Health Promotion

What does GTPAL stand for and how are twins counted?

G=total pregnancies; T=term pregnancies; P=preterm pregnancies; A=abortions/miscarriages; L=living children. Twins count as ONE pregnancy under T/P but TWO living children.

How do presumptive, probable, and positive signs of pregnancy differ?

Presumptive=reported by patient (amenorrhea, nausea, quickening). Probable=objective but not proof (positive pregnancy test, uterine changes, Braxton Hicks). Positive=definite fetus: FHR heard, fetus visualized on ultrasound, fetal movement felt/seen by examiner.

Which prenatal numbers should be automatic?

FHR 110–160 bpm; quickening about 16–20 weeks; fundus near umbilicus at about 20 weeks; fundal height in cm roughly equals weeks gestation from about 20–36 weeks.

Which pregnancy findings require prompt reporting?

Vaginal bleeding, leakage/gush of fluid, significant decreased fetal movement, regular preterm contractions, fever, severe persistent vomiting, severe headache, vision changes, RUQ/epigastric pain.

How does the nurse distinguish true labor from Braxton Hicks?

True labor causes progressive cervical dilation/effacement and contractions become regular, stronger, longer, and closer. Braxton Hicks do NOT cause progressive cervical change.

A pregnant client becomes dizzy and hypotensive while lying supine. What should the nurse do?

Turn the client to the LEFT lateral side. The uterus may be compressing the vena cava and reducing venous return/placental perfusion.

What pregnancy nutrition facts are highest yield?

Folic acid prevents neural tube defects; iron supports RBC production; calcium + vitamin D support bones; protein supports tissue growth. Normal-BMI pregnancy weight gain is about 25–35 lb.

How should iron be taken and what effects are expected?

Vitamin C improves iron absorption. Dark stools and constipation are expected. Calcium can reduce absorption if taken at the same time.

Why does physiologic anemia occur in pregnancy?

Plasma volume increases more than RBC volume, causing hemodilution. Think: more fluid than cells.

What is the RhoGAM rule?

Unsensitized Rh-negative mother: give around 28 weeks and within 72 hr postpartum if infant is Rh-positive; also after miscarriage, bleeding, trauma, amniocentesis, etc. It PREVENTS sensitization.

What does high vs low maternal AFP suggest?

HIGH AFP=possible open neural tube defect, multiples, or wrong dates. LOW AFP can be associated with chromosomal abnormalities such as Down syndrome.

Which prenatal tests are screening versus diagnostic?

Quad screen and cell-free DNA/NIPT=screening. CVS and amniocentesis=diagnostic. CVS is earlier; amniocentesis can evaluate neural tube defects.

How do NST, BPP, and CST differ?

Reactive NST=accelerations=reassuring. BPP assesses fetal breathing, movement, tone, fluid, and NST. Negative CST=no late decels=good; positive CST=late decels=concerning.

What is the NCLEX rule for gestational diabetes screening?

The 1-hour glucose challenge is a SCREEN. An abnormal result requires further glucose tolerance testing and does not automatically diagnose GDM.

A laboring client is GBS-positive. What should the nurse expect?

IV antibiotics during labor, commonly penicillin or ampicillin, to reduce neonatal GBS infection.

What TORCH/infection associations should be automatic?

Toxoplasmosis=cat litter/raw meat; Rubella=no MMR during pregnancy, vaccinate postpartum; CMV=young children's saliva/urine; active genital herpes at labor usually means C-section; syphilis in pregnancy=penicillin.

A client has ruptured membranes for more than 18 hours, fever, fetal tachycardia, or foul/purulent fluid. What should the nurse suspect?

Intraamniotic infection/chorioamnionitis. Prolonged rupture of membranes increases maternal and neonatal infection risk.

Suspected intraamniotic infection: oxytocin or antibiotics first?

Administer prescribed IV antibiotics promptly. Treat the infection rather than prioritizing oxytocin.

What does light green or brown amniotic fluid suggest?

Meconium. Monitor the fetus/newborn closely for compromise and meconium aspiration risk.

What is VEAL CHOP?

Variable=Cord compression; Early=Head compression; Accelerations=Okay; Late=Placental insufficiency.

