NCLEX-PN Health Promotion and Maintenance Practice Questions

Growth and development, prevention, and health teaching across the lifespan within the PN role. It sits under Health Promotion and Maintenance on the NCLEX-PN test plan and carries an approximate weight of 9% of the exam.

Below are 12 practice questions for this domain — 8 multiple-choice and 4 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-PN the distractors are usually plausible actions that are simply lower priority, so knowing why an answer is wrong is worth as much as knowing why one is right.

How to use this page. Read the vignette, commit to an answer, and only then open “Show the answer and rationales”. Reading the worked answer first feels productive and teaches almost nothing — the recall attempt is what makes it stick.

Select-all-that-apply items are graded all-or-nothing: partial credit does not exist, so a single missed option loses the whole question.

Easy Multiple choice

1. First screening mammogram — instruction to reinforce

A nurse is reinforcing instructions for a client who is scheduled for her first screening mammogram next week.

Which instruction should the nurse include?

  1. Do not apply deodorant, powder, or lotion under your arms or on your breasts on the day of the exam.
  2. Have nothing to eat or drink after midnight before the exam.
  3. Schedule the exam for the week just before your menstrual period.
  4. Arrange for someone to drive you home after the sedation wears off.
Show the answer and rationales

Correct answer: A

  • A. Correct . Many of these products contain particles, such as aluminum, that show up as white specks on the image and can mimic calcifications, obscuring the result or triggering unnecessary follow-up.
  • B. Incorrect . A mammogram is an X-ray of breast tissue — no fasting is required. Fasting instructions apply to certain blood tests and procedures involving sedation or contrast.
  • C. Incorrect . Breasts are most tender and swollen the week before a period, which makes compression more uncomfortable. Clients are advised to avoid that week, not to choose it.
  • D. Incorrect . Mammography uses brief breast compression and no sedation, so the client can drive and resume normal activity immediately.

Reference: American Cancer Society mammogram preparation guidance

Easy Multiple choice

2. Levels of prevention — community health fair

A nurse is assisting at a community health fair that offers several services, including vaccinations, blood pressure checks, nutrition classes, and rehabilitation demonstrations.

Which activity at the fair is an example of secondary prevention?

  1. Measuring blood pressure to detect unrecognized hypertension.
  2. Administering influenza vaccine at the vaccination booth.
  3. Teaching a group about heart-healthy, low-sodium meal planning.
  4. Demonstrating home exercises to a client recovering from a stroke.
Show the answer and rationales

Correct answer: A

  • A. Correct . Secondary prevention detects disease early in people who do not yet have symptoms so treatment can begin sooner. Blood pressure screening to find unrecognized hypertension is a classic example.
  • B. Incorrect . Immunization stops disease before it ever starts, which makes it primary prevention, not secondary.
  • C. Incorrect . Health teaching aimed at preventing disease from developing is primary prevention because no disease is being detected or treated.
  • D. Incorrect . Rehabilitation after a stroke limits disability from disease that already exists, which is tertiary prevention.

Reference: CDC health promotion guidance; USPSTF screening recommendations

Easy Multiple choice

3. Preconception folic acid — statement of understanding

A nurse at a community clinic is reinforcing preconception teaching, initiated by the RN, with a client who plans to become pregnant within the next year.

Which client statement indicates understanding of the teaching?

  1. I will start taking 400 micrograms of folic acid every day now, before I become pregnant.
  2. I will begin a folic acid supplement as soon as a pregnancy test is positive.
  3. I only need extra folic acid if my diet is low in fruits and vegetables.
  4. I should wait until the second trimester to start prenatal vitamins.
Show the answer and rationales

Correct answer: A

  • A. Correct . The CDC recommends 400 mcg of folic acid daily for anyone capable of becoming pregnant. The neural tube closes within the first weeks of pregnancy, so supplementation must begin before conception to prevent defects such as spina bifida.
  • B. Incorrect . The neural tube forms in the first weeks after conception, often before the pregnancy is recognized — waiting for a positive test is too late for full protection.
  • C. Incorrect . It is difficult to get enough folate from diet alone, so a daily supplement or fortified foods supplying 400 mcg of folic acid is recommended for everyone capable of pregnancy, regardless of diet.
  • D. Incorrect . The second trimester is well past the window when folic acid prevents neural tube defects — supplementation belongs before conception and through early pregnancy.

Reference: CDC folic acid recommendations for the prevention of neural tube defects

Medium Multiple choice

4. Discouraged client with obesity — appropriate response

A client with a BMI of 34 and newly elevated blood pressure tells a nurse that reaching a healthy weight would mean losing 80 pounds, so trying feels pointless.

