Physiological Integrity - Reduction of Risk Potential
What this domain tests
Predicting complications before they happen. This domain rewards the nurse who acts on the earliest sign and who knows pre- and post-procedure care. Think in systems: immobility brings atelectasis, deep vein thrombosis, pressure injury, and constipation; surgery brings bleeding, infection, dehiscence, and anesthesia complications; contrast brings kidney injury and delayed allergic reaction.
Labs and diagnostics
Know clinically meaningful directions rather than memorizing decimals: rising creatinine means worsening renal function; dropping platelets mean bleeding risk; rising potassium means cardiac risk; a falling PaO2 or rising CO2 means respiratory failure. Before contrast, verify creatinine and metformin use; after contrast, encourage fluids and watch urine output. Post-lumbar puncture, keep the client flat to reduce headache. After cardiac catheterization, monitor the access site and distal pulses, and report expanding hematoma, cool extremity, or back pain.
Perioperative care
Preoperative: verify consent, allergies, NPO status, and baseline vitals. Postoperative: airway first, then circulation, then pain and wound. Early ambulation and incentive spirometry are prevention, not comfort.
Traps
Items where the nurse waits for a confirmatory test while the client is deteriorating; items calling a late sign (hypotension, bradycardia in neuro shock) the earliest sign; items that let a client eat or drink before a procedure requiring NPO; items that check only the dressing and not the distal circulation.
Worked rule
For any 'which client first' item, find the finding that signals a body system failing now - airway, breathing, circulation, neuro - and act on it before documentation or teaching.