NCLEX-RN Health Promotion and Maintenance Practice Questions

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

Below are 12 practice questions for this domain — 7 multiple-choice and 5 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-RN 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. Levels of prevention — identify secondary

A community health nurse is presenting a program on the three levels of prevention to a group of nursing students.

Which activity should the nurse identify as an example of secondary prevention?

  1. Scheduling a screening mammogram for a 47-year-old client.
  2. Administering influenza vaccine at a community clinic.
  3. Teaching a high school class about seat belt use.
  4. Referring a client recovering from a stroke to a rehabilitation program.
Show the answer and rationales

Correct answer: A

  • A. Correct . Secondary prevention detects disease early in asymptomatic people so treatment can begin when it is most effective — screening tests such as mammography are the classic example.
  • B. Incorrect . Immunization prevents disease from occurring in the first place, which makes it primary prevention, not early detection.
  • C. Incorrect . Injury-prevention education stops a problem before it starts — this is primary prevention.
  • D. Incorrect . Rehabilitation limits disability and restores function after disease is already established, which is tertiary prevention.

Reference: CDC health promotion frameworks; American Cancer Society breast cancer screening guidelines

Easy Multiple choice

2. Teach-back — evaluating client understanding

A nurse has finished teaching a client with newly diagnosed hypertension how to use a home blood pressure monitor.

Which action by the nurse is the best way to evaluate the client's understanding?

  1. Ask the client to demonstrate the procedure and explain the steps in the client's own words.
  2. Ask the client whether the instructions were clear.
  3. Give the client a printed pamphlet to review at home.
  4. Document that teaching was completed and the client verbalized understanding.
Show the answer and rationales

Correct answer: A

  • A. Correct . Teach-back with return demonstration directly verifies that the client understood and can perform the skill — it is the most reliable way to evaluate learning and reveals exactly what needs re-teaching.
  • B. Incorrect . A yes-or-no question invites a polite yes regardless of actual understanding — clients with low health literacy often say they understand when they do not.
  • C. Incorrect . Written material reinforces teaching but does not evaluate whether learning occurred, and it assumes adequate reading literacy.
  • D. Incorrect . Documentation records the teaching but is not itself an evaluation — understanding must first be confirmed objectively, such as with teach-back.

Reference: AHRQ health literacy universal precautions toolkit (teach-back method)

Medium Select all that apply

3. Breastfeeding — signs of effective feeding

A home health nurse visits a mother and her 5-day-old newborn who is exclusively breastfed. The nurse assesses whether breastfeeding is effective.

Which findings indicate the newborn is breastfeeding effectively? Select all that apply.

  1. The newborn breastfeeds 8 to 12 times in 24 hours.
  2. The newborn has at least 6 wet diapers per day with pale yellow urine.
  3. The mother can hear the newborn swallowing during feedings.
  4. The newborn appears relaxed and content after most feedings.
  5. The newborn sleeps 6 hours between daytime feedings.
  6. The urine is dark amber with reddish brick-dust staining in the diaper.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Frequent feeding — 8 to 12 times per day — is expected in a breastfed newborn and indicates adequate feeding frequency and milk supply stimulation.
  • B. Correct . By 5 to 7 days of age, 6 or more wet diapers daily with pale or nearly colorless urine indicates adequate milk intake and hydration.
  • C. Correct . Audible swallowing during sustained sucking shows the newborn is actually transferring milk, not just latching without intake.
  • D. Correct . Satiety behavior — a relaxed, content newborn after feeding — is a reassuring sign that the feeding satisfied the infant's hunger.
  • E. Incorrect . Routinely sleeping this long between feedings would drop the feeding count below 8 per day. A sleepy newborn who feeds infrequently is at risk for inadequate intake and should be awakened to feed.
  • F. Incorrect . Concentrated dark urine or urate crystals at 5 days of age suggest inadequate fluid intake — by this age urine should be dilute and pale. This finding warrants a feeding evaluation.

Reference: CDC newborn breastfeeding basics; American Academy of Pediatrics (HealthyChildren.org) guidance on signs of adequate milk intake

Medium Multiple choice

4. Colonoscopy follow-up call — finding to act on

A clinic nurse makes a follow-up telephone call to a client the evening after a screening colonoscopy during which two polyps were removed.

Which client report requires the nurse to instruct the client to seek emergency care?

