Fundamentals HESI Exit Exam Latest Version 2026 | Real Exam Questions & Correct Answers | Grade A | NCLEX-RN® Preparation & Nursing Fundamentals Review PDF

INSTANT PDF DOWNLOAD — This is the comprehensive HESI Exit Exam preparation guide for Fundamentals of Nursing (Latest Version 2026), featuring real exam-style questions and correct answers. Designed for nursing students preparing for the HESI Exit Exam and NCLEX-RN®, this resource consolidates the essential nursing fundamentals concepts required to achieve a high score on the HESI Exit Exam and pass the NCLEX-RN® on the first attempt. The guide is meticulously aligned with HESI testing blueprints, NCLEX-RN® test plan, and current evidence-based nursing practice standards. This verified resource provides comprehensive coverage of key Fundamentals HESI Exit Exam topics, including: Safe and Effective Care Environment (management of care—advance directives (living will, durable power of attorney for healthcare, DNR, POLST), informed consent (nurse's role: witness signature, confirm patient competency and voluntary consent, ensure patient received information from provider, do NOT provide information about procedure beyond nurse's scope), patient rights (Patient Care Partnership, right to refuse treatment, right to privacy and confidentiality (HIPAA), right to access medical records, right to participate in care decisions, right to informed consent, right to refuse participation in research), confidentiality (protected health information (PHI)—name, DOB, SSN, medical record number, account numbers, biometric identifiers, photographs, any unique identifier, permitted uses without authorization (treatment, payment, healthcare operations (TPO), public health reporting, law enforcement specific circumstances, organ donation, research with IRB approval, coroner/medical examiner, serious threat to health/safety), mandatory reporting (child abuse/neglect (report to Child Protective Services (CPS) or state child welfare agency), elder abuse/neglect (report to Adult Protective Services (APS)), domestic violence (encourage reporting, mandatory in some states), gunshot wounds/stabbings (mandatory reporting to law enforcement in most states), communicable diseases (reportable diseases per state list (TB, HIV, syphilis, gonorrhea, chlamydia, hepatitis, measles, pertussis, COVID-19)), impaired healthcare provider (report to state board of nursing)), delegation (five rights of delegation: right task (within delegatee's scope of practice, predictable, minimal risk of adverse outcomes, standard procedure), right circumstance (patient stable, resources available, appropriate setting), right person (competent, trained, licensed, scope allows, experience, demonstrated skills), right direction/communication (clear instructions: what, when, where, how, expected outcomes, timeframes, reporting requirements, documentation expectations), right supervision/evaluation (monitor performance, intervene if needed, feedback, evaluate outcomes, accountability remains with RN), RN may delegate to LPN/LVN (stable predictable patients, standard procedures, tasks within LPN scope—may not perform initial assessment, develop nursing care plan, complex/unstable patient care, patient education, discharge planning, may administer medications (oral, IM, IV, subcutaneous) depending on state Nurse Practice Act, may perform sterile procedures (catheterization, wound care, tracheostomy care) with demonstrated competency), RN may delegate to UAP (CNA, PCT, MA, nursing assistant—ADLs (bathing, feeding without swallowing precautions, toileting, ambulation, positioning), vital signs on stable patients, intake/output, specimen collection, basic comfort measures, may NOT delegate nursing judgment tasks (assessment, evaluation), patient education, complex technical skills, sterile procedures (except per facility policy after demonstrated competency)), priority setting frameworks (ABCs (airway, breathing, circulation), Maslow's Hierarchy of Needs (physiological (oxygen, fluids, nutrition, temperature, elimination, shelter, sex) → safety (security, stability, protection from harm) → love/belonging (friendship, family, intimacy) → esteem (achievement, mastery, recognition, respect) → self-actualization (reaching full potential)), safety and risk reduction (least restrictive/least invasive first, acute vs chronic, actual vs potential, unstable vs stable, teaching vs treating, nursing process sequence (assess before implement), pharmacological priority (check allergies first, then vital signs/labs, then administer)), ethical principles (autonomy (right