Page 2 Health Promotion and Maintenance Study Guide for the NCLEX-RN® exam

Developmental Transitions and Stages

In each developmental phase, there are normal expectations for physical, cognitive, social, and emotional growth that the nurse will need to know. This next section of each stage of growth will include normal developmental milestones for each group, followed by the main needs of each age group, and finally, the warning signs of abnormal growth and development.


Infants are age 1 to 12 months. Physically, they should have the ability to suckle as well as a grasping reflex when an object or finger is in their palm. Infants should also have the ability to focus their eyes for short periods on an object. They may have swollen breasts or genitalia, white acne bumps or milia on their face, and slightly misshapen heads that become rounder with age. They should learn to grasp with the thumb and index finger (pincer grasp). Infants will vocalize or “coo” and may respond selectively to spoken words.

Needs— Infants must form bonds with their parents and caregivers.

Warning Signs— Abnormal developmental signs include not rolling from tummy to side by age 10 months as well as not transferring toys/objects from hand to hand by age 9 months.


Preschool age is defined as age 1 to 4 years old. These children enjoy physical activities and exhibit finer motor skills and greater physical coordination. They should dress and undress themselves, be able to use and manipulate small objects with their hands and fingers and will show progressive control over their bowel movements and bladders.

Children of this age are aware of limits. They may say “no” frequently and should have a vocabulary of anywhere between 500 to 3,000 words. Their sentences will be short, phrases with three to four words. They may be able to use a pencil to draw simple shapes. They believe adults know everything and are eager to please those around them.

Needs— Preschool aged children need consistency and they need to feel secure in their environments. They need close supervision to keep them from harm in dangerous settings, but they should also have some unstructured playtime and independence.

Warning Signs— Abnormal developmental signs include not walking by age 18 months, not having a vocabulary of at least 15 words, not being able to follow simple commands or imitate words or actions, not being interested in playing with other children or engaging in “pretend” play, and excessive focus on violence or other mature subject matter.


School-aged children are between the ages of 5 and 12 years old. Their physical coordination is more advanced, and they should be able to perform activities that require a combination of motions such as jumping rope, riding a bicycle, and skipping. They can follow more complicated, multi-step commands and have the ability to retain information. School-aged children should be able to recall their full names, their address, as well as how old they are. During this stage, these children may tend to identify with or emulate their same-sex parent.

Needs— Early intervention is necessary in this group if there are vision and/or hearing problems. These often become apparent as children enter the classroom. Physically, scoliosis or a lateral curvature of the spine may develop at this age. Likewise, this should be caught early to provide the proper intervention.

Warning Signs— Continued bed-wetting or enuresis is a concern in this age group, especially in older children. Children of this age should also not verbalize or show outward signs of anxiety about school or home as this is abnormal for this developmental stage.


Adolescence is defined as ages 12 to 18. These children normally struggle to find their own sense of identity. They form strong relationships with their peers, and it is normal for them to engage in somewhat risky behavior due to a natural sense of immortality. Physically, there are many changes including the development of secondary sexual characteristics with increased hormones as well as a growing interest in, and concern with, physical attractiveness.

Needs— The physical changes of puberty can be overwhelming and distressing to this group. They need preparation for and discussion of what is normal during this time. Adolescents can also exhibit labile swings of mood and personality due to these changes.

Warning Signs— Excessive aggressiveness and persistent misbehavior (especially at school) are warning signs of abnormal development in this group.

Adults (Working Adults)

Adults of working age fall between 19 to 64 years of age. During this stage, people seek to find meaning or purpose in their lives through work, family, and other relationships. For ages 19 to 34, Erikson’s theory of psychosocial development states that this phase of adulthood is to resolve the conflict of intimacy versus isolation. These adults are focused on finding a partner/starting a family or deciding to be single. From 35 to 64, adults work to resolve the conflict of generativity versus stagnation according to Erikson. At this point, adults find more meaning in their work and look to find ways to leave a lasting legacy in the world.

Physically, adults are considered in their prime between the ages of 25 to 35 years old. After that, chronic medical conditions may develop and adults may need to make lifestyle modifications to treat and/or adjust these changes.

Needs— The demands of long-term relationships, marriages, workplace relationships, and politics as well as parenting can all positively or negatively influence development and functioning in this group.

Warning Signs— Abnormalities in this group can include substance abuse (alcohol, medications, or illicit drugs) as well as a feeling that life is meaningless.

Older Adults (Retirement Aged)

Older adults are those who fall between 65 and 85 years of age. These adults demonstrate a slow decline of physical functioning and will likely retire from the workplace. They often experience a slow decline of cognitive function as well. Erikson’s theory for this age group is that they must resolve the conflict of ego integrity or despair. It is his final stage of development in which he believed adults either look back on their lifetime and accomplishments with a sense of satisfaction, or they feel despair if they don’t feel a sense of meaning or purpose from their life.

This group begins to experience significant changes in interpersonal relationships due to illness, decline of function, and death of others around them during this phase of life.

Needs— These adults may have difficulty transitioning to life away from the workplace. They may also struggle with the changes in or loss of close personal relationships.

Warning Signs— Most adults will feel a sense of pride or peace with their life to this point. It is abnormal for them to feel a sense of despair or regret about their life in this phase.

