Where this fits in the test plan

Basic Care and Comfort is about 9% of the items you will see. That percentage is worth taking literally when you plan revision time: a category at 9% deserves roughly 9% of your question practice, not equal time with everything else.

Mobility and Immobility

Positioning, transfers and the hazards of bed rest

Positioning items give a condition and ask for the position. Device items ask about gait and stair sequence. Both are pure recall and should be banked.

Subtopics: Positioning · Safe transfer · Assistive devices · Complications of immobility

Position by condition

Raised intracranial pressure: head of bed 30 degrees, head midline. Respiratory distress: upright, leaning forward. After lumbar puncture: flat. After liver biopsy: right side. Air embolism: left side, head down. Unconscious without spinal injury: side-lying recovery position.

Cane and crutch sequence

The cane goes on the strong side and moves with the weak leg. Up the stairs the strong leg leads; down the stairs the weak leg and the device lead.

Complications of immobility

Pressure injury, deep vein thrombosis, atelectasis and pneumonia, constipation, muscle atrophy, contracture, bone demineralisation and orthostatic hypotension.

Safe transfer

Lock the wheels, lower the bed, use a gait belt, keep the load close, bend the knees rather than the back, and get help for anything beyond your capacity.

High-yield points

• Reposition at least every two hours, and every hour in a chair.
• Do not massage reddened bony prominences.
• Keep the head of the bed at or below 30 degrees where possible to reduce shear.
• Use a mechanical lift rather than lifting a dependent client manually.
• Trapeze bars promote independent movement in bed.
• A client with a new hip replacement avoids crossing the legs, bending past 90 degrees at the hip and internal rotation.
• Passive range of motion prevents contracture when the client cannot move independently.

Nutrition and Oral Hydration

Therapeutic diets, dysphagia and enteral feeding

Diet items ask which foods fit a restriction. Feeding items ask about aspiration risk. Both are highly predictable once the pattern is learned.

Subtopics: Therapeutic diets · Dysphagia precautions · Enteral nutrition · Nutrition for healing

Common restrictions

Low sodium avoids processed, canned, cured and restaurant foods. Renal diets restrict potassium, phosphorus and protein as ordered. Low residue avoids raw fruit and vegetables, nuts and whole grains.

Dysphagia precautions

Sit upright at 90 degrees, chin tuck, small bites, thickened liquids as ordered, no straws, and remain upright for 30 to 60 minutes after eating.

Enteral feeding safety

Verify tube placement, elevate the head of the bed at least 30 degrees, check residual per policy, and flush before and after. Stop immediately for coughing, choking or desaturation.

Nutrients for healing

Protein, vitamin C and zinc support wound healing. Vitamin K supports clotting. Iron with vitamin C improves absorption.

High-yield points

• High potassium foods: bananas, oranges, potatoes, tomatoes, spinach, avocado, dried fruit.
• High sodium foods: canned soup, processed meats, cheese, pickles, soy sauce.
• Foods high in vitamin K such as leafy greens are kept consistent on warfarin, not avoided.
• Gluten-free means avoiding wheat, barley and rye; rice and corn are permitted.
• Assess for the return of a gag reflex before offering fluids after any airway procedure.
• Never add blue dye to enteral feeds to detect aspiration.
• Record intake and output accurately, including ice chips as half their volume.

Elimination

Bowel and bladder care, ostomies and catheters

Elimination items favour the least invasive effective intervention and the answer that protects skin and dignity.

Subtopics: Constipation and diarrhoea · Urinary retention · Ostomy care · Bladder training

Constipation management

Increase fluids, fibre and activity first. Stool softeners come next, then laxatives. Digital removal of an impaction requires an order and carries a vagal risk.

Urinary retention

Suspect it with frequent small voids, suprapubic distension and restlessness. Try privacy, running water, warm perineal water and upright positioning before catheterising.

Ostomy care

A stoma should be pink or red and moist. Pale, dusky or black means compromised circulation and is reported at once. Protect the peristomal skin and size the appliance to the stoma.

Output expectations

Ileostomy output is liquid to pasty and constant, raising dehydration risk. Colostomy output becomes more formed the more distal the stoma.

