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Study guide · Physiological Integrity

Physiological Adaptation

7 to 13% of the exam · 17 activity statements

Physiological Adaptation covers how the practical nurse cares for clients with acute and chronic physical conditions: wounds and drains, temperature, respiratory and cardiac needs, tracheostomy and ventilator care, ostomy care, fluid and electrolyte imbalance, dialysis and medical emergencies. NCLEX-PN items test whether you carry out this care correctly, recognize the signs that a condition is worsening, respond to an emergency in the right order and report changes outside your scope to the RN or provider.

A study feature written by ExamDragon, not part of the real exam. Each heading is one of the Related Activity Statements NCSBN lists for this category (17 of them), in our words; NCSBN's wording is in its Test Plan.

At a glance

Physiological Integrity
7 to 13%

of the exam (NCSBN's range)

Activity statements
17
Key terms
12

What this guide covers, statement by statement

  1. Reinforce teaching about the client's care and condition
  2. Look after drainage devices such as wound drains and chest tubes
  3. Help remove a client's wound drain
  4. Use cooling or warming measures to bring body temperature back to normal
  5. Care for wounds and change dressings
  6. Act fast in a life-threatening emergency, for example by starting CPR
  7. Act to improve breathing, for example with breathing treatments, suctioning or repositioning
  8. Look after a client who has a tracheostomy
  9. Take out sutures or staples
  10. Look after a client on a ventilator
  11. Help care for clients who have a pacemaker or other pacing device
  12. Spot and report basic abnormal findings on a cardiac rhythm strip
  13. Look after a client with a colostomy, ileostomy, urostomy or other ostomy
  14. Recognize signs of illness, whether sudden or long term
  15. Notice and report changes in the client's condition
  16. Look after clients whose fluid or electrolyte balance is off
  17. Look after a client having hemodialysis or peritoneal dialysis

1Reinforce teaching about the client's care and condition

  • Reinforce the teaching the RN or provider began about the client's condition, its care and warning signs, in plain language.
  • Cover what the client should do at home, what to avoid, and which symptoms to report, using the client's own words to confirm understanding.
  • Use demonstration and teach-back for skills such as checking a wound, measuring weight daily, or using a device.
  • Include the family or caregiver when the client agrees, especially for a client with memory or physical limits.
  • Provide materials in the client's language and reading level, with an interpreter when needed.
  • Report questions beyond your scope or a need for new teaching to the RN or provider; the practical nurse reinforces, not initiates, teaching on a new diagnosis.
  1. In practiceA client with heart failure is going home. The practical nurse reinforces weighing at the same time each morning and reporting a gain of 2 to 3 lb in a day or 5 lb in a week, and has the client repeat back the plan to confirm understanding.
  2. Where questions turnGiving a client a new explanation of a diagnosis the provider has not yet discussed, which is outside the practical nurse's role.
Practise this activity

2Look after drainage devices such as wound drains and chest tubes

  • Keep a wound drain (such as a Jackson-Pratt or Hemovac) compressed to maintain gentle suction, and secure it so it does not pull on the insertion site.
  • Empty the drain when it is about half full or per schedule, measure and record the amount and color, and recompress it.
  • A chest tube drains air or fluid from the pleural space; keep the system below the chest, upright and the tubing free of kinks and dependent loops.
  • Watch the water seal: gentle bubbling in the suction chamber is expected; continuous bubbling in the water seal can mean an air leak, and none with a rise and fall (tidaling) means the lung may have re-expanded or the tube is blocked.
  • Never clamp a chest tube without an order; keep an occlusive dressing and a clamp at the bedside, and if the tube is dislodged from the chest, cover the site per policy and report at once.
  • Report a sudden large increase in bright red drainage, or new shortness of breath, to the RN or provider.
  1. In practiceThe practical nurse empties a Jackson-Pratt drain at 40 mL of serosanguineous fluid, recompresses the bulb to restore suction and documents the amount and appearance, then reports to the RN that drainage has increased sharply and turned bright red.
  2. Where questions turnLeaving a wound drain bulb expanded after emptying, which loses the suction that pulls fluid from the wound.
Practise this activity

