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

Care

Nutrition and Oral Hydration

The LPN plays a vital role in assisting clients with their nutrition and hydration needs, especially for bedridden clients who are out of their normal routines. Proper nutrition supports tissue repair, maintains immune function, and prevents complications such as muscle wasting and pressure injuries. LPN responsibilities include monitoring client status, assisting with meals, reinforcing dietary education, and honoring individual therapeutic, cultural, or religious dietary preferences.

Therapeutic Diets

• Clear Liquid: Transparent liquids that leave minimal residue (e.g., broth, clear juices without pulp, gelatin, tea, coffee without dairy). Used short-term post-operatively or before procedures.

• Full Liquid: Includes clear liquids plus smooth dairy products, ice cream, pudding, refined cooked cereals (e.g., cream of wheat), and strained soups.

• Pureed & Mechanical Soft: Foods altered in texture for clients with chewing or swallowing difficulties. Pureed foods are blended to a smooth, pudding-like consistency. Mechanical soft foods are soft, chopped, or ground.

• Sodium-Restricted / Low Sodium: Prescribed for clients with heart failure, hypertension, or renal disease to prevent fluid retention. Avoid canned soups, processed meats, and salted snacks.

• Renal Diet: Controls intake of protein, sodium, potassium, phosphorus, and fluids to manage kidney workload.

• Diabetic / Consistent Carbohydrate: Focuses on balanced, consistent carbohydrate intake throughout the day to keep blood glucose levels stable.

• High Protein / High Calorie: Indicated for wound healing, burn recovery, cancer, or severe malnutrition.

Cultural and Religious Considerations

Respect individual dietary traditions, such as Kosher requirements (prohibiting pork and shellfish, requiring separate preparation of milk and meat), Halal dietary laws, or specific vegetarian/vegan preferences.

Monitor the Client

One of the first steps in addressing a client’s nutritional needs is monitoring his or her input and output (I&O). There are many obvious forms of intake and output, but the LPN should also be aware of some non-obvious forms such as IV fluids, sweat, or emesis. Also, the client’s disease or illness may have an impact on nutritional needs or the ability to eat or drink.

• Intake: Record all liquid taken into the body, including oral fluids (water, juice, broth), ice chips (calculated at half their volume; e.g., 100 mL of ice chips equals 50 mL of liquid), tube feedings, IV fluids, and liquid medications.

• Output: Measure and record all fluid lost from the body, including urine, emesis, liquid stool, surgical drain output, chest tube drainage, and gastrointestinal suction.

• Fluid Balance & Daily Weights: Daily weight measurement—taken at the same time every morning, on the same scale, wearing similar clothing—is the single most accurate indicator of fluid retention or loss. Monitor for signs of fluid overload (such as peripheral edema, lung crackles, and neck vein distention) or fluid volume deficit (such as poor skin turgor, dry mucous membranes, tachycardia, and dark concentrated urine).

Help and Teach

Some clients may need assistance eating and drinking, which can be provided by an LPN. The LPN should also promote independence in eating when appropriate. There are a number of assistive devices that the LPN can suggest to help the client eat independently. Further, the LPN should reinforce client teaching on any dietary or nutritional needs based on the client’s diagnosis. These might include such dietary restrictions as “high protein” or “calorie restriction.”

• Adaptive Devices: Suggest thick-handled or weighted utensils for clients with tremors, plate guards to prevent food from spilling off the dish, built-up cups, and non-skid place mats.

• Visually Impaired Assistance: Use the clock method to explain food locations on the plate (e.g., “Protein at 12 o’clock, vegetables at 3 o’clock, grain at 6 o’clock”) to foster client independence.

• Reinforcing Teaching: Educate clients and families on reading nutrition labels, adhering to fluid restrictions, and understanding how prescribed diets support their specific medical condition.

Eating Difficulties and Dysphagia

When assisting or monitoring clients during meals, the LPN must actively assess for signs of eating difficulties. Clients may be unaware of an inability to chew or swallow properly, creating severe choking and aspiration risks. Clients with eating difficulties must never eat unmonitored.

Assessment & Warning Signs:

• Chewing & Swallowing: Evaluate the client’s ability to chew food thoroughly and swallow safely. Unchewed food creates an immediate choking hazard.

