Basic Care and Comfort Study Guide for the NCLEX-PN Exam

General Information

There are many basic client needs that you’ll be responsible for ensuring during your work as an LPN. From movement to hygiene to bodily functions, part of your job will be to be sure all goes as smoothly as possible and monitor clients for any difficulties in these areas. The NCLEX-PN® test uses about 7% to 13% of its questions to this area of nursing. The outline below should help you know what to study, but if you still have questions, be sure to seek additional information.

Comfort

Mobility/Immobility and Body Use

Clients are often bedridden as opposed to ambulatory. Given the potential negative effects of prolonged immobility, it is important to pay close attention to each client’s mobility needs.

Assess the Client

When caring for clients, the first step is to assess their current condition as it relates to mobility. This is crucial in determining a client’s appropriate treatment and his or her risk for falls and risk for injury.

• Motor Skills: When assessing a client’s mobility, the nurse should first start with the client’s motor skills. Common motor skills to assess include strength, balance, and coordination. The nurse’s assessment can start with bedside tests such as sitting and shaking hands and progress to observed ambulation. When assessing a client’s gait and ambulation needs, special attention should always be paid to his or her risk for falling.

• Venous Insufficiency & VTE Prevention: When clients are bedridden, they are at risk for venous insufficiency and Deep Vein Thrombosis (DVT), as the blood that usually flows through the lower extremities when walking can become static. Pay attention to swelling, warmth, or dark discoloration in the lower legs and comply with orders for elastic compression stockings (TEDs) and/or sequential compression devices (SCDs) to increase venous return. Ensure proper measurement prior to application to avoid tissue constriction, and remove stockings or sleeves at least once per shift to inspect underlying skin integrity. Do not apply SCDs or compression stockings if the client exhibits signs of an active DVT (e.g., severe unilateral calf edema, pain, warmth).

Provide Support

A client with a chronic disorder that impacts his or her mobility will have different physical and psychosocial needs than a client in an acute situation that has made them immobile. Further, a client who was not expecting to be rendered immobile may need additional reinforcement more than a client who had prepared for immobility and may have been educated earlier in the process.

Teach

The LPN is responsible for reinforcing the education provided to the client, such as how to perform active and passive range of motion, strengthening, and/or isometric exercises. It is important that the client follows the provided teaching to maintain mobility. Further, when observing the client, the LPN should ensure the client maintains correct body alignment so that the exercises are most effective. Use of proper ergonomic principles when moving also helps to prevent unnecessary injury to both the client and the nurse.

Provide Care

For clients that are able to ambulate, the LPN can assist with transfers and walking. For some clients, adaptive equipment may be necessary, and the LPN should be trained on how to use these devices. For clients that are immobile and/or bedridden, the LPN can assist with repositioning at least every 2 hours and help the client practice active and passive range of motion exercises in the bed.

Maintain Skin Integrity

Clients that are immobile are at high risk for skin breakdown, and the LPN can assist with monitoring skin integrity and prevention of pressure injuries. The most effective way to prevent skin breakdown is frequent repositioning. Detailed skin assessments and meticulous hygiene are critical in identifying early stages of breakdown (such as non-blanchable erythema). Pressure-relieving devices, such as gel pillows, positioning wedges, and heel protectors, should be used as appropriate.

Assistive Devices

Some clients may need a variety of assistive devices, such as a cane, walker, or crutches to assist with ambulation, or specialized devices to assist with feeding or communication.

Understand and Teach Proper Use

When assisting a client to ambulate with assistive devices, the LPN must ensure that these devices are adjusted to the appropriate height and used correctly to avoid placing unnecessary strain on the body.

• Canes: The cane should be held on the client’s unaffected (strong) side. To ambulate, the client advances the cane forward 6 to 10 inches, then moves the affected (weak) leg forward level with the cane, and finally steps forward with the strong leg (Memory aid: COAL – Cane Opposite Affected Limb).

• Crutches: Ensure a 2 to 3 finger-width gap (1 to 1.5 inches) between the axillary pad and the armpit to prevent brachial plexus nerve injury. Handgrips should allow a slight elbow bend (approx. 20°–30°).
  • Going UP stairs: Advance the unaffected (strong) leg first, followed by the crutches and affected leg.
  • Going DOWN stairs: Advance the crutches and affected (weak) leg first, followed by the strong leg (Memory aid: “Up with the good, down with the bad”).
• Walkers: The client pushes the walker forward a short distance, steps into it with the weak leg first, and then follows with the strong leg. Remind the client never to pull up on a walker when standing up from a chair; they should push off the armrests instead.

Care for the Client

Clients with difficulty eating may use an enteral or parenteral tube, and the LPN will assist with feedings along with caring for the site. For clients with communication barriers, the LPN should be familiar with telecommunication devices, touch pads, and communication boards so that the LPN can converse with the client and reinforce client teaching.