3Help remove a client's wound drain

  • A wound drain is removed when drainage has dropped to the level the provider sets, with an order; the practical nurse assists.
  • Confirm the order, gather supplies, provide privacy, and explain what the client will feel (a brief pulling).
  • Release any suction first as policy states, loosen the securing suture or dressing, and support the client to breathe through it.
  • After removal, check that the drain is intact, cover the site with a dressing, and note any drainage.
  • Document the removal, the condition of the site and the client's tolerance.
  • Report bleeding, a drain that does not come out smoothly, or a tip that looks incomplete to the RN or provider.
  1. In practiceWith an order to remove a Jackson-Pratt drain, the practical nurse releases the suction, removes the drain in one smooth motion as the client exhales, checks that it is intact, dresses the site and documents the client's tolerance.
  2. Where questions turnPulling against resistance when a drain does not slide out, instead of stopping and reporting it.
Practise this activity

4Use cooling or warming measures to bring body temperature back to normal

  • For a fever, follow the plan: antipyretics if prescribed, light covers, a comfortable room, fluids if allowed, and find and report the likely cause.
  • For hyperthermia such as heat stroke, move the client to a cool place, remove excess clothing, apply cool measures as directed and report at once.
  • For hypothermia, warm the client gradually with warm blankets and a warm environment; handle gently, because a cold heart is irritable.
  • Avoid rapid cooling that causes shivering, which raises temperature and oxygen use; a cooling blanket is used per policy with skin protection.
  • Monitor temperature with the same route for trend, and watch the heart rate, blood pressure and mental status.
  • Report a very high or very low temperature, or a temperature not responding to measures, to the RN or provider.
  1. In practiceAn older client found outdoors in winter is confused with a temperature of 34.5 C (94 F). The practical nurse removes wet clothing, applies warm blankets, keeps the client still and warm, and reports to the RN while rewarming is done gradually.
  2. Where questions turnRewarming or cooling a client too quickly, causing shivering or stressing a cold, irritable heart.
Practise this activity

5Care for wounds and change dressings

  • Match technique to the wound: clean technique for many chronic wounds at home, sterile technique for a fresh surgical wound per policy.
  • Clean from the least contaminated area to the most (for a surgical incision, from the incision outward), using a new swab for each stroke.
  • Assess the wound: size, color, drainage, odor and the surrounding skin, and describe it objectively; report signs of infection (increasing redness, warmth, purulent drainage, odor, fever).
  • Choose the dressing the plan orders (for example moist-to-dry, hydrocolloid, foam) and keep the wound bed moist and the surrounding skin dry as appropriate.
  • If the wound separates (dehiscence) or organs protrude (evisceration), cover with sterile saline-soaked gauze, keep the client still with knees bent, and call for help at once.
  • Document the wound and the care, and report a wound that is not healing or is worsening.
  1. In practiceWhile changing a dressing, the practical nurse sees the surgical incision has opened and a loop of bowel is visible. The nurse covers it with sterile saline-soaked gauze, positions the client supine with knees bent, keeps the client NPO and calls for help at once, because this is an evisceration.
  2. Where questions turnPushing protruding tissue back in or leaving an evisceration uncovered instead of covering it with sterile saline gauze and calling for help.
Practise this activity

6Act fast in a life-threatening emergency, for example by starting CPR

  • In a life-threatening emergency, check responsiveness, call for help and activate the emergency response, and start care without delay.
  • For a client with no pulse and not breathing normally, start high-quality CPR: compressions at 100 to 120 per minute, about 2 inches deep for an adult, allowing full recoil, with minimal interruptions.
  • Use an AED as soon as it arrives and follow its prompts; for a witnessed collapse, early defibrillation is key.
  • For choking in a responsive adult, alternate 5 back blows with 5 abdominal thrusts (chest thrusts in late pregnancy or when the abdomen cannot be encircled), as the 2025 AHA guidelines teach; if the client becomes unresponsive, start CPR.
  • Starting CPR and basic life support is within the practical nurse's scope; call the code team and the RN, and keep the emergency equipment coming.
  • After the event, help with care and documentation of what happened and what was done.
  1. In practiceThe practical nurse finds a client unresponsive, not breathing normally and without a pulse. The nurse calls for help, activates the code, begins chest compressions at once and has another staff member bring the AED and notify the RN.
  2. Where questions turnLeaving the client to go find help or equipment first, instead of calling out, activating the code and starting compressions.
Practise this activity

7Act to improve breathing, for example with breathing treatments, suctioning or repositioning

