A.L.L.
coyura Academy
NCLEX-RN
PHYSIOLOGICAL
INTEGRITY
Study Guide + Practice Questions
The largest NCLEX-RN category (~43-67%) — Pharmacological Therapies, Basic Care,
Reduction of Risk Potential, and Physiological Adaptation all in one complete guide.
— What's Inside: — — You Will Master: —
• ABGs, electrolytes & fluid balance • Interpret ABGs and electrolyte imbalances
• Pharmacology: high-alert drugs & safety • Apply the 6 rights of medication admin
• Vital signs & haemodynamic assessment • Recognise abnormal vitals and respond
• Post-operative & wound care nursing • Provide safe post-operative nursing care
• Cardiac, respiratory & neuro emergencies • Identify MI, PE, stroke and respond first
• Endocrine crises & metabolic disorders • Manage DKA, HHS, SIADH, and Addison crisis
• Reduction of risk: labs & complications • Anticipate complications from labs & trends
• Physiological adaptation across systems • Adapt care for all major body system disorders
Physiological Integrity is the heart of clinical nursing — understand the body, master the NCLEX.
Pharmacology Basic Care Risk Reduction Physio Adapt
~13-19% ~6-12% ~9-15% ~11-17%
Created by ALLcoyura Academy
,A.L.L.
coyura Academy
PHARMACOLOGICAL THERAPIES & MEDICATION SAFETY
Pharmacology is ~13-19% of the NCLEX — know high-alert drugs, safety rules, and key interactions.
HIGH-ALERT MEDICATIONS — Drugs Requiring Extra Caution
Drug/Class Safety Rules & Key Nursing Actions
Insulin Never give IV push undiluted. Clear before cloudy (regular before NPH). Double-check doses. Watch for hypoglycaemia.
Heparin IV Check aPTT 4-6 hr after rate change (therapeutic 60-100 sec). Antidote: protamine sulfate. Monitor for HIT
(thrombocytopaenia).
Warfarin Check PT/INR regularly (therapeutic 2-3). Antidote: vitamin K. Hold for INR >3 without bleeding; FFP for active
haemorrhage.
Concentrated KCl NEVER give IV push (fatal cardiac arrest). Must be diluted; max 10 mEq/hr peripherally. Continuous cardiac monitoring.
Opioids Respiratory depression risk. Hold if RR <12. Antidote: naloxone. Assess pain and sedation before each dose.
Chemotherapy Hazardous — PPE required. Extravasation causes tissue necrosis. Extreme caution with doses, routes, and scheduling.
Digoxin Narrow therapeutic index (0.5-2.0 ng/mL). Hold if apical pulse <60. Toxicity: nausea, visual changes, bradycardia,
dysrhythmias. Monitor K+.
Lithium Therapeutic 0.6-1.2 mEq/L. Toxicity (>1.5): coarse tremor, confusion, ataxia. Maintain consistent sodium and hydration.
KEY DRUG INTERACTIONS & ANTIDOTES: COMMON DRUG SIDE EFFECTS — NCLEX HIGH-YIELD:
Interaction Consequence & Nursing Action Drug/Class Key Side Effects to Monitor
SSRIs + MAOIs NEVER combine — serotonin syndrome ACE inhibitors Dry, persistent cough (bradykinin).
(hyperthermia, clonus, agitation). 5-week Angioedema (rare, life-threatening). Check
washout for fluoxetine before MAOI. K+.
Warfarin + NSAIDs Increased bleeding risk — avoid; monitor INR Statins Myopathy/rhabdomyolysis — report muscle
closely if used. pain. Avoid grapefruit (CYP3A4 inhibition).
ACE inhibitors + Hyperkalaemia risk — monitor potassium Corticosteroids Hyperglycaemia, fluid retention,
K-sparing diuretics levels closely. immunosuppression, adrenal suppression.
Never stop abruptly.
