Physiological Integrity
The nurse provides and directs nursing care that focuses on physiological integrity. The Registered Nurse promotes physical health and wellness by delivering care and comfort, decreasing a client’s potential for risk, and directing health modifications. The categories covered under this topic include:
- Basic care and comfort
- Pharmacological and parenteral therapies
- Reduction of risk reduction
- Physiological adaptation
Basic Care and Comfort
The act of providing basic care and comfort provides nursing assistance to clients in the performance of activities of daily living. This category accounts for about 9% of the questions on the NCLEX-RN exam. The following categories include, but are not limited to:
Assistive Devices
This section provides helpful information for nursing care involving assistive devices for the client. The RN will assess the client’s use of assistive devices, promote the client’s ability to compensate for a physical or sensory impairment, manage the care for the client who uses assistive devices and prosthetic apparatuses, and evaluate the proper use of assistive devices by the client.
Elimination
This section discusses the importance of nursing care to promote elimination of the client. The RN will assess and manage the client with an alteration in bowel or urinary elimination, perform irrigations (bladder, ear, eye), perform skin care for incontinent clients, provide alternative measures to promote a client’s voiding or a toileting schedule, record output, and evaluate the client’s ability to eliminate particularly if elimination is maintained or restored.
Mobility and Immobility
This section provides NCLEX-RN exam information discussing mobility and immobility. The RN will be able to recognize immobility complications (skin breakdown, contractures, risk for injury), assess range of motion, mobility, gait, strength, and motor skills, assess skin and initiate nursing care measures to maintain skin integrity and prevent skin breakdown, and use knowledge of psychomotor skills when providing care to immobile clients. Nurses also apply, maintain, and remove orthopedic devices and devices used to promote venous return, educate the client about repositioning techniques for an immobilized client, maintain the client’s correct body alignment, and assist with the adjustment of client’s traction device. The nurse must also execute interventions to promote circulation and evaluate the client’s response to nursing interventions to minimize immobility complications.
Non-Pharmacological Comfort Interventions
This section will cover the important non-pharmacological comfort interventions involved in nursing care. The RN will assess the client’s need for complementary, alternative medicine, palliative care, symptom management, non-curative treatments, or other appropriate therapies. The RN should assess the client’s pain level and need for pain management, identify variances in client perception and response to pain, and apply knowledge of pathophysiology to comfort care interventions. The RN should know how to integrate alternative and complementary therapies into the client’s plan of care, identify complementary therapies and potential contraindications, and counsel the client regarding options for palliative care including symptom management, non-curative treatments, and care choices. The RN should respect client palliative care, symptom management, and non-curative treatment choices, assist the client who is receiving end of life care including symptom management, and provide comfort interventions and measures to alleviate pain in clients. The RN should be familiar with non-pharmacological comfort measures and evaluate their response to the interventions, outcomes of alternative and complementary therapies, and palliative care or symptom management.
Nutrition and Oral Hydration
This section provides information on how nursing care impacts nutrition and oral hydration. The RN must be able to assess a client’s ability to eat and swallow, and look for potential or actual interactions between food and their medications. The RN must advance the client’s independence in eating, consider and manage nutritional requirements and intake, dietary restrictions, body mass index (BMI), nutritional supplements, special diets (low sodium, high protein), and calorie counts. The RN must deliver nutrition through continuous or intermittent tube feeding, and evaluate side effects of client tube feeding and intervene. The nurse must also monitor hydration status, intake and output, evaluate the influence of health status on the intake and output of the client, and intervene accordingly.
Personal Hygiene
This section will cover the role of the nurse on personal hygiene of the client. The RN will assess the client for adequacy of personal hygiene habits and to determine their usual hygiene routine, intervene in client performance of activities of daily living, educate the client on necessary adaptation for activities of daily living (lifted toilets, shower handles), and perform post-mortem care on the deceased client.
