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Study guide · Health Promotion and Maintenance

Health Promotion and Maintenance

6 to 12% of the exam · 16 activity statements

Health Promotion and Maintenance covers care across the lifespan: pregnancy, labor, the postpartum period and the newborn, growth and development from infancy through older adulthood, screening, prevention and teaching. NCLEX items ask you to recognize what is expected for an age or stage and what is not, to choose the right screening or teaching for the client in front of you, and to spot the danger sign that needs action now.

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 (16 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
16
Key terms
15

What this guide covers, statement by statement

  1. Give care and teaching during pregnancy
  2. Plan or take part in health teaching for the community
  3. Do focused screenings, such as for vision or depression
  4. Teach the client how to prevent and address risky health behaviours
  5. Teach the client about preventive care and staying healthy
  6. Give care and teaching after childbirth
  7. Do full, head-to-toe health assessments
  8. Gauge how ready the client is to learn and what helps or hinders it
  9. Care for and teach about children from birth to age 2
  10. Care for and teach about children and teens aged 3 to 17
  11. Care for and teach adults aged 18 to 64
  12. Care for and teach older adults aged 65 and up
  13. Judge whether the client can manage care at home and plan to match
  14. Assess and teach about health risks tied to family, population and community
  15. Care for and teach a client who is pregnant or in labour
  16. Offer resources that reduce barriers to communication

1Give care and teaching during pregnancy

  • Estimate the due date with Naegele's rule: the first day of the last menstrual period, minus 3 months, plus 7 days (and plus 1 year).
  • Fundal height in centimeters roughly equals the weeks of gestation from about 20 to 36 weeks; at about 20 weeks the fundus is at the umbilicus.
  • Teach folic acid supplementation (commonly 0.4 mg daily) before conception and in early pregnancy to reduce neural tube defects.
  • Teach the client to avoid alcohol (no amount is known to be safe), tobacco and recreational drugs, raw or undercooked meat and unpasteurized dairy (listeria), handling cat litter (toxoplasmosis) and fish high in mercury.
  • Inactivated vaccines such as influenza and Tdap are given in pregnancy; live vaccines such as MMR and varicella are not.
  • Danger signs to report at once: vaginal bleeding, leaking fluid, severe headache or vision changes, epigastric or right upper quadrant pain, decreased fetal movement, fever, persistent vomiting and signs of preterm labor.
  1. In practiceA client at 32 weeks of gestation calls the clinic with a headache that will not go away and spots in her vision. The nurse tells her to come in to be seen now, and the client's blood pressure and urine protein are checked, because these are warning signs of preeclampsia.
  2. Where questions turnTreating a severe headache, vision changes or swelling of the face and hands as a normal discomfort of pregnancy.
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2Plan or take part in health teaching for the community

  • Primary prevention stops disease before it starts (immunization, health education, seat belts); secondary prevention finds disease early (screening); tertiary prevention limits disability from an existing disease (rehabilitation, support groups).
  • Start with a community needs assessment: data on the population's health, resources and what the community itself identifies as a priority.
  • Plan with community partners and leaders, set measurable goals, and choose a setting and time the target group can reach.
  • Use culturally appropriate materials in the group's preferred language and plain language, with visuals and examples relevant to the audience.
  • Evaluate the program against its goals (knowledge, behavior change, health outcomes) and revise it.
  1. In practiceA community health nurse plans a blood pressure program for a neighborhood with high rates of stroke. The nurse meets with local leaders, offers free screening at a place of worship after services and teaches in the residents' preferred language, because programs designed with the community reach more people.
  2. Where questions turnCalling a screening program primary prevention; screening is secondary prevention.
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3Do focused screenings, such as for vision or depression

  • Screening identifies people who may have a condition; a positive screen leads to referral for a diagnostic evaluation, not to a diagnosis.
  • Vision: a Snellen chart at 20 feet (6 m), one eye covered at a time; 20/20 means the client reads at 20 feet what a person with normal vision reads at 20 feet.
  • Nutrition: weight, height and body mass index (adult normal 18.5 to 24.9), recent unplanned weight loss, intake and ability to obtain and prepare food.
  • Depression: a brief tool such as the PHQ-2, followed by the PHQ-9 if positive; any positive depression screen is followed by asking directly about thoughts of suicide.
  • Other targeted screens include hearing, developmental milestones in children, scoliosis (forward bend test) in adolescents, falls in older adults, alcohol use and intimate partner violence (asked privately).
  1. In practiceDuring a clinic visit, a client answers that for the past month she has had little interest in doing things and has felt down most days. The nurse completes the full depression questionnaire, asks directly whether she has had thoughts of harming herself and reports the result to the primary health care provider, because a positive screen needs follow-up and safety assessment.
  2. Where questions turnTreating a positive screening result as a diagnosis, or skipping the suicide question after a positive depression screen.
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4Teach the client how to prevent and address risky health behaviours

