Vital signs, mobility and falls, pressure injuries and wound care, restraints, NG tubes and catheters — the safety framework nearly every other question rests on.
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Must-know for the exam
✓Know normal adult vitals: heart rate 60-100/min, respiratory rate 12-20/min, blood pressure around 120/80 mmHg, temperature about 36.5-37.5 C, SpO2 at least 95%.
✓Reposition immobile patients at least every 2 hours and use a validated tool (for example the Braden scale) to assess and prevent pressure injuries over bony prominences.
✓Falls prevention: bed low and locked, call bell in reach, non-slip footwear, and identify high-risk patients — falls are a leading preventable harm.
✓Restraints are a last resort, need a time-limited prescriber order, and require the least-restrictive option plus frequent checks of circulation, skin and patient needs.
✓Confirm NG tube placement before feeds or medication using aspirate pH (about 5.5 or below) or X-ray, not the air-insufflation whoosh test.
✓Keep a urinary drainage system closed and the bag below bladder level to prevent catheter-associated infection, and remove catheters as early as possible.
How the exam frames fundamentals & safety questions
Fundamentals questions rarely ask you to recall a fact in isolation; they give a bedside scenario and test whether you can (1) recognise a finding as NORMAL or ABNORMAL, (2) decide how URGENT it is, and (3) choose the correct PRIORITY nursing action — usually before you call the doctor. Because patient safety is a core professional duty, the 'safe, least-harm' option is very often the key.
A reliable frame for any fundamentals stem:
•MEASURE and INTERPRET — compare the vital sign or assessment finding against the normal range and, more importantly, against the patient's own baseline and trend. A single value matters less than a CHANGING trend.
•PRIORITISE with ABC and safety — airway, breathing and circulation first; then immediate physical safety (falls, restraints, skin, aspiration). When two answers are both 'correct', pick the one that prevents the most serious, most immediate harm.
•ACT within scope — assess further, position the patient safely, stop a harmful process, and stay with an unstable patient; delegate stable, routine tasks; escalate abnormal findings.
•PREVENT — much of this domain is about stopping harm before it happens: fall precautions, repositioning to protect skin, aseptic device care, and never using a restraint when a less restrictive measure would do.
Numbers quoted here are widely used reference values for adults; paediatric, pregnant and older-adult ranges differ, and facilities vary — read every figure against your own DHA-aligned local policy and the patient's baseline before acting.
Vital signs — normal ranges, red flags & measurement pitfalls
Vital signs are the fastest window on physiological stability, and the exam expects you to know the adult reference ranges and, crucially, when a value demands action:
•TEMPERATURE — roughly 36.1–37.2°C (about 37°C oral). Fever (pyrexia) suggests infection or inflammation; a temperature below ~35°C is hypothermia. Route matters: rectal reads highest, axillary lowest.
•HEART RATE (pulse) — 60–100 beats/min at rest in adults. Below 60 is bradycardia, above 100 is tachycardia. Assess rate, RHYTHM (regular vs irregular) and volume; an irregular or thready pulse is a red flag.
•RESPIRATORY RATE — 12–20 breaths/min. Below 12 (bradypnoea) or above 20 (tachypnoea) is significant; count for a full minute and observe effort, depth and pattern. Respiratory rate is the EARLIEST and most sensitive sign of deterioration and is the one most often missed.
•BLOOD PRESSURE — a normal adult value is around 120/80 mmHg. Hypertension and hypotension both need context; a systolic below ~90 mmHg with symptoms suggests shock. Use the CORRECT cuff size (a cuff too small reads falsely high; too large reads falsely low), support the arm at heart level, and do not measure over an IV, fistula or the side of a mastectomy.
•OXYGEN SATURATION (SpO2) — normally 95–100%; interpret against the target for the patient (a lower target, e.g. 88–92%, may be set for chronic CO2 retainers). Cold peripheries, poor perfusion, nail polish and motion cause false readings.
•PAIN — the 'fifth vital sign'; assess and document it and act on it, because untreated pain itself destabilises other vitals.
Exam anchors: a rising respiratory rate and falling SpO2 are early deterioration; do not dismiss a single abnormal value — RECHECK, look at the TREND and the patient, and escalate. When in doubt, the safe action is to assess the patient directly, not to rely on the monitor alone.
