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Study guide · Health Promotion and Maintenance

Health Promotion and Maintenance

6 to 12% of the exam · 19 activity statements

Health Promotion and Maintenance covers pregnancy, birth and the postpartum period, newborns, growth and development from infancy to older age, health assessment and screening, teaching and readiness to learn, prevention of high-risk behaviours, immunizations and community care. The practical nurse collects data, compares findings with expected norms, reinforces teaching, and reports what is outside the expected range. REx-PN items use Canadian guidance: the Canadian Immunization Guide, Health Canada and the Public Health Agency of Canada, Transport Canada for car seats and provincial screening programs where British Columbia and Ontario agree.

A study feature written by ExamDragon, not part of the real exam. Each heading is one of the Related Activity Statements the Test Plan lists for this category (19 of them), in our words; the official wording is in the Test Plan.

At a glance

Health Promotion and Maintenance
6 to 12%

of the exam (the Test Plan's range)

Activity statements
19
Key terms
9

What this guide covers, statement by statement

  1. Care for and teach clients during pregnancy
  2. Care for and teach a client before birth
  3. Care for and teach a labouring client, outside active labour
  4. Care for and teach clients after birth
  5. Care for newborns, infants and toddlers from birth through age 2, and teach their families
  6. Care for and teach children and teens aged 3 to 17
  7. Care for and teach adults aged 18 to 64
  8. Care for and teach older adults aged 65 and up
  9. Carry out full health assessments
  10. Gauge how ready and able a client is to learn and how they learn best
  11. Do preventive screening, such as vision, hearing, memory or diet checks
  12. Teach clients how to avoid and address risky health behaviours, such as smoking
  13. Teach clients how to stay healthy, such as regular checkups and vaccines
  14. Plan or join health activities for clients in the community
  15. Judge whether a client can manage care at home and plan to match
  16. Assess the social and other factors shaping a client's health and act on them
  17. Find community services for a client and help them reach them
  18. Spot what gets in the way of communication
  19. Assess growth and development at every age

1Care for and teach clients during pregnancy

  • Collect prenatal data: weight, blood pressure, urine for protein and glucose, fundal height and fetal heart rate, and report anything outside the expected range.
  • Estimate the date of birth with Naegele's rule: first day of the last menstrual period minus 3 months plus 7 days.
  • Reinforce a daily multivitamin with folic acid, no alcohol, tobacco or cannabis, and food safety (no unpasteurized cheeses, cold deli meats unless steaming hot, raw sprouts, undercooked meat or eggs).
  • Fish low in mercury, such as canned light tuna and salmon, is encouraged; limit high-mercury fish.
  • Teach the warning signs to report: bleeding, leaking fluid, severe headache, visual changes, upper abdominal pain, sudden swelling and reduced fetal movement.
  1. In practiceAt 9 weeks, a client asks what to avoid eating. The nurse reinforces avoiding unpasteurized soft cheeses, cold deli meats and raw sprouts, and encourages well-cooked eggs and low-mercury fish.
  2. Where questions turnTelling a pregnant client to avoid all fish instead of choosing low-mercury fish.
Practise this activity

2Care for and teach a client before birth

  • Blood pressure of 140/90 mm Hg or higher after 20 weeks, with proteinuria, headache, visual changes or upper abdominal pain, suggests preeclampsia: report at once.
  • Signs of preterm labour before 37 weeks: regular tightening, low backache, pelvic pressure, menstrual-like cramps, a change in discharge or leaking fluid.
  • Rh-negative clients receive Rh immune globulin at about 28 weeks and after bleeding or trauma; screening for gestational diabetes is usually done at 24 to 28 weeks.
  • In later pregnancy, encourage side-lying rather than lying flat on the back to prevent supine hypotension.
  • Reinforce attention to fetal movement and coming in if movement decreases.
  1. In practiceAt 34 weeks, a client's blood pressure is 150/98 mm Hg with a headache and 2+ protein. The nurse reports at once instead of suggesting rest and a recheck.
  2. Where questions turnTreating a headache or sudden swelling in later pregnancy as a minor discomfort.
Practise this activity

