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

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.

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.

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.

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.

What is the immediate priority intervention sequence for cardiac arrest (BLS)?

C-A-B: Check responsiveness/pulse, start high-quality Chest compressions (100-120/min, 2-2.4 inch depth), open the Airway, and provide Breathing/rescue breaths; attach an AED/defibrillator as soon as available.

Which cardiac rhythms are shockable, and which are not?

Shockable: ventricular fibrillation (VF) and pulseless ventricular tachycardia (pulseless VT). Non-shockable: asystole and pulseless electrical activity (PEA)—treat with CPR and epinephrine.

What is the classic triad of symptoms in pulmonary embolism, and the initial nursing priority?

Sudden dyspnea, pleuritic chest pain, and hemoptysis (often with tachycardia and anxiety). Priority is administer high-flow oxygen, elevate the head of bed, and anticipate anticoagulation.

What are the signs of cardiac tamponade (Beck's triad)?

Beck's triad: hypotension, muffled/distant heart sounds, and jugular venous distention. Also look for pulsus paradoxus. Treatment is emergency pericardiocentesis.

What are the hallmark labs and clinical signs of diabetic ketoacidosis (DKA)?

Blood glucose >250 mg/dL, metabolic acidosis (pH <7.3, HCO3 <18), ketonemia/ketonuria, Kussmaul respirations, fruity breath, dehydration, and altered mental status; most common in type 1 diabetes.

How does hyperosmolar hyperglycemic state (HHS) differ from DKA?

HHS has much higher glucose (often >600 mg/dL), severe dehydration, and high serum osmolality but little or no ketosis/acidosis. It occurs mainly in type 2 diabetes and carries a higher mortality.

What is the priority treatment order for DKA?

Fluids first (IV normal saline) to restore volume, then IV regular insulin to lower glucose, and potassium replacement as insulin drives K+ into cells (monitor closely to prevent hypokalemia).

What are the signs of thyroid storm (thyrotoxic crisis)?

Severe hyperthermia, extreme tachycardia/dysrhythmias, hypertension, agitation/delirium, vomiting, and diarrhea. Treat with antithyroid drugs (PTU/methimazole), beta-blockers, cooling, and supportive care.

What are the signs of myxedema coma?

Severe hypothyroidism causing hypothermia, bradycardia, hypotension, hypoventilation, hyponatremia, hypoglycemia, and decreased level of consciousness. Treat with IV levothyroxine and supportive care.

What is Addisonian crisis (acute adrenal insufficiency) and its key features?

Life-threatening cortisol deficiency causing severe hypotension, hyponatremia, hyperkalemia, hypoglycemia, and shock. Treat emergently with IV hydrocortisone, fluids, and glucose.

What is the SIRS/sepsis criteria progression from sepsis to septic shock?

Sepsis = life-threatening organ dysfunction from a dysregulated response to infection. Septic shock = sepsis with persistent hypotension requiring vasopressors to keep MAP >=65 mmHg plus lactate >2 mmol/L despite adequate fluid resuscitation.

What is the qSOFA score and its components?

qSOFA rapidly screens for sepsis risk outside the ICU; 2 or more of: respiratory rate >=22/min, altered mentation (GCS <15), and systolic BP <=100 mmHg.

What are the key elements of the Surviving Sepsis 'hour-1 bundle'?

Measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics, begin rapid 30 mL/kg crystalloid for hypotension or lactate >=4, and apply vasopressors if hypotensive during/after fluids to keep MAP >=65 mmHg.

What is the first-line vasopressor for septic shock?

Norepinephrine is the first-line vasopressor to maintain a mean arterial pressure of at least 65 mmHg after adequate fluid resuscitation.

What are the classic ECG and symptom findings of an acute myocardial infarction (STEMI)?

ST-segment elevation, crushing substernal chest pain radiating to the left arm/jaw, diaphoresis, nausea, and dyspnea; elevated troponin confirms infarction. Treat with MONA-B and reperfusion (PCI or thrombolytics).

What is the nursing priority and positioning for acute pulmonary edema?

Place the patient in high-Fowler's position with legs dependent, give high-flow oxygen, and administer IV loop diuretics (furosemide), morphine, and nitroglycerin to reduce preload and improve oxygenation.

What are the hallmark signs of acute respiratory distress syndrome (ARDS)?