  • Position the client to ease breathing: upright or high Fowler's, leaning forward on a table for severe shortness of breath.
  • Apply oxygen by the ordered device and rate; for a client with chronic lung disease, use the lowest effective flow and watch the response.
  • Encourage deep breathing and coughing, splinting an incision with a pillow, and use of the incentive spirometer.
  • Suction only when needed (secretions you can hear or see, or a falling oxygen saturation): hyperoxygenate first, apply suction on withdrawal, and limit each pass to about 10 to 15 seconds.
  • Watch the response: oxygen saturation, respiratory rate and effort, color and breath sounds, and report worsening.
  • Report rising work of breathing, a falling oxygen saturation despite oxygen, or a change in level of consciousness to the RN or provider.
  1. In practiceA client is working hard to breathe with an oxygen saturation of 88% on room air. The practical nurse sits the client upright, applies the ordered oxygen, coaches slow deep breaths, rechecks the saturation and reports to the RN that it remains low despite oxygen.
  2. Where questions turnSuctioning routinely on a schedule rather than only when secretions are present, which can lower oxygen and irritate the airway.
Practise this activity

8Look after a client who has a tracheostomy

  • Keep the airway patent: humidified oxygen as ordered, suction secretions when needed, and keep the stoma clean and dry.
  • Provide tracheostomy care with the technique policy requires, cleaning the inner cannula and changing the dressing and ties, and keep an obturator and a spare tube of the same size at the bedside.
  • When changing ties, keep a hand or a helper securing the tube so it is not dislodged, and make the ties snug enough for one or two fingers.
  • Suction the tracheostomy only as needed, hyperoxygenating first and limiting each pass; watch the oxygen saturation and heart rate.
  • If the tube is dislodged, call for help and, per policy, use the obturator and spare tube; keep the stoma open and give oxygen.
  • Report bleeding, signs of infection, or a change in breathing to the RN or provider.
  1. In practiceWhile changing tracheostomy ties, the practical nurse keeps one hand holding the tube in place while a helper secures the new ties snugly enough for one finger, then checks the stoma and documents the care.
  2. Where questions turnRemoving the old ties before the new ones are secure, which can let the tracheostomy tube come out.
Practise this activity

9Take out sutures or staples

  • Suture or staple removal needs an order and confirmation that the wound edges are well approximated and healing.
  • Clean the incision per policy, then remove alternate sutures or staples first and check that the edges hold before removing the rest.
  • For sutures, cut close to the skin on one side and pull the knot toward the incision so no outside part passes through the tissue.
  • Use a staple remover under each staple, squeeze to lift both ends free, and lift straight up.
  • If the wound starts to separate, stop, cover it and report; apply any ordered adhesive strips to support the edges.
  • Document the number removed and the appearance, and report signs of infection or separation.
  1. In practiceWith an order to remove staples, the practical nurse cleans the incision, removes every other staple first, confirms the edges stay approximated, then removes the rest and applies adhesive strips as ordered.
  2. Where questions turnRemoving all sutures or staples at once before checking that the wound edges hold, risking dehiscence.
Practise this activity

10Look after a client on a ventilator

  • A ventilator supports breathing; the practical nurse assists with care under the RN's direction, with set limits on scope.
  • Keep the head of the bed raised about 30 to 45 degrees, give frequent oral care, and keep the airway and tubing secure to prevent ventilator-associated pneumonia.
  • Watch the client and the alarms: a high-pressure alarm often means secretions, coughing or a kink; a low-pressure alarm often means a disconnection or a leak.
  • Never silence an alarm without finding the cause; check the client first, then the tubing and the machine.
  • If the tubing has come apart, reconnect it at once; if the cause cannot be fixed at once, call for help and ventilate with a manual resuscitation bag per training.
  • Report alarms you cannot resolve, a falling oxygen saturation, or a change in the client at once; ventilator settings are managed by the RN, respiratory therapist and provider.
  1. In practiceA ventilator high-pressure alarm sounds. The practical nurse checks the client first, finds audible secretions and a strong cough, suctions as needed per policy, sees the alarm clear and reports the event to the RN.
  2. Where questions turnSilencing a ventilator alarm to stop the noise without first checking the client and the cause.
Practise this activity

