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NUR 5434 FNP III Module 1
Screening & Counseling
Define the evidence-based rating scale categories used by USPSTF (A, B, C, D, I)
*Evidence-based preventive services are graded by the U.S. Preventative Services Task
Force (USPSTF) based on the balance of benefits and harms
Grade A: strongly recommended- there is a high certainty of substantial net benefit.
Providers SHOULD offer or provide this service.
Grade B: recommended- there is a high certain or moderate benefit or moderate
certainty of moderate-to-substantial benefit. Providers should offer or provide this
service.
Grade C: Selectively recommended- there is at least moderate certainty of small net
benefit. Providers should offer based on individual circumstances.
Grade D: NOT recommended- there is moderate or high certainty of no net benefit or
that harm outweighs benefits. DISCOURAGE use of this service.
Grade I: Insufficient evidence- current evidence is lacking or conflicting, so NO
RECOMMENDATION can be made; if it is offered by providers, patients should
understand the uncertainty
Identify the major A and B ratings for prevention screening, counseling topics, and
prevention meds for adults as recommended by the USPSTF. Especially know the
cancer detection recommendations for breast, cervical, prostate, colon, and lung
Breast Cancer- screening mammography-Grade B recommendation biennial mammograms
for women aged 40-74. Early detection via mammography has shown moderate-to-
substantial benefit in reducing mortality.
Cervical Cancer- pap smear and HPV testing- recommended screening women ages 21-65;
pap test every 3 years in those ages 21-29. For ages 30-65 recommend pap every 3 years,
high-risk HPV test every 5 years or co-testing (pap+HPV) every 5 years. Screening can be
stopped after age 65 if there’s a history of adequate normal results.
Colorectal Cancer- colonoscopy, FIT, or other approved tests- Grade A for screening all adults
aged 50-75. Grade B for screening ages 45-49 due to rising colorectal cancer occurrences in
, 2
younger adults. Different ways to do these screenings including colonoscopy every 10 years,
annual fecal occult blood tests. Etc.)
Lung Cancer- Grade B recommendations of low-dose CT scan annually in high-risk adults age
50-80 who have a 20 or more pack-year smoking history, currently smoke, or quit smoking
within last 15 years. This detects lung cancer at earlier treatable stages and has a moderate
net benefit in this high-risk group.
Prostate Cancer- NO grade A/B recommendation. Grade C for men age 55-69 so
individualized decision-making so providers should discuss potential benefits vs. harms and
respect patient preferences
HIV- Grade A screening recommendations for all adolescents and adults age 15-65 at least
once and those at high risk
Hep C- Grade B screening recommendations for one-time screening for adults age 18-79
STI- Grade B screening for chlamydia/gonorrhea in sexually active women less than and up
to 24 years old. Syphilis screening grade A for high-risk individuals.
Preventative medication & counseling- smoking cessation Grade A recommendation to ask
all adults about tobacco use, advise them to quit, provide behavioral interventions and FDA
approved medications to assist with tobacco/smoking cessation; alcohol misuse counseling
Grade B recommendation to screen adults for unhealthy alcohol use and provide brief
counseling interventions; fall prevention Grade B recommendation for community-dwelling
older adults at risk for falls…exercise, PT, vitamin D supplementation
• Identify the D ratings that are advised NOT to use for prevention due to negative
outcomes
Grade D screening women for cervical cancer that are <21 or >65 or s/p hysterectomy.
Grade D screening men for prostate cancer who are 70 or older.
• Identify the CDC-ACIP recommended adult immunizations for routine and high-risk
individuals with an emphasis on TD/Tdap, Zostavax, Shingrix, Prevnar, Pneumovax,
Influenza, HPV, MMR, and Varicella
TD/Tdap- adults should receive one Tdap booster to protect against pertussis, then Td or
Tdap booster every 10 years; pregnant women need with every pregnancy between 27-36
weeks (this is to pass immunity to the newborn)
Zostavax- Zoster live vaccine and is NO LONGER RECOMMENDED due to low efficacy; if a
patient has had in the past they will need Shingrix series
NUR 5434 FNP III Module 1
Screening & Counseling
Define the evidence-based rating scale categories used by USPSTF (A, B, C, D, I)
*Evidence-based preventive services are graded by the U.S. Preventative Services Task
Force (USPSTF) based on the balance of benefits and harms
Grade A: strongly recommended- there is a high certainty of substantial net benefit.
