National Council Licensure Examination for Registered Nurses (NCLEX-RN) Physiological Integrity: Physiological Adaptation Syllabus

Physiological Integrity: Physiological Adaptation syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Physiological Integrity: Physiological Adaptation in National Council Licensure Examination for Registered Nurses (NCLEX-RN), not a summary of it.

1. 1

   Fluid, Electrolyte, and Acid-Base Balance

   4 topics

   • Fluid volume imbalances
     • Dehydration and fluid volume overload
   • Electrolyte imbalances
     • Sodium, potassium, calcium, magnesium disorders
   • Acid-base disturbances
     • Metabolic and respiratory acidosis and alkalosis
   • Compensatory mechanisms and correction
2. 2

   Medical Emergencies and Hemodynamic Instability

   4 topics

   • Shock and its management
     • Hypovolemic, cardiogenic, distributive, obstructive shock
   • Cardiopulmonary emergencies
     • Cardiac arrest, ACLS, and basic life support
     • Respiratory failure and airway emergencies
   • Metabolic and endocrine crises
     • DKA, HHS, and hypoglycemia
   • Sepsis recognition and management
3. 3

   Pathophysiology of Chronic and Acute Illness

   4 topics

   • Cardiovascular and respiratory disorders
     • Heart failure, MI, COPD, pneumonia
   • Neurologic and musculoskeletal disorders
     • Stroke, seizures, increased intracranial pressure
   • Renal, hepatic, and gastrointestinal disorders
     • Acute kidney injury, cirrhosis, GI bleeding
   • Endocrine, hematologic, and oncologic disorders
4. 4

   Advanced Therapies and Body System Support

   4 topics

   • Respiratory support and mechanical ventilation
     • Oxygen delivery and ventilator management
     • Chest tubes and pleural drainage
   • Renal replacement therapies
     • Hemodialysis and peritoneal dialysis
   • Alterations in body systems and adaptation
   • Pacemakers and circulatory support devices

Physiological Integrity: Physiological Adaptation flashcards for National Council Licensure Examination for Registered Nurses (NCLEX-RN)

24 of 54 cards from the Physiological Integrity: Physiological Adaptation deck — real questions with worked answers.

1. What is the normal serum sodium range, and what defines hyponatremia vs. hypernatremia?

   Normal serum sodium is 135-145 mEq/L. Hyponatremia is <135 mEq/L; hypernatremia is >145 mEq/L.

2. What are the classic signs of fluid volume deficit (hypovolemia)?

   Tachycardia, hypotension (especially orthostatic), weak/thready pulse, decreased urine output (<30 mL/hr), poor skin turgor, dry mucous membranes, flat neck veins, increased hematocrit and BUN, and weight loss.

3. What are the classic signs of fluid volume excess (hypervolemia)?

   Bounding pulse, hypertension, distended neck veins, crackles in lungs, dyspnea, peripheral/dependent edema, weight gain, and decreased hematocrit and BUN due to dilution.

4. Why is 1 kg of body weight change clinically significant in fluid balance?

   1 kg (2.2 lb) of weight change equals approximately 1 liter (1000 mL) of fluid gained or lost, making daily weights the most reliable indicator of fluid status.

5. What ECG changes and clinical signs characterize hyperkalemia, and what is the normal potassium range?

   Normal K+ is 3.5-5.0 mEq/L. Hyperkalemia (>5.0) causes tall peaked T waves, widened QRS, prolonged PR, bradycardia, muscle weakness, and risk of cardiac arrest.

6. What ECG changes characterize hypokalemia?

   Hypokalemia (<3.5 mEq/L) causes flattened T waves, ST depression, prominent U waves, and risk of dysrhythmias; clinically it causes muscle weakness, leg cramps, and decreased bowel motility.

7. What is the most urgent emergency treatment for life-threatening hyperkalemia?

   IV calcium gluconate to stabilize the cardiac membrane (does not lower K+), followed by IV insulin with dextrose and/or albuterol to shift K+ into cells, then removal via Kayexalate, loop diuretics, or dialysis.