Rest and Sleep
This section discusses how a nurse must promote rest and sleep. The RN should assess a client’s need for sleep and intervene as needed, apply knowledge of client health conditions to promote sleep and rest interventions, schedule client care activities to promote adequate rest (cluster nursing care, enforce visitor hours), and minimize environmental factors that disturb rest (keep noise and light in the hallways and nursing station to a minimum).
Pharmacological and Parenteral Therapies
The nurse will administer pharmacological and parenteral therapies in nursing practice. The RN must provide nursing care related to the administration of medications and parenteral treatments. This category accounts for about 15% of the questions on the NCLEX-RN exam. The nursing actions included in these therapies are, as follows:
Adverse Effect, Contraindications, Side Effects and Interactions
This section will cover the adverse effects, contraindications, side effects, and interactions from medications and parenteral therapy. The nurse must identify any actual and potential contraindication and incompatibilities to the administration of each medication, assess the client for medication side effects, and recognize the signs and symptoms of an allergic reaction to a medication or parenteral therapy. The RN must educate the client on common side effects, adverse effects, and possible interactions of each medication that they are taking and inform the client when to inform their healthcare provider about these medication effects and contraindications. The RN must document side effects and adverse effects the client experiences from medications and parenteral therapy, observe for expected interactions among the client prescribed medications and fluids,evaluate and document the client’s response to actions taken to counteract side effects and reverse adverse effects of medications and parenteral therapy
Blood and Blood Products
This section will cover the important nursing knowledge to perform the care of the client receiving blood and blood products. The nurse will identify the client according to the agency’s procedure prior to the administration of blood or blood products, verify correct venous access for blood and blood product administration, document the needed information for administration of blood and blood products, monitor appropriate vital signs, administer blood and blood products, and evaluate the client response to blood or blood products.
Central Venous Access Devices
This section reviews the nursing knowledge surrounding central venous access devices that a nurse must understand before taking the NCLEX-RN. The RN will educate the client about the purpose for the central venous access device, assess the device for tunneling, infection, and implantation, assess central lines, and provide care for the client with a central venous access device while teaching the client how to care for it.
Dosage Calculation
This section will review the critical nursing knowledge regarding medication dosage calculations. The nurse will use critical thinking skills and clinical decision-making when calculating dosages and complete the medication dosage calculations necessary for the nurse to administer medications safely.
Medication Administration
This section will discuss the important nursing knowledge regarding medication administration. The nurse must know the rights of medication administration, review pertinent data prior to medication administration (i.e. lab data, allergies, interactions), mix medications from vials or intravenous bags if needed, and prepare and administer medications. Next, the nurse will administer and document medication given by common and parenteral routes, titrate medication dosage related to client assessment and ordered parameters, and assist with the medication reconciliation process upon client admission, transfer, and discharge. The nurse must manage medication in a safe and precise setting, dispose of the unused medications according to agency policy, and continuously evaluate suitability and accuracy of the medication order for the client. The nurse is responsible for client education surrounding each administered medication and should educate the client about their new or current medications and self-administration procedures.
Outcomes and Expected Actions
This section will discuss nursing knowledge regarding the outcomes and expected actions from medication administration. The nurse must obtain information regarding the list of a client’s prescribed medications, use critical thinking when discussing anticipated effects and outcomes from medications, evaluate the client’s use of medications over time and their response to medication.
Parenteral and Intravenous Therapies
This section will review parenteral and intravenous therapies that nurses administer. The nurse must be able to use the knowledge of math, nursing procedures, and psychomotor skills when caring for a client receiving intravenous and parenteral therapy, access the appropriate veins for parenteral and intravenous therapies and inform the client about their specific need for intermittent parenteral fluid therapy. The nurse must prepare the client for intravenous (IV) catheter insertion, protect the IV site, and monitor the IV infusion and use of an infusion pump. The nurse should also educate the client about all steps of the process and evaluate the client’s response to IV fluid therapy.
