Skip to content

Get the app

Study guide · Health Promotion and Maintenance

Health Promotion and Maintenance

6 to 12% of the exam · 17 activity statements

Health Promotion and Maintenance covers growth and development across the lifespan, pregnancy, labor, the postpartum period and the newborn, screening, immunizations, prevention of risky behaviors and the barriers that get in the way of communication and learning. The practical nurse collects data, compares findings with expected norms, reinforces teaching and reports what is outside the expected range. Items test what is normal for an age or stage, what needs reporting and which teaching to reinforce.

A study feature written by ExamDragon, not part of the real exam. Each heading is one of the Related Activity Statements NCSBN lists for this category (17 of them), in our words; NCSBN's wording is in its Test Plan.

At a glance

Health Promotion and Maintenance
6 to 12%

of the exam (NCSBN's range)

Activity statements
17
Key terms
11

What this guide covers, statement by statement

  1. Help look after clients during pregnancy
  2. Point clients to resources in their community
  3. Help monitor a client who is in labor
  4. Watch over the recovery of a stable client after birth
  5. Measure the client's development against expected milestones
  6. Help clients through normal life changes, such as bonding with a baby, becoming a parent or retiring
  7. Take part in health screening and health promotion programs
  8. Give information that helps prevent risky behaviors, such as substance use, unsafe sex or smoking
  9. Gather the client's health history, including personal and family medical history
  10. Gather baseline physical data such as skin condition, height and weight
  11. Find clients who need required or optional immunizations
  12. Meet the care needs of newborns, infants and toddlers from birth through age 2
  13. Meet the care needs of children and teens aged 3 to 17
  14. Meet the care needs of adults aged 18 to 64
  15. Meet the care needs of adults aged 65 and older
  16. Spot what gets in the way of communication
  17. Spot what gets in the way of learning

1Help look after clients during pregnancy

  • Collect data at prenatal visits: weight, blood pressure, urine for protein and glucose, fundal height (in centimeters, about equal to the weeks of pregnancy from about 20 to 36 weeks) and fetal heart rate.
  • The estimated date of birth by Naegele's rule is the first day of the last menstrual period minus 3 months plus 7 days (plus one year).
  • Report danger signs at once: vaginal bleeding, leaking fluid, severe headache, visual changes, pain under the ribs or in the upper abdomen, sudden swelling of the face or hands, decreased fetal movement, and signs of preterm labor before 37 weeks.
  • A blood pressure of 140/90 mm Hg or higher after 20 weeks may signal a hypertensive disorder of pregnancy; report it to the RN or provider.
  • Reinforce teaching: folic acid, prenatal vitamins, no alcohol or tobacco, food safety, lying on the side (not flat on the back) in later pregnancy to avoid supine hypotension.
  1. In practiceAt a clinic visit at 32 weeks, a client's blood pressure is 152/98 mm Hg and she reports a headache that will not go away. The nurse rechecks the pressure, checks her urine for protein and reports to the RN and provider at once, because these findings suggest preeclampsia.
  2. Where questions turnTreating a headache, visual change or sudden swelling in later pregnancy as a normal discomfort instead of reporting it.
Practise this activity

2Point clients to resources in their community

  • Common resources include home health, hospice, meals delivered to the home, food assistance programs, transportation services, adult day programs, respite care, support groups, crisis lines and public health clinics.
  • Match the resource to the need the client names: food, transport, caregiver relief, finances, mental health, substance use treatment.
  • Social workers and case managers coordinate referrals; the PN identifies the need and reports it to the RN.
  • Respect the client's choice to use a resource or not.
  • Give accurate, current contact information and make sure the client can reach it (language, cost, location).
  1. In practiceAn older client being discharged after a hip fracture lives alone and says she cannot cook while using her walker. The nurse reports the need to the RN and case manager and gives her information on a home-delivered meal program, because nutrition supports healing and safety at home.
  2. Where questions turnGiving general advice instead of linking the client to the specific resource that meets the need.
Practise this activity

