Start, Repeat or Stop: Applying Screening Guidance to a 66-Year-Old Woman at Her First Medicare Wellness Visit
Student Name
American College of Education
NUR4073: Health Promotion
Module 3 Assignment
Instructor Name
November 16, 2026
The Client's Relevant History
The client is a 66-year-old retired school librarian attending her first Medicare Annual Wellness Visit after moving to be near her daughter. She and her records are composites written for this assignment. Her records from her previous practice show a normal screening colonoscopy at age 56 with no polyps, a combined cervical cytology and human papillomavirus test that was negative at ages 58 and 63, and a screening mammogram three years ago that was normal. She has never had a bone density test. She smoked about half a pack a day for twenty-four years, roughly twelve pack-years, and quit at age 46. She has no personal history of cancer, no relatives with cancers of the breast, ovary or bowel, and no history of fracture. Her body mass index is 23.
Screening decisions for an older adult depend on details like these more than on age alone. A screening recommendation is a rule with conditions, and each condition has to be checked against the record before a test is ordered, repeated or retired. The following sections apply each relevant recommendation in turn.
Tests to Start or Resume
Osteoporosis. The Task Force recommends screening for osteoporosis to prevent fractures in women aged 65 or older (U.S. Preventive Services Task Force [USPSTF], 2025). The client is 66 and has never been screened, so screening should start now, usually with dual-energy x-ray absorptiometry of the hip and spine. The recommendation does not set a fixed interval for repeat testing; the interval will depend on the result, and a normal result in a woman with no other risk factors usually supports a longer gap before any repeat.
Breast cancer. The Task Force recommends biennial screening mammography for women aged 40 to 74 (USPSTF, 2024). The client's last mammogram was three years ago, so she is overdue by about a year and should be screened now and then every two years until age 74. For women 75 and older the Task Force could not determine whether screening does more good than harm, so the decision at that point will be an individual one based on her health and preferences.
Colorectal cancer. The Task Force recommends screening adults aged 50 to 75 for colorectal cancer, with several acceptable strategies and intervals, including colonoscopy every ten years and a fecal immunochemical test every year (USPSTF, 2021a). Her normal colonoscopy was ten years ago at 56, so she is due now. Because a colonoscopy at 66 would carry her to age 76, one year past the age range for routine screening, this is likely to be her last screening colonoscopy if it is normal, and she may reasonably choose an annual stool test instead.
The colorectal choice deserves a short shared decision-making conversation rather than a default order. A colonoscopy needs bowel preparation, sedation and a driver, but a normal result would likely complete her screening. An annual stool test needs no preparation and can be done at home, but it must be repeated every year until 75, and a positive result still leads to colonoscopy. Presenting both options with those trade-offs, and recording her choice, respects the recommendation's own position that several strategies are acceptable and that adherence matters more than which test is chosen.
A Test to Stop
Cervical cancer. The Task Force recommends against screening for cervical cancer in women older than 65 who have had adequate prior screening and are not otherwise at high risk (USPSTF, 2018). Adequate prior screening is generally defined as three consecutive negative cytology results or two consecutive negative combined cytology and human papillomavirus tests within the previous ten years, with the most recent test within the last five years. The client's negative co-tests at 58 and 63 meet that definition: two consecutive negative co-tests within ten years, the most recent three years ago. She has no history of a high-grade precancerous lesion and no other high-risk condition.
Screening should therefore stop. The decision needs to be explained to her, because many women have been told for decades that a yearly or three-yearly test is essential, and stopping can feel like neglect. Retiring a screening test is part of screening, and documenting why it was retired protects the client from being screened again by a clinician who does not see the reasoning. The record should state that cervical screening was discontinued at 66 on the basis of adequate prior negative screening.
Tests That Do Not Apply
Lung cancer. Yearly low-dose computed tomography is recommended only when three conditions hold together: an age between 50 and 80, at least 20 pack-years of smoking, and either current smoking or a quit date within the last 15 years (USPSTF, 2021b). The client meets the age criterion but fails both of the others: her history is about twelve pack-years, and she quit twenty years ago. She is not eligible, and screening her would expose her to radiation and the risk of false-positive findings without the balance of benefit the recommendation is based on.