to self-determination, informed consent, right to refuse treatment), beneficence (acting for the good of others, promoting well-being, preventing harm), nonmaleficence (do no harm, avoid causing harm, risk-benefit analysis), justice (fair distribution of resources, equitable treatment, non-discrimination), fidelity (keeping promises, loyalty, commitment to patient), veracity (truthfulness, honesty, full disclosure), accountability (responsibility for actions, accepting consequences), confidentiality (protecting private information)), ethical dilemmas (conflict between two or more ethical principles, no single correct answer, ethics committee consultation available), legal issues (Nurse Practice Act (defines scope of practice, educational requirements, licensure requirements, grounds for disciplinary action), standards of care (professional standards (ANA Scope and Standards of Practice), institutional policies and procedures), negligence (conduct that falls below standard of care, elements: duty, breach of duty, causation, damages), malpractice (professional negligence—failure to meet standard of care causing injury to patient, elements same as negligence plus professional relationship with patient, injury/damages must be proved), common nursing malpractice claims (failure to monitor, failure to report change in condition, medication errors, falls/injury, failure to follow orders/policies, equipment injury, documentation errors, failure to obtain informed consent, failure to communicate, pressure injuries), Good Samaritan laws (protect healthcare professionals providing emergency care outside of employment setting, provided care is within scope of practice, no gross negligence or willful misconduct, no expectation of compensation)), safety and infection control (hand hygiene (WHO 5 moments for hand hygiene: before touching patient, before clean/aseptic procedure, after body fluid exposure risk, after touching patient, after touching patient surroundings), alcohol-based hand rub (60-90% alcohol, preferred method unless hands visibly soiled, C. difficile, diarrheal illness, spore-forming organisms (soap and water required)), PPE (standard precautions (gloves, gown, mask, eye protection, face shield) for all patients, transmission-based precautions (contact (private room or cohort, gloves, gown, dedicated equipment—MRSA, VRE, C. diff, RSV, draining wounds), droplet (private room, mask within 3 feet, patient transport limited—influenza, pertussis, meningococcal meningitis, rubella, mumps), airborne (negative pressure AIIR, N95 respirator, patient wears surgical mask during transport—TB, measles, varicella, disseminated zoster), protective environment (reverse isolation—immunocompromised patients, stem cell transplant), donning PPE (gown, mask, eye protection, gloves), doffing PPE (gloves, eye protection, gown, mask—hand hygiene between steps), fall prevention (fall risk assessment tools (Morse Fall Scale, Hendrich II Fall Risk Model), interventions (bed alarm, chair alarm, nonslip socks, low bed, call light within reach, frequent rounding, toileting schedule, clutter-free environment, adequate lighting, handrails, bed in lowest position with brakes locked, hourly rounding), restraints (physical (vest, wrist, ankle, belt, geri-chair with tray) and chemical (medications used to control behavior or restrict freedom of movement not part of treatment plan), criteria (imminent danger to self or others, less restrictive alternatives failed), physician order within 1 hour of application, face-to-face evaluation by physician/APP within 1 hour, time-limited orders (adults: 4 hours for restraint, 4 hours for seclusion; children: 2 hours (9-17 years) or 1 hour (9 years)), continuous monitoring, documentation every 15-30 minutes (vital signs, skin integrity, nutrition/hydration, elimination, range of motion, circulation checks), debriefing with patient and family after release, restraint-free environment goal), seizure precautions (padding side rails, oxygen and suction at bedside, bed in lowest position, IV access, rescue medications (benzodiazepines—lorazepam, diazepam, midazolam)), seizure first aid (protect from injury, turn to side, time seizure, do NOT put anything in mouth, do NOT restrain, administer rescue medication per order if seizure 5 minutes or repeated seizures), fire safety (RACE: Rescue, Alarm, Contain/close doors, Extinguish/Evacuate; PASS: Pull pin, Aim at base of fire, Squeeze handle, Sweep side to side), equipment safety (IV pumps (program correctly, alarms, no free-flow), bed alarms (test regularly), suction equipment (function, pressure