3Help monitor a client who is in labor

  • Assist the RN in monitoring the laboring client: contractions (frequency is from the start of one to the start of the next; duration from start to end of one), fetal heart rate, vital signs, bladder and comfort.
  • A normal fetal heart rate baseline is 110 to 160 beats per minute; early decelerations mirror contractions and are usually benign.
  • Late decelerations suggest poor placental blood flow and variable decelerations suggest cord compression; the usual first actions are to turn the client to her side, and report to the RN at once.
  • After the membranes rupture, check the fetal heart rate first, then the fluid's color, amount and odor; green or foul fluid is reported.
  • If the umbilical cord is seen or felt, call for help, keep pressure of the presenting part off the cord and position the client knee-chest or with hips raised; stay with her.
  1. In practiceWhile helping monitor a client in active labor, the nurse sees the fetal heart rate fall after the peak of each contraction and return slowly after it ends. The nurse turns the client to her left side and calls the RN to the room at once, because late decelerations suggest the fetus is not getting enough oxygen.
  2. Where questions turnLeaving the client to find help after a cord prolapse, or interpreting fetal monitoring and acting alone when the RN must be involved.
Practise this activity

4Watch over the recovery of a stable client after birth

  • Check the fundus: right after birth it is firm, midline and near the umbilicus, then it descends about 1 cm (one fingerbreadth) a day.
  • A boggy fundus needs massage until firm; a fundus that is high and pushed to one side usually means a full bladder, so help the client void.
  • Lochia goes from rubra (red, first days) to serosa (pinkish brown) to alba (yellowish white); large clots, a foul odor or soaking a pad in an hour or less are reported.
  • Collect data on breasts, bladder, bowel, perineum or incision, legs (pain, swelling, warmth in one calf), mood and attachment.
  • Rh-negative clients with an Rh-positive newborn receive Rh immune globulin, usually within 72 hours, and nonimmune clients may receive the rubella vaccine before discharge, with teaching to avoid pregnancy for about a month.
  1. In practiceFour hours after a vaginal birth, the nurse finds the client's fundus boggy, 2 cm above the umbilicus and to the right. She massages it, helps the client empty her bladder, rechecks the fundus and reports to the RN, because a full bladder keeps the uterus from contracting and raises the risk of hemorrhage.
  2. Where questions turnIgnoring a displaced fundus or heavy bleeding as normal lochia, or forgetting the bladder as the cause.
Practise this activity

5Measure the client's development against expected milestones

  • Compare each child with expected milestones in gross motor, fine motor, language and social skills, using standardized tools as policy directs.
  • Common infant markers: social smile by about 2 months, rolls over around 4 to 6 months, sits without support around 6 to 9 months, pincer grasp around 9 to 10 months, first steps around 12 months.
  • Birth weight about doubles by 5 to 6 months and triples by 12 months.
  • Erikson's stages guide expected psychosocial tasks: trust (infant), autonomy (toddler), initiative (preschool), industry (school age), identity (adolescent), intimacy, generativity and integrity in adulthood.
  • Report any loss of a skill a child once had, or milestones clearly missed, to the RN or provider; for preterm infants, use the age corrected for prematurity until about age 2.
  1. In practiceAt a well-child visit, a 12-month-old cannot sit without support and does not babble. The nurse documents the findings and reports them to the RN and provider, because a delay in more than one area needs further evaluation.
  2. Where questions turnReassuring parents that a child will "catch up" when a milestone is clearly missed or a skill has been lost.
Practise this activity

6Help clients through normal life changes, such as bonding with a baby, becoming a parent or retiring

  • Bonding signs include holding the newborn face to face (en face), touching, talking in a high voice, calling the baby by name and noting family features.
  • Report poor attachment signs: little eye contact, negative comments about the baby, refusing to hold or care for the baby.
  • Postpartum blues (tearfulness, mood swings in the first days, resolving within about 2 weeks) are common; sadness lasting longer, trouble functioning or thoughts of harming self or baby are reported at once.
  • Prepare older siblings for a new baby: involve them, give one-on-one time, expect some regression.
  • Other transitions such as retirement, children leaving home or moving to a care facility bring loss and change; ask how the client is coping and point to supports.
  1. In practiceOn the second day after birth, a mother cries easily but holds and talks to her baby and says she is tired. The nurse offers support, encourages rest and reinforces the signs of postpartum depression to report, because these early blues are expected but she should know what is not.
  2. Where questions turnLabelling persistent sadness or thoughts of harm as baby blues, or overreacting to expected tearfulness in the first days.
Practise this activity

