A 48-year-old female asks the nurse about cervical cancer screening. She had a Pap smear and HPV test last year, both negative. When is her next screening due?

In 4 years (5 years from last test). For women 30-65 years with Pap smear and HPV co-testing, the recommended interval is every 5 years if both tests are negative. Since her last test was 1 year ago, she should be screened again in 4 years (when 5 years have passed since the last test). Annual screening is not recommended with co-testing, and screening continues until age 65.

At what age should colorectal cancer screening begin for an average-risk adult?

Age 45. Current guidelines recommend beginning colorectal cancer screening at age 45 for average-risk adults. This was updated from age 50 based on increasing colorectal cancer incidence in younger adults. High-risk individuals (family history, inflammatory bowel disease, certain genetic syndromes) should begin screening earlier.

A nurse is teaching a 55-year-old man about prostate cancer screening. Which statement by the nurse is most accurate?

"Let's discuss the benefits and risks so you can make an informed decision.". Prostate cancer screening with PSA is a shared decision between patient and provider. The test can detect cancer early but also leads to overdiagnosis and overtreatment. Guidelines recommend discussing benefits (early detection) and risks (false positives, unnecessary biopsies, treatment side effects) to support informed decision-making. Routine annual PSA for all men is not current practice.

4.6 Health Screening Guidelines | NCLEX-RN (Registered Nurse) | Free Exam Prep

Health Screening Overview

Health screening detects disease before symptoms appear, enabling early intervention and improved outcomes. Nurses educate clients about recommended screenings and help ensure access to preventive care.

Principles of Screening

Effective screening programs should:

Detect conditions where early treatment improves outcomes
Use tests that are reliable, valid, and acceptable to patients
Be cost-effective at the population level
Have treatment available for detected conditions

Cancer Screening Guidelines

Breast Cancer Screening

Age/Risk	Recommendation
Average risk, 40-44	Option to begin annual mammography
Average risk, 45-54	Annual mammography
Average risk, 55+	Annual or biennial mammography
High risk	Earlier screening, may include MRI

High-risk factors:

BRCA1/BRCA2 gene mutations
Personal history of breast cancer
Strong family history (first-degree relatives)
Previous chest radiation (e.g., Hodgkin lymphoma treatment)

Clinical Breast Exam: Recommended periodically; patient should know own breasts and report changes.

Breast Self-Awareness: Women should be familiar with how their breasts normally look and feel and report changes promptly.

Cervical Cancer Screening

Age	Recommendation
<21 years	No screening
21-29 years	Pap smear every 3 years
30-65 years	Pap + HPV co-testing every 5 years (preferred) OR Pap alone every 3 years
>65 years	May discontinue if adequate prior screening
Post-hysterectomy	No screening if cervix removed for benign reasons

HPV Vaccination: Recommended at age 11-12 (can start at 9); catch-up through age 26.

Key Point: Cervical cancer screening begins at 21 regardless of sexual activity. HPV testing is not recommended before age 30 as a primary screen.

Colorectal Cancer Screening

Method	Frequency
Colonoscopy	Every 10 years (gold standard)
FIT (Fecal Immunochemical Test)	Annually
Stool DNA test (Cologuard)	Every 1-3 years
CT colonography	Every 5 years
Flexible sigmoidoscopy	Every 5 years

Who to Screen:

Average risk: Begin at age 45
High risk: Earlier screening (personal/family history, IBD, certain genetic syndromes)

If FIT is positive: Colonoscopy is required regardless of any prior colonoscopy.

Lung Cancer Screening

Who qualifies:

Age 50-80 years
20+ pack-year smoking history
Current smoker OR quit within past 15 years

Method: Annual low-dose CT (LDCT)

Discontinue when:

Has not smoked for 15+ years, OR
Develops health problem limiting life expectancy or willingness to have treatment

Prostate Cancer Screening

Recommendation: Shared decision-making between patient and provider

Age	Guidance
50-69	Discuss pros/cons of PSA testing
<50	Consider earlier for high-risk (African American, family history)
>70	Generally not recommended

Key Point: Routine PSA screening is controversial due to overdiagnosis; emphasize informed decision-making.

Skin Cancer Screening

No routine screening recommendation for general population
Patients should perform self-exams and report changes
Clinical skin exam for high-risk individuals
Use ABCDE for melanoma recognition:
- Asymmetry
- Border irregularity
- Color variation
- Diameter >6 mm
- Evolving (changing)

Cardiovascular Screening

Blood Pressure

Category	Systolic	Diastolic
Normal	<120	<80
Elevated	120-129	<80
Stage 1 HTN	130-139	80-89
Stage 2 HTN	≥140	≥90

Screening: At every healthcare visit for all adults.

Lipid Screening

When to begin: Age 20 for average-risk adults

Frequency: Every 4-6 years if normal; more often if risk factors

Component	Desirable Level
Total Cholesterol	<200 mg/dL
LDL ("bad")	<100 mg/dL
HDL ("good")	>40 mg/dL (men), >50 mg/dL (women)
Triglycerides	<150 mg/dL

Diabetes Screening

Who to screen:

All adults age 35+ (every 3 years if normal)
Earlier if overweight/obese with risk factors
All adults with hypertension

Methods:

Fasting plasma glucose (FPG)
HbA1c
2-hour oral glucose tolerance test (OGTT)

Test	Normal	Prediabetes	Diabetes
FPG	<100 mg/dL	100-125	≥126
HbA1c	<5.7%	5.7-6.4%	≥6.5%

Other Important Screenings

Osteoporosis

DEXA Scan Recommendations:

Women age 65+
Men age 70+
Earlier if risk factors present (low body weight, steroid use, smoking, prior fracture)

Depression

Screen all adults, especially:

Pregnant and postpartum women
Chronic disease patients
Adolescents

Tools: PHQ-2 (initial), PHQ-9 (full assessment)

Sexually Transmitted Infections

Population	Screening
Sexually active women <25	Annual chlamydia and gonorrhea
Pregnant women	Syphilis, HIV, Hep B at first prenatal; others based on risk
MSM (men who have sex with men)	At least annual HIV, syphilis, chlamydia, gonorrhea
HIV-positive individuals	Annual screening for STIs

Hepatitis C

Who to screen:

All adults age 18-79 (at least once)
Anyone with risk factors (IV drug use, blood transfusion before 1992)

Preventive Care Summary by Age

Age Group	Key Screenings
18-39	BP, lipids (age 20+), STIs if sexually active, depression
40-49	Add mammography (age 40), diabetes (age 35+)
50-64	Add colonoscopy (age 45+), lung cancer if smoker
65+	Add DEXA, consider discontinuing some screenings

Exam Tips

Know when to START each screening (age triggers)
Know frequency of repeat screenings
Recognize high-risk factors that warrant earlier screening
Understand shared decision-making for prostate cancer screening
Remember colorectal cancer screening now starts at 45 (updated from 50)
Cervical cancer screening starts at 21 regardless of sexual activity

NCLEX-RN

1Introduction

2Chapter 2: Management of Care

3Chapter 3: Safety and Infection Prevention and Control

4Chapter 4: Health Promotion and Maintenance

5Chapter 5: Psychosocial Integrity

6Chapter 6: Basic Care and Comfort

7Chapter 7: Pharmacological and Parenteral Therapies

8Chapter 8: Reduction of Risk Potential

9Chapter 9: Physiological Adaptation

Key Takeaways