Metformin + contrast Hold 48 hr before/after iodinated contrast —
dye risk of lactic acidosis from renal impairment. Furosemide Hypokalaemia, hyponatraemia, ototoxicity (IV
high dose). Monitor electrolytes.
Tyramine + MAOIs Hypertensive crisis — avoid aged cheeses,
cured meats, red wine, fermented foods. Metoprolol/Beta-blockers
Bradycardia, hypotension, mask
hypoglycaemia. Never stop abruptly.
Created by ALLcoyura Academy Page 2
,A.L.L.
coyura Academy
FLUIDS, ELECTROLYTES & ACID-BASE BALANCE
ABG interpretation and electrolyte imbalances appear on every NCLEX exam — master the patterns.
ABG INTERPRETATION — 4-Step Method
ABG Concept Values, Causes & Nursing Actions
Normal Values pH 7.35-7.45 | PaCO2 35-45 mmHg | HCO3 22-26 mEq/L | PaO2 80-100 mmHg | O2 sat >95%
Step 1 — pH pH <7.35 = ACIDOSIS. pH >7.45 = ALKALOSIS.
Step 2 — CO2 CO2 high (>45) = respiratory acidosis. CO2 low (<35) = respiratory alkalosis. CO2 moves OPPOSITE to pH.
(respiratory)
Step 3 — HCO3 HCO3 low (<22) = metabolic acidosis. HCO3 high (>26) = metabolic alkalosis. HCO3 moves SAME as pH.
(metabolic)
Step 4 — If the non-primary component moves toward normal — compensation is occurring. Partial vs. fully compensated.
Compensation
Resp Acidosis pH low, CO2 high. Causes: COPD, hypoventilation, sedation, pneumonia. Tx: improve ventilation.
Resp Alkalosis pH high, CO2 low. Causes: hyperventilation, anxiety, mechanical over-ventilation. Tx: address cause.
Metabolic Acidosis pH low, HCO3 low. Causes: DKA, renal failure, diarrhoea, lactic acidosis, aspirin toxicity. Kussmaul breathing.
Metabolic Alkalosis pH high, HCO3 high. Causes: vomiting, NG suction, diuretics, antacid overuse. Hypoventilation compensates.
ELECTROLYTE IMBALANCES: IV FLUID TYPES & USES:
Imbalance Signs, Symptoms & Treatment IV Fluid Tonicity, Use & Key Caution
Hypokalaemia (<3.5) Muscle weakness, leg cramps, U waves on 0.9% NaCl (NS) — Expands vascular volume. Uses:
ECG, constipation, dysrhythmias. Tx: oral/IV Isotonic haemorrhage, hypovolaemia, blood
K+. Never IV push. transfusion (only fluid compatible).
Hyperkalaemia (>5.0) Peaked T waves, wide QRS, bradycardia, Lactated Ringer's — Similar to plasma. Burns, dehydration. NOT
cardiac arrest risk. Tx: calcium gluconate, Isotonic for liver failure (contains lactate).
insulin+glucose, kayexalate, dialysis.
0.45% NaCl — Moves fluid INTO cells. Uses:
Hyponatraemia Confusion, seizures, cerebral oedema. Hypotonic hypernatraemia, cellular dehydration. RISK:
(<135) Severe: IV hypertonic saline. Correct slowly cerebral oedema.
to prevent osmotic demyelination.
D5W — Isotonic in Becomes hypotonic in body (glucose
Hypernatraemia Thirst, confusion, lethargy. Tx: hypotonic bag metabolised). Used for free water
(>145) fluids, free water. Correct slowly. replacement. NOT for resuscitation.
Hypocalcaemia (<8.5) Chvostek/Trousseau signs, tetany, 3% NaCl — Pulls fluid FROM cells into vascular space.
laryngospasm, seizures. Tx: IV calcium Hypertonic Uses: severe hyponatraemia with neuro
gluconate (emergency). symptoms. ICU only — risk of osmotic
demyelination.
