National Council Licensure Examination for Registered Nurses (NCLEX-RN) Physiological Integrity: Basic Care and Comfort Syllabus

Which serum protein is the best indicator of recent/acute nutritional status and why?

Prealbumin, because of its short half-life (~2 days) it reflects recent changes; albumin (half-life ~21 days) reflects long-term status.

What clinical signs suggest protein-energy malnutrition?

Unintended weight loss, muscle wasting, edema, poor wound healing, thin/brittle hair, low albumin/prealbumin, and impaired immunity.

Differentiate enteral from parenteral nutrition.

Enteral = nutrition delivered into a functioning GI tract via a tube (NG, NJ, PEG/G-tube). Parenteral = nutrition delivered intravenously, bypassing the GI tract (PPN or TPN).

What is the priority nursing action to verify NG/feeding tube placement before each feeding?

Confirm placement (X-ray confirmation initially; ongoing checks via gastric aspirate pH ≤5 and external tube length marking). Also check residual volume and elevate HOB 30-45 degrees during/after feeding.

What is TPN and why must it be given through a central line?

Total Parenteral Nutrition is a hypertonic IV solution of dextrose, amino acids, lipids, electrolytes, and vitamins; its high osmolarity would damage peripheral veins, so it requires a central venous catheter.

What are the major complications of TPN to monitor for?

Hyperglycemia and rebound hypoglycemia (if abruptly stopped), infection/sepsis (line), fluid overload, electrolyte imbalances, and refeeding syndrome. Monitor blood glucose regularly.

What is refeeding syndrome and which electrolyte shift is most dangerous?

A potentially fatal fluid/electrolyte shift when nutrition is restarted in a malnourished patient; characterized by hypophosphatemia (also hypokalemia and hypomagnesemia). Reintroduce calories slowly.

What nursing measures prevent aspiration during enteral feeding?

Keep HOB elevated 30-45 degrees during and at least 30-60 min after feeding, verify tube placement, check gastric residual volume, and use continuous over bolus feeds in high-risk patients.

What is the normal recommended daily fluid intake for an average adult?

Approximately 2,000-3,000 mL/day (about 1,500 mL from beverages); intake should roughly balance output.

List clinical signs of dehydration (fluid volume deficit).

Thirst, dry mucous membranes, poor skin turgor, decreased/concentrated urine output, tachycardia, hypotension, weight loss, elevated hematocrit and BUN, and increased urine specific gravity.

List clinical signs of fluid volume overload.

Edema, weight gain, bounding pulse, distended neck veins, crackles in lungs, dyspnea, hypertension, and decreased hematocrit (dilutional).

What is the most reliable indicator of fluid status changes in a patient?

Daily weight measured at the same time, same scale, same clothing; a 1 kg (2.2 lb) change equals approximately 1 liter of fluid.

Define dysphagia and name common causes.

Difficulty swallowing; causes include stroke, neuromuscular disorders (Parkinson's, ALS, MS), esophageal obstruction/strictures, and head/neck cancers.

What are the standard aspiration precautions for a patient with dysphagia?

Sit upright 90 degrees during meals and 30-60 min after, use thickened liquids and modified diet textures, small bites, chin-tuck swallowing, no straws, ensure full alertness, and keep suction available.

What are clinical signs that a patient is aspirating during eating?

Coughing or choking with swallowing, wet/gurgly voice, drooling, pocketing of food, throat clearing, and unexplained low-grade fever or recurrent pneumonia.

Why should thin liquids be thickened for many dysphagia patients?

Thin liquids move quickly and are easily aspirated; thickening slows transit, improving swallow control and reducing aspiration risk.

What is the normal frequency range for bowel elimination, and how are constipation and diarrhea defined?

Normal ranges from 3 times/day to 3 times/week. Constipation = infrequent, hard, difficult-to-pass stools; diarrhea = frequent loose/watery stools.

What nursing/dietary interventions promote normal bowel elimination and prevent constipation?

Increase dietary fiber (25-30 g/day), adequate fluids, regular physical activity, establish a toileting routine, and respond promptly to the urge to defecate.

What is a fecal impaction and how is it managed?

A hardened mass of stool that cannot be passed; signs include continuous oozing of liquid stool (paradoxical diarrhea) around the mass. Managed with oil-retention/cleansing enema and, if needed, digital removal.

Differentiate a cleansing enema from a retention enema.

Cleansing enema stimulates peristalsis and is expelled (e.g., tap water, saline, soapsuds) to empty the bowel. Retention enema is held in (e.g., oil to soften stool, medicated) for a prolonged period.

What is the normal adult urine output and what defines oliguria?

Normal ~1,500 mL/day; minimum acceptable ~30 mL/hr. Oliguria = output <400 mL/day (or <30 mL/hr); anuria = <100 mL/day.

Differentiate urinary retention from urinary incontinence.

Retention = inability to empty the bladder, causing accumulation of urine. Incontinence = involuntary loss/leakage of urine (types include stress, urge, overflow, and functional).

What are key nursing measures to prevent catheter-associated urinary tract infections (CAUTI)?

Use sterile technique on insertion, perform daily perineal care, keep the drainage bag below bladder level, maintain a closed system, ensure unobstructed flow, and remove the catheter as early as possible.

What does cloudy, foul-smelling urine with dysuria and frequency typically indicate?

A urinary tract infection (UTI); other findings may include hematuria, urgency, and suprapubic discomfort.

Name nonpharmacological interventions for pain relief.

Cutaneous stimulation (massage, heat/cold), repositioning, distraction, guided imagery, relaxation/deep breathing, music therapy, TENS, and biofeedback.

When is cold therapy versus heat therapy indicated?

Cold (vasoconstriction) for acute injury/swelling, inflammation, and to reduce bleeding and numb pain in the first 24-48 hours. Heat (vasodilation) for chronic pain, muscle stiffness/spasm, and to promote circulation and healing.

What is the Gate Control Theory of pain and how does it support nonpharmacological methods?

It proposes that non-painful stimuli (e.g., rubbing, massage, TENS) close the 'gate' in the spinal cord, blocking pain signals from reaching the brain — explaining why cutaneous stimulation relieves pain.

What nonpharmacological comfort measures help with anxiety and promote relaxation?

Deep/diaphragmatic breathing, progressive muscle relaxation, guided imagery, meditation/mindfulness, music therapy, and creating a calm environment.

What is the difference between complementary and alternative therapies?

Complementary therapies are used alongside conventional medicine; alternative therapies are used in place of conventional medicine. Combined use is called integrative medicine.

Give examples of mind-body and biologically-based complementary therapies.

Mind-body: meditation, yoga, tai chi, biofeedback, guided imagery, hypnosis. Biologically-based: herbal supplements, aromatherapy, dietary/nutritional therapies.

Why must nurses assess herbal/supplement use, and name a key safety concern?

Herbs can interact with prescribed drugs (e.g., St. John's wort reduces effectiveness of many drugs; ginkgo, garlic, ginger, and vitamin E increase bleeding risk). Always document use and check for interactions before procedures/surgery.

What are acupuncture and acupressure, and what comfort outcome are they used for?

Acupuncture inserts thin needles, and acupressure applies finger pressure, at specific body points to balance energy flow; both are used as complementary therapies for pain, nausea, and stress relief.