Page 1 Physiological Adaptation Study Guide for the NCLEX-PN® exam
How to Prepare for the Physiological Adaptation Questions on the NCLEX-PN® Test
The NCLEX-PN® test allots about 7% to 13% of its questions to the area of physiological adaptation, covering things like changes in body systems, electrolyte imbalances, and medical emergencies. There’s a lot to know, so use the outline below to help you prepare. And if you still have questions, be sure to consult other resources for more information.
Alterations in Body Systems
When caring for patients, the PN must be knowledgeable not only of the patient’s current disease process but also the basic physiological changes that may impact the patient’s status.
Signs and Symptoms
The PN should be able to identify the signs and symptoms of the following common issues that may present themselves in caring for both inpatients and outpatients. These items may be ancillary to the focal disease process being treated, and they may cause unnecessary complications if not recognized early.
All patients are at risk of infection, whether a nosocomial infection while in the hospital or an infection of a healing incision after surgery. The PN should note any temperature changes, swelling, redness, mental confusion, or foul smelling urine as these may be signs of an infection.
Hypoglycemia or Hyperglycemia
Both PNs and patients should be aware of signs of hypo- and hyperglycemia. If a patient is sweaty, clammy, and/or confused, he or she may be hypoglycemic and require a simple carbohydrate snack to increase blood pressure. On the other hand, a patient with increased thirst and appetite along with frequent urination may be hyperglycemic and require insulin.
Acute or Chronic Illness
When assessing a patient, the PN should be aware of known illnesses and suspected or potential illnesses. These may be acute or chronic, and the PN will need to identify their related signs and symptoms.
Fluid or Electrolyte Imbalance
Many patients are at risk for fluid and/or electrolyte imbalance. This may be a lack of or excess of fluids or electrolytes, and the signs and symptoms of this imbalance will depend upon what item is in minimal quantities versus excessive quantities.
Standards and General Principles
There are widely accepted standards and general principles that the PN will need to refer to while caring for patients.
Patients may have occasional or continuous cardiac monitoring. The PN should be able to recognize and report basic abnormalities on a client cardiac monitor strip. Occurrences such as an arrhythmia or a block may require an intervention.
The Disease Process
Depending on the disease process for which the patient is being treated, the PN should consider the general principles of the disease process when providing care. For example, the disease may impact the patient’s injury and repair process, immunity, or cellular structure.
Pathophysiology looks at the changes in the body as a result of a disease. The PN should apply knowledge of basic pathophysiology when monitoring the patient for alterations in the body systems that may be affected.
Routine patient care will likely involve some of the tasks below. It is imperative that the PN be familiar with these devices, equipment, and tasks.
Devices and Equipment
The PN may encounter patients that have or are using certain devices and/or pieces of equipment. There are considerations for these that may require additional care or monitoring. The PN should be able to provide care for these patients and, if encountering a device or piece of equipment that is unfamiliar, ask the care team for assistance.
A patient that has air or fluid in the lungs may have a chest tube in place. Care should be taken to ensure this does not become dislodged. Post-surgical patients may have a wound drain, and the PN may be responsible for removing this drain at the appropriate time and should follow protocol.
A patient may require a tracheostomy either temporarily or permanently to assist with respiratory functions. Care should be taken to ensure the airway stays patent, the dressing is maintained, and infections are prevented.
Patients may also have a type of ostomy for various alterations in elimination. These include, but are not limited to, a colostomy, ileostomy, or urostomy. The PN should be able to provide care to these clients and reinforce teaching on ostomy care.
Patients who are unable to breathe independently will likely require a ventilator. Care should be taken to ensure the ventilator remains connected. Further, actions should be taken to prevent infections such as ventilator-associated pneumonia.
Patients who have a history of cardiac alterations may require a pacemaker. The PN should be able to perform a check of the pacemaker and reinforce education about the signs of pacemaker malfunction.
Additionally, the PN’s responsibility may include providing care to correcting other alterations in the patient’s body system. These may include physiologic signs to measure and monitor or wounds to care for. The PN should follow the facility’s policies and procedures for monitoring and interventions.
As part of routine care and monitoring, the patient’s temperature will be taken. When the patient’s temperature is outside of the normal or desired range, the PN may be asked to provide cooling or warming measures to restore the patient to a normal temperature.
The PN may encounter patients undergoing peritoneal dialysis. Peritoneal dialysis is an alternative to hemodialysis. A catheter is placed in the abdomen, and the peritoneum serves as a filter to remove waste products from the blood in cases of kidney failure.
Increased Intracranial Pressure
Patients who have had head trauma may have or be at risk for increased intracranial pressure. Increased intracranial pressure can be life-threatening and can impair cerebral perfusion and cause hypoxia and compression of the cerebral arteries.
The PN may be asked to care for a patient who has experienced a seizure or experiences seizures on a regular basis. Not all seizures are predictable. The priority for these patients is to ensure the patient’s safety during and after a seizure.
Pregnancy, Labor, and Delivery
When caring for a pregnant patient, there are a number of considerations to ensure the health and safety of the patient. Further, when the patient is in labor, the PN should be on alert for signs of eclampsia, precipitous labor, and/or hemorrhage.
Patients who have experienced trauma or have undergone surgery may have wounds that the PN will need to care for. There are various wound care protocols depending on the type of wound. Further, the PN may be asked to perform dressing changes.
In some departments, the PN will be caring for a patient after a surgical procedure. The immediate surgical recovery typically takes place in the PACU (post-anesthesia care unit) or an ICU (intensive care unit). The patient’s needs for monitoring and care will be dependent on the type of procedure and type of anesthesia used.
Sutures and Staples
Patients with a surgical wound will likely have sutures or staples to assist in appropriate healing and closure. After the skin edges are healing appropriately, the PN may be asked to remove these sutures or staples. The PN should take care to monitor for any signs of wound infection.
One of the most important physiologic processes to monitor is the patient’s respiratory status. When needed, the PN should intervene to improve this status. This may include breathing treatments, suctioning, and/or repositioning.
Fluid and Electrolyte Balance
Patients may be at risk for a fluid and/or electrolyte imbalance. The PN should provide interventions to restore fluid and/or electrolyte balance and monitor the patient’s response to these interventions. The type of intervention will depend on what fluid or electrolyte is out of range.