Which response by the nurse is appropriate?

  1. Losing even 5 to 10 percent of your current weight can meaningfully improve your blood pressure, blood sugar, and cholesterol.
  2. You are right that losing a smaller amount of weight will not change your health risks.
  3. A prescription weight-loss medication is the only realistic option at your BMI.
  4. You should plan to lose all 80 pounds within the next 6 months.
Show the answer and rationales

Correct answer: A

  • A. Correct . Modest weight loss of 5 to 10 percent measurably lowers blood pressure, improves glucose control, and improves lipid profiles. Reframing toward an achievable goal addresses the client's discouragement and supports realistic behavior change.
  • B. Incorrect . This is factually wrong — health benefits begin with modest weight loss — and it reinforces the client's hopelessness instead of supporting change.
  • C. Incorrect . Lifestyle change is the foundation of obesity management at any BMI. Recommending a specific medication also exceeds the PN role — pharmacotherapy decisions belong to the provider.
  • D. Incorrect . That pace far exceeds the safe, sustainable rate of about 1 to 2 pounds per week and sets the client up for failure, worsening the discouragement the client already expressed.

Reference: CDC healthy weight guidance on benefits of modest 5-10 percent weight loss

Medium Multiple choice

5. Irregular cycles after menarche — appropriate response

The parent of a 12-year-old who began menstruating 4 months ago tells a nurse at a school health clinic that the periods have skipped entire months and asks whether something is wrong.

Which response by the nurse is appropriate?

  1. Irregular cycles are common during the first year or two after periods begin and usually become more regular over time.
  2. Skipped periods at this age usually indicate a hormone disorder that needs laboratory testing right away.
  3. Your child should see the provider immediately because cycles should be regular from the very first period.
  4. Most 12-year-olds settle into a predictable 28-day cycle within a month or two of their first period.
Show the answer and rationales

Correct answer: A

  • A. Correct . Early cycles are often anovulatory, so skipped or long cycles are an expected part of normal pubertal development. Most adolescent cycles fall between 21 and 45 days and regulate as the hypothalamic-pituitary-ovarian axis matures.
  • B. Incorrect . This is inaccurate and needlessly alarming — anovulatory irregularity is the norm shortly after menarche, and immediate hormone testing is not indicated for this expected pattern.
  • C. Incorrect . Cycles are not expected to be regular from the start. Urgent referral for expected developmental variation is unnecessary and increases family anxiety.
  • D. Incorrect . Adolescent cycles vary widely, commonly 21 to 45 days, and often take 1 to 2 years to become predictable — promising a 28-day cycle within weeks sets a false expectation.

Reference: ACOG Committee Opinion 651, Menstruation in Girls and Adolescents

Medium Select all that apply

6. Low health literacy — reinforcing insulin pen teaching

A nurse is reinforcing teaching that the RN initiated about a newly prescribed insulin glargine prefilled pen. When handed the printed instruction sheet, the client glances at it, sets it aside, and says it will be easier to figure out at home. The client left several blanks on the intake paperwork.

Which strategies should the nurse use when reinforcing the teaching? Select all that apply.

  1. Use plain, everyday words instead of medical terms.
  2. Ask the client to explain in their own words how to use the pen.
  3. Have the client demonstrate the injection steps with the pen.
  4. Ask the client whether they understand before ending the session.
  5. Give the client a detailed manufacturer pamphlet to study at home.
  6. Speak more loudly and repeat the original explanation word for word.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Setting written material aside and leaving forms blank are common signs of limited health literacy. Plain language is a universal precaution that helps every client, regardless of reading level.
  • B. Correct . This is the teach-back method — the most reliable way to confirm understanding. It checks how well the nurse explained, not the client's intelligence.
  • C. Correct . Return demonstration confirms the client can actually perform the psychomotor skill, which written or verbal instruction alone cannot guarantee.
  • D. Incorrect . Closed yes-or-no questions like this do not verify understanding — many clients say yes to avoid embarrassment. Teach-back replaces this question.
  • E. Incorrect . The client has already deferred reading the instruction sheet, which suggests written material is a barrier. Adding denser text does not address the literacy gap.
  • F. Incorrect . Limited health literacy is not a hearing problem. Repeating the same explanation louder does not make it clearer — the message should be simplified and confirmed with teach-back.

Reference: AHRQ Health Literacy Universal Precautions Toolkit (Teach-Back, Tool 5)

Medium Multiple choice

7. Nicotine patch — need for further teaching

A nurse is reinforcing teaching for a client who began using a 21 mg nicotine transdermal patch yesterday as part of a smoking cessation program.

Which client statement indicates a need for further teaching?