3Care for and teach a labouring client, outside active labour

  • The practical nurse supports clients in early labour and before active labour; care in active labour belongs to the RN, midwife or primary health care provider.
  • When membranes rupture, check the fetal heart rate first, then note the time, colour, amount and odour of the fluid; green or brown fluid is reported.
  • Teach when to come in: membranes rupture, bright red bleeding, reduced fetal movement, constant severe pain, or contractions in the pattern the care provider gave.
  • Support early labour with fluids, rest, walking, position changes, breathing and comfort measures.
  • Report a fever, a fetal heart rate outside the expected range or any sign of cord prolapse at once.
  1. In practiceA client in early labour feels a gush of fluid. The nurse checks the fetal heart rate first, then records clear fluid at 1420 and reports to the RN.
  2. Where questions turnRecording the fluid before checking the fetal heart rate.
Practise this activity

4Care for and teach clients after birth

  • The fundus should be firm, midline and near the umbilicus after birth, descending about 1 cm a day; boggy means massage, high and to the side means a full bladder.
  • Lochia changes from rubra (red) to serosa (pinkish-brown) to alba (yellowish-white); soaking a pad in 1 hour or less, large clots or a foul odour are reported.
  • Report fever of 38 °C or higher, a red, warm, swollen calf, a red painful breast area, severe headache and chest pain or shortness of breath.
  • Baby blues (tearfulness in the first two weeks) are common; low mood lasting longer, or any thought of harm to self or the baby, is reported.
  • Rh-negative, non-sensitized clients with an Rh-positive infant receive Rh immune globulin within 72 hours; support breastfeeding and perineal comfort.
  1. In practiceSix hours after birth, a client's fundus is firm, 2 cm above the umbilicus and to the right. The nurse helps her void and rechecks the fundus, which returns to midline.
  2. Where questions turnMassaging a firm fundus instead of emptying the bladder.
Practise this activity

5Care for newborns, infants and toddlers from birth through age 2, and teach their families

  • Newborns may lose up to about 7 to 10% of birth weight in the first days; a loss over 7% prompts a feeding assessment and over 10% is reported; birth weight doubles by about 4 to 6 months and triples by 12 months.
  • Safe sleep: on the back, in the infant's own crib or bassinet in the parents' room for at least 6 months, a firm flat mattress and nothing else in the crib.
  • Breastfed infants receive daily vitamin D drops; solids start at about 6 months with iron-rich foods first, common allergens offered early and no honey before 12 months.
  • Milestones: social smile by 2 months, sitting by about 6 months, walking by about 12 to 15 months, several words by 18 months, two-word phrases by 2 years; not walking by 18 months is reported.
  • Immunizations follow the provincial schedule from 2 months; car seats are rear-facing in the back seat.
  1. In practiceA breastfed baby weighs 3,180 g on day 3 after a birth weight of 3,450 g, a 7.8% loss. The nurse checks latch and feeding frequency and reports the finding to the RN.
  2. Where questions turnAccepting any newborn weight loss as normal without calculating it.
Practise this activity

6Care for and teach children and teens aged 3 to 17

  • Erikson: preschool initiative, school-age industry, adolescence identity; Piaget: preschool magical thinking, school-age concrete thinking, adolescence abstract thinking.
  • Car safety: forward-facing seat with harness, then a booster until the seat belt fits (about 145 cm), back seat until 13.
  • Adolescents get time alone with the nurse, with confidentiality explained along with its limits (risk of serious harm).
  • Preteens receive school-based vaccines, including HPV for all genders and hepatitis B, as provincial programs set.
  • Reinforce helmets, water safety, sun protection, healthy screen time, sleep, physical activity and nutrition.
  1. In practiceA parent asks whether a 7-year-old who is 122 cm tall can use the seat belt alone. The nurse reinforces a booster seat until the belt fits properly.
  2. Where questions turnLetting a parent stay for an entire adolescent visit, or promising absolute confidentiality.
Practise this activity