7Take part in health screening and health promotion programs

  • Screening finds disease early; health promotion helps people stay well (activity, nutrition, sleep, stress management).
  • Common screenings the PN may help with include blood pressure, weight and body mass index, blood glucose, vision and hearing, and reminders for cancer screening per current guidelines.
  • Prepare the client for the screening, collect data accurately and record and report abnormal results to the RN or provider.
  • Respect privacy and consent at community screening events.
  • Use the opportunity to reinforce teaching on risk factors and follow-up.
  1. In practiceAt a community blood pressure screening, a man's reading is 168/104 mm Hg and he has no regular provider. The nurse rechecks the pressure after he rests, explains the result, and refers him to a provider for follow-up per the program's protocol, because screening has value only when abnormal results are followed up.
  2. Where questions turnRecording an abnormal screening result without making sure the client knows and has follow-up.
Practise this activity

8Give information that helps prevent risky behaviors, such as substance use, unsafe sex or smoking

  • Ask about tobacco, vaping, alcohol, drug use and sexual practices privately and without judgment.
  • For tobacco, a brief approach works: ask, advise to quit, assess readiness, assist (counseling, cessation aids per the provider), arrange follow-up.
  • Reinforce safer sex: correct condom use, testing for sexually transmitted infections, vaccination against HPV and hepatitis B.
  • For substance use, reinforce harm reduction information as policy allows (not driving after use, never using alone, naloxone for opioid overdose) and refer to treatment.
  • Adolescents need confidential time without a parent, within the limits of the law.
  1. In practiceA 17-year-old at a clinic visit says she vapes every day and wants to stop. With the parent out of the room, the nurse praises her wish to quit, reinforces the provider's plan and gives her information on a teen cessation program, because readiness to quit is the moment to help.
  2. Where questions turnLecturing or using scare tactics, or asking about risky behaviors in front of a parent.
Practise this activity

9Gather the client's health history, including personal and family medical history

  • Collect the health history: current concerns, past illnesses, surgeries, hospitalizations, medications (including herbal and over-the-counter), allergies, immunizations and lifestyle.
  • Family history covers conditions in parents, siblings and grandparents, such as heart disease, diabetes, cancer and mental illness.
  • Use open-ended questions, a private setting and the client's preferred language with a qualified interpreter.
  • The LPN/VN collects history data within the facility's forms; the RN completes the initial comprehensive assessment and analyzes the data.
  • Report findings that need attention, for example a family history of early heart disease or a medication the client did not mention to the provider.
  1. In practiceDuring intake, a client mentions she takes an herbal supplement for mood that she did not list on her form. The nurse records it and reports it to the RN and provider, because some supplements interact with prescription medications.
  2. Where questions turnLeaving out over-the-counter or herbal products, or using a family member to interpret health history.
Practise this activity

10Gather baseline physical data such as skin condition, height and weight

  • Measure height and weight accurately: same scale, same time of day, similar clothing; infants are weighed without a diaper and measured lying down.
  • Check skin for color, temperature, moisture, turgor, lesions and pressure areas, especially over bony prominences.
  • Collect baseline vital signs and pain level, and use a validated risk tool for pressure injury or falls as policy directs.
  • Baseline data allow later changes to be recognized; record exact values with units.
  • Report abnormal findings such as a reddened area that does not blanch or unexplained weight loss.
  1. In practiceOn admission to a skilled care facility, the nurse finds a 2 cm area of nonblanchable redness over the resident's sacrum. She documents the size and location, relieves the pressure and reports it to the RN, because nonblanchable redness is a stage 1 pressure injury.
  2. Where questions turnWeighing at different times or on different scales, which makes a trend unreliable.
Practise this activity