  • Match teaching to the stage of change: precontemplation (raise awareness), contemplation (weigh pros and cons), preparation (make a plan), action (support the change), maintenance (prevent relapse).
  • Tobacco: ask every client about use, advise quitting clearly, assess readiness, assist with a plan and cessation aids, and arrange follow-up.
  • Use a nonjudgmental approach and motivational interviewing: open questions, reflective listening and the client's own reasons for change.
  • A client who drinks heavily every day should not stop alcohol abruptly without medical care, because withdrawal can cause seizures and delirium.
  • Teach safer sex practices (condom use, STI testing, HIV prevention options), and harm reduction for clients not ready to stop a behavior.
  1. In practiceA client who smokes a pack a day says he likes smoking and has no plans to quit. The nurse asks what he knows about how smoking affects his breathing problems and offers information without pressure, because a client in precontemplation needs awareness before a quit plan will work.
  2. Where questions turnGiving a detailed quit plan to a client who is not yet considering change.
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5Teach the client about preventive care and staying healthy

  • Inactivated vaccines cannot cause the infection; live attenuated vaccines (such as MMR and varicella) are generally not given in pregnancy or to people with severe immunosuppression.
  • A mild illness, with or without a low fever, is not a reason to delay a vaccine; a severe allergic reaction to a previous dose or a vaccine component is a contraindication.
  • Several vaccines can be given at the same visit at different sites; observe clients, especially adolescents, for about 15 minutes after a vaccine because of fainting.
  • Annual influenza vaccination is recommended for almost everyone 6 months of age and older.
  • Cancer and chronic disease screening (blood pressure, cervical, breast, colorectal, diabetes) starts at ages and intervals set by current guidelines; teach the client to follow them with their primary health care provider.
  • Teach daily health habits: regular physical activity, a balanced diet, adequate sleep, sun protection with broad-spectrum sunscreen and regular dental care.
  1. In practiceA parent brings a 4-year-old for scheduled vaccines and mentions the child has a runny nose and no fever. The nurse proceeds with the vaccines as prescribed and explains that a mild cold does not lower the vaccine's effect or safety, because delaying leaves the child unprotected.
  2. Where questions turnDelaying a vaccine for a mild cold, or giving a live vaccine to a pregnant or severely immunosuppressed client.
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6Give care and teaching after childbirth

  • After birth the fundus is firm, midline and at about the umbilicus, then descends about 1 cm (one fingerbreadth) a day.
  • A boggy fundus is massaged first (supporting the lower uterine segment) until firm; a fundus that is high and deviated 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); a foul odor suggests infection, and saturating a pad in an hour or less suggests hemorrhage.
  • Postpartum blues (tearfulness in the first days, gone within about 2 weeks) are common; depression lasts longer and interferes with function; postpartum psychosis (hallucinations, thoughts of harming the infant) is an emergency.
  • An Rh-negative client who gives birth to an Rh-positive infant receives Rh immune globulin within 72 hours; a client who is not immune to rubella receives the vaccine postpartum and is taught to avoid pregnancy for the recommended time after.
  • Teach breastfeeding on demand, about 8 to 12 times in 24 hours, perineal care, and signs to report (heavy bleeding, fever, calf pain, breast redness).
  1. In practiceTwo hours after a vaginal birth, the nurse finds the client's fundus soft and above the umbilicus with heavy bright red bleeding. The nurse massages the fundus until it is firm, checks the bladder and notifies the primary health care provider, because uterine atony is the leading cause of postpartum hemorrhage.
  2. Where questions turnCalling the provider or giving a medication before massaging a boggy fundus.
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7Do full, head-to-toe health assessments