7Care for and teach adults aged 18 to 64

  • Adult screening that British Columbia and Ontario share: colorectal FIT every 2 years from 50 to 74 for average risk; cervical and breast screening as the provincial program invites.
  • BMI = weight in kg ÷ height in metres squared; 25 to 29.9 overweight, 30 or more obese, as a starting point for discussion.
  • Canadian 24-Hour Movement Guidelines: at least 150 minutes a week of moderate to vigorous activity, muscle strengthening twice a week, sedentary time 8 hours or less, 7 to 9 hours of sleep.
  • Canada's Food Guide: half the plate vegetables and fruits, a quarter whole grains, a quarter protein foods, water as the drink of choice.
  • Adults need a tetanus and diphtheria booster every 10 years and influenza vaccine every year.
  1. In practiceA 52-year-old with no symptoms asks about colon cancer screening. The nurse reinforces the provincial FIT every 2 years and that an abnormal result leads to colonoscopy.
  2. Where questions turnRecommending tests such as tumour-marker blood tests or yearly colonoscopy for average-risk adults.
Practise this activity

8Care for and teach older adults aged 65 and up

  • Expected aging: high-frequency hearing loss, presbyopia and need for more light, less thirst, thinner skin, slower reaction time, less muscle mass.
  • Sudden confusion, new incontinence or a sudden loss of function is not aging; report it (delirium has a treatable cause).
  • Vaccines for older adults: yearly influenza, pneumococcal vaccine as the Canadian Immunization Guide recommends for their age and risk, recombinant zoster in two doses from 50 (even after shingles), tetanus and diphtheria every 10 years.
  • Prevent falls and dehydration, review medications for polypharmacy, encourage activity and social connection.
  • Erikson's stage for older adults is integrity versus despair; life review and meaningful roles support it.
  1. In practiceA 72-year-old says having shingles once means the vaccine is not needed. The nurse explains that shingles can recur and the vaccine is still advised.
  2. Where questions turnCalling new confusion in an older adult a normal part of aging.
Practise this activity

9Carry out full health assessments

  • A head-to-toe health assessment collects subjective data (history, symptoms) and objective data (inspection, palpation, percussion, auscultation).
  • For the abdomen, inspect, auscultate, percuss, then palpate, so that touch does not change bowel sounds.
  • Blood pressure needs the right cuff (bladder about 80% of the arm's circumference long, about 40% wide), the arm supported at heart level and the client seated and rested.
  • Choose tools that fit the client: age-appropriate pain scales, temperature routes and growth charts for children.
  • Compare findings with the client's baseline and expected norms, and report what is outside them.
  1. In practiceA client with a large arm has a reading of 168/94 mm Hg with a standard cuff. The nurse rechecks with a larger cuff before reporting.
  2. Where questions turnPalpating the abdomen before listening, or acting on a reading taken with the wrong cuff.
Practise this activity

10Gauge how ready and able a client is to learn and how they learn best

  • Readiness to learn depends on comfort, emotional state, motivation and timing; relieve pain, anxiety or nausea before teaching.
  • Ask how the client learns best: hands-on learners need demonstration and return demonstration, visual learners pictures and video.
  • Check for barriers: low health literacy, vision or hearing loss, language, cognition, culture and denial.
  • Teach in short sessions with plain language and confirm understanding with teach-back.
  • Involve family or support people as the client wishes, without bypassing the client.
  1. In practiceA client with incisional pain at 8 out of 10 is due for discharge teaching. The nurse arranges pain relief first and teaches once she can concentrate.
  2. Where questions turnTeaching a client in severe pain because discharge is soon.
Practise this activity

11Do preventive screening, such as vision, hearing, memory or diet checks

  • Screening identifies clients who need a full assessment; a positive screen is reported, not treated as a diagnosis.
  • Nutrition screening asks about unintended weight loss in the past 6 months and eating less than usual for more than a week.
  • Brief cognitive screens combine three-word recall with clock drawing; vision uses an eye chart, hearing a whispered voice test.
  • Screen for falls, depression, developmental milestones in children and substance use as policy and age call for.
  • Use the screening tool exactly as designed and record the score.
  1. In practiceOn admission, a client says she has lost weight without trying over the past few months. The nurse records a positive nutrition screen and refers to the dietitian per policy.
  2. Where questions turnConfusing one screen with another, such as an eye chart for a cognitive screen.
Practise this activity