• Signs of Dysphagia: Observe closely for warning signs of swallowing impairment, including:

  • Coughing or choking during or after swallows
  • Frequent throat clearing
  • A wet or “gurgly” voice after eating or drinking
  • Drooling or inability to manage secretions
  • “Pocketing” food in the cheeks

Aspiration Risk & Precautions

Aspiration occurs when food, liquid, saliva, or tube feeding enters the trachea and lungs instead of the esophagus. High-risk populations include clients with dysphagia, sedated clients, and those with neurological impairments (e.g., post-stroke, Parkinson’s disease).

• Positioning: Seat the client fully upright in High-Fowler’s position (90°) or at least 45° to 90° during all oral intake. Keep the client upright for 30 to 60 minutes after eating.

• Swallow Techniques: Teach the chin-tuck maneuver (tucking the chin down toward the chest while swallowing) to close off the airway and direct food safely into the esophagus.

• Dietary Modifications: Serve prescribed thickened liquids (nectar-thick, honey-thick, or pudding-thick).

• Feeding Environment: Avoid rushing, offer small bites, and avoid using straws for clients with severe dysphagia, as straws increase fluid velocity and elevate aspiration risk.

Enteral Tubes

Clients unable to safely swallow or consume adequate nutrition orally may rely on an enteral tube (such as an NG, G-tube, or J-tube). The LPN must maintain tube safety and patency to prevent complications.

Placement Verification:

• Initial Check: X-ray confirmation is the definitive method to verify tube placement following initial insertion.

• Bedside Checks: Prior to administering medications or intermittent feedings, verify tube placement by measuring external tube length and testing gastric aspirate pH (a pH of 5.5 or lower typically indicates correct gastric placement). Injecting air into the tube while listening over the stomach with a stethoscope is unreliable and is no longer recommended as a primary verification step.

• Aspiration Prevention: Keep the Head of Bed (HOB) elevated to 30° to 45° at all times during continuous feedings, and for at least 30 to 60 minutes following intermittent feedings.

• Gastric Residual Volume (GRV): Measure GRV prior to intermittent feeds and every 4 to 6 hours during continuous feedings per facility protocol. High residual volumes indicate delayed gastric emptying and an elevated risk for aspiration. Reinfuse aspirate per protocol to prevent fluid and electrolyte imbalances unless contraindicated.

• Tube Patency: Flush enteral tubes with warm water before and after medication administration, before and after intermittent feeds, and routinely during continuous feedings to prevent clogging.

Elimination

1. Risk Identification & Key Assessments

Identifying risks early prevents severe elimination complications. Inadequate fluid intake and medications like opioids slow gastrointestinal motility, leading to constipation or fecal impaction. Encourage 2,000 to 3,000 mL/day of fluids unless restricted by renal or cardiac conditions. Additionally, normal adult urinary output must be at least 30 mL/hour; report any output below this threshold for two consecutive hours.

Bowel Sound Assessment

Auscultate for bowel sounds in all four quadrants using a stethoscope to evaluate motility. Decreased sounds indicate sluggish peristalsis, while absent sounds require immediate escalation.

• Hypoactive: Common post-operatively or with severe constipation.

• Absent: You must listen continuously for 5 full minutes across all quadrants before documenting sounds as absent. Inform the care team immediately.

2. Bowel Management & Devices

When bowel protocols are required, the LPN assists with interventions like enemas, ostomy maintenance, and rectal tubes.

Enema Administration

Place the client in the Left Side-Lying (Sims’) position and insert the lubricated tube 3 to 4 inches into the adult rectum. If the client complains of severe abdominal cramping or pain during the flow, lower or pause the container until the cramping stops, then resume at a slower rate.

Ostomy & Rectal Devices

• Stoma Appearance: A healthy stoma is pink or beefy red and moist. A pale, dark red, purple, or black stoma indicates ischemia or necrosis and requires immediate reporting.

• Wafer Sizing: Cut the skin barrier opening 1/8 inch larger than the stoma to prevent tissue constriction while protecting surrounding skin. Empty pouches when 1/3 to 1/2 full.

• Rectal Tubes: Used short-term for uncontrolled liquid diarrhea to protect perineal skin integrity.

3. Urinary Catheters & Bladder Care

CAUTI Prevention

To prevent Catheter-Associated Urinary Tract Infections (CAUTIs), always keep the catheter drainage bag below the level of the bladder to prevent urine reflux. Maintain a closed drainage system and perform daily perineal care using mild soap and water.

Continuous Bladder Irrigation (CBI)

CBI uses a three-way catheter to clear blood clots after surgery. Adjust the flow rate to maintain a clear, light pink or rose-colored urine output. To calculate true urine output, subtract the total volume of irrigation fluid infused from the total volume collected in the drainage bag.

