BAYLOR UNIVERSITY NURSING PAPER 1 (2026) |
REVISION QUESTIONS AND DETAILED ANSWERS |
EXAM NEWEST. - 150 Questions
Section 1: Health Promotion and Maintenance (Questions 1-19)
1 A community health initiative aims to reduce cardiovascular disease burden. Using the RE-AIM framework,
which metric best captures the public health impact if the program reaches 60% of the target population but only
30% of those adopt the behavior change?
A) Reach × Adoption × Implementation × Maintenance
B) Effectiveness × Reach × Adoption
C) Reach × Efficacy × Adoption
D) Implementation × Maintenance × Reach
Answer: A
Rationale: The RE-AIM framework defines public health impact as Reach × Effectiveness × Adoption ×
Implementation × Maintenance. Option A correctly includes all five dimensions. Option B omits Implementation
and Maintenance, which are critical for sustained impact. Option C substitutes Efficacy (controlled) for
Effectiveness (real-world). Option D omits Effectiveness.
2 A 35-year-old asymptomatic individual with a first-degree relative diagnosed with colorectal cancer at age 45
presents for a wellness visit. According to the US Preventive Services Task Force (USPSTF) guidelines, what is
the most appropriate recommendation?
A) Begin screening at age 45 with colonoscopy every 10 years
B) Begin screening at age 40 or 10 years before the youngest affected relative's diagnosis, whichever is earlier
C) Begin screening at age 50 with fecal immunochemical testing annually
D) Refer for genetic counseling and consider colonoscopy now
Answer: B
Rationale: For individuals with a first-degree relative with colorectal cancer before age 60, guidelines recommend
initiating screening at age 40 or 10 years before the youngest affected relative's diagnosis, whichever is earlier.
Option A is for average-risk individuals. Option C is outdated (age 50) and does not account for family history.
Option D is for hereditary syndromes, which require more specific criteria (e.g., multiple relatives, young age).
3 In a population-based smoking cessation program, the quit rate at 6 months is 15% in the intervention group and
10% in the control group. The number needed to treat (NNT) is:
A) 5
B) 10
C) 20
D) 50
Answer: C
Rationale: NNT = 1 / (absolute risk reduction) = 1 / (0.15 - 0.10) = .05 = 20. Option A (5) would correspond to
an ARR of 0.20. Option B (10) to ARR 0.10. Option D (50) to ARR 0.02.
4 A nurse practitioner is counseling a 55-year-old woman with a 10-year atherosclerotic cardiovascular disease
(ASCVD) risk of 7.5% about statin therapy. According to the ACC/AHA guidelines, which statement is most
accurate?
,A) Statin therapy is not indicated because her risk is below 10%
B) A moderate-intensity statin is recommended after a discussion of risk-benefit
C) High-intensity statin is indicated because she has a risk factor of age >50
D) Statin therapy should be initiated only if LDL >190 mg/dL
Answer: B
Rationale: ACC/AHA guidelines recommend moderate-intensity statin for primary prevention in individuals with
ASCVD risk 7.5-19.9% after clinician-patient risk discussion. Option A is incorrect because the threshold is 7.5%.
Option C is not supported; high-intensity statin is for risk >20% or clinical ASCVD. Option D applies to familial
hypercholesterolemia, not this scenario.
5 Which of the following best describes the concept of 'health literacy' as it relates to health promotion?
A) The ability to read and write in a healthcare context
B) The capacity to obtain, process, and understand basic health information to make appropriate health decisions
C) The level of education a person has achieved
D) The ability to navigate the healthcare system
Answer: B
Rationale: Health literacy, as defined by Healthy People 2030, includes the ability to find, understand, and use
health information. Option A is too narrow (reading/writing only). Option C confuses with educational attainment.
Option D is a component but not the full definition.
6 A public health department is implementing a community-based intervention to increase physical activity
among adults. Using the socio-ecological model, which strategy addresses the organizational level?
A) Building walking trails in parks
B) Offering worksite fitness programs with flexible hours
C) Providing pedometers to individuals
D) Creating a social media campaign about benefits of exercise
Answer: B
Rationale: The socio-ecological model includes individual, interpersonal, organizational, community, and policy
levels. Worksite programs represent the organizational level. Option A is community-level (built environment).
Option C is individual-level. Option D is interpersonal or community-level (media).
7 A 45-year-old man with prediabetes (HbA1c 6.2%) asks about prevention. According to the Diabetes Prevention
Program (DPP) trial, which intervention is most effective?
