4.2 Health Screening and Disease Prevention

Levels of Prevention

Nearly every prevention item asks you to classify an activity. Memorize the verb: prevent (primary), detect (secondary), or limit damage (tertiary).

Trap: the same content can be different levels depending on context. Teaching a low-sodium diet to a healthy person is primary; teaching it to a heart-failure patient to prevent readmission is tertiary.

Childhood Immunization Timing (CDC Schedule)

MMR and varicella are live vaccines—contraindicated in pregnancy and significant immunosuppression, and given no earlier than 12 months because maternal antibodies interfere before then.

The exam tests vaccine spacing and contraindications more than exact dates. Two live vaccines (such as MMR and varicella) must be given on the same day or separated by at least 4 weeks; if separated by less, the second dose does not count. A mild illness with low-grade fever is not a contraindication—holding a vaccine for a runny nose is a common wrong answer. True contraindications are a previous anaphylactic reaction to the vaccine or a component, and live vaccines in pregnancy or immunocompromise.

After any vaccine, observe the patient for 15 minutes for anaphylaxis, document the lot number and site, and provide the federally required Vaccine Information Statement.

Adult Immunizations

Screening Recommendations the Exam Expects

Cancer Screening (USPSTF)

The heavily tested anchor is colorectal screening beginning at 45 for average risk; earlier with family history or genetic risk.

Cardiometabolic and Infection Screening

• Blood pressure: check at least annually; confirm elevated readings.
• Lipid panel: periodically in adults; risk-based.
• Diabetes: screen adults with overweight/obesity or other risk factors.
• HIV: at least once for everyone 13-64; more often if high risk.
• Hepatitis C: at least once for adults 18-79.
• Chlamydia/gonorrhea: annually for sexually active women under 25.

Pediatric Screening

The LPN/LVN's Prevention Role and Common Traps

Traps: the LPN/LVN reinforces but does not perform the initial comprehensive teaching or design the plan; do not give a live vaccine to a pregnant or immunosuppressed patient; and recommending a colonoscopy "only if symptoms appear" is wrong—screening is for asymptomatic people. Address barriers (cost, fear, culture, access) by connecting patients to community resources rather than dismissing concerns.

Putting Prevention Levels to Work

A reliable strategy on prevention items is to ignore the disease named in the stem and focus on the timing relative to disease. If the patient has no disease yet and you are blocking a future problem—folic acid before conception to prevent neural tube defects, fluoride to prevent caries, a tetanus shot—it is primary. If the patient may already have silent disease and you are looking for it—a fasting glucose, a Pap test, a depression screening questionnaire—it is secondary.

If the patient already carries a diagnosis and you are preventing it from getting worse or restoring function—teaching foot care to a diabetic to prevent amputation, pulmonary rehab in COPD, occupational therapy after a stroke—it is tertiary. Education is the most confusing distractor because it spans all three levels depending on the audience, so always anchor your answer to whether disease is absent, hidden, or established.