Pharmacological Pain Management
This section discusses nursing knowledge of pharmacological pain management. TheRN must assess a client’s need for administration of a PRN pain medication, document pharmacological pain management appropriate for the client’s age and diagnosis, administer pharmacological pain management, administer controlled substances within the facility’s and legal guidelines, and evaluate the client’s use and response to pain medications.
Total Parenteral Nutrition
This section will review total parenteral nutrition (TPN) that nurses administer. The nurse should administer TPN, recognize the side effects and adverse events related to TPN intervene if needed, educate the client and family about the need and important considerations for TPN, and evaluate the client response to the total parenteral nutrition therapy. The RN will apply knowledge of nursing procedures, client pathophysiology, mathematics, and psychomotor skills for the client receiving TPN.
Reduction of Risk Potential
The reduction of risk potential is how nurses reduce the likelihood that clients will acquire complications or health problems related to existing conditions, treatments, or procedures. This category accounts for about 12% of the questions on the NCLEX-RN exam. The related conditions include:
Changes and Abnormalities in Vital Signs
This section will discuss changes and abnormalities in vital signs that nurses should know. The nurse should evaluate invasive monitoring data, monitor changes in client vital signs, and apply knowledge of nursing procedures and psychomotor skills when assessing vital signs.
Diagnostic Tests
This section will discuss the diagnostic tests that a nurse should know. The nurse will apply knowledge of nursing procedures and psychomotor skills when caring for clients undergoing diagnostic testing and compare client diagnostic findings. The RN will evaluate monitoring data (fetal heart monitoring, amniocentesis, ultrasound), complete both maternal and fetal diagnostic tests, monitor the results, and intervene appropriately.
Laboratory Values
This section will review the laboratory values that a nurse should know. The Nurse must identify the lab values for ABGs, BUN, cholesterol, glucose, hematocrit, hemoglobin, glycosylated hemoglobin (HgbA1C), platelets, potassium, sodium, white blood cells (WBC), Creatinine, PT, PTT, APTT, and INR. The nurse will compare client lab values to the normal range of values, educate the client about the procedure of lab tests, obtain blood and other bodily fluid specimens (wound, stool, urine), monitor the client lab values, and notify the client’s primary health care provider about the test results.
Potential for Alterations in Body Systems
This section will cover nursing knowledge for the potential for alterations in body systems. The Nurse will identify a client’s potential for aspiration and skin breakdown, recognize a client with increased risk for insufficient vascular perfusion, and educate the client how to minimize complications associated with the illness and activity level. The nurse should evaluate client data as compared to the baseline client and monitor the client output for changes from baseline.
Potentials for Complications of Diagnostic Tests, Treatments, and Procedures
This section will review the nursing skills that nurses perform and the resulting potential for complications of diagnostic tests, treatments, and procedures.
The Nurse will assess the client for an abnormal after a diagnostic test and procedure, apply nursing knowledge and skill to caring for a client at risk for complications,and use precautions to prevent injury associated with a procedure. Nurses also must be adept at performing skills like inserting, caring for, and removing a urinary catheter, peripheral intravenous line, maintain tube patency, and deliver care for clients experiencing electroconvulsive therapy.
The nurse will also monitor the client for bleeding precautions, understand proper client positioning to reduce complications after diagnostic tests, treatments, and procedures, intervene according to manage and prevent potential complications, including neurological and aspiration, and evaluate the client’s response to the tests, treatments, and procedures.
Potential for Complications from Surgical Procedures and Health Alterations
This section will review the knowledge nurses must possess regarding the potential for complications from surgical procedures and health alterations. The nurse must apply nursing knowledge of health conditions to observe for complications and evaluate the client’s reaction to post-operative interventions to prevent complications.
System Specific Assessments
This section will discuss the system specific assessments that the nurse must perform. The nurse should assess the client’s neurological status, peripheral pulses, peripheral edema, hypoglycemia or hyperglycemia,and wound healing. The nurse must identify variations in client health status, perform nursing interventions appropriately, assess the client for risk, and perform a focused assessment.