A) Metformin 850 mg twice daily
B) Lifestyle modification targeting 7% weight loss and 150 minutes of physical activity per week
C) Low-carbohydrate diet without structured physical activity
D) Vitamin D supplementation 4000 IU daily
Answer: B
Rationale: The DPP trial showed lifestyle intervention reduced diabetes incidence by 58% compared to 31% with
metformin. Option B reflects the DPP protocol. Option A is less effective. Option C lacks evidence for long-term
prevention. Option D is not supported by major trials.
8 In a cohort study, the relative risk of developing lung cancer among smokers compared to non-smokers is 20.
The population attributable risk percent (PAR%) is 85%. What does this imply?
A) 85% of lung cancer cases in the population are due to smoking
B) Smokers have an 85% higher risk of lung cancer than non-smokers
C) If smoking were eliminated, lung cancer incidence would decrease by 85% in smokers
,D) The risk of lung cancer among smokers is 20 times that of non-smokers, and 85% of cases are attributable to
smoking
Answer: D
Rationale: Relative risk of 20 indicates smokers have 20 times the risk. PAR% of 85% means 85% of lung cancer
cases in the population are attributable to smoking. Option A is partially correct but incomplete. Option B confuses
relative risk with attributable risk. Option C incorrectly restricts to smokers.
9 A nurse is evaluating a community-based hypertension screening program. Which measure best assesses the
program's validity?
A) Proportion of screen-positive individuals who are confirmed hypertensive on follow-up
B) Number of individuals screened per month
C) Cost per case detected
D) Percentage of target population reached
Answer: A
Rationale: Validity of a screening program is assessed by positive predictive value (PPV), which is the proportion of
screen-positives who truly have the disease. Option A describes PPV. Option B is a measure of reach (process).
Option C is cost-effectiveness. Option D is coverage.
10 Which immunization schedule is recommended by the CDC for an adult with asplenia who has not received
any pneumococcal vaccine?
A) PCV15 followed by PPSV23 at least 8 weeks later
B) PPSV23 only, with a second dose after 5 years
C) PCV20 alone as a single dose
D) PCV13 followed by PPSV23 after 1 year
Answer: A
Rationale: For asplenic adults, CDC recommends PCV15 (or PCV20) followed by PPSV23 at least 8 weeks later.
Option A is correct. Option B (PPSV23 only) is insufficient. Option C (PCV20 alone) is acceptable but not the
preferred sequence for those not previously vaccinated. Option D uses PCV13, which has been replaced by
PCV15/20.
11 A community health initiative aims to reduce cardiovascular disease (CVD) incidence over 10 years. Based on
the most recent evidence from the American Heart Association, which combination of population-level
strategies is most likely to achieve a significant reduction in CVD burden across all socioeconomic strata?
A) Mandatory reduction of sodium content in processed foods combined with a sugar-sweetened beverage tax
and increased access to green spaces
B) Universal screening for hypertension at age 40 with pharmacotherapy initiation for all with BP >130/80
mmHg
C) Individual counseling sessions for high-risk individuals focusing on dietary fat reduction and smoking
cessation
D) Mass media campaigns promoting the Mediterranean diet and daily physical activity of 30 minutes
Answer: A
Rationale: Population-level structural interventions (sodium reduction, sugar tax, green spaces) address root
environmental determinants and have been shown to produce broad, equitable reductions in CVD incidence.
Screening (B) is secondary prevention, not primary; individual counseling (C) has limited reach and adherence;
mass media (D) alone lacks evidence for sustained behavior change.
, 12 A nurse is evaluating the effectiveness of a worksite wellness program designed to prevent metabolic
syndrome. The program includes a 12-week intervention of supervised aerobic exercise three times per week
and nutrition education. Which outcome measure would provide the strongest evidence of reduced metabolic
risk at the population level?
A) Reduction in mean waist circumference by 3 cm from baseline
B) Decrease in the proportion of employees with fasting blood glucose 100 mg/dL
C) Increase in self-reported daily fruit and vegetable intake to 5 servings
D) Improvement in the overall Framingham Risk Score by at least 10%
Answer: B
Rationale: Metabolic syndrome diagnosis requires three of five criteria; fasting glucose is a core component. A
decrease in the proportion with impaired fasting glucose directly reduces metabolic syndrome prevalence. Waist
circumference (A) is one criterion but less specific; dietary intake (C) is a process measure; Framingham Risk
Score (D) predicts CVD, not metabolic syndrome specifically.