Hypercalcaemia Bones, groans, moans, stones, psychic
(>10.5) overtones. Tx: IV saline hydration + loop D5 0.45% NaCl Hypotonic. Maintenance fluids. Not for
diuretics, bisphosphonates. volume resuscitation.
Hypomagnesaemia Often co-exists with
(<1.5) hypokalaemia/hypocalcaemia. DTR
diminished. Tx: IV/IM magnesium sulphate.
Created by ALLcoyura Academy Page 3
, A.L.L.
coyura Academy
CARDIAC, RESPIRATORY & NEUROLOGICAL EMERGENCIES
Recognise the emergency, identify the priority nursing action, and intervene immediately.
CARDIAC EMERGENCIES
Emergency Key Features & Priority Nursing Actions
Acute MI (STEMI) Crushing chest pain radiating to arm/jaw, diaphoresis, nausea. PRIORITY: aspirin 325 mg chewed STAT, 12-lead ECG, O2,
IV access, nitro (hold if SBP <90). PCI within 90 min.
Heart Failure Dyspnoea, orthopnea, crackles, S3 gallop, JVD, oedema. Position HOB 45-90°. O2, furosemide IV, morphine (reduces
preload/anxiety). Daily weights — 2 kg gain = fluid overload.
Hypertensive Crisis BP >180/120 with end-organ damage. IV labetalol or nitroprusside. Reduce MAP by no more than 25% in first hour to
prevent ischaemia.
Cardiac Tamponade Beck's Triad: hypotension, JVD, muffled heart sounds. Paradoxical pulse. Emergency pericardiocentesis. Prepare for
surgery.
Aortic Dissection Sudden tearing/ripping chest/back pain. BP differential between arms. Do NOT give anticoagulants. Surgical emergency. IV
nitroprusside/beta-blocker.
RESPIRATORY EMERGENCIES: NEUROLOGICAL EMERGENCIES:
Emergency Key Features & Priority Actions Emergency Key Features & Priority Actions
Pulmonary Embolism Sudden pleuritic chest pain, dyspnea, Ischaemic Stroke FAST: Face drooping, Arm weakness,
tachycardia, hypoxia. Haemoptysis. Dx: CT Speech difficulty, Time to call 911. tPA within
pulmonary angiography. Tx: anticoagulation 4.5 hr of onset. No anticoagulants before tPA.
(heparin), thrombolytics for massive PE. BP management critical.
Tension Tracheal deviation AWAY from affected side, Haemorrhagic Stroke Sudden severe headache ('thunderclap'),
Pneumothorax absent breath sounds, hypotension, JVD. N/V, hypertension. CT first — NO tPA.
EMERGENCY needle decompression then Surgical evaluation. BP control.
chest tube.
Increased ICP Cushing's Triad: hypertension + bradycardia
Acute Respiratory RR >30 or <8, O2 sat <90% despite O2. + irregular respirations. HOB 30°, neutral
Failure Position upright, prepare for intubation. head position, hyperventilate if herniation
Mechanical ventilation may be needed. imminent, mannitol IV.
Pulmonary Oedema Pink frothy sputum, severe dyspnea, crackles Status Epilepticus Seizure >5 min or repeated without recovery.
throughout. Sit upright. Furosemide IV, O2, Protect airway; don't restrain; time seizure. IV
nitrates. May need CPAP/BiPAP. lorazepam or diazepam STAT. Phenytoin to
follow.
ARDS Refractory hypoxia despite high FiO2.
Bilateral lung infiltrates. Prone positioning Meningitis Fever, severe headache, nuchal rigidity,
≥16 hr/day. Low tidal volume ventilation (6 Kernig's/Brudzinski's signs, photophobia.
mL/kg). No cure — supportive. Airborne + contact precautions. IV antibiotics
STAT (before LP if delay suspected).