  1. I can still smoke a cigarette or two when my cravings are strong.
  2. I will put the patch on clean, dry, hairless skin and use a different spot each day.
  3. If vivid dreams bother me, I can take the patch off at bedtime.
  4. I will fold used patches sticky sides together and keep them away from children and pets.
Show the answer and rationales

Correct answer: A

  • A. Correct . Smoking while using the patch adds inhaled nicotine on top of the transdermal dose and risks nicotine overdose — symptoms include nausea, dizziness, and a racing heartbeat. Product labeling instructs users not to smoke while on patch therapy.
  • B. Incorrect . This is correct technique — applying to clean, dry, intact skin and rotating sites promotes absorption and prevents skin irritation, so no further teaching is needed.
  • C. Incorrect . Removing the patch at bedtime is the labeled remedy for vivid dreams and other sleep disturbances, so this statement shows correct understanding.
  • D. Incorrect . Used patches retain enough nicotine to poison a child or pet, so folding them closed and disposing of them safely is exactly what the labeling instructs.

Reference: FDA DailyMed labeling for nicotine transdermal system

Medium Select all that apply

8. Older adult exercise plan — statements of understanding

A nurse is reinforcing teaching about a new exercise plan with a 70-year-old client whose provider has cleared the client to begin physical activity after years of a sedentary lifestyle.

Which client statements indicate understanding of the teaching? Select all that apply.

  1. I will aim for about 150 minutes of moderate activity, like brisk walking, spread across the week.
  2. I will do muscle-strengthening activities at least 2 days each week.
  3. I will add balance exercises, like standing on one foot, to help prevent falls.
  4. Since I have been inactive, I will start slowly and build up over time.
  5. If I cannot manage the full 150 minutes, there is no benefit to exercising at all.
  6. Chest pain during exercise is just muscle soreness I should push through.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Adults, including older adults, need at least 150 minutes of moderate-intensity aerobic activity each week — for example, 30 minutes a day, 5 days a week.
  • B. Correct . Muscle-strengthening on 2 or more days per week is part of the national activity guidelines and helps preserve strength and function with aging.
  • C. Correct . Older adults should include balance training along with aerobic and strengthening activity because it improves function and reduces the risk of falls and fall injuries.
  • D. Correct . Previously inactive older adults should start with lower-intensity, shorter sessions and progress gradually, which reduces injury risk and improves long-term adherence.
  • E. Incorrect . Some activity is always better than none — health benefits begin well below the 150-minute target, so partial amounts still count.
  • F. Incorrect . Chest pain, pressure, or dizziness during activity is never normal soreness — the client should stop and report it so the provider can evaluate for a cardiac cause.

Reference: CDC Physical Activity Guidelines for adults 65 and older

Medium Multiple choice

9. Postmenopausal client — finding to report

A nurse in a primary care clinic is collecting data from a 58-year-old client whose last menstrual period was 6 years ago. The client reports occasional hot flashes, vaginal dryness, difficulty falling asleep, and two episodes of vaginal spotting during the past month.

Which finding is most important for the nurse to report to the registered nurse?

  1. Two episodes of vaginal spotting during the past month.
  2. Occasional hot flashes.
  3. Vaginal dryness.
  4. Difficulty falling asleep.
Show the answer and rationales

Correct answer: A

  • A. Correct . Bleeding that occurs 12 or more months after the final menstrual period is never normal. About 90 percent of clients diagnosed with endometrial cancer present with postmenopausal bleeding, so this finding must be reported promptly so the client can be evaluated.
  • B. Incorrect . Vasomotor symptoms are a common, expected effect of declining estrogen after menopause. They warrant comfort measures and documentation, not urgent escalation.
  • C. Incorrect . Vaginal dryness is an expected result of low estrogen and is managed with lubricants or moisturizers — it is not a red-flag finding.
  • D. Incorrect . Sleep disturbance is common around and after menopause, often related to night sweats. It deserves follow-up teaching but is not the priority finding here.

Reference: ACOG guidance on evaluation of postmenopausal bleeding

Hard Select all that apply

10. New hypertension — lifestyle instructions to reinforce

A nurse is reinforcing teaching initiated by the RN about lifestyle changes for a client with newly diagnosed stage 1 hypertension (blood pressure 136/86 mm Hg). The client smokes a pack of cigarettes daily and drinks two to three beers most evenings.

Which instructions should the nurse include? Select all that apply.