4. Multi-Site Irrigation Guidelines

Ear, Eye, and Wound Techniques

Irrigation cleanses and removes foreign objects or drainage across various body sites. Wound irrigation requires a 35 mL syringe with a 19-gauge catheter to flush prescribed saline from the cleanest area out to the dirtiest edges. For eye irrigation, flush gently across the eye from the inner canthus to the outer canthus to avoid contaminating the unaffected eye or lacrimal duct.

Ear Irrigation Rules

• Always use warm, body-temperature solution—cold fluid triggers severe vertigo and nausea via the caloric reflex.

• Adults & Children >3 years: Pull the pinna UP and BACK.

• Children <3 years: Pull the pinna DOWN and BACK.

• Direct the fluid stream toward the top wall of the ear canal, never directly at the tympanic membrane.

5. Incontinence & Perineal Skin Care

Incontinence places the perineum at high risk for moisture damage and breakdown from ammonia and digestive enzymes. Cleanse the area immediately following incontinence episodes, always wiping from front to back (cleanest to dirtiest) to prevent pushing intestinal bacteria (E. coli) toward the urinary tract. Apply barrier creams containing zinc oxide or petroleum jelly to form a protective seal over vulnerable skin.

Personal Hygiene

Many hospitalized clients feel a loss of control. One of the basic needs clients can usually continue independently, or with assistance, is their personal hygiene.

Assist with Hygiene

The LPN can be instrumental in assisting with client hygiene. The LPN should first assess the clients and determine their usual personal hygiene habits and routines. As many hospitalized clients have impairments, the LPN should reinforce teaching on required adaptations for performing activities of daily living, such as use of a shower chair or handrails.

Site Care

Clients that have an enteral tube will need site care in addition to their routine personal hygiene activities. The skin should be assessed for breakdown and/or infection around the insertion site on a regular basis. When bathing the client, special care should be taken to ensure the tube does not become dislodged or misplaced.

Postmortem Care

Postmortem care is a vital component of end-of-life care that honors the dignity and respect of the deceased client while providing compassionate support to grieving family members. The LPN directly provides postmortem care following the official declaration of death, ensuring that physical preparation, cultural considerations, and administrative responsibilities are carried out accurately and respectfully.

• assessment and preparation: Verify that death has been officially declared by the designated provider. Determine if the death requires notification of the coroner/medical examiner or if an autopsy is planned. If an autopsy or a coroner’s investigation is required, all invasive lines, tubes, and medical equipment must remain in place. If no autopsy is needed, remove all lines, catheters, and equipment per facility policy.

• body care and positioning: Place the body in a supine position with the head slightly elevated on a pillow to prevent facial discoloration from blood pooling. Gently close the client’s eyes and mouth (inserting dentures if applicable). Perform a bed bath, comb the hair, apply clean dressings to wounds, and place an absorbent pad or diaper under the perineum to manage fluid leakage.

• support of family and cultural beliefs: Honor the client’s and family’s cultural, religious, or spiritual traditions regarding body handling. Prepare the room and body for family viewing by tidying the space, adjusting lighting, and placing clean bed linens up to the client’s chest level. Allow the family private time to grieve.

• identification and inventory: Confirm client identification and attach required identification tags (e.g., on the toe/ankle, outer body shroud, and personal belongings) according to agency policy. Carefully do inventory and document all personal belongings before returning them to designated family members or securing them.

• transportation and documentation: Place the body respectfully in a shroud or body bag for transfer to the morgue or funeral home. Document these details:

  • the time of death pronouncement
  • the provider’s name
  • the care provided
  • the disposition of personal items
  • any notifications (e.g., organ donation agencies)
  • all transfer details

Rest and Sleep

Most, if not all, clients in an inpatient or outpatient setting are at risk for interrupted rest and sleep, which can have a negative impact on the healing processes.

Assess the Client

To promote optimal rest and sleep, the client should be assessed, and the LPN can identify the client’s usual rest and sleep patterns: ability to nap during the day, ideal bedtime, sleep rituals, or measures that may increase sleep quality. The LPN can use the client’s preferences to determine how and when to interact with the client.

Promote Rest and Sleep

Given that clients are disturbed or interrupted multiple times during the day and night for vital signs monitoring or medication administration, it is important to promote adequate rest and sleep whenever possible. Client care activities should be scheduled to promote adequate rest and sleep as opposed to multiple interruptions. Further, the LPN can provide measures to promote sleep and rest as appropriate.