13 A public health department is planning a colorectal cancer screening program. According to the U.S. Preventive
Services Task Force (USPSTF) 2021 guidelines, which screening strategy should be recommended for
average-risk adults to maximize both adherence and detection of advanced adenomas?
A) Annual high-sensitivity fecal immunochemical test (FIT) with colonoscopy if positive
B) Colonoscopy every 10 years beginning at age 45
C) CT colonography every 5 years
D) Multitarget stool DNA testing every 3 years
Answer: B
Rationale: The USPSTF gives an A recommendation for colonoscopy every 10 years (ages 45–75) as a primary
screening method; it is the gold standard for detection and removal of adenomas. FIT (A) is an alternative but less
sensitive for advanced adenomas; CT colonography (C) requires bowel preparation and radiation; stool DNA (D) is
less specific and more costly.
14 A nurse practitioner is counseling a group of adults with prediabetes (HbA1c 5.7-6.4%) on diabetes prevention.
Based on the Diabetes Prevention Program (DPP) outcomes and current American Diabetes Association
recommendations, which intervention component is most critical for achieving a 58% reduction in progression
to type 2 diabetes?
A) Metformin therapy for all participants regardless of age
B) A structured lifestyle intervention targeting 7% weight loss and 150 minutes of moderate physical activity per
week
C) Daily self-monitoring of blood glucose to guide dietary choices
D) A low-carbohydrate diet with less than 30 grams of carbohydrates per day
Answer: B
Rationale: The DPP demonstrated that intensive lifestyle intervention (7% weight loss, 150 min/week activity)
reduced diabetes incidence by 58% in adults with prediabetes, superior to metformin (31% reduction). Metformin
(A) is recommended for those with BMI 35 or age <60; self-monitoring (C) is not standard for prediabetes;
low-carb diet (D) lacks long-term evidence for prevention.
15 A school-based program aims to prevent obesity in adolescents. Using a socio-ecological framework, which
intervention strategy is most likely to produce sustainable changes in body mass index (BMI) trajectories?
A) Providing daily physical education classes with a focus on competitive sports
B) Implementing a school-wide policy that eliminates sugar-sweetened beverages and increases access to water
fountains
REVISION QUESTIONS AND DETAILED ANSWERS |
EXAM NEWEST. - 150 Questions
Section 1: Health Promotion and Maintenance (Questions 1-19)
1 A community health initiative aims to reduce cardiovascular disease burden. Using the RE-AIM framework,
which metric best captures the public health impact if the program reaches 60% of the target population but only
30% of those adopt the behavior change?
A) Reach × Adoption × Implementation × Maintenance
B) Effectiveness × Reach × Adoption
C) Reach × Efficacy × Adoption
D) Implementation × Maintenance × Reach
Answer: A
Rationale: The RE-AIM framework defines public health impact as Reach × Effectiveness × Adoption ×
Implementation × Maintenance. Option A correctly includes all five dimensions. Option B omits Implementation
and Maintenance, which are critical for sustained impact. Option C substitutes Efficacy (controlled) for
Effectiveness (real-world). Option D omits Effectiveness.
2 A 35-year-old asymptomatic individual with a first-degree relative diagnosed with colorectal cancer at age 45
presents for a wellness visit. According to the US Preventive Services Task Force (USPSTF) guidelines, what is
the most appropriate recommendation?
A) Begin screening at age 45 with colonoscopy every 10 years
B) Begin screening at age 40 or 10 years before the youngest affected relative's diagnosis, whichever is earlier
C) Begin screening at age 50 with fecal immunochemical testing annually
D) Refer for genetic counseling and consider colonoscopy now
Answer: B
Rationale: For individuals with a first-degree relative with colorectal cancer before age 60, guidelines recommend
initiating screening at age 40 or 10 years before the youngest affected relative's diagnosis, whichever is earlier.
Option A is for average-risk individuals. Option C is outdated (age 50) and does not account for family history.
Option D is for hereditary syndromes, which require more specific criteria (e.g., multiple relatives, young age).
3 In a population-based smoking cessation program, the quit rate at 6 months is 15% in the intervention group and
10% in the control group. The number needed to treat (NNT) is:
A) 5
B) 10
C) 20
D) 50
Answer: C
Rationale: NNT = 1 / (absolute risk reduction) = 1 / (0.15 - 0.10) = .05 = 20. Option A (5) would correspond to
an ARR of 0.20. Option B (10) to ARR 0.10. Option D (50) to ARR 0.02.