settings), oxygen tanks (no smoking near oxygen, secure tanks upright, check level before transport), hazardous material handling (Safety Data Sheets (SDS), proper labeling, spill management)), health promotion and maintenance (developmental stages (infant (birth-12 months)—trust vs mistrust (Erikson), sensorimotor (Piaget), weight doubles by 6 months, triples by 12 months, anterior fontanelle closes 12-18 months, posterior closes 2-3 months, dentition 6-8 months (lower central incisors), gross motor (2-4 months lifts head, 4-6 months rolls over, 6-8 months sits alone, 8-10 months crawls, 10-12 months cruises, 12-15 months walks independently), fine motor (pincer grasp 9-10 months), object permanence 4-8 months, stranger anxiety 7-9 months, separation anxiety 8-12 months, car seat (rear-facing until age 2 or height/weight limit), safe sleep (back to sleep, firm mattress, no soft bedding, room-sharing not bed-sharing), no honey before 12 months (botulism), no cow's milk before 12 months, immunization schedule (birth: HepB; 2 months: HepB, DTaP, Hib, IPV, PCV13, RV; 4,6 months: DTaP, Hib, IPV, PCV13, RV; 6 months: HepB, influenza annually starting 6 months), toddler (1-3 years)—autonomy vs shame/doubt, preoperational (Piaget), negativism ("no"), temper tantrums (time-out 1 minute per year of age), parallel play, toilet training (18-30 months, readiness signs (stays dry 2 hours, indicates need, pulls pants up/down, interest in potty), no pressure, positive reinforcement), forward-facing car seat with harness until age 4, injury prevention (falls, burns, drowning, poisoning, choking), limit juice to 4 oz/day, whole milk until age 2 then low-fat/non-fat, immunization schedule (12-15 months: MMR, Varicella, Hib, PCV13, HepA; 15-18 months: DTaP), dental care (first dental visit by first birthday, brush with rice-sized fluoride toothpaste after age 2), no screen time 18 months except video chatting, preschooler (3-6 years)—initiative vs guilt, preoperational (Piaget), magical thinking, animism, cooperative play, gender identity stable by age 4-5, fears (dark, monsters), booster seat (age 4-7 until seat belt fits properly), no front seat until age 13, immunization schedule (4-6 years: DTaP, IPV, MMR, Varicella), dental care (brush with pea-sized fluoride toothpaste twice daily, floss, dental visits every 6 months, sealants on 6-year molars at age 6), school-age (6-12 years)—industry vs inferiority, concrete operational (Piaget), conservation, classification, seriation, logical thinking about concrete objects, same-gender peer groups, bullying, learning disabilities (dyslexia, ADHD), Tdap at 11-12 years, HPV (Gardasil-9) starting at 9-11 years (2 doses 6-12 months apart if start 15 years, 3 doses if start ≥15 years or immunocompromised), MenACWY at 11-12 years (booster at 16 years), adolescent (12-20 years)—identity vs role confusion, formal operational (Piaget), abstract thinking, hypothetical-deductive reasoning, invincibility fable, imaginary audience, risk behaviors (substance use, unprotected sex, reckless driving, violence), HEADSS assessment (Home, Education/employment, Activities, Drugs, Sexuality, Suicidality/depression), CRAFFT substance use screen, PHQ-9 depression screen, immunization schedule (MenACWY booster at 16 years, MenB shared decision-making 16-23 years, HPV if not previously completed, Tdap if not at 11-12 (then every 10 years), influenza annually, COVID-19 per CDC), contraception counseling (LARC methods (IUD, implant) first-line, OCPs, patch, ring, Depo-Provera, condoms), STI prevention (condoms, HPV vaccine, hepatitis B vaccine, PrEP for HIV prevention), young adult (20-40 years)—intimacy vs isolation, health promotion (healthy diet, exercise (150 minutes moderate aerobic per week), stress management, sleep (7-9 hours), smoking cessation, limit alcohol (≤2 drinks/day men, ≤1 drink/day women), regular health screenings (BP, cholesterol, diabetes, dental, vision, hearing), immunizations (Tdap every 10 years, influenza annually, HPV catch-up through age 26 (shared decision-making 27-45), MMR if non-immune, varicella if non-immune), reproductive health (contraception, preconception counseling (folic acid 400-800 mcg daily), prenatal care, STI screening (chlamydia, gonorrhea annually for sexually active women 25 years), Pap smear (age 21-65 every 3 years, or co-testing with HPV every 5 years age 30-65)), middle adult (40-65 years)—generativity vs stagnation, health screenings (mammogram (age 40-44 shared decision-making, 45-54 annually, 55+ biennially), colonoscopy (age 45-75 every 10 years, or FIT annually, or Cologuard every 3 