11Find clients who need required or optional immunizations

  • Check the client's immunization record against the current CDC schedule for age, health conditions, pregnancy, occupation and travel.
  • Influenza vaccine is recommended every year for nearly everyone 6 months and older; Td or Tdap boosters every 10 years, and Tdap during each pregnancy.
  • Live vaccines such as MMR and varicella are not given during pregnancy or to people who are severely immunocompromised.
  • A severe allergic reaction to a previous dose or to a vaccine component is a contraindication; a mild illness, with or without a low fever, is not.
  • Reinforce the expected effects (soreness, low fever), what to report, and record the vaccine, lot number, site and date.
  1. In practiceA pregnant client at 28 weeks asks if she can have the vaccines her toddler is getting, including MMR. The nurse explains that live vaccines such as MMR are avoided during pregnancy and reports her questions to the provider, who can recommend the vaccines that are advised in pregnancy, such as Tdap and influenza.
  2. Where questions turnDelaying a vaccine for a mild cold, or giving a live vaccine to a pregnant or immunocompromised client.
Practise this activity

12Meet the care needs of newborns, infants and toddlers from birth through age 2

  • Newborn care: keep warm, skin-to-skin contact, identification bands, vitamin K and eye prophylaxis as ordered; jaundice in the first 24 hours is reported.
  • Safe sleep: on the back, on a firm flat surface in the parents' room, with no pillows, bumpers, blankets or toys, and no bed sharing.
  • Feeding: breastfed newborns feed about 8 to 12 times a day; enough wet diapers and weight gain show adequate intake; no honey before 12 months (botulism risk).
  • Toddler safety: rear-facing car seat as long as the seat allows, poison and medication storage, water safety, stair gates and avoiding choking foods such as whole grapes, nuts and hot dogs.
  • Signs of illness to report in an infant: fever in a baby under 3 months, poor feeding, lethargy, fewer wet diapers, breathing difficulty.
  1. In practiceA new father says he plans to put a soft bumper and blanket in the crib so the baby will be cozy. The nurse reinforces that the baby should sleep on the back in a crib with only a fitted sheet, because soft bedding raises the risk of sudden infant death.
  2. Where questions turnApproving soft bedding, side sleeping or honey for an infant, or missing jaundice in the first day of life.
Practise this activity

13Meet the care needs of children and teens aged 3 to 17

  • Preschoolers think magically and may see illness as punishment; use simple words, play and dolls to prepare them for procedures.
  • School-age children want to understand and help; give concrete explanations and let them do parts of their care.
  • Adolescents value privacy, independence and peers; give them time without parents and address body image, sexuality, substance use and mental health.
  • Safety: booster seat until the adult belt fits (often around 4 feet 9 inches, or 145 cm), back seat until age 13, helmets for bikes, water safety and safe storage of firearms.
  • Collect data on growth, school performance, sleep, activity and mood, and report signs of abuse, depression or self-harm.
  1. In practiceA 4-year-old needs a dressing change and is frightened. The nurse lets him put a bandage on a stuffed animal first and tells him it will feel like a tight hug, because play and simple words reduce a preschooler's fear.
  2. Where questions turnUsing adult explanations with a young child, or interviewing a teen only with the parent present.
Practise this activity

14Meet the care needs of adults aged 18 to 64

  • Early adulthood centers on career, relationships and family; middle adulthood on caring for children and aging parents, and on chronic disease risk.
  • Reinforce screening per current guidelines, such as blood pressure, cholesterol, diabetes, cervical, breast and colorectal cancer screening at the recommended ages.
  • Promote healthy weight, activity, sleep, stress management, limited alcohol and no tobacco.
  • Ask about work, family and caregiving stress, and depression.
  • Respect the adult's right to make informed choices about their own health.
  1. In practiceA 48-year-old client at a clinic says he has never had colorectal cancer screening. The nurse reinforces that screening is recommended at his age and reports to the provider so screening can be arranged, because early detection improves outcomes.
  2. Where questions turnAssuming a working-age adult has no screening needs or that stress at work is not a health issue.
Practise this activity