4 A nurse practitioner is counseling a 55-year-old woman with a 10-year atherosclerotic cardiovascular disease
(ASCVD) risk of 7.5% about statin therapy. According to the ACC/AHA guidelines, which statement is most
accurate?
,A) Statin therapy is not indicated because her risk is below 10%
B) A moderate-intensity statin is recommended after a discussion of risk-benefit
C) High-intensity statin is indicated because she has a risk factor of age >50
D) Statin therapy should be initiated only if LDL >190 mg/dL
Answer: B
Rationale: ACC/AHA guidelines recommend moderate-intensity statin for primary prevention in individuals with
ASCVD risk 7.5-19.9% after clinician-patient risk discussion. Option A is incorrect because the threshold is 7.5%.
Option C is not supported; high-intensity statin is for risk >20% or clinical ASCVD. Option D applies to familial
hypercholesterolemia, not this scenario.
5 Which of the following best describes the concept of 'health literacy' as it relates to health promotion?
A) The ability to read and write in a healthcare context
B) The capacity to obtain, process, and understand basic health information to make appropriate health decisions
C) The level of education a person has achieved
D) The ability to navigate the healthcare system
Answer: B
Rationale: Health literacy, as defined by Healthy People 2030, includes the ability to find, understand, and use
health information. Option A is too narrow (reading/writing only). Option C confuses with educational attainment.
Option D is a component but not the full definition.
6 A public health department is implementing a community-based intervention to increase physical activity
among adults. Using the socio-ecological model, which strategy addresses the organizational level?
A) Building walking trails in parks
B) Offering worksite fitness programs with flexible hours
C) Providing pedometers to individuals
D) Creating a social media campaign about benefits of exercise
Answer: B
Rationale: The socio-ecological model includes individual, interpersonal, organizational, community, and policy
levels. Worksite programs represent the organizational level. Option A is community-level (built environment).
Option C is individual-level. Option D is interpersonal or community-level (media).
7 A 45-year-old man with prediabetes (HbA1c 6.2%) asks about prevention. According to the Diabetes Prevention
Program (DPP) trial, which intervention is most effective?
A) Metformin 850 mg twice daily
B) Lifestyle modification targeting 7% weight loss and 150 minutes of physical activity per week
C) Low-carbohydrate diet without structured physical activity
D) Vitamin D supplementation 4000 IU daily
Answer: B
Rationale: The DPP trial showed lifestyle intervention reduced diabetes incidence by 58% compared to 31% with
metformin. Option B reflects the DPP protocol. Option A is less effective. Option C lacks evidence for long-term
prevention. Option D is not supported by major trials.
8 In a cohort study, the relative risk of developing lung cancer among smokers compared to non-smokers is 20.
The population attributable risk percent (PAR%) is 85%. What does this imply?
A) 85% of lung cancer cases in the population are due to smoking
B) Smokers have an 85% higher risk of lung cancer than non-smokers
C) If smoking were eliminated, lung cancer incidence would decrease by 85% in smokers
,D) The risk of lung cancer among smokers is 20 times that of non-smokers, and 85% of cases are attributable to
smoking
Answer: D
Rationale: Relative risk of 20 indicates smokers have 20 times the risk. PAR% of 85% means 85% of lung cancer
cases in the population are attributable to smoking. Option A is partially correct but incomplete. Option B confuses
relative risk with attributable risk. Option C incorrectly restricts to smokers.
9 A nurse is evaluating a community-based hypertension screening program. Which measure best assesses the
program's validity?
A) Proportion of screen-positive individuals who are confirmed hypertensive on follow-up
B) Number of individuals screened per month
C) Cost per case detected
D) Percentage of target population reached
Answer: A
Rationale: Validity of a screening program is assessed by positive predictive value (PPV), which is the proportion of
screen-positives who truly have the disease. Option A describes PPV. Option B is a measure of reach (process).
Option C is cost-effectiveness. Option D is coverage.
10 Which immunization schedule is recommended by the CDC for an adult with asplenia who has not received
any pneumococcal vaccine?
A) PCV15 followed by PPSV23 at least 8 weeks later
B) PPSV23 only, with a second dose after 5 years
C) PCV20 alone as a single dose
D) PCV13 followed by PPSV23 after 1 year
Answer: A
Rationale: For asplenic adults, CDC recommends PCV15 (or PCV20) followed by PPSV23 at least 8 weeks later.