12Teach clients how to avoid and address risky health behaviours, such as smoking

  • Tobacco: ask every client, advise quitting clearly and personally, and act by offering support (nicotine replacement, including combined patch and short-acting forms, and quit programs).
  • Harm reduction: never use alone, carry naloxone, call 911 and give naloxone in an overdose, use new supplies from needle distribution programs.
  • Naloxone wears off before many opioids, so emergency help is always called; Canada's Good Samaritan Drug Overdose Act offers some legal protection to callers.
  • Safer sex: condoms every time with water- or silicone-based lubricant, testing with new partners, vaccines (HPV, hepatitis B) and information about HIV pre-exposure prophylaxis.
  • Pack-years = packs per day times years smoked; Canada's Guidance on Alcohol and Health and the lower-risk cannabis guidelines support informed choices.
  1. In practiceA client who uses opioids collects a naloxone kit. The nurse reinforces calling 911, giving naloxone and staying with the person, since naloxone can wear off.
  2. Where questions turnTelling a client to cut down for a long time before attempting to quit, or that naloxone alone is enough.
Practise this activity

13Teach clients how to stay healthy, such as regular checkups and vaccines

  • Immunizations follow the Canadian Immunization Guide and the provincial schedule: infant series from 2 months, school-based programs, and adult boosters.
  • Adults: tetanus and diphtheria every 10 years (one adult dose as Tdap), influenza every year from 6 months of age.
  • Tdap is recommended in every pregnancy to protect the newborn from pertussis.
  • Older adults: pneumococcal vaccine as the Canadian Immunization Guide recommends for their age and risk, and recombinant zoster from 50.
  • Health maintenance includes regular visits with a primary health care provider, dental and eye care, screening the province offers and sun protection.
  1. In practiceA pregnant client who had Tdap two years ago asks why it is offered again. The nurse explains that it is advised in every pregnancy to protect the baby.
  2. Where questions turnBelieving one dose of a vaccine always protects for life.
Practise this activity

14Plan or join health activities for clients in the community

  • The practical nurse takes part in community care: immunization clinics, school health, home visits, outreach and health fairs.
  • Observe clients for 15 minutes after a vaccine (30 if there is a concern), with an anaphylaxis kit ready.
  • Keep vaccines between 2 and 8 °C; when the temperature goes out of range, label them do not use, keep them cold and contact public health.
  • Apply routine practices in community settings and adapt teaching to the group or setting.
  • Document and report as the program requires, including adverse events following immunization.
  1. In practiceA school clinic's vaccine refrigerator reads 9.5 °C for 3 hours. The nurse labels the vaccines do not use, keeps them refrigerated and calls public health.
  2. Where questions turnDiscarding or using vaccines after a cold chain break without public health advice.
Practise this activity

15Judge whether a client can manage care at home and plan to match

  • Assess what the client can do at home: daily activities, medication management, mobility, cognition and the support available.
  • Watch the client perform key tasks (taking medications, using a walker) rather than relying on what they say.
  • Check the home: stairs, bathroom layout, grab bars, lighting, trip hazards and emergency access.
  • Contribute to the plan: home care, equipment, blister packs or large-print labels, meal programs, and caregiver support.
  • Report findings that make home care unsafe to the RN and team.
  1. In practiceA client with poor vision was discharged with seven medications. The nurse asks her to show how she takes them and then suggests pharmacy blister packaging.
  2. Where questions turnDeciding a client cannot manage before assessing what they can do.
Practise this activity

