Nursing Fundamentals and Health Assessment
Domain 1 tests the foundation of every other paper: the nursing process, vital signs, asepsis, positioning and mobility, wound and pressure-area care, and a systematic head-to-toe health assessment. Stems usually ask for the first action, the priority assessment, or the abnormal finding, so knowing normal ranges and assessment order matters more than memorising definitions.
Numbers you must hold
- Adult pulse 60–100/min, respirations 12–20/min, oral temperature 36.5–37.5 °C, SpO₂ ≥95% on room air.
- Report adult urine output below 30 mL/h (about 0.5 mL/kg/h) - often the earliest sign of hypovolaemia.
- Pain is assessed with a validated tool: 0–10 numeric scale for adults, Wong–Baker FACES or FLACC for children who cannot self-report.
Assessment order
- Abdomen: inspect, auscultate, percuss, palpate - auscultate first so palpation does not alter bowel sounds.
- Chest: inspect, palpate, percuss, auscultate, comparing side to side at standard sites.
- Use the nursing process as your answer key: assess before you intervene, and reassess after every intervention.
Worked example
A 68-year-old is 6 hours after abdominal surgery. He is restless, pulse 118/min, BP 98/60 mmHg (baseline 138/84), urine 15 mL in the last hour, dressing dry. What first? Reasoning: restlessness plus tachycardia, a falling BP and oliguria point to early hypovolaemic shock - concealed bleeding or third-spacing. First, inspect the wound, abdomen and dressing and repeat a full set of observations, then escalate, give oxygen and start IV fluids per protocol while informing the surgeon. Do not simply chart and monitor when values already cross a reportable threshold, and do not reach for analgesia first, since it can mask deterioration.
Traps
Assuming a normal blood pressure excludes shock (young and pregnant patients compensate until 30–40% loss); auscultating the abdomen after palpation; documenting a critical value instead of acting on it.