  1. Severe, worsening abdominal pain with a firm, distended abdomen and a temperature of 101.2 F (38.4 C).
  2. Mild abdominal cramping and bloating that improve after passing gas.
  3. A small streak of blood on the first bowel movement after the procedure.
  4. Feeling drowsy and tired for the rest of the day after the procedure.
Show the answer and rationales

Correct answer: A

  • A. Correct . Severe or worsening abdominal pain, distension, and fever after colonoscopy are warning signs of bowel perforation or postpolypectomy complications — the client needs emergency evaluation, not observation at home.
  • B. Incorrect . Air is insufflated into the colon during the procedure, so mild cramping and bloating relieved by passing flatus are expected and resolve on their own.
  • C. Incorrect . A small amount of blood can be expected after polyp removal. The client should monitor and report bleeding only if it becomes heavy or persistent.
  • D. Incorrect . Residual drowsiness from sedation is expected on the day of the procedure — the client should rest and avoid driving, but this does not require emergency care.

Reference: MedlinePlus colonoscopy aftercare guidance; gastroenterology guidance on recognition of post-colonoscopy perforation

Medium Multiple choice

5. MMR vaccine — which client to withhold

A nurse in a community health clinic is preparing to administer the measles, mumps, and rubella (MMR) vaccine to four adult clients during a catch-up immunization event.

The nurse should withhold the vaccine and notify the provider for which client?

  1. A client who is 8 weeks pregnant.
  2. A client who has a mild upper respiratory infection without fever.
  3. A client who reports an allergy to eggs.
  4. A client who is breastfeeding a 2-month-old infant.
Show the answer and rationales

Correct answer: A

  • A. Correct . MMR is a live attenuated vaccine and is contraindicated during pregnancy. Vaccination is deferred until after delivery, and clients who receive MMR should avoid pregnancy for 4 weeks afterward.
  • B. Incorrect . Mild acute illness without fever is not a contraindication to vaccination — withholding the dose would delay protection unnecessarily.
  • C. Incorrect . Egg allergy is not a contraindication to MMR. The vaccine is grown in chick embryo fibroblast culture but contains negligible egg protein and is considered safe for clients with egg allergy.
  • D. Incorrect . Breastfeeding is not a contraindication to MMR. In fact, postpartum vaccination is recommended for clients found nonimmune to rubella during pregnancy.

Reference: CDC MMR and rubella vaccine recommendations (contraindications and precautions)

Medium Select all that apply

6. Obesity counseling — appropriate approaches

A clinic nurse is counseling an adult client with a body mass index of 32 who states a readiness to begin losing weight.

Which nursing approaches are appropriate? Select all that apply.

  1. Use nonjudgmental, person-first language when discussing weight.
  2. Explain that losing 5 to 10 percent of body weight can improve blood pressure and blood glucose.
  3. Use open-ended questions to explore the client's motivation and goals.
  4. Review screening results for blood pressure, blood glucose, and lipids.
  5. Recommend a goal of losing 5 pounds per week for rapid results.
  6. Start a very-low-calorie diet of 800 calories per day without provider supervision.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Weight stigma reduces engagement with care. Person-first, nonjudgmental language (a client with obesity, not an obese client) builds the therapeutic relationship needed for behavior change.
  • B. Correct . Even modest weight loss of 5 to 10 percent produces clinically meaningful improvements in blood pressure, glycemic control, and lipids — a realistic initial goal supports motivation.
  • C. Correct . Motivational interviewing — open-ended questions, reflective listening, and affirmations — is the evidence-based counseling approach for a client who is ready to change.
  • D. Correct . Obesity raises the risk of hypertension, type 2 diabetes, and dyslipidemia — screening for these comorbidities is part of comprehensive care.
  • E. Incorrect . A safe, sustainable rate of weight loss is about 1 to 2 pounds per week. Faster loss is rarely maintained and increases the risk of muscle loss and gallstones.
  • F. Incorrect . Very-low-calorie diets require medical supervision because of risks such as gallstones, electrolyte disturbances, and nutritional deficiencies — they are not a self-directed first-line approach.

Reference: CDC healthy weight loss guidance; Obesity Action Coalition on benefits of 5 to 10 percent weight loss; AHRQ motivational interviewing resources

Medium Select all that apply

7. Osteoporosis prevention — postmenopausal teaching

A nurse is teaching a 56-year-old postmenopausal client whose recent DEXA scan shows low bone density (osteopenia) about protecting bone health and preventing progression to osteoporosis.

