6–12% of the exam — the fundamentals of hands-on nursing. Positioning, therapeutic diets, safe mobility, elimination, and sleep. The content is concrete, which makes it high-yield once you’ve drilled the key scenarios.
Positioning by scenario
Positioning questions are pure points if you know the pairings:
- Respiratory distress — high Fowler’s (upright) to maximize lung expansion.
- After a lumbar puncture — lie flat to reduce headache.
- Unconscious / post-seizure / decreased gag — side-lying (recovery) to protect the airway.
- Tube feeding — head of bed elevated at least 30–45° to prevent aspiration.
- Post-op knee/hip — follow the specific precautions (e.g., avoid hip flexion beyond 90° and adduction after total hip).
- Pregnant client (late) — left lateral to relieve pressure on the vena cava.
Therapeutic diets
| Condition | Diet focus |
|---|---|
| Heart failure / hypertension | Low sodium; fluid limits if ordered |
| Chronic kidney disease | Limit protein, potassium, phosphorus, sodium |
| Cirrhosis / high ammonia | Often protein-restricted during encephalopathy |
| Celiac disease | Strict gluten-free (no wheat, barley, rye) |
| On warfarin | Keep vitamin K (leafy greens) consistent, not zero |
| Anticoagulant/bleeding risk | Watch interacting foods and supplements |
Dysphagia safety: for swallowing difficulty, sit the client fully upright, thicken liquids as ordered, small bites, chin slightly tucked, and never rush. Aspiration is the danger.
Mobility & safety
- Body mechanics — bend at the knees, keep the load close, push rather than pull, get help or a lift for heavy transfers.
- Cane/walker — cane goes on the strong side; move the cane and the weak leg together.
- Crutches — weight on the hands, not the axillae, to avoid nerve damage.
- Immobility risks — pressure injuries, DVT, pneumonia, constipation. Reposition, encourage movement, and assess skin regularly.
Elimination, rest & comfort
- Pain — the client’s self-report is the standard; assess before and after intervention, and use non-pharmacologic measures alongside medication.
- Constipation/immobility — fiber, fluids, and activity where appropriate.
- Sleep hygiene — consistent schedule, limit stimulants, cluster care to protect rest, especially for hospitalized clients.
- Ostomy/catheter care — protect skin, maintain closed drainage, keep bags below bladder level to prevent backflow.
Practice it: reinforce this category with explained questions in the question bank, and see how much of your exam it fills on the test plan page.