Very Old Adults (Elderly)

Elderly adults are defined as those over the age of 85. These adults show progressive decline of both physical and cognitive functioning. They will likely experience heavy loss of interpersonal relationships.

Needs— These adults need help learning to find acceptance and meaning in their lives.

Warning Signs— Suicidal thoughts or behavior is abnormal for this age group.

Health Promotion and Disease Prevention

In the traditional medical model, health was defined as the absence of disease. However, today we recognize that many people enjoy a high quality of life (healthy life) despite one or more health challenges. The term “health and wellness” is a more encompassing term that is used to represent a state of physical, social, and emotional well-being and/or the pursuit of each. Nurses play a critical role in educating and empowering patients to take control of their own health. They can help patients find the health resources they need based on their specific health condition and/or disability. Be familiar with programs in each of the following areas of health promotion and wellness.

Weight Management

Healthy weight management should focus on incremental changes to move patients toward a desirable weight for their height and build. It is important to note that even a modest weight loss of 10 to 20 pounds can significantly positively impact those with chronic health conditions such as type II diabetes.

Smoking Cessation

The reasons people continue to smoke despite the known negative health effects are numerous. Nicotine addiction, depression, anxiety, habit and repeated exposure to smoking-associated stimuli in both social and workplace settings all play a role. Often those with low incomes, low education and psychosocial problems find it difficult to quit. More than one strategy will typically be necessary to achieve successful smoking cessation.


Nutrition plays a large role in health and wellness. While good, sensible eating is universally recommended, remember that special groups will need more specific recommendations. Patients with hypertension should avoid excess sodium and sodium-containing foods such as canned or processed foods. Patients at risk for osteoporosis should be encouraged to increase their calcium intake. Those with diabetes will need restricted carbohydrates, and those with high cholesterol should avoid saturated fats like those in red/fatty meats and trans fats in deep fried and fast foods.


The overall health benefits of exercise are immense and for everyone at any age or activity level. Exercise can help improve cardiovascular and respiratory function, assist in weight control, stimulate metabolism, improve sleep, decrease the risk of osteoporosis/strengthen bones, and improve overall strength, balance, flexibility and endurance. There is also good evidence to show exercise can improve mental health and positively impact a number of disorders such as depression and anxiety. Exercise also decreases social isolation.

Other Therapies

Be aware that many patients will incorporate other alternative therapies with their traditional western medical regimens. These may include massage, acupuncture, hypnosis, and others. Patients often take over-the-counter medications, vitamins, supplements and homeopathic remedies such as herbs or essential oils. Some patients may see alternative medical providers such as a shaman or chiropractor.

Breast Health

The importance of performing a breast self-examination (BSE) should be taught to every female patient once they reach puberty. Women should do their BSE during day 5 to 7 of their menstrual cycle on a monthly basis. Menopausal patients should also continue to perform monthly BSEs.

Testicle Health

Testicular cancer is one of the most curable solid tumors. It is most common in men ages 15 to 35 years. Male patients should be counseled on the importance of testicular self-examination and should perform one regularly, preferably after bathing when the scrotum is most relaxed. Any swelling, lumps or other abnormalities need to be reported immediately to the patient’s medical provider.

Hormone Replacement Therapy (HRT)

Perimenopausal and menopausal women may be candidates for hormone replacement therapy (HRT) to help control the negative symptoms of their condition such as hot flashes, sweating, and vaginal dryness. While HRT has protective effects against the development of osteoporosis, it may increase the risk of the development of coronary artery disease (CAD), breast cancer, deep vein thrombosis (DVT), and stroke. Therefore, the risks and benefits of HRT need to be carefully weighed for each individual patient.


Immunizations play an important part of overall health and wellness throughout a patient’s lifetime. Generally, most immunizations are given to children aged 2 to 12 months. The hepatitis B vaccine is given to newborns, and the annual flu vaccine may be given after the age of 6 months. College freshmen who plan on living in dormitories who are previously unvaccinated should receive the meningococcal vaccine. Adults over the age of 60 should all receive the vaccination to prevent shingles (herpes zoster) as well as pneumococcal pneumonia.

Oral Health

The importance of the connection between oral health and other physical disease should be stressed from an early age. Gum disease or periodontal disease has been linked to diabetes, heart disease and other chronic, inflammatory conditions. Patients should be counseled on the importance of dental visits and cleanings every six months beginning at the age of 2 years.

Mental Health

Nurses often deal more intimately with patients than any other member of the healthcare team. They may be the first to identify a patient’s mental health issues or those at risk for developing depression, anxiety, etc. Nurses can provide these patients with helpful suggestions on how to effectively manage stress and assist with arranging care for those who need intervention from a mental health specialist or counselor.

Heart Disease and Stroke Prevention

High blood pressure is frequently associated with heart problems and strokes. Nurses can identify blood pressure abnormalities and encourage patients to monitor their own blood pressure at home, especially those who have a family history of hypertension. Nurses can also help educate patients on worrisome symptoms and the normal parameters for both systolic and diastolic blood pressures.

Skin Health

Nurses should counsel all patients on the dangers of excessive ultraviolet (UV) exposure and the importance of regular skin cancer screenings. They can also provide helpful information on sunscreen, protective clothing, and times of day to avoid outdoor activities.