NCLEX-RN · Health Promotion and Maintenance
NCLEX-RN: Growth, Development and Childbearing Care Concepts
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Overview
This chapter follows a person from before birth through old age. It covers normal growth and development, care during pregnancy, labor and the weeks after birth, and care of the newborn. Knowing what is normal helps you spot what is not.
During pregnancy, teach the client to report danger signs right away, such as vaginal bleeding, a severe headache, vision changes, sudden swelling of the face or hands, fluid leaking, or the baby moving less. High blood pressure with these signs may point to preeclampsia. During labor, watch the fetal heart rate pattern; a late deceleration suggests the baby is not getting enough oxygen through the placenta.
After birth, check the fundus often. It should be firm and in the middle; a soft fundus needs massage, and a fundus pushed to one side often means a full bladder. Lochia changes from red to pinkish-brown to whitish over the following weeks. For children, know the main milestones and Erikson's stages, so you can match care and teaching to the child's age.
Key concepts
Pregnancy danger signs
Signs that need quick reporting: vaginal bleeding, severe headache, blurred vision or spots, sudden swelling of the face or hands, leaking fluid, fever, or less fetal movement.
Memory tipHeadache plus vision changes plus swelling: think preeclampsia and check the blood pressure.
Preeclampsia
A pregnancy condition with new high blood pressure, usually after 20 weeks, with signs of organ stress such as protein in the urine, headache or vision changes. It can lead to seizures (eclampsia).
Memory tipMagnesium sulfate is used to prevent seizures; watch reflexes, breathing and urine output, and keep calcium gluconate nearby.
Source: American College of Obstetricians and Gynecologists · as of 2026
Fetal heart rate patterns
A normal baseline is about 110 to 160 beats per minute. Early decelerations come from head pressure and are harmless. Late decelerations suggest poor blood flow through the placenta. Variable decelerations suggest cord compression.
Memory tipRemember VEAL CHOP: Variable-Cord, Early-Head, Accelerations-OK, Late-Placenta.
Source: American College of Obstetricians and Gynecologists · as of 2026
Response to late decelerations
Turn the client to her side, stop any oxytocin infusion, give oxygen and IV fluids as ordered, and notify the provider.
Memory tipThink 'more blood and oxygen to the placenta': position, stop oxytocin, fluids, oxygen.
Postpartum fundus check
After birth the uterus should feel firm and be in the midline. A soft, boggy fundus can lead to heavy bleeding, so massage it. A fundus that is high and pushed to one side usually means a full bladder.
Memory tipBoggy: massage. Off to the side: help the client empty her bladder.
Lochia
Vaginal discharge after birth. It changes from red (rubra) to pinkish-brown (serosa) to whitish (alba). Large clots, a bad smell or a return to bright red bleeding should be reported.
Memory tipRed, then pink, then white: 'Rubra, Serosa, Alba'.
Erikson's stages
Each age has a main task: infants learn trust, toddlers independence (autonomy), preschoolers initiative, school-age children industry, teens identity, and older adults integrity.
Memory tipLet toddlers make simple choices; let teens have privacy and talk to them directly.
Often tested
- Know the pregnancy danger signs that must be reported right away.
- Match each fetal heart rate deceleration to its cause with VEAL CHOP.
- For late decelerations: side position, stop oxytocin, fluids, oxygen, call the provider.
- A boggy fundus is massaged; a fundus pushed to one side points to a full bladder.
- Lochia goes from red to pink to white; heavy bleeding or a bad smell is not normal.
- Match teaching to Erikson's stage, for example giving toddlers simple choices.
Easy to confuse: Fetal heart rate decelerations
| Type | Likely cause | Nurse response |
|---|---|---|
| Early | Pressure on the baby's head | Normal, keep watching |
| Variable | Cord compression | Change the mother's position |
| Late | Poor blood flow through placenta | Side position, stop oxytocin, fluids, oxygen, notify |
3 sample questions
Verified practice questions from this unit.
Question 1. A parent asks why the newborn needs a vitamin K injection soon after birth. Which response by the nurse is correct?
- ① "It helps lower the chance of newborn jaundice."
- ② "It protects your baby from hepatitis B."
- ③ "Newborns do not yet have enough vitamin K to help their blood clot."
- ④ "It protects your baby's eyes from infection."
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Answer: ③ "Newborns do not yet have enough vitamin K to help their blood clot."
Key point: Vitamin K shot prevents bleeding in newborns
Newborns are born with low vitamin K, and their gut does not yet have the bacteria that make it. Vitamin K is needed for blood to clot. One injection soon after birth prevents vitamin K deficiency bleeding, a rare but serious bleeding problem that can affect the brain.
Wrong choices
- "It protects your baby's eyes from infection" describes the eye ointment (erythromycin), not vitamin K.
- "It helps lower the chance of newborn jaundice" is not correct. Jaundice is managed with feeding and, if needed, light therapy.
- "It protects your baby from hepatitis B" describes the hepatitis B vaccine, a different injection.
Question 2. A client who is 32 weeks pregnant calls the clinic. Which symptom requires the nurse's immediate follow-up?
- ① Heartburn after large meals
- ② A severe headache with blurred vision
- ③ Needing to urinate more often
- ④ Mild swelling of both ankles at the end of the day
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Answer: ② A severe headache with blurred vision
Key point: Headache + vision changes in pregnancy can signal preeclampsia
A severe headache with blurred vision or other vision changes in the second half of pregnancy can be a sign of preeclampsia with severe features (high blood pressure that affects organs). This can lead to seizures (eclampsia), stroke, or problems with the placenta. The client needs to be seen right away for a blood pressure check and further testing.
Wrong choices
- "Mild swelling of both ankles at the end of the day" is common in late pregnancy, especially after standing. Sudden swelling of the face or hands would need follow-up.
- "Heartburn after large meals" is common because hormones relax the stomach valve and the uterus presses on the stomach.
- "Needing to urinate more often" is common late in pregnancy as the baby presses on the bladder. Burning or pain would need follow-up.
Question 3. A client in labor is receiving an oxytocin infusion. The fetal heart rate monitor shows late decelerations with several contractions. What should the nurse do first?
- ① Increase the oxytocin rate to speed up the birth
- ② Stop the oxytocin infusion
- ③ Tell the client to push with the next contraction
- ④ Document the finding and keep watching the monitor
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Answer: ② Stop the oxytocin infusion
Key point: Late decelerations on oxytocin: stop the oxytocin first
Late decelerations mean the baby is not getting enough oxygen from the placenta during contractions. Oxytocin makes contractions stronger and more frequent, which further reduces blood flow to the placenta. The first step is to stop the oxytocin. Then the nurse turns the client onto her side, gives IV fluids and oxygen if ordered, and notifies the provider.
Wrong choices
- "Document the finding and keep watching the monitor" delays care. Late decelerations need action now.
- "Increase the oxytocin rate to speed up the birth" would make contractions stronger and make the baby's oxygen problem worse.
- "Tell the client to push with the next contraction" is not right unless the cervix is fully dilated, and it does not fix the cause.