Non-Pharmacological Comfort & Thermal Interventions

The effectiveness of non-pharmacological comfort interventions is vital in holistic nursing care. They may include imagery, massage, repositioning, physical interventions, or thermal applications.

Thermal Therapies (Heat & Cold)

Apply heat or cold applications for a maximum of 15 to 20 minutes at a time to prevent the “rebound phenomenon” (where prolonged exposure produces the opposite physiological effect, causing tissue injury). Always place a barrier (towel or cloth) between the device and the skin.

• Heat Application: Promotes vasodilation, increases blood flow, and relaxes muscles. Do not apply heat to active bleeding, acute localized inflammation (e.g., acute appendicitis), or severe vascular disease.

• Cold Application: Promotes vasoconstriction, reduces swelling (edema), and numbs acute pain. Do not apply cold to areas with impaired peripheral circulation or Raynaud’s disease.

Pain

The vast majority of clients in inpatient or outpatient settings will have some level of pain that needs treatment. While pharmacologic treatment is often necessary, non-pharmacological interventions are critical tools the LPN uses to ensure maximum comfort.

Assess Pain Level

Pain is a subjective experience and will differ from one client to another. To best assess a client’s pain level, there are a number of standardized scales, both verbal and non-verbal:

• Numeric Rating Scale (0–10): Used for alert, verbal adults and children who can quantify pain. Clients self-report their pain intensity by selecting a single whole number along a continuum from 0 to 10. A score of 0 represents “no pain,” 1 to 3 indicates mild pain, 4 to 6 signifies moderate pain, and 7 to 10 represents severe or the worst possible pain.

• Wong-Baker FACES Scale: Used for young children, non-English speaking clients, or those with mild cognitive impairments. Clients choose one of six illustrated cartoon facial expressions that best matches their current level of discomfort, ranging from a smiling face to a crying face. Each face corresponds to a specific even numerical score (0, 2, 4, 6, 8, or 10), where 0 means “no hurt” and 10 means “hurts worst.”

• FLACC Scale (Face, Legs, Activity, Cry, Consolability): Used for infants, young children, or non-verbal post-operative clients. A clinician evaluates the client across five distinct behavioral categories: Face, Legs, Activity, Cry, and Consolability. Each category receives a score from 0 to 2 based on observed behaviors, which are summed to give a total pain score ranging from 0 to 10 (higher total scores indicate greater pain).

• PAINAD Scale: Used for non-verbal clients with advanced dementia. An observer assesses five specific behavioral indicators: breathing, negative vocalization, facial expression, body language, and consolability. Each indicator is rated on a 0 to 2 scale depending on the severity of distress, yielding a total score from 0 to 10 (0 = no pain, 10 = severe pain).

In addition to formal scales, observe for non-verbal indicators of discomfort, such as grimacing, restlessness, guarding, or changes in vital signs.

Provide Pain Therapy

There are many additional treatments for pain aside from pharmacological treatments. For example, clients may benefit from imagery, massage, or repositioning to provide comfort. As with any pain therapy, always monitor the client’s response or lack thereof. When caring for a client with inflammation or swelling, consider heat/cold treatments or limb elevation to decrease swelling and discomfort.

General Comfort and Palliative Care

For some clients, the treatment goal will not be to cure disease, but to make the client as comfortable as possible. In palliative care, the focus is on providing a measure of comfort care and managing symptoms rather than treating the underlying disease process. When caring for a palliative care client, it is extremely important to respect the client’s choices and assist as needed.

Assess the Clients’ Needs for Care

When caring for a palliative care client, it is important to constantly assess the client’s pain level and his or her need for intervention. The LPN should assist in planning comfort interventions as needed and reinforce teaching on these care interventions to both the client and their family.

Provide Care

Comfort and palliative care interventions will primarily include pharmacological and non-pharmacological comfort interventions. The LPN should assist with treatment as appropriate and constantly monitor the outcome and client response, paying close attention to the client’s physical comfort and emotional well-being.

Other Considerations

There are additional considerations for the LPN to be aware of to meet the clients’ needs.

Visually or Hearing Impaired Clients

The LPN will often encounter visually impaired or hearing-impaired clients. Utilize assistive devices to facilitate communication, like telecommunication devices (TDD) and communication boards. Clients with visual impairment should have clear access to their corrective lenses, and written materials should be provided in a font and size that is readable to them. The LPN should also be cognizant of how these impairments may require modifications to activities like ambulating, ensuring the environment is free of obstacles.

Using Alternative and Complementary Therapy

Some clients may be interested in alternative and complementary therapies. The LPN should be respectful of alternative measures the client may explore. The LPN can also suggest common complementary therapies such as music therapy, guided imagery, or aromatherapy that may improve the client’s overall experience.

Managing Stress

When the LPN is caring for a client in an inpatient or outpatient setting, the client will likely be under some level of added stress related to hospitalization or medical diagnosis. The LPN can assist with and reinforce teaching on stress management techniques, such as relaxation breathing, light physical exercise, and meditation.