years), prostate cancer screening (shared decision-making age 55-69, PSA), lung cancer screening (LDCT annually for age 50-80, 20+ pack-year smoking history, current smoker or quit within 15 years), diabetes screening (age 35+ every 3 years, earlier if risk factors), cholesterol screening (every 4-6 years), osteoporosis screening (DXA age 65+ for women, earlier if risk factors)), older adult (65+ years)—ego integrity vs despair, physiological changes (decreased skin turgor, thinning skin, wrinkles, age spots, decreased sweat/sebaceous glands (dry skin, thermoregulation), decreased muscle mass (sarcopenia), decreased bone density (osteoporosis, fracture risk), decreased height (vertebral compression), joint stiffness (osteoarthritis), decreased gastric motility (constipation), decreased liver function (drug metabolism), decreased renal function (CrCl 1 mL/min/year after age 30, drug excretion), decreased lung function (vital capacity, FEV1), decreased immune function (increased infection risk), decreased vision (presbyopia, cataracts, glaucoma, macular degeneration), decreased hearing (presbycusis (high-frequency hearing loss)), decreased taste/smell (nutrition), decreased cognitive processing speed, memory changes (working memory, episodic memory), sleep changes (less deep sleep, more awakenings, earlier wake time), fall prevention (home safety assessment (remove loose rugs, improve lighting, grab bars, handrails, nonslip mats, clear pathways), assistive devices (cane, walker), medication review (deprescribe Beers Criteria medications (anticholinergics, benzodiazepines, non-benzodiazepine hypnotics, NSAIDs, sulfonylureas (glyburide), muscle relaxants, antipsychotics for dementia)), advance care planning (advance directives, DNR, POLST, surrogate decision-maker), immunizations (influenza annually (high-dose or adjuvanted for age 65+), pneumococcal (PCV13 + PPSV23 (if not previously given), or PCV20 alone (preferred), or PCV15 + PPSV23), zoster (Shingrix (recombinant, two doses 2-6 months apart, age 50+), preferred over Zostavax (live, no longer available in US)), Tdap (once then Td or Tdap every 10 years), RSV (age 60+ shared decision-making, one dose), COVID-19 per CDC), elder abuse screening (physical, emotional, sexual, neglect, financial exploitation, report to APS), caregiver support (respite care, support groups, education, home health services, adult day care, Meals on Wheels), psychosocial integrity (therapeutic communication techniques—active listening (SOLER: Sit facing patient, Open posture, Lean toward patient, Eye contact (culturally appropriate), Relaxed demeanor), restatement (repeating patient's words to show understanding, encourage elaboration), reflection (directing back patient's feelings/thoughts for awareness), clarification (asking for more information to understand message, checking accuracy), open-ended questions (allow patient to direct response, explore feelings, "Tell me about...", "How did you feel when..."), closed-ended questions (elicit specific information, "yes/no" or short factual answers—emergency assessment, specific data collection), focusing (concentrating on key issues, keeping conversation on track), exploring (asking for more detail about specific topic, "Tell me more about..."), paraphrasing (restating in nurse's own words to confirm understanding), summarizing (reviewing key points of conversation at end, ensures mutual understanding), silence (allows patient time to think, process emotions, gather thoughts, especially during grief, shock, strong emotions), providing information (facts about procedures, treatments, medications, diagnosis in understandable terms), offering self (availability, presence, "I will stay with you", "I am here"), touch (therapeutic (hand on hand, shoulder) when culturally appropriate, convey caring, comfort), humor (therapeutic when used appropriately, relieves tension, builds rapport, must be sensitive to patient's condition and culture), nontherapeutic techniques—false reassurance ("Everything will be fine"—dismisses patient's concerns, unrealistic), stereotyping (labeling patient based on group membership—assumptions interfere with individualized care), defensive responses (responding to criticism or perceived attack, defending actions rather than exploring patient's concerns), disapproving responses (judging, criticizing patient's behavior or feelings, "You shouldn't feel that way"), approval (agreeing with patient, implies patient right/wrong, can create dependency, "You're right to be angry"), changing the subject (redirecting away from uncomfortable topics, avoids patient's expressed concerns), asking "why" questions (patient may feel defensive, interrogated, "Why did you do that?"