Refractory hypoxemia (low PaO2 unresponsive to oxygen), bilateral 'white-out' infiltrates on chest X-ray, decreased lung compliance, and noncardiogenic pulmonary edema; managed with mechanical ventilation using low tidal volumes and PEEP.

What is the Cushing's triad of increased intracranial pressure?

Hypertension with a widening pulse pressure, bradycardia, and irregular/abnormal respirations—a late and ominous sign of increased ICP and impending herniation.

What are the early signs of increased intracranial pressure and key nursing interventions?

Earliest sign is a change in level of consciousness, plus headache, restlessness, and pupillary changes. Interventions: elevate head of bed 30 degrees, keep head midline, prevent Valsalva, avoid hypercapnia, and limit suctioning.

What distinguishes autonomic dysreflexia, and what is the immediate nursing action?

A life-threatening sympathetic response in spinal cord injury at/above T6, causing severe hypertension, pounding headache, bradycardia, and diaphoresis above the lesion. First action: raise the head of bed (sit upright) and remove the trigger—usually a full bladder or bowel.

What are the key features and emergency treatment of myasthenic crisis vs. cholinergic crisis?

Both cause severe muscle weakness and respiratory failure. Myasthenic crisis = undermedication (improves with edrophonium); cholinergic crisis = overmedication with SLUDGE symptoms (worsens with edrophonium). Priority for both is airway/ventilation support.

What are the phases and management priorities of acute kidney injury (AKI)?

Phases: onset, oliguric (decreased output, fluid overload, hyperkalemia, metabolic acidosis), diuretic (large output, risk of dehydration/hypokalemia), and recovery. Manage fluids/electrolytes, treat hyperkalemia, and consider dialysis.

What is the dietary and ammonia-lowering management of hepatic encephalopathy?

Administer lactulose to reduce ammonia (titrate to 2-3 soft stools/day), give rifaximin to reduce ammonia-producing gut bacteria, and monitor neurologic status; protein is moderated rather than severely restricted.

What are the signs and emergency management of esophageal varices hemorrhage?

Massive hematemesis, melena, and hypovolemic shock in a cirrhosis patient. Manage with airway protection, fluid/blood resuscitation, octreotide/vasopressin to reduce portal pressure, and endoscopic banding or sclerotherapy; balloon tamponade if needed.

What are the indications and key ABG goal for mechanical ventilation, and what does PEEP do?

Indicated for respiratory failure (e.g., PaO2 <60 on high O2, PaCO2 >50 with acidosis, apnea). PEEP (positive end-expiratory pressure) keeps alveoli open at end-expiration to improve oxygenation, but high levels risk decreased cardiac output and barotrauma.

What does a high-pressure ventilator alarm vs. a low-pressure alarm indicate?

High-pressure alarm = increased resistance/obstruction (secretions, kinked tubing, biting, coughing, bronchospasm, decreased compliance). Low-pressure alarm = a leak or disconnection in the circuit or cuff.

What are the main types of renal replacement therapy and the key difference between hemodialysis and peritoneal dialysis?

Hemodialysis filters blood through an external dialyzer (fast, 3-4 hrs, requires vascular access and anticoagulation); peritoneal dialysis uses the peritoneum as the membrane via dwelling dialysate (slower, gentler, infection risk is peritonitis with cloudy effluent). Continuous renal replacement therapy (CRRT) is used for hemodynamically unstable ICU patients.

What are the indications for emergent dialysis (AEIOU mnemonic)?

AEIOU: Acidosis (severe metabolic), Electrolytes (refractory hyperkalemia), Intoxications (dialyzable toxins), Overload (fluid overload unresponsive to diuretics), and Uremia (symptomatic—pericarditis, encephalopathy).

What are the five letter codes' first three positions in pacemaker coding, and what do failure to capture vs. failure to sense mean?

Position 1 = chamber paced, 2 = chamber sensed, 3 = response to sensing. Failure to capture = pacing spike not followed by depolarization (no QRS/P after spike). Failure to sense = pacemaker fires despite intrinsic beats (spikes in wrong places, risking R-on-T).

What is an intra-aortic balloon pump (IABP) and the principle of counterpulsation?

A mechanical circulatory support device in the descending aorta that inflates during diastole (increasing coronary perfusion) and deflates just before systole (decreasing afterload), improving cardiac output in cardiogenic shock and unstable angina.