Mastering Scenario-Based Questions on the CHES Exam

If there is one area where well-prepared candidates still lose points on the CHES exam, it is scenario-based questions. These items go beyond testing whether you can recall a definition or identify a term. They present a realistic professional situation and ask you to determine the best course of action, drawing on your understanding of health education competencies, theories, and processes.

Scenario-based questions make up a significant portion of the exam, and their complexity increases on the MCHES version. Understanding how these questions are constructed and developing a systematic approach for working through them is one of the highest-return investments you can make during your preparation. For context on the overall test structure, see our guide to the CHES exam format.

What Makes Scenario Questions Different

Standard multiple-choice questions test a single concept in isolation. You either know the answer or you do not. Scenario-based questions operate differently in three important ways.

Multi-step reasoning. The correct answer often depends on applying a sequence of logic rather than retrieving a single fact. You may need to identify what phase of a program the scenario describes, determine which competency applies, and then select the action that aligns with that competency.

Application over recall. Knowing the definition of a formative evaluation is not enough. The question may describe a program in its early stages and ask what type of evaluation the health educator should conduct, requiring you to connect the definition to a specific professional context.

Multiple plausible answers. Unlike straightforward recall items where three options are clearly wrong, scenario questions frequently include two or three answer choices that could be defensible in some context. The challenge is selecting the one that is most appropriate given the specific details of the scenario.

This structure mirrors real professional practice, where health education specialists rarely face decisions with a single obvious path. The exam rewards the same kind of disciplined thinking that effective practice demands.

Anatomy of a Scenario Question

Every scenario-based question has three components that you should learn to identify quickly.

The stem is the paragraph or set of sentences that describes the situation. It includes the context you need: the setting, the population, the phase of the program, and the challenge or decision point facing the health educator. Every word in the stem is there for a reason.

The question follows the stem and tells you what the item is actually asking. Pay careful attention to qualifiers such as "first," "most appropriate," "best," or "next step." These words define the criteria for the correct answer and frequently distinguish between two otherwise reasonable choices.

The answer options typically include four choices. In a well-constructed scenario item, at least two options will be defensible in a general sense. Your task is not to find the right answer in the abstract but to find the best answer in the specific context described.

A Step-by-Step Approach

Developing a consistent method for working through scenario questions reduces errors caused by rushing, second-guessing, or misreading. The following four-step process works well for most candidates.

Step 1: Read the Stem Carefully and Identify What Is Being Asked

Read the entire stem before looking at the answer choices. Identify the key details: Who is the health educator? What population are they working with? What phase of the project or program is described? What specific challenge or decision point has been presented?

Then read the question itself. Note any qualifying words. "What should the health educator do first?" is a different question than "What should the health educator do?" The first version asks you to sequence actions and select the initial priority.

Step 2: Identify the Area of Responsibility Being Tested

Before evaluating the answer options, determine which of the eight Areas of Responsibility the question is testing. Is the scenario describing a needs assessment situation (Area I), a planning decision (Area II), an implementation challenge (Area III), or an evaluation question (Area IV)? Correctly categorizing the item narrows the field of possible best answers and activates the relevant knowledge in your memory.

Step 3: Eliminate Obviously Wrong Answers

Even in scenario questions with multiple plausible options, one or two choices are usually clearly inferior. They may describe an action that skips a necessary step, contradicts a professional standard, or applies the wrong phase of the program cycle to the situation. Eliminate these first. Reducing four options to two or three makes your final decision more focused and less overwhelming.

Step 4: Choose the Best Answer, Not Just a Correct One

This is the most critical step and the one where many candidates stumble. Among the remaining options, ask yourself which answer most directly addresses the specific situation described in the stem, which one aligns most closely with the competency being tested, and which one a skilled health educator would most likely choose in that exact context.

If two options seem equally strong, return to the stem and look for a detail you may have glossed over. There is almost always a contextual clue that tips the balance toward one answer.

Pro Tip: When stuck between two answers, ask yourself which one is more specific to the scenario described and which one is a general best practice. The exam typically rewards the context-specific answer over the generic one.

Common Traps and How to Avoid Them

Exam writers are skilled at constructing distractors that exploit predictable reasoning errors. Knowing these patterns in advance helps you avoid them.

The "all of the above" trap. When this option appears, candidates often select it because it feels safe. However, "all of the above" is only correct when every listed option is appropriate in the specific context. If even one option is wrong or suboptimal for the scenario, "all of the above" is incorrect.

The overly specific answer. One option may describe a very detailed action that sounds impressive but is too narrow for the situation described. If the scenario asks about a broad program planning decision, an answer focused on a single data collection instrument is likely too specific.

The overly general answer. Conversely, an option that is vague and broadly applicable may feel correct because it is hard to argue against. But scenario questions reward precision. An answer that could apply to any situation is usually not the best answer for a specific one.

The right action at the wrong time. An option may describe something a health educator should absolutely do, but not at the stage described in the scenario. Conducting a summative evaluation is important, but it is the wrong answer if the program has not yet been implemented.

Reading into the question. Resist the temptation to add information that is not in the stem. If the scenario does not mention budget constraints, do not let an answer that addresses funding influence your choice. Work only with the information provided.

Practice Example Walkthrough

Consider the following original example to illustrate the approach in action.

A health educator at a county health department has been asked to develop a diabetes prevention program for adults in a rural community. The health educator has reviewed county-level health data but has not yet spoken with community members. What should the health educator do next?

A) Develop program goals and objectives based on the county data B) Select an evidence-based curriculum for diabetes prevention C) Conduct focus groups with community members to understand local needs and priorities D) Design an evaluation plan to measure program outcomes

Applying the approach: The stem describes a health educator in the early stages of program development who has secondary data but no primary community input. The question asks for the next step. This is an Area I (Assessment) question.

Options A, B, and D all describe legitimate health education activities, but they skip a critical step. Moving to planning, curriculum selection, or evaluation before gathering community-level input violates the principle that effective programs are built on comprehensive needs assessment. Option C is the best answer because it addresses the gap identified in the stem: the health educator has not yet engaged the community directly.

Notice that none of the wrong answers are absurd. Each describes something the health educator will eventually need to do. The question tests your ability to sequence actions correctly within the program development process.

Pro Tip: After reviewing practice questions, do not just check whether you got the right answer. Read the rationale for every option, including the ones you correctly eliminated. Understanding why wrong answers are wrong strengthens your ability to eliminate similar distractors on the real exam.

Building Confidence Through Practice

Scenario-based questions feel difficult because they require a different kind of thinking than most academic coursework prepares you for. But like any skill, the ability to dissect a scenario, identify the competency being tested, and select the best answer improves with deliberate practice.

Build scenario practice into your study plan from the beginning rather than saving it for the final weeks. Start with a few questions after each study session and gradually increase the volume as you move through the eight areas. Keep a log of questions you miss and note whether the error was content-related or strategy-related. Content gaps can be filled with additional study. Strategy errors, such as misreading a qualifier, rushing through the stem, or reading information into the question, require a different kind of correction: slowing down and applying the four-step process consistently.

Avoid the temptation to memorize specific question-and-answer pairs. The exam will not repeat the exact scenarios you practiced with. Instead, focus on internalizing the reasoning process so that you can apply it to any scenario the exam presents. If you can reliably identify the area being tested, eliminate weak options, and select the most contextually appropriate answer, you are well-positioned to handle whatever the exam puts in front of you. For additional preparation strategies, see our guide to common study mistakes so you can steer clear of the pitfalls that trip up other candidates.

This content is not affiliated with or endorsed by NCHEC. CHES and MCHES are registered trademarks of NCHEC.