Module 6 of 9 · Free NCLEX Prep Course · The RN Network
Nutrition, mobility, elimination, rest, and nonpharmacological comfort — the fundamentals that quietly fill a large share of exam questions. Know your therapeutic diets and your assistive devices.
Nutrition and Therapeutic Diets
Aspiration precautions: high-Fowler's for meals and 30–60 minutes after, chin-tuck when directed, thickened liquids per speech therapy, no straws for many dysphagia diets, small bites, no rushing.
Heart-healthy/DASH: low sodium (commonly under 2 g/day), low saturated fat, rich in fruits/vegetables. Renal diet (dialysis): restrict potassium, phosphorus, sodium, and fluids; protein needs are individualized — often higher on dialysis.
Hepatic encephalopathy: moderate — not eliminated — protein, low sodium; lactulose titrated to 2–3 soft stools daily.
Celiac disease: no wheat, barley, or rye — rice, corn, and potatoes are safe. COPD: smaller frequent meals; rest before eating.
Foods high in potassium: bananas, oranges, potatoes, tomatoes, spinach, avocados. High in vitamin K (steady intake on warfarin): leafy greens.
Enteral feeding: verify tube placement per policy (pH aspirate, X-ray for initial placement), head of bed at least 30 degrees, check residuals per protocol, flush before and after meds.
Mobility, Positioning, and Assistive Devices
Crutch gaits: three-point for non-weight-bearing on one leg; up stairs — good leg first; down stairs — crutches and bad leg first ("up with the good, down with the bad"). Weight on hands, never axillae.
Cane: hold on the STRONG side, advance cane with the weak leg, cane height at wrist crease/greater trochanter.
Walker: advance walker, then step in — never carry it while walking; no towels or bags on the front bar.
Positioning classics: post-lumbar puncture — flat; post-liver biopsy — right side; unaffected-side-lying after pneumonectomy varies by surgeon but classic teaching is operative side down or back; post-cataract — avoid operative side, avoid bending/straining; amputation — avoid prolonged hip flexion, prone periods for above-knee amputation per protocol.
Log roll for spinal precautions; HOB under 30 degrees limits for some spinal injuries; neutropenic and airborne rooms differ — do not confuse positioning with isolation.
Prevent contractures and footdrop in immobile clients: ROM, repositioning every 2 hours, ankle support devices.
Elimination: Catheters, Ostomies, Bowel Care
Indwelling catheter care: sterile insertion, maintain a closed system, bag below bladder and off the floor, secure to the thigh, perineal care daily — and advocate for removal daily (CAUTI prevention).
No urine output in a catheterized client: check for kinks and dependent loops FIRST, then bladder scan — mechanical causes before calling the provider.
Healthy stoma: pink/red and moist. Dark, dusky, or black stoma = ischemia — report immediately.
Ileostomy output is liquid and continuous: highest risk of dehydration and skin breakdown; avoid enteric-coated meds. Sigmoid colostomy output is formed; irrigation possible per provider.
Empty ostomy pouches when one-third to one-half full; a properly fitting wafer protects the skin.
Constipation care ladder: fluids, fiber, and activity before laxatives; stool softeners for clients who must avoid straining (cardiac, post-op eye/brain surgery).
Rest, Sleep, and Nonpharmacological Comfort
Sleep hygiene: consistent schedule, dark cool room, no screens/caffeine/heavy meals near bedtime, get out of bed if not asleep in ~20 minutes.
Cluster nighttime care in hospitals to protect sleep cycles; reassess sedatives in older adults — they raise fall and delirium risk.
Nonpharm pain tools: repositioning, heat/cold (20 minutes on, barrier between skin and pack), massage, distraction, guided imagery, music, relaxation breathing — document effectiveness like any intervention.
Heat contraindicated over areas of impaired sensation, acute injury (first 24–48 hours), or active bleeding; cold contraindicated with impaired circulation.
End-of-life comfort: mouth care, repositioning, managing secretions, and presence; Cheyne-Stokes respirations and mottling are expected — prepare the family.
Reposition immobile clients at least every 2 hours (every 1 hour in chairs), float heels, use lift devices to avoid shear — never massage reddened bony prominences.
Stage pressure injuries: 1 — intact skin, nonblanchable redness; 2 — partial-thickness open blister; 3 — full-thickness into subcutaneous fat; 4 — bone/tendon/muscle visible; unstageable — slough/eschar obscures the base; deep tissue injury — purple/maroon intact skin.
Foot care for diabetes: inspect daily, wash and dry (especially between toes), no bare feet, well-fitting shoes, nails trimmed straight across, no heating pads on feet, report any break in skin.
Oral care for unconscious clients: side-lying, suction available, never place fingers in the mouth.
Practice Questions
Answer each question, then read the rationale — the rationale is where the learning happens.
1.The nurse observes a client with a new left leg amputation using crutches. Which observation indicates correct technique going UP stairs?
Rationale: "Up with the good, down with the bad": ascending, the strong leg leads and the crutches support the affected side coming up behind. Descending reverses it — crutches and affected leg go down first.
2.A client with dysphagia is starting oral intake. Which nursing action is MOST important?
Rationale: Upright positioning during and after meals is the foundational aspiration precaution. Thin liquids and straws increase aspiration risk in most dysphagia diets, and large or rushed bites are unsafe.
3.The nurse assesses a client's new colostomy on post-op day 1. Which finding must be reported to the surgeon immediately?
Rationale: A dusky or black stoma indicates ischemia and threatens stoma viability — a surgical emergency. Edema, red color, scant blood-tinged mucus, and absent stool on day 1 are expected early findings.
4.An immobile client scores 11 on the Braden scale. Which intervention is the priority?
Rationale: A Braden score of 11 is high risk. Scheduled repositioning with heel elevation directly relieves pressure. Massaging reddened prominences damages tissue, donut cushions impair circulation, and protein should be increased — not limited — to support skin integrity.
5.A client on warfarin asks about diet. Which statement indicates correct understanding?
Rationale: Warfarin is antagonized by vitamin K. Clients do not eliminate greens — they keep intake consistent so the INR stays stable. Sudden increases or decreases both destabilize anticoagulation.
6.An hour after starting a continuous enteral feeding, the nurse finds the client coughing with a wet-sounding voice. What should the nurse do FIRST?
Rationale: Coughing and a wet voice during enteral feeding suggest aspiration — stop the source immediately, then position, assess, suction as needed, and notify the provider. Stopping the feeding is the single fastest way to limit ongoing harm.