★Health Promotion & Maintenance · 6–12% of the exam
Health Promotion and Maintenance
Module 4 of 9 · Free NCLEX Prep Course · The RN Network
Growth and development, maternity and newborn care, immunizations, and screenings — the wellness side of nursing. The NCLEX loves developmental milestones and the findings that separate normal from "notify the provider."
Growth and Development Milestones
Infant: social smile 2 months, rolls front-to-back ~4–5 months, sits unsupported ~6–8 months, pincer grasp and pulls to stand ~9–10 months, first words and walking ~12 months. Birth weight doubles by 6 months, triples by 12.
Toddler (1–3 yr): parallel play, temper tantrums are normal autonomy-seeking (Erikson: autonomy vs. shame), 2-word phrases by 2 years, toilet training readiness ~18–24+ months.
Preschool (3–5 yr): associative/cooperative play emerges, magical thinking, fears mutilation (use adhesive bandages generously), Erikson: initiative vs. guilt.
School age (6–12 yr): concrete operations, rules-based cooperative play, industry vs. inferiority — hospitalized school-agers cope best with schedules and participation in care.
Adolescent: identity vs. role confusion, peer group is central, abstract thinking develops, privacy and body image dominate concerns — interview without parents present for risk topics.
Red flags to report: no social smile by 3 months, not sitting by 9 months, not walking by 18 months, loss of previously acquired milestones at any age.
Immunization Essentials
Birth: hepatitis B. Infant series (2, 4, 6 months): DTaP, IPV, Hib, PCV, rotavirus (oral). Influenza yearly starting at 6 months.
MMR and varicella are live vaccines given at 12–15 months and 4–6 years — live vaccines are contraindicated in pregnancy and severe immunosuppression.
Tdap booster at 11–12 years, then Td/Tdap every 10 years; Tdap during every pregnancy (27–36 weeks) to protect the newborn from pertussis.
HPV vaccine recommended starting at age 11–12.
Mild illness or low-grade fever is NOT a contraindication to vaccination; anaphylaxis to a prior dose or vaccine component is.
Sore arm, fussiness, and low-grade fever after vaccines are expected — teach comfort measures rather than alarm.
Prenatal Care and Warning Signs
Naegele's rule for due date: first day of last menstrual period − 3 months + 7 days (+ 1 year).
Danger signs to report immediately: vaginal bleeding, severe headache with visual changes (preeclampsia), sudden face/hand swelling, epigastric pain, fever, decreased fetal movement, gush of fluid before term.
Preeclampsia: BP ≥140/90 after 20 weeks with proteinuria or organ signs. Severe features include BP ≥160/110, headache, visual changes, RUQ pain. Magnesium sulfate prevents seizures — monitor respirations, reflexes, and urine output; calcium gluconate is the antidote.
Nutrition: folic acid 400 mcg daily before and during early pregnancy prevents neural tube defects; avoid alcohol entirely, limit high-mercury fish, avoid unpasteurized products and deli meats (listeria).
Weekly kick counts in the third trimester: report fewer than 10 movements in 2 hours per common protocols.
Newborn and Postpartum Care
APGAR at 1 and 5 minutes (heart rate, respirations, tone, reflex irritability, color): 7–10 normal, 4–6 moderate difficulty, 0–3 resuscitation.
Normal newborn: HR 110–160, RR 30–60, temp 97.7–99.5°F axillary, glucose ≥40–45. Acrocyanosis (blue hands/feet) is normal in the first day; central cyanosis is never normal.
Expected findings that alarm parents: milia, erythema toxicum, vernix, lanugo, molding, caput succedaneum (crosses suture lines — resolves). Cephalohematoma does not cross suture lines and raises jaundice risk.
Cord care: keep clean and dry, fold diaper below the cord, report redness/drainage/foul odor. Never submerge until the cord falls off (1–2 weeks).
Safe sleep: supine ("back to sleep"), firm surface, nothing in the crib, room-sharing without bed-sharing, no overheating.
Postpartum assessment (BUBBLE-LE): Breasts, Uterus (firm, midline, descending ~1 cm/day), Bladder, Bowels, Lochia (rubra → serosa → alba; saturating a pad in an hour = report), Episiotomy/incision, Lower extremities (DVT signs), Emotions. A boggy uterus gets fundal massage first; a deviated uterus means a full bladder.
Screening and Adult Health Maintenance
Common screening rhythms (per current US guidance; individualize by risk): colorectal cancer screening starting at 45; mammography commonly starting at 40–50 per shared decision-making; cervical cancer screening from 21; lipid and diabetes screening for adults with risk factors; abdominal aortic aneurysm ultrasound once for men 65–75 who ever smoked.
Blood pressure at every visit; hypertension teaching emphasizes weight, sodium (DASH diet), activity, alcohol moderation, and medication adherence even when asymptomatic.
Tobacco cessation: ask at every encounter; the 5 A's (Ask, Advise, Assess, Assist, Arrange) plus pharmacotherapy doubles quit rates.
Older adult prevention: yearly fall risk review, vision/hearing checks, immunizations (influenza yearly; pneumococcal, zoster, RSV per age guidance), and medication reconciliation for polypharmacy.
Teach testicular self-exam monthly after a warm shower (young men — highest testicular cancer incidence 15–35) and breast awareness/self-exam per preference days after menses.
Practice Questions
Answer each question, then read the rationale — the rationale is where the learning happens.
1.The parent of a 9-month-old asks whether development is on track. Which finding should the nurse report to the provider?
Rationale: Rolling typically occurs by 4–6 months; absence at 9 months is a developmental red flag. Sitting unsupported, babbling without true words, and stranger anxiety are all normal at 9 months.
2.A client at 34 weeks gestation reports a severe headache and seeing spots. Her BP is 168/112. Which order should the nurse implement FIRST?
Rationale: Severe-range BP with headache and visual changes indicates preeclampsia with severe features and imminent seizure risk. Magnesium sulfate for seizure prophylaxis is the priority; monitoring labs continues but does not come before protecting the client from eclampsia.
3.During a newborn assessment, which finding requires immediate intervention?
Rationale: Central (circumoral) cyanosis with tachypnea (RR over 60) indicates respiratory distress. Acrocyanosis, RR 30–60, and milia are all expected newborn findings.
4.One hour after vaginal delivery, the nurse finds the client's uterine fundus boggy and displaced to the right of midline. What should the nurse do FIRST?
Rationale: A boggy fundus gets immediate fundal massage to stimulate contraction and control bleeding. Right displacement signals a full bladder, so emptying the bladder follows. Medications and provider notification come if the uterus stays atonic.
5.Which client should NOT receive the MMR vaccine today?
Rationale: MMR is a live attenuated vaccine and is contraindicated in pregnancy. Mild illness with low-grade fever is not a contraindication; household contacts of immunocompromised people SHOULD be vaccinated; egg allergy is not a contraindication to MMR.
6.The nurse teaches an adolescent about testicular self-examination. Which statement indicates correct understanding?
Rationale: Monthly self-exam after a warm shower (when the scrotum is relaxed) is the correct technique and frequency. Testicular cancer is most common in males 15–35 regardless of family history, and most lumps are benign but every lump gets evaluated.