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Difficulty: Very hardHealth Screening

An outpatient triage nurse is reviewing the electronic health records of several clients scheduled for health maintenance visits today. Based on current evidence-based guidelines, which of the following clients require immediate scheduling or referral for a specific secondary prevention health screening? Select all that apply.

  1. A 62-year-old client with a 25-pack-year smoking history who successfully quit 8 years ago, and has never had a low-dose computed tomography (LDCT) scan.Answer
  2. B
    A 25-year-old female client who received the complete human papillomavirus (HPV) vaccine series in adolescence, presenting to request her first cervical cytology and HPV DNA co-test.
  3. A 38-year-old client with no personal medical history whose mother was diagnosed with colorectal cancer at age 45, who has never had a screening colonoscopy.Answer
  4. D
    A 55-year-old female client undergoing natural menopause, with a normal body mass index and no history of fragility fractures, requesting a baseline dual-energy x-ray absorptiometry (DEXA) scan.
  5. A 42-year-old client with a body mass index (BMI) of 28 kg/m228 \text{ kg/m}^2, a blood pressure of 132/84 mmHg132/84 \text{ mmHg}, and no prior fasting blood glucose or hemoglobin A1C assessments on file.Answer
  6. F
    A 30-year-old client who sustained a minor outdoor laceration, requesting a tetanus, diphtheria, and pertussis (Tdap) antibody titer to screen for a potential developing infection.

Answer

The clients requiring immediate screening are the 62-year-old former smoker (requires LDCT), the 38-year-old with a family history of early colorectal cancer (requires colonoscopy), and the overweight 42-year-old (requires diabetes screening).
The correct selections strictly reflect current national evidence-based guidelines for secondary prevention. The former smoker meets the age (50-80), pack-year (≥20 \ge 20), and quit-duration (<15<15 years) criteria for annual lung cancer screening. The client with a parental history of early-onset colorectal cancer requires screening starting 10 years before the relative's diagnosis, which calculates to age 35. The 42-year-old meets the age and weight criteria for type 2 diabetes screening, which is recommended for nonpregnant adults aged 35 to 70 with a BMI of 25 or higher.

Step-by-Step Solution

1
Evaluate the 62-year-old client's smoking history against current lung cancer screening guidelines.
The client meets the exact criteria for annual LDCT.
Guidelines recommend LDCT for adults aged 50-80 with a 20+ pack-year history who currently smoke or quit within 15 years.
2
Analyze the 38-year-old client's familial risk for colorectal cancer.
The client is 3 years overdue for a screening colonoscopy.
Screening must begin 10 years prior to the first-degree relative's age of diagnosis (45 - 10 = 35) when the diagnosis occurs before age 60.
3
Assess the 42-year-old client's cardiometabolic risk profile.
The client requires type 2 diabetes screening.
Adults aged 35-70 who are overweight (BMI≥25BMI \ge 25) or obese require abnormal blood glucose screening.
4
Rule out screenings that misapply age parameters or represent a misunderstanding of prevention levels.
The 25-year-old, 55-year-old, and 30-year-old clients do not require the specific interventions they are requesting.
Co-testing for cervical cancer begins at 30; routine DEXA begins at 65; and Tdap is primary prophylaxis, not a secondary screening for acute infection.

Key Concept

Applying evidence-based, age- and risk-specific health screening guidelines across the adult lifespan.
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Topics

Health Screening

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