Recurrent variable decelerations: first basic action?

Reposition the client. Think cord compression; also evaluate for prolapse and stop oxytocin if indicated.

Recurrent late decelerations while receiving oxytocin: what actions matter?

Stop oxytocin, reposition side/left lateral, increase IV fluids/correct hypotension, and notify the provider if persistent.

Why is uterine tachysystole dangerous?

Too many contractions cause inadequate uterine relaxation, decreased placental blood flow, and fetal hypoxia.

After spontaneous rupture of membranes or amniotomy, what becomes an immediate priority?

Assess the fetal heart rate promptly because cord prolapse/compression can occur.

What do dilation, effacement, and station mean?

Dilation=0–10 cm opening. Effacement=0–100% thinning. Station: 0=at ischial spines; negative=high; positive=descending toward birth.

Postpartum client has a boggy uterus. First action?

Massage the fundus. Boggy uterus suggests uterine atony and hemorrhage risk.

Postpartum fundus is firm but displaced upward/right. What should the nurse suspect?

A full bladder. Assist the client to void.

What is the lochia sequence?

Rubra=red; Serosa=pink/brown; Alba=yellow/white.

Baby blues versus postpartum depression?

Baby blues are mild and usually resolve within about 2 weeks. Persistent/severe symptoms longer than 2 weeks or impaired function suggest postpartum depression.

What newborn jaundice finding is abnormal?

Jaundice during the FIRST 24 hours is concerning. Physiologic jaundice usually appears after 24 hours.

Caput versus cephalohematoma?

Caput CROSSES suture lines. Cephalohematoma does NOT cross sutures and increases jaundice risk.

What newborn prophylaxis should be associated with its purpose?

Vitamin K=prevents bleeding; erythromycin eye ointment=prevents serious neonatal eye infection; Hep B vaccine=newborn immunization. HBsAg-positive mother: newborn gets Hep B vaccine + HBIG.

What are the most important newborn safety rules?

BACK to sleep; firm flat sleep surface; no pillows, loose blankets, or stuffed toys; rear-facing car seat in the back seat.

A 7-month-old has not said words yet. Is that expected?

Yes. Spoken words are not expected at 7 months; babbling and consonant sounds are appropriate.

A 7-month-old still has obvious head lag when pulled to sitting. Expected or report?

REPORT. Head lag should disappear much earlier, usually by about 4 months.

A 7-month-old's weight gain has slowed compared with early infancy. Is this always abnormal?

No. Weight gain normally slows during later infancy. Assess the overall growth pattern.

A 7-month-old's posterior fontanel is no longer palpable. Expected or abnormal?

Expected. The posterior fontanel normally closes early in infancy.

What is the developmental sequence to remember for infants?

Head control → roll → sit → crawl → stand → walk. Development progresses head-to-toe and simple-to-complex.

What are the age/play/Erikson anchors?

Infant=Trust vs Mistrust; Toddler=Autonomy vs Shame, parallel play; Preschool=Initiative vs Guilt, associative play; School-age=Industry vs Inferiority, cooperative play; Adolescent=Identity vs Role Confusion.

What infertility risk factors should the nurse recognize?

Advanced maternal age, endometriosis, PCOS/anovulation, recurrent chlamydia/PID/tubal scarring, and extremes of body weight.

A 38-year-old seeking pregnancy counseling: is age itself an infertility risk factor?

Yes. Female fertility declines with age, particularly after age 35.

A client with primary hypertension needs diet teaching. What teaching strategy is most effective?

Use active, practical involvement. Help the client identify lower-sodium food choices rather than just giving written material.

A client has low health literacy. Which teaching techniques are best?

Use plain language, teach-back, repeat key information, visual aids, and small chunks. Do not simply speak louder or overload with detail.

What is teach-back?

Ask the client to explain or demonstrate the information in their own words so the nurse can verify understanding.

How should the nurse assess orthostatic blood pressure?

Have the client rest supine and obtain BP/HR, then stand and repeat measurements after standing.

Where should a client be positioned to assess jugular venous distention?

Head of bed around 30–45 degrees, commonly about 45 degrees.