Abdominal aortic aneurysm. The aneurysm recommendation treats sexes and smoking histories differently: a single ultrasound is advised for male former or current smokers in their late sixties and early seventies, routine screening is advised against for women who never smoked, and for women of that age who did smoke the Task Force found the evidence inconclusive (USPSTF, 2019). The client falls into the last group. That is not a recommendation to screen or not to screen; it is a statement that the evidence cannot settle the question. Without a family history of aneurysm or other reason for concern, the reasonable course is to discuss it briefly and not order the test routinely.
The Plan in Summary
Taken together, the client leaves the visit with a clear plan. Bone density testing starts now, with the interval to be set by the result. Mammography resumes now and repeats every two years until 74. Colorectal screening is due now, by colonoscopy or by an annual stool test at her choice, with screening likely ending at 75. Cervical screening stops, with the reason documented. Lung cancer screening does not apply because of her pack-years and the time since she quit, and aneurysm screening is not routinely indicated for a woman with her history. The nurse's role in this plan is to check every condition against the record, explain each decision, including the ones to stop, and record the dates so that the next clinician can follow the plan without starting over.
Conclusion
Applying screening guidance well means more than knowing which tests exist. For this 66-year-old woman, six recommendations produced three decisions to start or resume, one to stop and two to leave a test aside, and each depended on details in her history: prior results and their dates, pack-years and quit date. Screening guidance protects patients when its conditions are applied carefully and harms them through unnecessary testing when they are not. The interval and the stopping rule are as much a part of each recommendation as the test itself.
References
U.S. Preventive Services Task Force. (2018). Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA, 320(7), 674-686. https://doi.org/10.1001/jama.2018.10897
U.S. Preventive Services Task Force. (2019). Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement. JAMA, 322(22), 2211-2218. https://doi.org/10.1001/jama.2019.18928
U.S. Preventive Services Task Force. (2021a). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238
U.S. Preventive Services Task Force. (2021b). Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(10), 962-970. https://doi.org/10.1001/jama.2021.1117
U.S. Preventive Services Task Force. (2024). Screening for breast cancer: US Preventive Services Task Force recommendation statement. JAMA, 331(22), 1918-1930. https://doi.org/10.1001/jama.2024.5534
U.S. Preventive Services Task Force. (2025). Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA, 333(6), 498-508. https://doi.org/10.1001/jama.2024.27154
How this NUR 4073 Module 3 example is structured
NUR 4073 Module 3 in many sections works through screening guidance, including who qualifies and how often it repeats; your classroom's instructions decide the client and which recommendations to cover. This example gives the client's relevant history first, because eligibility depends on it, then takes each recommendation in turn and applies it in the same three steps: the eligibility rule, how the client's history meets or misses it, and the resulting decision with its interval. Two of the six decisions are to stop or not start, which is where screening papers most often go wrong. A summary table in prose closes the paper as a plan the client could keep.
NUR4073 Module 3 questions, answered
What does NUR4073 Module 3 usually ask for?
NUR4073 Module 3 in many sections asks students to apply screening guidelines to a client or population: who qualifies for each screening, which test is used and how often it repeats. Many versions use United States Preventive Services Task Force recommendations. Your classroom's instructions decide the client, the number of screenings and whether you must include stopping rules.
How do I show when a screening test should stop?
State the recommendation's upper age limit or stopping condition, then check it against the client's record. Cervical screening, for example, stops after 65 when prior screening has been adequate, which has a specific definition based on the number and timing of negative tests. Show the dates, reach the decision and note how it should be documented.
What does an insufficient evidence statement mean for a client?
It means the Task Force could not determine whether the benefits outweigh the harms, so it neither recommends for nor against the test. In practice, the decision is individual and based on the client's risk factors and preferences. In a paper, explain what the statement means rather than treating it as a recommendation to screen.
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