11Help care for clients who have a pacemaker or other pacing device

  • A pacing device helps the heart maintain an adequate rate; the client may have a permanent pacemaker or temporary pacing.
  • Monitor the pulse for rate and regularity; report a sustained rate below the pacemaker's set rate, which can mean the device is not capturing.
  • Watch for and report dizziness, fainting, palpitations, or hiccups that do not stop, which can signal a pacing problem.
  • Protect a new pacemaker site: limit movement of the arm on that side as ordered, keep the dressing clean and dry, and report redness, swelling or drainage.
  • Reinforce teaching: check the pulse as taught, carry the device card, and follow guidance about strong magnetic fields.
  • Report a heart rate or symptoms that suggest the device is not working to the RN or provider.
  1. In practiceA client with a new pacemaker set at 60 has a pulse of 44 and feels dizzy. The practical nurse keeps the client safe and at rest and reports to the RN and provider at once, because the rate below the set rate suggests the pacemaker is not capturing.
  2. Where questions turnDismissing a pulse below the pacemaker's set rate as not important, when it can mean the device is failing to pace.
Practise this activity

12Spot and report basic abnormal findings on a cardiac rhythm strip

  • The practical nurse recognizes and reports basic rhythm findings; interpretation and treatment belong to the RN and provider.
  • Know normal sinus rhythm: a regular rhythm with a rate of 60 to 100 and a P wave before each QRS.
  • Recognize and report an obvious abnormality: a very fast or very slow rate, a chaotic rhythm, or many irregular beats.
  • Report asystole (a flat line) or a rhythm without a pulse at once and begin emergency response and CPR as indicated.
  • Check the client, not just the monitor: loose leads or motion can mimic a dangerous rhythm, so confirm with the pulse.
  • Document the finding and the time, and report changes promptly.
  1. In practiceThe monitor shows a flat line for a client. The practical nurse immediately checks the client, finds no pulse and not breathing, calls for help, activates the code and starts CPR, after confirming the leads are attached.
  2. Where questions turnReacting to an alarm from a loose lead without checking the client, or ignoring a flat line without confirming the pulse.
Practise this activity

13Look after a client with a colostomy, ileostomy, urostomy or other ostomy

  • An ostomy diverts stool or urine to a stoma; a healthy stoma is pink to red and moist, and reddish color is expected while a pale, dusky or black stoma is reported at once.
  • Empty the pouch when it is about one-third full, and change the appliance per schedule, protecting the peristomal skin with the right barrier.
  • Measure the stoma and cut the barrier to fit; a gap lets output irritate the skin, while too tight a fit can injure the stoma.
  • Expect output by ostomy type: liquid from an ileostomy (watch for dehydration and electrolyte loss), more formed from a colostomy, and urine with mucus from a urostomy.
  • Reinforce teaching on emptying, skin care, diet and odor control, and involve the client in self-care.
  • Report a stoma that is dusky or black, no output with distension, or skin breakdown that is worsening.
  1. In practiceThe practical nurse changes a colostomy appliance and notes the stoma is pink and moist, measures it, cuts the barrier to fit snugly, protects the skin and reinforces emptying the pouch at one-third full, then reports to the RN that the peristomal skin is becoming excoriated.
  2. Where questions turnMistaking a normal reddish, moist stoma for a problem, or missing a true dusky, black stoma that signals poor blood supply.
Practise this activity

14Recognize signs of illness, whether sudden or long term

  • Collect data on symptoms of acute and chronic illness and compare them with the client's baseline: pain, breathing, intake, output, weight, skin and mental status.
  • Know classic patterns to recognize: chest pain with sweating and nausea for a possible heart problem, one-sided weakness and slurred speech for a possible stroke, and increasing thirst and urination for high blood sugar.
  • Link symptoms to the client's known conditions and medications.
  • Act on an urgent pattern within scope and report at once; time matters for problems such as stroke and heart attack.
  • Document the symptoms objectively, including when they started and what makes them better or worse.
  • Report a new or worsening symptom, or one outside your scope to act on, to the RN or provider.
  1. In practiceA client suddenly has a drooping face, weakness in the right arm and slurred speech. The practical nurse notes the time the symptoms began, keeps the client safe, and reports to the RN and provider at once, because these are signs of a possible stroke where time is critical.
  2. Where questions turnWaiting to see whether sudden stroke-like symptoms pass instead of reporting them immediately.
Practise this activity

15Notice and report changes in the client's condition

  • Compare the client with the earlier shift and the baseline; a change is often the first sign of a serious problem.
  • Watch the trend: a heart rate climbing over several checks, a blood pressure drifting down, rising confusion, or a falling urine output.
  • Early warning signs of deterioration include a change in mental status, fast or labored breathing, a rising or falling heart rate, low blood pressure and low oxygen saturation.
  • Report the change promptly and clearly, using a structured handoff such as situation, background, assessment and recommendation.
  • Keep the client safe while you report, and do not wait for the next routine check when a change is concerning.
  • Document what changed, when, and what you reported and did.
  1. In practiceOver two hours a client's heart rate rises from 84 to 118, the blood pressure falls and the client becomes confused. The practical nurse reports the trend to the RN at once using SBAR, because these changes together suggest the client is deteriorating.
  2. Where questions turnCharting each abnormal value without connecting the trend and reporting that the client is getting worse.
Practise this activity