—instead ask "Tell me about..."), giving advice (telling patient what to do rather than helping patient explore options, unless patient explicitly asks for information), minimizing feelings (downplaying patient's emotions, "It's not that bad", "Everyone goes through this"), probing (pushing for information patient not ready to share, violating privacy), leading questions (questions suggesting expected answer, "You're not in pain, are you?"), aggressive communication (hostile, demanding, violating rights of others, "You must..." "You need to..."), passive communication (failing to express own needs, apologetic, indirect, allowing others to violate rights, difficulty saying "no"), passive-aggressive communication (indirect expression of hostility, sarcasm, backhanded compliments, procrastination, intentional inefficiency), assertive communication (direct, honest, respectful expression of thoughts and feelings while respecting rights of others, "I think...", "I feel...", "I need...", sets clear boundaries), therapeutic relationship phases—preinteraction (review available data, explore own feelings, prepare for initial interaction), orientation/introductory (establish trust, set mutually acceptable goals, define roles and boundaries, discuss parameters of relationship (time, place, confidentiality, termination), create contract (verbal or written), orient to environment), working (implement interventions, address problems, maintain therapeutic relationship, explore patient's feelings and concerns, overcome resistance behaviors, manage transference (patient unconsciously redirects feelings from past significant person onto nurse) and countertransference (nurse unconsciously redirects feelings onto patient—seek supervision, self-awareness), facilitate behavior change, promote problem-solving), termination (review progress toward goals, reinforce gains, discuss feelings about ending relationship, summarize accomplishments, provide referrals if needed, plan for follow-up), boundaries (professional boundaries (therapeutic purpose, clear roles, time-limited, focus on patient needs), boundary violations (excessive self-disclosure, secrecy, role reversal, dual relationship (friend, family, business partner, romantic/sexual relationship—NEVER sexual with current or former patient, unethical, illegal, grounds for license revocation)), signs of boundary crossing (giving special favors, spending extra time with one patient, exchanging gifts beyond small tokens (cultural considerations), visiting patient off-duty, keeping secrets, discussing personal problems, giving personal contact information, accepting large monetary gifts)), stress and coping—general adaptation syndrome (Selye: alarm (fight-or-flight, sympathetic activation), resistance (adaptation, cortisol release), exhaustion (resource depletion, illness, death)), coping mechanisms (adaptive (problem-focused (direct action, information seeking, planning), emotion-focused (positive reappraisal, acceptance, humor, social support, relaxation, meditation, exercise), meaning-focused (spirituality, religion, values), palliative (denial, avoidance, substance use (maladaptive if chronic)), maladaptive defense mechanisms (denial (refusing to acknowledge reality), repression (unconsciously blocking unacceptable thoughts), regression (returning to earlier developmental stage), projection (attributing own unacceptable thoughts/feelings to others), displacement (redirecting emotions to safer target), reaction formation (behaving opposite to true feelings), rationalization (creating logical explanations for irrational behavior), sublimation (channeling unacceptable impulses into acceptable activities (most adaptive)), compensation (overcoming weakness by excelling in another area), intellectualization (using logic/rational thinking to avoid emotions), isolation (separating feelings from thoughts), undoing (ritualistic behavior to negate previous action)), anxiety—mild (restlessness, increased alertness, mild tension, increased motivation, normal, no intervention needed), moderate (focused on immediate concerns, narrowed perception, shakiness, voice tremors, increased heart rate/respirations, patient can still learn, assist with problem-solving), severe (greatly reduced perception, difficulty focusing, confusion, hyperventilation, tachycardia, diaphoresis, somatic complaints (headache, nausea, dizziness), trembling, can only focus on one detail, cannot problem-solve, need calm presence, short simple directions, reduce