A nurse is reviewing the records of several clients to determine cervical cancer screening recommendations. Which of the following clients should the nurse refer for a Papanicolaou (Pap) test?

A. A 21-year-old client who had a normal Pap test one year ago. The American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) recommend that cervical cancer screening (Pap test) begin at age 21, regardless of sexual history. Screening should be done every 3 years for individuals aged 21-29, assuming results are normal. Since this client had a Pap test one year ago, they do not need immediate screening but should follow the standard 3-year interval. B. A 32-year-old client who had a total vaginal hysterectomy last year. A total hysterectomy (removal of the uterus and cervix) for non-cancerous reasons generally means that Pap tests are no longer necessary. However, if the hysterectomy was due to cervical cancer, continued screening might be needed. C. A 47-year-old client who had a negative combined Pap and HPV test 5 years ago. For clients 30-65 years old, Pap tests can be done every 3 years OR combined Pap and HPV (co-testing) every 5 years. Since this client had a negative co-test 5 years ago, they are due for screening now, but they would not have been referred earlier. D. A 15-year-old client who recently completed the vaccine series for human papillomavirus (HPV). The HPV vaccine does not replace the need for Pap tests but helps reduce the risk of cervical cancer. Routine Pap testing does NOT begin before age 21, so this client does not yet need screening.