What does a loud blowing sound at the 2nd intercostal space, RIGHT sternal border suggest?

A murmur in the AORTIC area. Aortic=2nd ICS right sternal border; pulmonic=2nd ICS left.

What is a normal renal/urinary physical-assessment finding?

An empty bladder should generally be nonpalpable and nontender.

What diet pattern creates a higher risk for vitamin B12 deficiency/megaloblastic anemia?

A strict vegan diet without adequate B12-fortified foods or supplementation.

Which finding in a client taking hormone replacement therapy requires reporting?

New unilateral leg swelling or pain, which may indicate DVT.

What should a postmenopausal woman know about vaginal bleeding or spotting?

Postmenopausal bleeding is NOT a normal insignificant aging change and should be evaluated.

What should a client taking an oral bisphosphonate be taught?

Take with plain water as directed and remain upright for at least 30 minutes to reduce esophageal irritation.

What nutrition teaching is especially important for older/postmenopausal women?

Adequate calcium and vitamin D plus weight-bearing/resistance exercise to support bone health.

A participant says, "I can't get lung cancer because I don't smoke." Correct understanding?

No. Smoking is the major risk, but nonsmokers can still develop lung cancer from radon, secondhand smoke, occupational exposures, and other causes.

What are the classic CAUTION cancer warning signs?

Change in bowel/bladder habits; A sore that doesn't heal; Unusual bleeding/discharge; Thickening/lump; Indigestion/difficulty swallowing; Obvious change in wart/mole; Nagging cough/hoarseness.

Which cancer-warning statements require follow-up?

Persistent cough/hoarseness, unexplained lump, changing/itchy/irregular mole, unusual bleeding such as black/tarry stools, or a sore that does not heal.

What melanoma warning pattern should I remember?

ABCDE: Asymmetry, Border irregularity, Color variation, Diameter/enlargement, Evolving/changing lesion.

Which home-fall-prevention statement shows a need for more teaching?

"I walk around in stockings/socks only." Socks can slip; use well-fitting nonskid footwear.

What interventions reduce fall risk in older adults?

Remove loose rugs/clutter, improve lighting, install handrails/grab bars, use nonskid footwear, review medications, check vision/hearing, and encourage strength/balance exercise.

What does DASH teaching focus on?

Hypertension. Emphasize fruits/vegetables, whole grains, lean protein/low-fat dairy, and reduce sodium/processed foods.

What foods commonly contain large amounts of hidden sodium?

Processed meats, canned foods, frozen/packaged meals, fast food, salty snacks, and sauces/condiments.

What nutrition rules are frequently tested?

Vitamin C improves iron absorption; vitamin D helps calcium absorption; folic acid prevents neural tube defects; increase fluids when increasing fiber.

What vaccine concepts are highest yield?

Flu annually when age-eligible; Tdap every pregnancy and adult boosters as recommended; adolescent Tdap/HPV/MenACWY; shingles for older adults; MMR and varicella are live vaccines and generally avoided during pregnancy/significant immunosuppression.

What major prevention/screening anchors should I know?

Breast cancer screening begins in mid-adulthood per current guidance; colorectal screening generally begins at 45 average risk; osteoporosis screening commonly at 65+ for women or earlier if high risk; lung cancer screening uses low-dose CT for qualifying high-risk smoking histories.

How should the nurse approach intimate partner violence screening?

Ask privately and nonjudgmentally, assess immediate safety, and provide resources. Do not pressure the client or make decisions for them.

What are the major safety risks by developmental stage?

Infant=safe sleep/choking/car seat; Toddler=poisoning/drowning/falls; Preschool=burns/traffic/drowning; School-age=helmets/sports; Adolescent=driving/substances/sexual health/mental health; Older adult=falls/medications.

What poisoning-prevention teaching is NCLEX-focused?

Lock medications/chemicals, keep products in original containers, do not call medicine candy, and do NOT induce vomiting unless specifically instructed by poison control/emergency guidance.

Heat exhaustion versus heat stroke?

Heat exhaustion=sweating, weakness, dizziness, nausea; cool environment and fluids if appropriate. Heat stroke=very high temperature plus altered mental status/neurologic dysfunction and is an EMERGENCY.