  • The health history includes the reason for seeking care in the client's words, the history of the present problem, past history, medications (including over-the-counter and herbal products), allergies, family and social history, and a review of systems.
  • The usual order of physical examination is inspection, palpation, percussion and auscultation; for the abdomen it is inspection, auscultation, percussion, then palpation, so palpation does not change bowel sounds.
  • Compare findings side to side and with the client's own baseline; a change from baseline matters more than one value.
  • Provide privacy, explain each step, use a qualified interpreter when needed and ask about the client's own cultural and spiritual preferences.
  • A comprehensive assessment covers all body systems as well as function, nutrition, mental health and social needs; a focused assessment looks at one problem.
  1. In practiceDuring an admission assessment, the nurse examines the client's abdomen. The nurse inspects it, listens for bowel sounds in all four quadrants, percusses and then palpates, because pressing on the abdomen first can change the bowel sounds.
  2. Where questions turnPalpating the abdomen before auscultating it.
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8Gauge how ready the client is to learn and what helps or hinders it

  • Assess readiness before teaching: physical state (pain, fatigue, nausea), emotional state (anxiety, denial, fear), motivation and what the client already knows.
  • Relieve pain and severe anxiety before teaching, because they block learning.
  • Match the method to the domain: cognitive (facts: discussion, reading), affective (attitudes: discussion of feelings and values), psychomotor (skills: demonstration and return demonstration).
  • Ask how the client prefers to learn and look for barriers: health literacy, language, vision, hearing and cognition.
  • Adults learn best with information that is relevant now and builds on their experience; confirm learning with teach-back.
  1. In practiceA client newly diagnosed with diabetes rates abdominal pain at 8 of 10 when the nurse arrives for insulin teaching. The nurse treats the pain first and returns to teach once the client is comfortable, because a client in severe pain cannot focus on learning.
  2. Where questions turnStarting teaching when the client is in pain, exhausted, very anxious or still in denial.
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9Care for and teach about children from birth to age 2

  • Apgar scores at 1 and 5 minutes rate heart rate, respiratory effort, muscle tone, reflex irritability and color (0 to 2 each); 7 to 10 is reassuring.
  • Safe sleep: on the back, on a firm flat surface in the infant's own crib or bassinet, room-sharing without bed-sharing, with no pillows, bumpers or soft toys.
  • Jaundice in the first 24 hours of life is not physiologic and is reported at once; jaundice appearing after 24 hours is often physiologic but is still monitored.
  • Growth: birth weight about doubles by 6 months and triples by 12 months; the posterior fontanel closes by about 2 months and the anterior by about 12 to 18 months.
  • Milestones: rolls over around 4 to 6 months, sits without support around 6 to 8 months, pincer grasp around 9 to 10 months, walks around 12 months, uses two-word phrases by about 2 years; toddlers seek autonomy and show negativism and tantrums.
  • No honey before 12 months (botulism); prevent choking in toddlers by avoiding whole grapes, nuts, popcorn and hot dog pieces; use a rear-facing car seat for as long as the seat's limits allow.
  1. In practiceA newborn is noted to have yellow skin at 18 hours of age. The nurse reports it to the primary health care provider at once and prepares for a bilirubin level, because jaundice before 24 hours suggests a pathologic cause such as hemolysis.
  2. Where questions turnCalling jaundice in the first 24 hours normal, or teaching that a newborn may sleep on the stomach or in the parents' bed.
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10Care for and teach about children and teens aged 3 to 17

  • Preschoolers (3 to 5) are in initiative versus guilt, think magically and fear bodily injury; explain procedures just before them, simply, using dolls or play, and use bandages to reassure.
  • School-age children (6 to 12) are in industry versus inferiority, think concretely and like rules and tasks; explain with diagrams and let them help with care.
  • Adolescents (13 to 17) are in identity versus role confusion; give privacy, interview them alone with confidentiality explained (and its limits for safety), and address body image and peers.
  • Use an age-appropriate pain scale, such as a faces scale for young children who can point.
  • Teach injury prevention by age: booster seats until the seat belt fits correctly, helmets for bikes and scooters, water safety, and screen time, sleep and nutrition habits.
  • Adolescents face risks of substance use, unsafe sex, depression and suicide; screen for them privately and nonjudgmentally.
  1. In practiceA 15-year-old comes to the clinic with a parent for a sports physical. The nurse asks the parent to step out for part of the visit and asks the adolescent privately about substance use, sexual activity and mood, explaining confidentiality and its limits, because adolescents answer more honestly without a parent present.
  2. Where questions turnExplaining a procedure to a preschooler days ahead in detailed terms, or interviewing an adolescent only with a parent present.
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11Care for and teach adults aged 18 to 64