Therapeutic Procedures
This section will discuss nursing care and knowledge regarding therapeutic procedures. The nurse will assess the client’s recovery from all types of surgical anesthesia, educate care for clients experiencing the therapeutic procedures, and minimize complications by implementing precautions while repositioning a client with a musculoskeletal condition. The nurse will monitor the client preoperatively, intraoperatively, and postoperatively, observe the performance of therapeutic devices, educate the client about surgical considerations, deliver surgical care, and provide nursing care during and following sedation.
Physiological Adaptation
Nurses must promote physiological adaptation, the act of managing and providing care for clients with acute, chronic, or life-threatening health conditions. This category accounts for about 14% of the questions on the NCLEX-RN exam. The related conditions include:
Alterations in Body Systems
This section will discuss nursing care and knowledge regarding alterations in body systems. The nurse will assess the client’s adaptation to illness and modifications to health, identify the signs and symptoms of infectious diseases, apply knowledge of nursing procedures and pathophysiology to the care of a client with alterations in body systems, monitor wounds for signs and symptoms of infection, care for a patient with an infectious disease, and educate the client about managing their health. The nurse will also assist with invasive procedures, assess tube drainage and maintain drains, care for ventilator-dependent patients, implement and monitor phototherapy, monitor adverse effects of radiation therapy, and maintain thermoregulation of the patient. Nurses should be able to provide wound care and perform dressing changes, manage the client receiving peritoneal dialysis, provide suctioning and care for an ostomy, perform pulmonary hygiene, intracranial pressure, remove staples, and care for the seizure client. The nurse will evaluate the client response to surgery, provide safe postoperative care, manage care for the client experiencing complications of pregnancy, labor, and delivery, promote client progress toward recovery from alteration in body systems, and evaluate achievement of client treatment goals.
Fluid and Electrolyte Imbalances
This section will review nursing care for fluid and electrolyte imbalances. The nurse must identify signs and symptoms of fluid and electrolyte imbalances, apply nursing knowledge of diseases when caring for the client with fluid and electrolyte imbalances, manage the care of the client with fluid and electrolyte imbalance, and evaluate the client’s response to corrective interventions.
Hemodynamics
This section will discuss what the NCLEX-RN will expect the nurse to know about hemodynamics. The nurse will assess the cardiac output, cardiac rhythm strip abnormalities, apply nursing knowledge to create interventions in response to abnormal hemodynamics, educate the client with techniques to manage decreased cardiac output, and provide nursing interventions to improve the client’s cardiovascular status. The nurse will monitor and maintain arterial lines, manage a pacing device, care for a telemetry and hemodialysis patient, manage the care of a client with alteration in hemodynamics, tissue perfusion, and hemostasis, and evaluate the patient’s outcome.
Illness Management
This section examines nursing care and knowledge in illness management. The nurse must identify reportable client data, educate the client about managing an acute or chronic illness, promote the continuity of care in illness management, and evaluate the effectiveness of the treatment regimen for a client with an acute or chronic diagnosis. The nurse will also promote oxygenation and be able to perform gastric lavage.
Medical Emergencies
This section discusses the nurse’s role in dealing with unexpected medical emergencies. The nurse will apply nursing knowledge to the client experiencing a medical emergency, educate the client regarding emergency interventions, notify the healthcare provider about emergency situations, provide emergency care, evaluate and document the response to emergency interventions.
Pathophysiology
This section discusses the importance of a nurse’s knowledge in pathophysiology in nursing care. Pathophysiology is the study of disease and disordered physiology. The RN must understand the overall principles of pathophysiology and identify how those principles of pathophysiology are directly involved in a client’s acute and chronic conditions.
Unexpected Response to Therapies
This section will discuss how nurses deal with unexpected responses to therapies. The RN will assess the client for unexpected or adverse responses to therapy (intracranial hemorrhage), identify signs and symptoms of complications and intervene appropriately when providing client care, and promote recovery of the client from the adverse effect to therapy like urinary tract infection.