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

  1. Aim for a total calcium intake of 1,200 mg per day from food and supplements combined.
  2. Take 800 to 1,000 international units of vitamin D daily.
  3. Perform weight-bearing exercise, such as brisk walking, on most days of the week.
  4. Remove throw rugs and clutter at home to reduce the risk of falls.
  5. Choose swimming as the main form of exercise to protect the bones.
  6. Take the full daily calcium amount in one single dose to improve absorption.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Women age 51 and older need 1,200 mg of calcium daily. Dietary sources count toward the total, with supplements making up only the shortfall.
  • B. Correct . Adults age 50 and older need 800 to 1,000 IU of vitamin D daily — vitamin D enables calcium absorption and supports the muscle strength needed to avoid falls.
  • C. Correct . Weight-bearing and muscle-strengthening exercise loads the skeleton, slows bone loss, and reduces fall and fracture risk.
  • D. Correct . Fragility fractures often result from falls — home fall-proofing is a core part of fracture prevention in clients with low bone density.
  • E. Incorrect . Swimming is excellent cardiovascular exercise but is not weight-bearing, so it does not meaningfully stimulate bone density. Walking, dancing, and resistance training are better choices for bone health.
  • F. Incorrect . The body absorbs calcium best in amounts of about 500 to 600 mg or less at a time — doses should be divided across the day, not taken all at once.

Reference: Bone Health and Osteoporosis Foundation calcium and vitamin D recommendations; BHOF clinician guidance on exercise and fall prevention

Medium Multiple choice

8. Perimenopause — statement needing further teaching

A nurse is counseling a 49-year-old client who reports irregular menstrual periods and frequent hot flashes. The client's last menstrual period was 4 months ago.

Which client statement indicates a need for further teaching?

  1. Since my periods have become irregular, I can stop using birth control now.
  2. Dressing in layers and avoiding triggers such as caffeine may help my hot flashes.
  3. I will know I have reached menopause after 12 months in a row without a period.
  4. Weight-bearing exercise can help protect my bones as my estrogen level falls.
Show the answer and rationales

Correct answer: A

  • A. Correct . This statement shows a knowledge gap. Ovulation can still occur intermittently during perimenopause, so pregnancy remains possible — contraception is needed until menopause is confirmed by 12 consecutive months without a period.
  • B. Incorrect . This reflects correct understanding — layered clothing, a cool environment, and avoiding personal triggers are first-line lifestyle measures for vasomotor symptoms.
  • C. Incorrect . This is accurate — menopause is defined as 12 consecutive months of amenorrhea, occurring at an average age of 51.
  • D. Incorrect . This is accurate — declining estrogen accelerates bone loss, and weight-bearing exercise helps preserve bone density through the menopause transition.

Reference: ACOG and North American Menopause Society guidance on perimenopause; MedlinePlus menopause overview

Medium Select all that apply

9. Smoking cessation — client ready to quit

A clinic nurse is counseling a client who smokes one pack of cigarettes per day and states a desire to quit within the next month.

Which interventions should the nurse include in the plan? Select all that apply.

  1. Help the client set a quit date within the next 2 weeks.
  2. Discuss FDA-approved cessation medications such as nicotine replacement therapy.
  3. Refer the client to a telephone quitline for ongoing counseling support.
  4. Arrange follow-up contact during the first week after the quit date.
  5. Suggest switching to low-tar light cigarettes as a first step.
  6. Advise the client to delay quitting until major life stressors are resolved.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . For a client ready to quit, the Assist step of the 5 A's includes negotiating a specific quit date, ideally within 2 weeks, while motivation is high.
  • B. Correct . Nicotine replacement therapy, varenicline, and bupropion are evidence-based first-line cessation aids that roughly double quit rates compared with willpower alone.
  • C. Correct . Quitlines such as 1-800-QUIT-NOW provide free behavioral counseling, and combining counseling with medication is more effective than either alone.
  • D. Correct . The Arrange step calls for follow-up soon after the quit date — preferably within the first week — because relapse risk is highest early.
  • E. Incorrect . Light or low-tar cigarettes are not safer — smokers compensate by inhaling more deeply or smoking more, and this advice delays an actual quit attempt.
  • F. Incorrect . The client is ready to change now — delaying squanders motivation. The plan should instead include coping strategies for stress and triggers after quitting.

Reference: US Public Health Service clinical practice guideline on treating tobacco use (5 A's); CDC smoking cessation resources

Hard Multiple choice

10. 18-month milestones — finding to refer

A nurse in a pediatric clinic is reviewing parental reports during the 18-month well-child visit, which includes routine developmental screening.