  • Young adults are in intimacy versus isolation; middle adults in generativity versus stagnation.
  • Leading health risks in this age group include heart disease, cancer, injuries, substance use and mental health problems; teach diet, activity, not smoking and limiting alcohol.
  • Screen as current guidelines recommend: blood pressure, weight, lipids, diabetes for those at risk, cervical, breast and colorectal cancer, and depression.
  • Address reproductive health: contraception, preconception care, sexual health and, in midlife, menopause symptoms and bone health.
  • Ask about stress from work, parenting and caring for aging parents, and about intimate partner violence, in private.
  1. In practiceA 52-year-old client caring for both teenage children and a parent with dementia reports poor sleep and constant tiredness. The nurse screens for depression, asks about support and refers the client to caregiver and respite resources, because caregiver strain affects the caregiver's own health.
  2. Where questions turnAssuming a working-age adult has no screening or health promotion needs because they feel well.
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12Care for and teach older adults aged 65 and up

  • Older adults are in integrity versus despair; life review and reminiscence support integrity.
  • Normal aging includes reduced thirst (higher dehydration risk), slower kidney and liver clearance (drug accumulation: start low and go slow), presbyopia and high-frequency hearing loss (face the client, speak clearly in a lower pitch, reduce background noise).
  • Illness often presents atypically: a urinary tract infection or pneumonia may show as new confusion or falls, with little or no fever.
  • New, sudden or fluctuating confusion is delirium until proven otherwise and needs prompt evaluation; dementia is gradual and progressive.
  • Review all medications for polypharmacy and potentially inappropriate drugs, and assess fall risk, nutrition, function and signs of elder abuse or neglect.
  • Recommended vaccines include annual influenza and vaccines against pneumococcal disease and shingles, per current guidelines.
  1. In practiceAn 82-year-old resident of a long-term care home is suddenly confused and agitated, with a temperature of 99.1 F (37.3 C). The nurse assesses for causes such as infection, dehydration or a new medication and reports the change to the primary health care provider, because acute confusion in an older adult is often the first sign of illness.
  2. Where questions turnAttributing new confusion in an older adult to normal aging or to existing dementia.
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13Judge whether the client can manage care at home and plan to match

  • Assess activities of daily living (bathing, dressing, toileting, eating, transferring) and instrumental activities (managing medications, meals, finances, transportation, phone, shopping).
  • Assess cognition, vision and hearing, the home's safety and layout, and who is available to help and how able they are.
  • Discharge planning begins on admission; involve the client, family, social work and therapy early.
  • Confirm that the client or caregiver can perform needed skills (insulin injection, dressing changes) by return demonstration before discharge.
  • Arrange resources that fill the gaps found: home health nursing, physical or occupational therapy, meal services, medical equipment and community supports.
  1. In practiceA client who lives alone is ready for discharge after a stroke and says she will manage on her own. The nurse assesses her ability to transfer, prepare meals and manage medications, finds she cannot open her pill bottles one-handed, and arranges occupational therapy, blister packs and home care, because a safe discharge depends on demonstrated function.
  2. Where questions turnAccepting a client's statement that they will manage at home without assessing function and support.
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14Assess and teach about health risks tied to family, population and community

  • Take a family history covering at least three generations (a genogram); first-degree relatives with early disease, such as colon or breast cancer or heart disease, can mean earlier or more frequent screening and a referral for genetic counseling.
  • Some genetic conditions are more common in certain ancestral groups; ask about ancestry rather than assuming it from appearance.
  • Social determinants of health (income, housing, food security, education, transportation, safety) shape health risks and are assessed routinely.
  • Environmental and occupational risks include lead in older homes, air pollution, noise, chemicals and repetitive strain; ask about the client's work and home.
  • Community risks are identified with population data (rates of disease, injury, vaccination) and guide programs and outreach.
  1. In practiceA 35-year-old client reports that her mother and her sister both had breast cancer before age 45. The nurse documents the family history and informs the primary health care provider, who may recommend earlier screening and genetic counseling, because early disease in close relatives raises the client's own risk.
  2. Where questions turnAssuming a client's risk from their appearance instead of asking about family history and self-reported ancestry.
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15Care for and teach a client who is pregnant or in labour