stimuli, PRN medication if ordered), panic (complete loss of control, disorganized behavior, distorted perceptions, hallucinations/delusions, immobility or extreme agitation, inability to communicate, risk of self-harm/harm to others, need safety, medication (benzodiazepines (lorazepam, diazepam), antipsychotics), physical restraint if danger to self/others, seclusion), crisis intervention (acute time-limited response (4-6 weeks) to overwhelming life event, phases (impact (shock, denial), recoil (awareness, emotional pain), reorganization (adaptation, coping)), crisis intervention steps (identify problem, ensure safety, provide support, examine alternatives, develop plan, obtain commitment), types of crisis (developmental (life transitions—marriage, birth, retirement), situational (unexpected events—job loss, illness, death, natural disaster), adventitious (external events—war, terrorism, crime, natural disaster)), grief and loss—Kübler-Ross stages (denial ("This can't be happening"), anger ("Why me?"), bargaining ("If I am good, then I will be cured"), depression (sadness, hopelessness, withdrawal), acceptance (peace, readiness to move forward, not necessarily happy, but at peace)), not linear, may go back and forth, duration varies, types of grief (normal (common, expected, time-limited), anticipatory (before death occurs, for patient and family, may facilitate closure), complicated (prolonged, intense, impaired function, maladaptive coping, need referral to grief counselor, support group, mental health professional), disenfranchised (grief not socially recognized or supported (miscarriage, pet loss, ex-spouse, hidden relationship)), traumatic grief (sudden, unexpected, violent death (accident, suicide, homicide)), prolonged grief disorder (DSM-5-TR: death of someone close 12 months ago (6 months children/adolescents), persistent pervasive grief response with ≥3 of: identity disruption, disbelief, avoidance, intense emotional pain, difficulty reintegrating, emotional numbness, life meaningless, intense loneliness, significant distress/impairment), end-of-life care (palliative care (symptom management, quality of life, any stage of illness, continues with curative treatment), hospice care (terminal illness with life expectancy ≤6 months, comfort-focused, no curative treatment, interdisciplinary team (nurse, physician, social worker, chaplain, bereavement counselor, volunteer), Medicare hospice benefit (two 90-day benefit periods, then unlimited 60-day periods, requires certification of terminal illness, no hospitalization for treatment of terminal illness (except respite care, symptom management not manageable at home), patient chooses hospice (elects to forgo Medicare-covered curative treatments)), pain management at end of life (around-the-clock opioids (morphine, hydromorphone, fentanyl), adjuvant analgesics (gabapentin, pregabalin, TCAs, corticosteroids), non-pharmacologic (positioning, massage, music, guided imagery, relaxation), avoid fear of respiratory depression (dose for comfort, tolerance develops), dyspnea management (oxygen, opioids (morphine reduces sensation of dyspnea), positioning (semi-Fowler's to high Fowler's), fan for air movement, anxiety management (lorazepam, diazepam)), terminal secretions ("death rattle")—position (side-lying), anticholinergic (scopolamine patch, glycopyrrolate, atropine drops sublingual), suction if needed (gentle, avoid deep suctioning), delirium at end of life (haloperidol, olanzapine, quetiapine, lorazepam (if agitation with anxiety)), nausea/vomiting (metoclopramide, ondansetron, haloperidol, scopolamine, prochlorperazine), constipation (stimulant laxatives (senna, bisacodyl) + stool softener (docusate) routinely, avoid stimulants if bowel obstruction, if obstruction (methylnaltrexone (Relistor) for opioid-induced constipation, naloxegol (Movantik), naldemedine (Symproic)), anorexia/cachexia (corticosteroids (dexamethasone, prednisone) for appetite, appetite stimulants (megestrol acetate (Megace), dronabinol (Marinol), mirtazapine (Remeron)), spiritual care (assess spiritual/religious needs, provide chaplain referral, respect rituals and practices, facilitate presence of spiritual leader, prayer, sacraments, reading sacred texts, creating sacred space), advance directives (living will (written instructions regarding end-of-life treatment preferences when patient unable to communicate), durable power of attorney for healthcare (healthcare proxy)—appoints surrogate decision-maker to make healthcare decisions when patient lacks capacity), DNR (do-not-resuscitate, physician order based on patient/family