8. What are Chvostek's and Trousseau's signs, and what imbalance do they indicate?

   Both indicate hypocalcemia (and can occur with hypomagnesemia). Chvostek's = facial twitching when the facial nerve is tapped. Trousseau's = carpal spasm when a BP cuff is inflated above systolic pressure.

9. What is the normal serum calcium range and the relationship between calcium and phosphorus?

   Normal total calcium is 9.0-10.5 mg/dL. Calcium and phosphorus have an inverse relationship—when one rises, the other falls.

10. What are the signs of hypermagnesemia and its hallmark assessment finding?

    Hypermagnesemia (>2.5 mg/dL) causes hypotension, bradycardia, lethargy, respiratory depression, and loss of deep tendon reflexes (a hallmark). Treat with IV calcium gluconate.

11. What is the normal arterial blood gas (ABG) range for pH, PaCO2, and HCO3?

    pH 7.35-7.45; PaCO2 35-45 mmHg; HCO3 22-26 mEq/L.

12. How do you interpret respiratory acidosis on an ABG?

    pH <7.35 with PaCO2 >45 mmHg. Caused by hypoventilation/CO2 retention (COPD, respiratory depression, airway obstruction).

13. How do you interpret respiratory alkalosis on an ABG?

    pH >7.45 with PaCO2 <35 mmHg. Caused by hyperventilation (anxiety, pain, fever, hypoxia, early sepsis).

14. How do you interpret metabolic acidosis on an ABG, and give common causes?

    pH <7.35 with HCO3 <22 mEq/L. Causes include DKA, lactic acidosis, renal failure, diarrhea, and shock.

15. How do you interpret metabolic alkalosis on an ABG, and give common causes?

    pH >7.45 with HCO3 >26 mEq/L. Causes include vomiting, prolonged nasogastric suction, antacid overuse, and diuretics.

16. What is the ROME mnemonic for ABG interpretation?

    ROME = Respiratory Opposite, Metabolic Equal. In respiratory disorders pH and PaCO2 move in opposite directions; in metabolic disorders pH and HCO3 move in the same direction.

17. How does the body compensate for metabolic acidosis vs. respiratory acidosis?

    For metabolic acidosis, the lungs compensate quickly by hyperventilating to blow off CO2 (Kussmaul respirations). For respiratory acidosis, the kidneys compensate slowly (hours to days) by retaining HCO3 and excreting H+.

18. How do you distinguish uncompensated, partially compensated, and fully compensated ABGs?

    Uncompensated: abnormal pH with only one (primary) system abnormal. Partially compensated: abnormal pH with both systems abnormal. Fully compensated: normal pH (7.35-7.45) with both PaCO2 and HCO3 abnormal.

19. What are the four main classifications of shock?

    Hypovolemic (volume loss), cardiogenic (pump failure), distributive (vasodilation—includes septic, anaphylactic, neurogenic), and obstructive (mechanical obstruction—e.g., tamponade, tension pneumothorax, PE).

20. What hemodynamic changes characterize early (compensated) vs. late (progressive) shock?

    Early/compensated: normal or slightly low BP, tachycardia, restlessness, cool clammy skin, slight respiratory increase. Late/progressive: marked hypotension, weak pulse, oliguria/anuria, altered mental status, metabolic acidosis, and organ failure.

21. How does neurogenic shock differ from other forms of distributive shock in vital signs?

    Neurogenic shock causes bradycardia (not tachycardia) along with hypotension and warm, dry skin, due to loss of sympathetic tone from spinal cord injury above T6.

22. What is the priority treatment for anaphylactic shock?

    Epinephrine IM (first-line) to reverse bronchoconstriction and vasodilation, maintain airway, give oxygen, IV fluids, and adjuncts such as antihistamines and corticosteroids.

23. What is the first-line management for hypovolemic shock?

    Identify and control the source of fluid/blood loss, then rapidly administer isotonic crystalloids (normal saline or lactated Ringer's) and blood products as needed; place two large-bore IVs.

24. What is the primary goal and main drug class used in cardiogenic shock?

    The goal is to improve myocardial contractility and cardiac output while reducing workload. Positive inotropes (e.g., dobutamine) increase contractility; vasodilators or an intra-aortic balloon pump may reduce afterload.

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