, organizational, and community factors.
D) Theory of Planned Behavior, focusing on attitudes, subjective norms, and perceived behavioral control.
Answer: C
Rationale: The Social Ecological Model recognizes that behavior is influenced by multiple levels: individual, social,
organizational, and environmental. For reducing sedentary behavior, it can incorporate individual motivation, peer
support, and workplace policies (e.g., standing desks, walking meetings). The Health Belief Model (A) and Theory
of Planned Behavior (D) are individual-level theories, while the Transtheoretical Model (B) focuses on readiness to
change but does not explicitly address environmental factors.
15 A nurse is reviewing evidence-based recommendations for immunizations in adults. According to the Advisory
Committee on Immunization Practices (ACIP) 2023-2024 schedule, which of the following vaccines is
recommended for all adults aged 19-26 years, regardless of other risk factors?
A) Human papillomavirus (HPV) vaccine.
B) Influenza vaccine annually.
C) Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine once.
D) Hepatitis B vaccine for those at risk.
Answer: A
Rationale: The ACIP recommends routine HPV vaccination for all persons through age 26 years if not adequately