16Assess the social and other factors shaping a client's health and act on them

  • Determinants of health include income, employment, education, housing, food security, social support, culture, gender and Indigenous identity, and access to services.
  • Ask about barriers in a respectful, non-judgmental way; a missed dose may reflect cost, not lack of knowledge.
  • Involve the social worker and community programs (drug coverage, food programs, housing services) and tell the primary health care provider so the plan can fit.
  • Provide culturally safe, trauma-informed care: ask what matters to the client and respect their preferences.
  • Adapt the plan to the client's situation, such as follow-up at a wound clinic for a client without stable housing.
  1. In practiceA client skips medication near the end of each month because money runs out. The nurse asks about costs and food and involves the social worker.
  2. Where questions turnRepeating teaching or labelling the client non-adherent when the barrier is cost.
Practise this activity

17Find community services for a client and help them reach them

  • Know common resources: 811 for nurse advice at any hour in British Columbia and Ontario, 911 for emergencies, 988 for suicide crisis support.
  • Caregiver supports include respite, adult day programs, provincial home care and the Alzheimer Society.
  • Other resources: meal programs, transportation services, quit programs, harm reduction sites, public health units and community health centres.
  • Match the resource to the need the client identifies and help them make the first contact.
  • Report needs that require a referral the nurse cannot make alone.
  1. In practiceA wife caring for her husband with dementia is exhausted. The nurse tells her about respite care and the Alzheimer Society's programs and reports the strain to the team.
  2. Where questions turnOffering general advice instead of a concrete resource.
Practise this activity

18Spot what gets in the way of communication

  • Barriers to communication include hearing or vision loss, language, aphasia, cognitive impairment, pain, noise, jargon and cultural differences.
  • For hearing loss: face the client in good light, speak clearly at a normal pace and a lower pitch, reduce noise, rephrase rather than repeat.
  • For a language barrier, use a professional interpreter in person, by phone or by video; avoid family members, especially children, except in an emergency.
  • Use plain language, pictures or written material in the client's language, and check understanding with teach-back.
  • Give the client time to respond and speak to the client directly, not to the companion.
  1. In practiceA client who speaks only Punjabi needs medication teaching and her son offers to interpret. The nurse arranges a professional phone interpreter.
  2. Where questions turnUsing a family member as the interpreter for teaching or consent.
Practise this activity

19Assess growth and development at every age

  • Erikson's stages: trust (infant), autonomy (toddler), initiative (preschool), industry (school-age), identity (adolescent), intimacy (young adult), generativity (middle adult), integrity (older adult).
  • Play develops from solitary to parallel (toddler) to cooperative (preschool) to games with rules (school-age).
  • Toddlers show negativism and tantrums as they seek autonomy; adolescents value peers, privacy and appearance.
  • Compare growth and development with expected milestones and growth charts; report delays, loss of skills or growth that crosses percentiles.
  • Transitions across the lifespan (school entry, puberty, parenthood, retirement, loss) are times to support coping and health.
  1. In practiceA parent worries that her 2-year-old plays beside other children but not with them. The nurse explains that parallel play is expected at this age.
  2. Where questions turnCalling expected behaviour, such as parallel play or toddler tantrums, a delay.
Practise this activity

Key terms

Naegele's rule
Estimated date of birth: first day of the last menstrual period minus 3 months plus 7 days.
Fundal height
The distance in centimetres from the pubic bone to the top of the uterus, roughly equal to the weeks of pregnancy from about 20 to 36 weeks.
Lochia
Vaginal discharge after birth, changing from rubra (red) to serosa (pinkish-brown) to alba (yellowish-white).
Rh immune globulin
An injection given to a non-sensitized Rh-negative client to prevent antibodies against Rh-positive fetal blood.
Fecal immunochemical test (FIT)
A home stool test for hidden blood used in provincial colorectal screening programs.
Pack-years
Packs of cigarettes smoked per day multiplied by the number of years smoked.
Teach-back
Asking the client to explain or show in their own words what was taught, to confirm understanding.
Determinants of health
The social and economic conditions, such as income, housing and education, that shape health.
Parallel play
Playing beside other children without interacting, typical of toddlers.

After this guide: You can compare a client with the norms for age and stage, reinforce prenatal, postpartum and newborn teaching and recognize what to report, apply Canadian immunization and screening recommendations, assess readiness to learn and barriers to communication, support harm reduction and healthy choices, and connect clients with home and community resources.

Practise Health Promotion and Maintenance