  • True labor: regular contractions that grow stronger and closer and cause cervical change; false labor contractions are irregular, do not change the cervix and often ease with walking, rest or hydration.
  • Normal fetal heart rate baseline is 110 to 160 beats per minute; early decelerations (head compression) are benign, variable decelerations reflect cord compression (reposition), and late decelerations reflect uteroplacental insufficiency.
  • For late decelerations or excessive contractions: stop an oxytocin infusion, turn the client to her side, give an IV fluid bolus as prescribed, apply oxygen per policy and notify the provider.
  • When membranes rupture, check the fetal heart rate first, then note the color, odor, amount and time of the fluid; green fluid suggests meconium.
  • Prolapsed cord: call for help, use a gloved hand to lift the presenting part off the cord, place the client in a knee-chest or Trendelenburg position and never try to push the cord back.
  • Third trimester bleeding: no vaginal examination until placenta previa is ruled out; painless bright red bleeding suggests previa, while painful bleeding with a rigid, tender uterus suggests abruption.
  1. In practiceA client in active labor has an oxytocin infusion, and the monitor shows repeated late decelerations. The nurse stops the oxytocin, turns her to her side, increases the IV fluid as prescribed and notifies the provider, because late decelerations mean the fetus is getting less oxygen from the placenta.
  2. Where questions turnDoing a vaginal examination on a client with third trimester bleeding, or continuing oxytocin when late decelerations appear.
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16Offer resources that reduce barriers to communication

  • Ask about the client's preferred language for health care on admission and record it.
  • Use a qualified medical interpreter (in person, by phone or by video), not family members, friends or children, for health information and consent.
  • Speak directly to the client, not to the interpreter, in short sentences, and confirm understanding with teach-back.
  • For clients with hearing loss, face the client in good light, reduce background noise, do not shout and use the client's hearing aids or a sign language interpreter if they use sign language.
  • For other barriers, use plain-language written materials in the client's language, large print or audio for low vision, and picture boards and yes or no questions for clients with aphasia.
  1. In practiceA client who speaks limited English needs teaching about a new anticoagulant, and her 12-year-old son offers to translate. The nurse thanks him and calls a qualified medical interpreter by video, because a child may not translate medical terms accurately and should not carry that responsibility.
  2. Where questions turnUsing a family member, especially a child, as the interpreter for health information.
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Key terms

Primary prevention
Actions that stop disease before it starts, such as immunization and health teaching.
Secondary prevention
Early detection of disease through screening, so it can be treated sooner.
Tertiary prevention
Care that limits disability or complications from an existing disease, such as rehabilitation.
Naegele's rule
Due date estimate: first day of the last menstrual period minus 3 months plus 7 days.
Fundal height
Distance from the symphysis pubis to the top of the uterus; in centimeters roughly equals weeks of gestation from about 20 to 36 weeks.
Lochia
Postpartum vaginal discharge, changing from rubra to serosa to alba.
Uterine atony
A uterus that does not contract firmly after birth; the leading cause of postpartum hemorrhage.
Apgar score
A rating of a newborn's heart rate, breathing, tone, reflexes and color at 1 and 5 minutes.
Late deceleration
A gradual fall in fetal heart rate after the peak of a contraction, signaling uteroplacental insufficiency.
Stages of change
Precontemplation, contemplation, preparation, action and maintenance; teaching is matched to the stage.
Teach-back
The client explains in their own words what they learned, to confirm understanding.
Instrumental activities of daily living
Tasks needed to live independently, such as managing medications, meals, money and transportation.
Delirium
An acute, fluctuating change in attention and thinking, often from illness or medication; needs prompt evaluation.
Social determinants of health
Conditions such as income, housing, food, education and transportation that shape health.
Qualified medical interpreter
A trained interpreter for health care communication, used instead of family members.

After this guide: After this guide you should be able to recognize what is normal and what is a danger sign at each stage from pregnancy through older adulthood, and choose the right screening, prevention and teaching for the client.

Practise Health Promotion and Maintenance