Created by ALLcoyura Academy Page 4
coyura Academy
NCLEX-RN
PHYSIOLOGICAL
INTEGRITY
Study Guide + Practice Questions
The largest NCLEX-RN category (~43-67%) — Pharmacological Therapies, Basic Care,
Reduction of Risk Potential, and Physiological Adaptation all in one complete guide.
— What's Inside: — — You Will Master: —
• ABGs, electrolytes & fluid balance • Interpret ABGs and electrolyte imbalances
• Pharmacology: high-alert drugs & safety • Apply the 6 rights of medication admin
• Vital signs & haemodynamic assessment • Recognise abnormal vitals and respond
• Post-operative & wound care nursing • Provide safe post-operative nursing care
• Cardiac, respiratory & neuro emergencies • Identify MI, PE, stroke and respond first
• Endocrine crises & metabolic disorders • Manage DKA, HHS, SIADH, and Addison crisis
• Reduction of risk: labs & complications • Anticipate complications from labs & trends
• Physiological adaptation across systems • Adapt care for all major body system disorders
Physiological Integrity is the heart of clinical nursing — understand the body, master the NCLEX.
Pharmacology Basic Care Risk Reduction Physio Adapt
~13-19% ~6-12% ~9-15% ~11-17%
Created by ALLcoyura Academy
,A.L.L.
coyura Academy
PHARMACOLOGICAL THERAPIES & MEDICATION SAFETY
Pharmacology is ~13-19% of the NCLEX — know high-alert drugs, safety rules, and key interactions.
HIGH-ALERT MEDICATIONS — Drugs Requiring Extra Caution
Drug/Class Safety Rules & Key Nursing Actions
Insulin Never give IV push undiluted. Clear before cloudy (regular before NPH). Double-check doses. Watch for hypoglycaemia.
Heparin IV Check aPTT 4-6 hr after rate change (therapeutic 60-100 sec). Antidote: protamine sulfate. Monitor for HIT
(thrombocytopaenia).
Warfarin Check PT/INR regularly (therapeutic 2-3). Antidote: vitamin K. Hold for INR >3 without bleeding; FFP for active
haemorrhage.
Concentrated KCl NEVER give IV push (fatal cardiac arrest). Must be diluted; max 10 mEq/hr peripherally. Continuous cardiac monitoring.
Opioids Respiratory depression risk. Hold if RR <12. Antidote: naloxone. Assess pain and sedation before each dose.
Chemotherapy Hazardous — PPE required. Extravasation causes tissue necrosis. Extreme caution with doses, routes, and scheduling.
Digoxin Narrow therapeutic index (0.5-2.0 ng/mL). Hold if apical pulse <60. Toxicity: nausea, visual changes, bradycardia,
dysrhythmias. Monitor K+.
Lithium Therapeutic 0.6-1.2 mEq/L. Toxicity (>1.5): coarse tremor, confusion, ataxia. Maintain consistent sodium and hydration.
KEY DRUG INTERACTIONS & ANTIDOTES: COMMON DRUG SIDE EFFECTS — NCLEX HIGH-YIELD:
Interaction Consequence & Nursing Action Drug/Class Key Side Effects to Monitor
SSRIs + MAOIs NEVER combine — serotonin syndrome ACE inhibitors Dry, persistent cough (bradykinin).
(hyperthermia, clonus, agitation). 5-week Angioedema (rare, life-threatening). Check
washout for fluoxetine before MAOI. K+.
Warfarin + NSAIDs Increased bleeding risk — avoid; monitor INR Statins Myopathy/rhabdomyolysis — report muscle
closely if used. pain. Avoid grapefruit (CYP3A4 inhibition).
ACE inhibitors + Hyperkalaemia risk — monitor potassium Corticosteroids Hyperglycaemia, fluid retention,
K-sparing diuretics levels closely. immunosuppression, adrenal suppression.
Never stop abruptly.