  1. Follow an eating plan rich in fruits, vegetables, whole grains, and low-fat dairy, such as the DASH diet.
  2. Keep sodium intake under about 2,300 mg per day, working toward 1,500 mg.
  3. Cut back on alcohol, ideally avoiding it altogether.
  4. Work toward quitting smoking, and ask about cessation resources.
  5. Switch from beer to red wine, which helps lower blood pressure.
  6. Once your blood pressure readings return to normal, the lifestyle changes are no longer needed.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . The DASH eating pattern is a first-line lifestyle therapy for hypertension and can lower systolic blood pressure by roughly 10 mm Hg or more with good adherence.
  • B. Correct . Guidelines recommend reducing sodium to less than 2,300 mg daily with an optimal target near 1,500 mg, which produces a meaningful drop in blood pressure.
  • C. Correct . Alcohol raises blood pressure. Current AHA/ACC guidance is to reduce intake, with abstaining best for blood pressure control — directly relevant for a client drinking two to three beers nightly.
  • D. Correct . Tobacco cessation is part of comprehensive hypertension management because smoking compounds cardiovascular risk and each cigarette transiently raises blood pressure. Offering resources supports the quit attempt.
  • E. Incorrect . No form of alcohol lowers blood pressure — alcohol raises it regardless of type. The idea that red wine is protective is a common misconception.
  • F. Incorrect . Lifestyle changes are ongoing therapy, not a short course — stopping them allows blood pressure to climb again. Improvement means the changes are working, not that they are finished.

Reference: AHA/ACC high blood pressure guideline, lifestyle management recommendations

Hard Select all that apply

11. Shingles vaccine — information to reinforce

A 62-year-old client at a clinic asks a nurse about the shingles vaccine after a neighbor developed shingles. The client had chickenpox as a child and received the older live zoster vaccine (Zostavax) several years ago.

Which information about the recombinant zoster vaccine (Shingrix) should the nurse reinforce? Select all that apply.

  1. The vaccine is recommended for adults age 50 and older.
  2. It is given as a 2-dose series, with the second dose 2 to 6 months after the first.
  3. People who have already had shingles should still receive the vaccine.
  4. Having received the older live zoster vaccine means this vaccine is not needed.
  5. The vaccine contains live virus and can cause shingles.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . The CDC recommends the recombinant zoster vaccine for immunocompetent adults 50 and older, so this 62-year-old client is in the recommended group.
  • B. Correct . The recombinant zoster vaccine requires 2 doses separated by 2 to 6 months — completing both doses is needed for full protection.
  • C. Correct . The recommendation applies whether or not a person reports a prior episode of shingles, because shingles can recur — the client's neighbor, for example, would still be a candidate once the acute episode resolves.
  • D. Incorrect . The CDC recommends the recombinant vaccine even for people who previously received Zostavax, because Zostavax is no longer available in the United States and its protection wanes.
  • E. Incorrect . Shingrix is a recombinant (non-live) vaccine, so it cannot cause shingles or chickenpox. Common effects are a sore arm, fatigue, and muscle aches for a day or two.

Reference: CDC herpes zoster (Shingrix) vaccine recommendations

Hard Multiple choice

12. Vaccines in pregnancy — which to withhold

At a community clinic during influenza season, a nurse is preparing vaccines for a client who reports she is 10 weeks pregnant. The clinic standing orders include the inactivated influenza vaccine for all adults and the MMR vaccine for clients without documented immunity. The record shows the client is not immune to rubella.

Which action should the nurse take?

  1. Administer the inactivated influenza vaccine, withhold the MMR vaccine, and notify the RN that the client is pregnant.
  2. Administer both vaccines as listed in the standing orders.
  3. Withhold both vaccines until after the client delivers.
  4. Administer the MMR vaccine and instruct the client to avoid pregnancy for the next 4 weeks.
Show the answer and rationales

Correct answer: A

  • A. Correct . Inactivated influenza vaccine is recommended during any trimester of pregnancy. MMR is a live attenuated vaccine and is contraindicated in pregnancy, so it is withheld and given postpartum instead. Notifying the RN keeps the withheld order within the PN's scope and chain of direction.
  • B. Incorrect . MMR contains live attenuated virus and is contraindicated during pregnancy because of theoretical risk to the fetus. Giving it as ordered without questioning would be an error.
  • C. Incorrect . Pregnant clients are at higher risk of severe influenza, and the inactivated flu vaccine is recommended at any point in pregnancy. Withholding it leaves the client and fetus unprotected during flu season.
  • D. Incorrect . The instruction to avoid pregnancy for 4 weeks applies to nonpregnant clients who receive a live vaccine before conception. This client is already pregnant, so MMR is contraindicated now and is deferred until after delivery.

Reference: CDC Guidelines for Vaccinating Pregnant Women; ACIP recommendations

Keep practising

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