High-yield points

• Empty an ostomy pouch when it is about one-third full.
• Teach clients with an ileostomy to chew thoroughly and to watch for blockage from high-fibre foods.
• A client with a new colostomy needs both practical teaching and time to express feelings about body image.
• For bladder training, offer toileting on a schedule rather than waiting for a request.
• Assess for impaction in a client with new liquid stool who has not passed formed stool for days.
• Keep the urinary drainage bag below the bladder and never allow it to touch the floor.

Rest and Sleep

Sleep hygiene and non-pharmacological support

The correct answer here is almost always a non-pharmacological measure, especially in older adults where sedatives increase falls and confusion.

Subtopics: Sleep hygiene · Sleep apnoea · Environmental measures

Sleep hygiene

Regular sleep and wake times, no caffeine in the afternoon, no heavy meals or vigorous exercise close to bedtime, a dark quiet cool room, and using the bed only for sleep.

Cluster care

Group nursing activities to allow uninterrupted sleep periods, particularly in critical care where sleep fragmentation contributes to delirium.

Obstructive sleep apnoea

Loud snoring, witnessed apnoea and daytime somnolence. Continuous positive airway pressure is the mainstay; caution with sedatives and opioids.

High-yield points

• Offer a warm drink, back rub, quiet environment and dimmed lights before requesting a hypnotic.
• Avoid waking a client for routine non-essential tasks overnight.
• Sedative hypnotics increase fall and confusion risk in older adults.
• Daytime napping longer than about 30 minutes worsens night-time insomnia.
• In sleep apnoea, position the client upright and use their own device when admitted.

Hygiene and Skin Integrity

Pressure injury prevention and wound care

Staging pressure injuries and knowing the prevention bundle covers most of this topic. Prevention questions outnumber treatment questions.

Subtopics: Pressure injury staging · Prevention · Wound care basics · Personal care

Staging

Stage 1 is intact skin with non-blanchable redness. Stage 2 is partial thickness with a shallow open area or blister. Stage 3 extends into subcutaneous fat. Stage 4 exposes muscle, tendon or bone. Unstageable is covered by slough or eschar. Deep tissue injury is a persistent maroon discolouration.

Prevention bundle

Reposition regularly, keep skin clean and dry, use a pressure-redistributing surface, manage moisture, optimise nutrition and hydration, and inspect skin daily.

Wound healing phases

Inflammatory, proliferative and maturation. Redness and warmth in the first days are expected inflammation, not infection.

Dressing principles

Keep the wound bed moist and the surrounding skin dry. Clean from least to most contaminated. Use sterile technique for open surgical wounds.

High-yield points

• Non-blanchable redness over a bony prominence is stage 1 and needs immediate offloading.
• Do not massage reddened areas or use donut-shaped devices.
• A wound covered in eschar cannot be staged until the base is visible.
• Assess nutrition in any client with poor healing; protein and vitamin C matter most.
• Change position at least every two hours in bed and every hour in a chair.
• Use a lift sheet rather than dragging, to avoid shear injury.

Non-Pharmacological Comfort

Heat, cold, positioning and complementary measures

These are the interventions the exam expects you to try alongside medication, and sometimes before it.

Subtopics: Heat and cold therapy · Relaxation techniques · Complementary therapies

Heat versus cold

Cold reduces swelling and is used in the first 24 to 48 hours after injury. Heat increases circulation and relieves stiffness and chronic muscle pain.

Safety limits

Apply either for no more than 15 to 20 minutes with a barrier between the source and the skin. Check the skin frequently, and avoid both in clients with impaired sensation or circulation.

Relaxation

Guided imagery, progressive muscle relaxation, controlled breathing, music and distraction all lower perceived pain and anxiety.

High-yield points

• Never apply heat over an area of active bleeding or acute inflammation.
• Do not use heat or cold on a client who cannot report discomfort without close monitoring.
• Distraction works best for brief procedural pain.
• Ask about complementary and herbal products, as many interact with prescribed medication.
• Comfort measures supplement analgesia; they do not replace it for severe pain.

More NCLEX practice and review

Everything on this site tagged NCLEX lives in the NCLEX category.

Sources

• NCSBN — NCLEX Test Plans (official blueprint and category weights)
• NCSBN — The NCLEX examination (official candidate information)