Metformin + contrast Hold 48 hr before/after iodinated contrast —
dye risk of lactic acidosis from renal impairment. Furosemide Hypokalaemia, hyponatraemia, ototoxicity (IV
high dose). Monitor electrolytes.
Tyramine + MAOIs Hypertensive crisis — avoid aged cheeses,
cured meats, red wine, fermented foods. Metoprolol/Beta-blockers
Bradycardia, hypotension, mask
hypoglycaemia. Never stop abruptly.
Created by ALLcoyura Academy Page 2
,A.L.L.
coyura Academy
FLUIDS, ELECTROLYTES & ACID-BASE BALANCE
ABG interpretation and electrolyte imbalances appear on every NCLEX exam — master the patterns.
ABG INTERPRETATION — 4-Step Method
ABG Concept Values, Causes & Nursing Actions
Normal Values pH 7.35-7.45 | PaCO2 35-45 mmHg | HCO3 22-26 mEq/L | PaO2 80-100 mmHg | O2 sat >95%
Step 1 — pH pH <7.35 = ACIDOSIS. pH >7.45 = ALKALOSIS.
Step 2 — CO2 CO2 high (>45) = respiratory acidosis. CO2 low (<35) = respiratory alkalosis. CO2 moves OPPOSITE to pH.
(respiratory)
Step 3 — HCO3 HCO3 low (<22) = metabolic acidosis. HCO3 high (>26) = metabolic alkalosis. HCO3 moves SAME as pH.
(metabolic)
Step 4 — If the non-primary component moves toward normal — compensation is occurring. Partial vs. fully compensated.
Compensation
Resp Acidosis pH low, CO2 high. Causes: COPD, hypoventilation, sedation, pneumonia. Tx: improve ventilation.
Resp Alkalosis pH high, CO2 low. Causes: hyperventilation, anxiety, mechanical over-ventilation. Tx: address cause.
Metabolic Acidosis pH low, HCO3 low. Causes: DKA, renal failure, diarrhoea, lactic acidosis, aspirin toxicity. Kussmaul breathing.
Metabolic Alkalosis pH high, HCO3 high. Causes: vomiting, NG suction, diuretics, antacid overuse. Hypoventilation compensates.
ELECTROLYTE IMBALANCES: IV FLUID TYPES & USES:
Imbalance Signs, Symptoms & Treatment IV Fluid Tonicity, Use & Key Caution
Hypokalaemia (<3.5) Muscle weakness, leg cramps, U waves on 0.9% NaCl (NS) — Expands vascular volume. Uses:
ECG, constipation, dysrhythmias. Tx: oral/IV Isotonic haemorrhage, hypovolaemia, blood
K+. Never IV push. transfusion (only fluid compatible).
Hyperkalaemia (>5.0) Peaked T waves, wide QRS, bradycardia, Lactated Ringer's — Similar to plasma. Burns, dehydration. NOT
cardiac arrest risk. Tx: calcium gluconate, Isotonic for liver failure (contains lactate).
insulin+glucose, kayexalate, dialysis.
0.45% NaCl — Moves fluid INTO cells. Uses:
Hyponatraemia Confusion, seizures, cerebral oedema. Hypotonic hypernatraemia, cellular dehydration. RISK:
(<135) Severe: IV hypertonic saline. Correct slowly cerebral oedema.
to prevent osmotic demyelination.
D5W — Isotonic in Becomes hypotonic in body (glucose
Hypernatraemia Thirst, confusion, lethargy. Tx: hypotonic bag metabolised). Used for free water
(>145) fluids, free water. Correct slowly. replacement. NOT for resuscitation.
Hypocalcaemia (<8.5) Chvostek/Trousseau signs, tetany, 3% NaCl — Pulls fluid FROM cells into vascular space.
laryngospasm, seizures. Tx: IV calcium Hypertonic Uses: severe hyponatraemia with neuro
gluconate (emergency). symptoms. ICU only — risk of osmotic
demyelination.
