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NCLEX: Health Promotion and Maintenance Category
In part 4 of understanding the NCLEX-RN test plan, the health promotion and maintenance control category will be discussed. Remember, that the NCLEX-RN Test Plan is organized into four major client needs categories, with two of these categories divided into subcategories. So you basically have 8 Client Needs categories.
Safe and Effective Care Environment
Management of Care (17-23%)
Safety and Infection Control (9-15%)
Health Promotion and Maintenance (6-12%)
Psychosocial Integrity (6-12%)
Basic Care and Comfort (6-12%)
Pharmacological and Parenteral Therapies (12-18%)
Reduction of Risk Potential (9-15%)
Physiological Adaptation (11-17%)
NCSBN (2015, p. 3).
Health Promotion and Maintenance Category
When you examine this category, you will find that a lot of client teaching across the lifespan is the focus. NCSBN defines health promotion and maintenance as “providing and directing nursing care of the client that incorporates knowledge of expected growth and development principles; prevention and early detection of health problems; and strategies to achieve optimal health” (NCSBN, 2013, p. 18). Nursing responsibilities covered under this subcategory include:
Ante/Intra/Postpartum and Newborn Care
Developmental Stages and Transitions
Health Promotion / Disease Prevention
Techniques of Physical Assessment
You will need to apply the content from this category throughout nursing school and throughout your nursing career. So, don’t wait until you graduate to study this for NCLEX. Teaching is a major part of nursing care. What is important to teach clients across the life span? How will you apply this information for every clinical client you have? Reviewing this material in a repetitive manner will help you get this material into your long-term memory. Download the NCLEX-RN® Detailed Test Plan - Candidate Version. Write down the related content for the safety and infection control subcategory. Then look up the correct answers. Consider making flashcards. Use this as a study guide throughout nursing school and when preparing for your NCLEX exam.
Ante/Intra/Postpartum and Newborn Care. Here are the statements included under this content:
1. Assess the client’s psychosocial response to pregnancy (e.g., support systems, perception of pregnancy, coping mechanisms).
2. Assess client for symptoms of postpartum complications (e.g., hemorrhage, infection).
3. Recognize cultural differences in childbearing practices.
4. Calculate the expected delivery date.
5. Check fetal heart rate during routine prenatal exams.
6. Assist clients with performing/learning newborn care (e.g., feeding).
7. Provide prenatal care and education.
8. Provide care to the client in labor.
9. Provide post-partum care and education.
10. Provide discharge instructions (e.g., post-partum and newborn care).
11. Evaluate the client’s ability to care for the newborn (NCSBN, 2013, p. 18).
Let’s answer a couple of statements about Ante/Intra/Postpartum and Newborn Care.
*Assess client for symptoms of postpartum complications (e.g., hemorrhage, infection).
Symptoms of postpartum hemorrhage:
- Uncontrolled bleeding
- Decreased blood pressure
- Increased heart rate
- A decrease in the red blood cell count (hematocrit)
- Swelling and pain in tissues in the vaginal and perineal area, if bleeding is due to a hematoma
Symptoms of infection:
- Lower abdominal pain and uterine tenderness, followed by fever.
- The uterus is soft, large, and tender
- Vaginal discharge may be decreased or profuse and malodorous, with or without blood (Davidson, London, & Ladewig, 2016).
*Calculate the expected delivery date.
Naegele's rule is the most common for calculating the estimated date of delivery. Subtract three months from the first day of the last menstrual period and add seven days to that date. If necessary add a year.
*Check fetal heart rate during routine prenatal exams.
Fetal heart tones can be heard with an ultrasound fetoscope around the 10 – 11th week of gestation. A regular stethoscope or fetoscope can detect fetal heart sounds between 18 to 20 weeks gestation. To auscultate fetal heart tones, a conductive gel is applied to the client’s skin. The fetoscope is placed at the midline just above the symphysis pubis with firm pressure. Count the fetal heart rate for 1 full minute noting the quality and rhythm. Inform the healthcare provider if fetal heart rate is not heard. Late in the pregnancy, use Leopold maneuvers to determine the position of the fetus. Placing the fetoscope over the fetal back to hear the heart tones. The normal fetal heart rate is 120 to 160 times a minute. Rates outside of this reference range can indicate fetal distress.
1. Have the client empty bladder.
2. Position a rolled towel under one hip to shift the uterus away from large blood vessels to prevent hypotension.
3. Face client, placing both hands on the abdomen, cupping hands around the fundus of the uterus. Palpate for the fetal part that occupies the fundus to help identify fetal lie and presentation. The fetal head will feel firm and round. The buttocks and legs will feel softer and less defined.
4. Position the palms of hands on the side of the client’s abdomen. Use the palmar surface of one hand to locate the fetal back. The fetal back will feel smooth and hard. Smaller fetal parts, such as the hands, feet, and elbows, will feel like irregular nodules when palpated.
5. Use the right hand to grasp the lower section of the client’s abdomen. Press inward over the inlet to the true pelvis. Note any movement and determine whether the presenting part is soft or firm. If there is movement, the presenting part is not engaged.
6. Face the client’s feet and place both hands on both sides of her uterus. Outline the fetal head with your fingertips. Palpate both sides of the abdomen to determine the cephalic prominence. If you find the cephalic prominence on the same side as the feet, hands, and elbows, the head is flexed and the vertex is presenting. If you find the cephalic prominence on the same side as the back, then the head is extended and the face is presenting (Davidson, London, & Ladewig, 2016).
By following this process throughout your nursing program, you will be focusing on key areas that NCSBN sees as important for the brand new nurse. Now you are ready to go through each of the other areas of the health promotion and maintenance category.
Article by: Debra S. McDonough, RN, MSN, EdD
Davidson, M., London, M., & Ladewig, P. (2016). Maternal-newborn nursing. Boston: Pearson
National Council of State Boards of Nursing, Inc. (2013). 2013 NCLEX-RN® Detailed Test Plan - Candidate Version. Chicago: Author.