Option A is correct. Option B (PPSV23 only) is insufficient. Option C (PCV20 alone) is acceptable but not the
preferred sequence for those not previously vaccinated. Option D uses PCV13, which has been replaced by
PCV15/20.
11 A community health initiative aims to reduce cardiovascular disease (CVD) incidence over 10 years. Based on
the most recent evidence from the American Heart Association, which combination of population-level
strategies is most likely to achieve a significant reduction in CVD burden across all socioeconomic strata?
A) Mandatory reduction of sodium content in processed foods combined with a sugar-sweetened beverage tax
and increased access to green spaces
B) Universal screening for hypertension at age 40 with pharmacotherapy initiation for all with BP >130/80
mmHg
C) Individual counseling sessions for high-risk individuals focusing on dietary fat reduction and smoking
cessation
D) Mass media campaigns promoting the Mediterranean diet and daily physical activity of 30 minutes
Answer: A
Rationale: Population-level structural interventions (sodium reduction, sugar tax, green spaces) address root
environmental determinants and have been shown to produce broad, equitable reductions in CVD incidence.
Screening (B) is secondary prevention, not primary; individual counseling (C) has limited reach and adherence;
mass media (D) alone lacks evidence for sustained behavior change.
, 12 A nurse is evaluating the effectiveness of a worksite wellness program designed to prevent metabolic
syndrome. The program includes a 12-week intervention of supervised aerobic exercise three times per week
and nutrition education. Which outcome measure would provide the strongest evidence of reduced metabolic
risk at the population level?
A) Reduction in mean waist circumference by 3 cm from baseline
B) Decrease in the proportion of employees with fasting blood glucose 100 mg/dL
C) Increase in self-reported daily fruit and vegetable intake to 5 servings
D) Improvement in the overall Framingham Risk Score by at least 10%
Answer: B
Rationale: Metabolic syndrome diagnosis requires three of five criteria; fasting glucose is a core component. A
decrease in the proportion with impaired fasting glucose directly reduces metabolic syndrome prevalence. Waist
circumference (A) is one criterion but less specific; dietary intake (C) is a process measure; Framingham Risk
Score (D) predicts CVD, not metabolic syndrome specifically.
13 A public health department is planning a colorectal cancer screening program. According to the U.S. Preventive
Services Task Force (USPSTF) 2021 guidelines, which screening strategy should be recommended for
average-risk adults to maximize both adherence and detection of advanced adenomas?
A) Annual high-sensitivity fecal immunochemical test (FIT) with colonoscopy if positive
B) Colonoscopy every 10 years beginning at age 45
C) CT colonography every 5 years
D) Multitarget stool DNA testing every 3 years
Answer: B
Rationale: The USPSTF gives an A recommendation for colonoscopy every 10 years (ages 45–75) as a primary
screening method; it is the gold standard for detection and removal of adenomas. FIT (A) is an alternative but less
sensitive for advanced adenomas; CT colonography (C) requires bowel preparation and radiation; stool DNA (D) is
less specific and more costly.
14 A nurse practitioner is counseling a group of adults with prediabetes (HbA1c 5.7-6.4%) on diabetes prevention.
Based on the Diabetes Prevention Program (DPP) outcomes and current American Diabetes Association
recommendations, which intervention component is most critical for achieving a 58% reduction in progression
to type 2 diabetes?
A) Metformin therapy for all participants regardless of age
B) A structured lifestyle intervention targeting 7% weight loss and 150 minutes of moderate physical activity per
week
C) Daily self-monitoring of blood glucose to guide dietary choices
D) A low-carbohydrate diet with less than 30 grams of carbohydrates per day
Answer: B
Rationale: The DPP demonstrated that intensive lifestyle intervention (7% weight loss, 150 min/week activity)
reduced diabetes incidence by 58% in adults with prediabetes, superior to metformin (31% reduction). Metformin
(A) is recommended for those with BMI 35 or age <60; self-monitoring (C) is not standard for prediabetes;
low-carb diet (D) lacks long-term evidence for prevention.
15 A school-based program aims to prevent obesity in adolescents. Using a socio-ecological framework, which
intervention strategy is most likely to produce sustainable changes in body mass index (BMI) trajectories?
A) Providing daily physical education classes with a focus on competitive sports
B) Implementing a school-wide policy that eliminates sugar-sweetened beverages and increases access to water
fountains