wishes, no CPR if cardiac or respiratory arrest, may be full code, DNR, or DNR with exceptions (DNR-CFA (comfort care arrest), DNR-CC (comfort care)), POLST/MOLST (portable medical order for seriously ill/frail individuals, more specific than advance directives, includes preferences for CPR, intubation, antibiotics, artificial nutrition, hospitalization, signed by patient and physician/NP/PA), postmortem care (confirm death (no pulse, no respirations, unresponsive pupils, no heart sounds), provider pronounces death, document time, offer family time with deceased, remove tubes/lines (unless autopsy, coroner case, leave in place per policy), clean body (close eyes, insert dentures, position supine with head elevated (prevents pooling/discoloration), place absorbent pad, roll in clean sheet, identity tags (two identifiers), release to funeral home, respect cultural/religious practices (rituals, washing, viewing, timing of burial/cremation), support family (offer to call family members, clergy, provide private space, allow family to stay as long as needed, provide grief resources), care of the nurse (debriefing, self-care, support from colleagues, EAP, counseling)), physiological integrity (basic care and comfort—hygiene (bathing (bed bath, tub bath, shower, bag bath), perineal care (front to back for females, retract foreskin for uncircumcised males, clean any drainage, indwelling catheter care (clean around meatus, secure tubing, keep bag below bladder)), oral care (brush teeth/gums, floss, rinse mouth, denture care (brush, soak, store in labeled container with water), special oral care for unconscious patient (side-lying, small amount of solution, swab gently, avoid aspiration), foot care (wash, dry between toes, trim nails straight across (diabetic patients: podiatrist referral, do not trim nails, do not soak feet, apply lotion not between toes)), hair care (comb, brush, shampoo (bed shampoo trough, dry shampoo cap, shower chair)), nail care (trim nails straight across, file edges, avoid cutting cuticles), pressure injury prevention (turning every 2 hours, support surfaces, moisture management, nutrition, offloading heels), elimination—urinary (promoting normal urination (privacy, normal position, running water, warm water over perineum, pour warm water over perineum, crede maneuver (suprapubic pressure), double voiding), urinary incontinence types (stress (leakage with cough, sneeze, laugh, exercise, increased intra-abdominal pressure, Kegel exercises, pessary, surgery), urge (leakage with sudden strong urge to void, overactive bladder (OAB), bladder training, anticholinergics (oxybutynin, tolterodine, solifenacin, darifenacin, fesoterodine), beta-3 agonist (mirabegron), neuromodulation), overflow (leakage with overdistended bladder, weak detrusor, obstruction (BPH, stricture), urinary retention, intermittent catheterization, alpha-blockers (tamsulosin), surgery for obstruction), functional (cognitive/physical impairment prevents reaching toilet in time, environmental modifications (commode, urinal, bedpan, scheduled toileting, prompted voiding)), urinary retention (inability to empty bladder, distended bladder (palpable suprapubic mass), discomfort, restlessness, elevated BP, decreased urine output, intermittent catheterization (straight catheter) for relief, indwelling catheter for ongoing retention, treat cause (medications (anticholinergics, opioids, alpha-agonists), obstruction (BPH, stricture, tumor), neurogenic bladder (spinal cord injury, multiple sclerosis, diabetes))), urinary catheterization (indwelling (Foley) catheter (sterile insertion, inflate balloon (10 mL sterile water for adult (5-10 mL for pediatric, 30 mL for post-prostatectomy), secure tubing to thigh (females) or abdomen (males) to prevent traction, keep bag below bladder, empty bag q4-8h or when full, perineal care daily, change catheter per policy (typically every 30 days for silicone, 14 days for latex), remove when no longer indicated (as soon as possible to prevent CAUTI)), intermittent (straight) catheterization (sterile or clean technique per facility policy, for urinary retention, neurogenic bladder, bladder training, frequency q4-6h, remove immediately after bladder emptied), external (condom) catheter (for males with incontinence, intact skin, no urinary retention, change daily, assess skin for irritation, breakdown, avoid wrapping too tight (constriction)), suprapubic catheter (catheter inserted through abdominal wall into bladder, for long-term indwelling, urethral obstruction, trauma, surgery, post-prostatectomy, change monthly, site care daily), catheter-associated