Hypercalcaemia Bones, groans, moans, stones, psychic
(>10.5) overtones. Tx: IV saline hydration + loop D5 0.45% NaCl Hypotonic. Maintenance fluids. Not for
diuretics, bisphosphonates. volume resuscitation.
Hypomagnesaemia Often co-exists with
(<1.5) hypokalaemia/hypocalcaemia. DTR
diminished. Tx: IV/IM magnesium sulphate.
Created by ALLcoyura Academy Page 3
, A.L.L.
coyura Academy
CARDIAC, RESPIRATORY & NEUROLOGICAL EMERGENCIES
Recognise the emergency, identify the priority nursing action, and intervene immediately.
CARDIAC EMERGENCIES
Emergency Key Features & Priority Nursing Actions
Acute MI (STEMI) Crushing chest pain radiating to arm/jaw, diaphoresis, nausea. PRIORITY: aspirin 325 mg chewed STAT, 12-lead ECG, O2,
IV access, nitro (hold if SBP <90). PCI within 90 min.
Heart Failure Dyspnoea, orthopnea, crackles, S3 gallop, JVD, oedema. Position HOB 45-90°. O2, furosemide IV, morphine (reduces
preload/anxiety). Daily weights — 2 kg gain = fluid overload.
Hypertensive Crisis BP >180/120 with end-organ damage. IV labetalol or nitroprusside. Reduce MAP by no more than 25% in first hour to
prevent ischaemia.
Cardiac Tamponade Beck's Triad: hypotension, JVD, muffled heart sounds. Paradoxical pulse. Emergency pericardiocentesis. Prepare for
surgery.
Aortic Dissection Sudden tearing/ripping chest/back pain. BP differential between arms. Do NOT give anticoagulants. Surgical emergency. IV
nitroprusside/beta-blocker.
RESPIRATORY EMERGENCIES: NEUROLOGICAL EMERGENCIES:
Emergency Key Features & Priority Actions Emergency Key Features & Priority Actions
Pulmonary Embolism Sudden pleuritic chest pain, dyspnea, Ischaemic Stroke FAST: Face drooping, Arm weakness,
tachycardia, hypoxia. Haemoptysis. Dx: CT Speech difficulty, Time to call 911. tPA within
pulmonary angiography. Tx: anticoagulation 4.5 hr of onset. No anticoagulants before tPA.
(heparin), thrombolytics for massive PE. BP management critical.
Tension Tracheal deviation AWAY from affected side, Haemorrhagic Stroke Sudden severe headache ('thunderclap'),
Pneumothorax absent breath sounds, hypotension, JVD. N/V, hypertension. CT first — NO tPA.
EMERGENCY needle decompression then Surgical evaluation. BP control.
chest tube.
Increased ICP Cushing's Triad: hypertension + bradycardia
Acute Respiratory RR >30 or <8, O2 sat <90% despite O2. + irregular respirations. HOB 30°, neutral
Failure Position upright, prepare for intubation. head position, hyperventilate if herniation
Mechanical ventilation may be needed. imminent, mannitol IV.
Pulmonary Oedema Pink frothy sputum, severe dyspnea, crackles Status Epilepticus Seizure >5 min or repeated without recovery.
throughout. Sit upright. Furosemide IV, O2, Protect airway; don't restrain; time seizure. IV
nitrates. May need CPAP/BiPAP. lorazepam or diazepam STAT. Phenytoin to
follow.
ARDS Refractory hypoxia despite high FiO2.
Bilateral lung infiltrates. Prone positioning Meningitis Fever, severe headache, nuchal rigidity,
≥16 hr/day. Low tidal volume ventilation (6 Kernig's/Brudzinski's signs, photophobia.
mL/kg). No cure — supportive. Airborne + contact precautions. IV antibiotics
STAT (before LP if delay suspected).
Created by ALLcoyura Academy Page 4