16Look after clients whose fluid or electrolyte balance is off

  • Recognize dehydration (dry mucous membranes, poor skin turgor, low blood pressure, fast pulse, concentrated urine, falling weight) and fluid overload (edema, crackles, distended neck veins, rising weight, high blood pressure).
  • Know key electrolyte signs: low potassium (weakness, cramps, irregular pulse) and high potassium (irregular pulse, which is dangerous); low sodium (confusion, headache) and high sodium (thirst, dry membranes).
  • Monitor intake and output and daily weight, and report a significant imbalance.
  • Give oral fluids or restrict them per the plan, and follow the diet (for example a potassium-rich or a fluid-restricted diet) as ordered.
  • Watch clients on diuretics, with vomiting or diarrhea, or on nasogastric suction closely, because they lose fluid and electrolytes.
  • Report critical electrolyte values and signs of imbalance to the RN or provider; IV replacement and the plan are theirs to manage.
  1. In practiceA client with diarrhea has dry mucous membranes, a heart rate of 112, a blood pressure of 94/60 and muscle cramps, with a potassium of 3.0 mmol/L reported. The practical nurse reports the findings and the low potassium to the RN and encourages oral fluids as allowed while awaiting orders.
  2. Where questions turnTreating weakness and an irregular pulse in a client on diuretics as fatigue instead of a possible potassium imbalance to report.
Practise this activity

17Look after a client having hemodialysis or peritoneal dialysis

  • Hemodialysis filters the blood through a machine using vascular access (a fistula, graft or catheter); protect the access and the client.
  • Protect a fistula or graft: no blood pressure, venipuncture or IV in that arm; check for a thrill (buzz) and bruit (sound), and report their loss.
  • Weigh the client before and after dialysis, monitor blood pressure, and watch for hypotension, cramping, dizziness or bleeding at the access site.
  • Peritoneal dialysis uses the abdomen's lining and dialysate instilled and drained; use sterile technique and watch the color of the drained fluid.
  • Cloudy drained dialysate, fever or abdominal pain can mean peritonitis and is reported at once; warm the dialysate as policy states (never in a microwave) and monitor inflow and outflow balance and weight.
  • Hold until after dialysis the medications the primary health care provider orders held, and report a missing thrill, bleeding, or signs of infection to the RN or provider.
  1. In practiceThe practical nurse cares for a client with an arm fistula and finds no thrill or bruit over it. The nurse keeps the arm free of blood pressure cuffs and sticks and reports the loss of the thrill to the RN and provider at once, because it can mean the fistula has clotted.
  2. Where questions turnTaking a blood pressure or drawing blood from the arm with a dialysis fistula, which can damage the access.
Practise this activity

Key terms

Jackson-Pratt drain
A bulb wound drain kept compressed to provide gentle suction that pulls fluid from a wound.
Chest tube
A tube that drains air or fluid from the pleural space so the lung can re-expand.
Dehiscence
Separation of the edges of a surgical wound.
Evisceration
Protrusion of internal organs through an open wound, a surgical emergency.
Stoma
The opening of an ostomy on the abdomen; a healthy stoma is pink to red and moist.
Peritonitis
Infection of the abdominal lining; in peritoneal dialysis it shows as cloudy drainage, fever and abdominal pain.
Fistula (dialysis)
A surgically joined artery and vein used for hemodialysis access; protect the arm and check the thrill and bruit.
Thrill and bruit
The buzz felt and the sound heard over a working dialysis access; their loss is reported.
Tracheostomy
A surgical opening into the trachea with a tube, kept clean and patent.
Ventilator-associated pneumonia
A lung infection linked to a ventilator, reduced by raising the head of the bed and frequent oral care.
SBAR
Situation, background, assessment and recommendation: a structured way to report a change to the RN or provider.
Asystole
No electrical activity in the heart, seen as a flat line; confirm the pulse and begin emergency response.

After this guide: After this guide you should be able to care for clients with acute and chronic physical conditions as a practical nurse, recognize the signs that a condition is worsening, respond to an emergency in the right order and report changes that belong to the RN or provider.

Practise Physiological Adaptation