15Meet the care needs of adults aged 65 and older

  • Expected aging changes include thinner, drier skin, reduced thirst, slower kidney and liver function, decreased vision and hearing (especially high pitches) and slower reaction time.
  • Older adults often show illness atypically: new confusion, falls or loss of appetite may be the first sign of infection or other illness; report a sudden change in mental status.
  • Take care with medications: many older adults take several drugs, and some (such as sedatives and drugs with strong anticholinergic effects) increase falls and confusion.
  • Prevent falls, dehydration, pressure injuries and social isolation; encourage activity and independence.
  • Erikson's task is integrity versus despair; reminiscence and meaningful roles support it.
  1. In practiceA resident who is usually alert becomes confused and agitated over one afternoon and has no fever. The nurse checks vital signs, intake and urine, and reports the sudden change to the RN, because acute confusion in an older adult can be the first sign of infection or another acute problem.
  2. Where questions turnAccepting new confusion as normal aging, or waiting for a fever before reporting a possible infection.
Practise this activity

16Spot what gets in the way of communication

  • Barriers include hearing or vision loss, a different language, cognitive impairment, pain, anxiety, cultural differences, a noisy setting and medical jargon.
  • Use a qualified interpreter (in person, phone or video), not a family member or child, for health information.
  • For hearing loss, face the client in good light, reduce noise, speak clearly in a normal or slightly lower pitch and do not shout; check that hearing aids are in and working.
  • Use plain language, short sentences, pictures and communication boards when needed; allow time for responses.
  • Notice nonverbal cues and check understanding.
  1. In practiceAn older client nods to every question but answers inconsistently. The nurse notices her hearing aid is not in, helps her put it in, moves to face her in good light and repeats the questions, because a sensory barrier was hiding her real answers.
  2. Where questions turnRaising your voice or using a family member to interpret, rather than removing the barrier.
Practise this activity

17Spot what gets in the way of learning

  • Barriers to learning include pain, anxiety, fatigue, low literacy or health literacy, language, sensory or cognitive limits, cultural beliefs and not being ready to learn.
  • Relieve pain and meet basic needs first; a client in pain or acute distress cannot learn.
  • Ask how the client learns best, use plain language and pictures, and teach in short sessions with return demonstration.
  • Do not assume that schooling equals health literacy; use teach-back with every client.
  • The PN reinforces teaching the RN or provider began and reports to the RN when the client cannot learn or meet the goal.
  1. In practiceA client with new diabetes is due for reinforcement on insulin injection but has pain of 8 of 10 after surgery. The nurse gives the ordered pain medication, returns when the pain has eased and then reinforces the steps with return demonstration, because pain blocks learning.
  2. Where questions turnPushing ahead with teaching while the client is in pain, anxious or not ready, or taking a nod as understanding.
Practise this activity

Key terms

Fundal height
The distance in centimeters from the pubic bone to the top of the uterus, about equal to the weeks of pregnancy from about 20 to 36 weeks.
Naegele's rule
Estimated date of birth: first day of the last menstrual period minus 3 months plus 7 days.
Late deceleration
A fall in fetal heart rate that begins after the peak of a contraction, suggesting poor placental blood flow.
Lochia
Vaginal discharge after birth, changing from rubra to serosa to alba.
Boggy fundus
A soft, poorly contracted uterus after birth that raises the risk of hemorrhage.
Developmental milestone
A skill most children reach within an expected age range.
Corrected age
A preterm infant's age adjusted for the weeks born early, used for development until about age 2.
Live vaccine
A vaccine made with weakened live organisms, such as MMR or varicella, avoided in pregnancy and severe immunosuppression.
Teach-back
Asking the client to explain or show in their own words what was taught, to confirm understanding.
Health literacy
The ability to find, understand and use health information to make decisions.
Atypical presentation
Illness that shows up in an older adult as confusion, falls or appetite loss rather than classic symptoms.

After this guide: You can compare a client with the norms for age and stage, collect history and baseline data, recognize what to report in pregnancy, labor, the postpartum period and the newborn, identify needed immunizations and screenings, and remove barriers before reinforcing teaching.

Practise Health Promotion and Maintenance