Providers SHOULD offer or provide this service.
Grade B: recommended- there is a high certain or moderate benefit or moderate
certainty of moderate-to-substantial benefit. Providers should offer or provide this
service.
Grade C: Selectively recommended- there is at least moderate certainty of small net
benefit. Providers should offer based on individual circumstances.
Grade D: NOT recommended- there is moderate or high certainty of no net benefit or
that harm outweighs benefits. DISCOURAGE use of this service.
Grade I: Insufficient evidence- current evidence is lacking or conflicting, so NO
RECOMMENDATION can be made; if it is offered by providers, patients should
understand the uncertainty
Identify the major A and B ratings for prevention screening, counseling topics, and
prevention meds for adults as recommended by the USPSTF. Especially know the
cancer detection recommendations for breast, cervical, prostate, colon, and lung
Breast Cancer- screening mammography-Grade B recommendation biennial mammograms
for women aged 40-74. Early detection via mammography has shown moderate-to-
substantial benefit in reducing mortality.
Cervical Cancer- pap smear and HPV testing- recommended screening women ages 21-65;
pap test every 3 years in those ages 21-29. For ages 30-65 recommend pap every 3 years,
high-risk HPV test every 5 years or co-testing (pap+HPV) every 5 years. Screening can be
stopped after age 65 if there’s a history of adequate normal results.
Colorectal Cancer- colonoscopy, FIT, or other approved tests- Grade A for screening all adults
aged 50-75. Grade B for screening ages 45-49 due to rising colorectal cancer occurrences in
, 2
younger adults. Different ways to do these screenings including colonoscopy every 10 years,
annual fecal occult blood tests. Etc.)
Lung Cancer- Grade B recommendations of low-dose CT scan annually in high-risk adults age
50-80 who have a 20 or more pack-year smoking history, currently smoke, or quit smoking
within last 15 years. This detects lung cancer at earlier treatable stages and has a moderate
net benefit in this high-risk group.
Prostate Cancer- NO grade A/B recommendation. Grade C for men age 55-69 so
individualized decision-making so providers should discuss potential benefits vs. harms and
respect patient preferences
HIV- Grade A screening recommendations for all adolescents and adults age 15-65 at least
once and those at high risk
Hep C- Grade B screening recommendations for one-time screening for adults age 18-79
STI- Grade B screening for chlamydia/gonorrhea in sexually active women less than and up
to 24 years old. Syphilis screening grade A for high-risk individuals.
Preventative medication & counseling- smoking cessation Grade A recommendation to ask
all adults about tobacco use, advise them to quit, provide behavioral interventions and FDA
approved medications to assist with tobacco/smoking cessation; alcohol misuse counseling
Grade B recommendation to screen adults for unhealthy alcohol use and provide brief
counseling interventions; fall prevention Grade B recommendation for community-dwelling
older adults at risk for falls…exercise, PT, vitamin D supplementation
• Identify the D ratings that are advised NOT to use for prevention due to negative
outcomes
Grade D screening women for cervical cancer that are <21 or >65 or s/p hysterectomy.
Grade D screening men for prostate cancer who are 70 or older.
• Identify the CDC-ACIP recommended adult immunizations for routine and high-risk
individuals with an emphasis on TD/Tdap, Zostavax, Shingrix, Prevnar, Pneumovax,
Influenza, HPV, MMR, and Varicella
TD/Tdap- adults should receive one Tdap booster to protect against pertussis, then Td or
Tdap booster every 10 years; pregnant women need with every pregnancy between 27-36
weeks (this is to pass immunity to the newborn)
Zostavax- Zoster live vaccine and is NO LONGER RECOMMENDED due to low efficacy; if a
patient has had in the past they will need Shingrix series