urinary tract infection (CAUTI) prevention (indication (only when necessary, remove ASAP), aseptic insertion, secure catheter, maintain closed drainage system, keep bag below bladder, empty bag regularly (separate container for each patient), perineal care daily, no routine irrigation, no routine changing (unless malfunction, obstruction, contamination), no antimicrobial-coated catheters? silver alloy catheters may reduce CAUTI but not routinely recommended per HICPAC, consider for high-risk, use smallest bore possible, avoid kinking, obstruction, assess daily for need)), bowel elimination (constipation (hard, dry, infrequent stools (3 per week), difficult/painful passage, causes (low fiber, low fluid, immobility, medications (opioids, anticholinergics, calcium channel blockers, diuretics, iron, calcium, aluminum antacids, ondansetron), bowel obstruction, hypothyroidism, hypercalcemia, diabetes, pregnancy, ignoring urge), nursing interventions (increase fiber (fruits, vegetables, whole grains, legumes, 25-30 g/day), increase fluids (2-3 L/day unless contraindicated), mobility/exercise, establish regular toileting schedule (after meals (gastrocolic reflex)), position (squatting, feet on stool (toilet stool), leaning forward), stool softeners (docusate), bulk-forming laxatives (psyllium (Metamucil), methylcellulose (Citrucel), polycarbophil (FiberCon), calcium polycarbophil), osmotic laxatives (polyethylene glycol (MiraLax, GlycoLax), lactulose, sorbitol, magnesium hydroxide (Milk of Magnesia), magnesium citrate (stimulant effect at high doses)), stimulant laxatives (senna (Senokot), bisacodyl (Dulcolax), cascara, castor oil, avoid long-term use (melanosis coli, dependence)), suppositories (glycerin (mild, for soft stools), bisacodyl (stimulant), for immediate relief), enemas (tap water (isotonic, volume 500-1000 mL), normal saline (isotonic, safe), soap suds (castile soap, 5 mL per liter of water, avoid if allergic, irritation), hypertonic (Fleets, 120 mL, draws water into colon, for small volume, contraindicated in infants, dehydration, renal impairment, electrolyte imbalance), oil retention (mineral oil, 100-200 mL, lubricate, soften hard stool, retention enema (hold 30-60 minutes)), large volume enema (500-1000 mL, for constipation, bowel prep), small volume enema (120 mL (Fleets), for constipation, avoid in renal impairment, elderly), enema administration (left Sim's position (left side-lying with right knee flexed), lubricate tip, insert 7-10 cm (3-4 inches) for adults, 5-7.5 cm (2-3 inches) for children, 2.5-4 cm (1-1.5 inches) for infants, instill slowly, have patient retain 5-15 minutes (large volume) or until urge (hypertonic), assist to commode/bedpan, document results (color, consistency, volume, presence of blood/mucus)), fecal impaction (hardened mass of stool in rectum, inability to pass stool, overflow incontinence (liquid stool leaks around impacted mass), abdominal pain, distension, nausea, anorexia, digital disimpaction (manual removal of stool, with provider order, lubricate gloved finger, gently break up stool, remove piece by piece, monitor vagal response (bradycardia, hypotension), follow with enema or suppository), diarrhea (loose, watery stools 3 per day, causes (infection, medications (antibiotics (C. difficile), laxatives, antacids (magnesium), chemotherapy, tube feeding, malabsorption, inflammatory bowel disease, hyperthyroidism, anxiety), nursing interventions (identify cause (stool culture, C. diff toxin, O&P, C. diff PCR), replace fluids/electrolytes (oral rehydration solution (ORS), IV fluids if severe), skin care (clean after each stool, apply barrier cream (zinc oxide, petroleum), perineal cleanser, avoid friction), antidiarrheals (loperamide (Imodium), diphenoxylate/atropine (Lomotil), bismuth subsalicylate (Pepto-Bismol))—avoid if infectious (C. diff, E. coli O157:H7, Salmonella, Shigella, Campylobacter), antibiotics (if bacterial infection, C. difficile: oral vancomycin or fidaxomicin, metronidazole no longer first-line), probiotics (Lactobacillus, Saccharomyces boulardii), hand hygiene (soap and water for C. diff), contact precautions (for C. diff), fecal incontinence (involuntary passage of stool, causes (sphincter damage (obstetric trauma, surgery), diarrhea, impaction, cognitive impairment, neurogenic (spinal cord injury, multiple sclerosis, diabetes)), nursing interventions (bowel training (scheduled toileting after meals, digital stimulation), pelvic floor exercises (Kegel), biofeedback, dietary modification (fiber to bulk stool), antidiarrheals for chronic diarrhea, incontinence pads/briefs,