Which parental report should the nurse refer to the provider for further developmental evaluation?

  1. The toddler does not try to say any words other than mama and dada.
  2. The toddler is not yet toilet trained.
  3. The toddler cries when the parent leaves the examination room.
  4. The toddler cannot pedal a tricycle.
Show the answer and rationales

Correct answer: A

  • A. Correct . By 18 months, most children try to say three or more words besides mama or dada. Absent expressive language at this age is a developmental red flag that warrants further evaluation — early intervention improves outcomes.
  • B. Incorrect . Toilet training readiness typically emerges between 18 and 24 months or later, and most children train well after 18 months — this is a normal finding.
  • C. Incorrect . Separation anxiety is an expected, healthy behavior in toddlers and reflects normal attachment, not a developmental concern.
  • D. Incorrect . Pedaling a tricycle is a gross motor milestone expected around 3 years of age — it would not be expected of an 18-month-old.

Reference: CDC Learn the Signs Act Early developmental milestones (18 months); AAP Bright Futures periodicity schedule for developmental screening

Hard Multiple choice

11. Combined oral contraceptives — who needs an alternative

A nurse in a family planning clinic is reviewing the histories of four clients who each request a prescription for combined estrogen-progestin oral contraceptives.

Which client should the nurse identify as needing an alternative method of contraception?

  1. A 36-year-old client who smokes 20 cigarettes per day.
  2. A 24-year-old client who has migraines without aura.
  3. A 30-year-old client whose mother had breast cancer at age 60.
  4. A 19-year-old client who reports irregular menstrual cycles.
Show the answer and rationales

Correct answer: A

  • A. Correct . Per the CDC US Medical Eligibility Criteria, being 35 or older and smoking 15 or more cigarettes per day is a category 4 condition — an unacceptable health risk — for combined hormonal contraceptives because of the elevated risk of heart attack and stroke. This client needs a progestin-only or nonhormonal method.
  • B. Incorrect . Migraine without aura is generally acceptable for combined hormonal contraceptives. It is migraine WITH aura that is a category 4 contraindication due to ischemic stroke risk.
  • C. Incorrect . A family history of breast cancer is category 1 — no restriction on combined hormonal contraceptive use.
  • D. Incorrect . Irregular cycles are not a contraindication; combined oral contraceptives are often chosen partly because they regulate the menstrual cycle.

Reference: CDC US Medical Eligibility Criteria for Contraceptive Use (combined hormonal contraceptives classifications)

Hard Select all that apply

12. First prenatal visit — health promotion teaching

A nurse is providing teaching at the first prenatal visit for a client at 10 weeks of gestation with an uncomplicated pregnancy. It is influenza season, and the record shows the client is not immune to rubella.

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

  1. Take a daily prenatal vitamin containing at least 400 micrograms of folic acid.
  2. Receive the inactivated influenza vaccine, which is safe in any trimester.
  3. Plan to receive the Tdap vaccine between 27 and 36 weeks of gestation.
  4. Aim for about 150 minutes of moderate-intensity activity, such as brisk walking, each week.
  5. An occasional glass of wine is acceptable after the first trimester.
  6. The MMR vaccine will be given today to protect the baby from rubella.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . At least 400 micrograms of folic acid daily before conception and through early pregnancy prevents fetal neural tube defects, which form in the first weeks of gestation.
  • B. Correct . The inactivated influenza vaccine is recommended during flu season for all pregnant clients and may be given in any trimester — influenza is more severe in pregnancy.
  • C. Correct . Tdap is recommended during every pregnancy at 27 to 36 weeks so protective pertussis antibodies transfer to the baby before birth.
  • D. Correct . For an uncomplicated pregnancy, 150 minutes of moderate aerobic activity weekly is recommended and supports healthy weight gain and cardiovascular fitness.
  • E. Incorrect . No amount of alcohol is known to be safe at any point in pregnancy — alcohol exposure can cause fetal alcohol spectrum disorders.
  • F. Incorrect . MMR is a live attenuated vaccine and is contraindicated during pregnancy. A client nonimmune to rubella is vaccinated postpartum, not during the pregnancy.

Reference: CDC vaccination guidance for pregnant patients (influenza, Tdap, MMR); ACOG prenatal nutrition and exercise recommendations

Keep practising

These same questions are mixed into the interactive quizzes for this domain, where they are graded and feed your spaced-repetition schedule. The timed mock exam draws from every domain at its real test-plan weight.

Study sets in this domain