A client experiences impaired swallowing after a stroke and has worked with speech-language pathology on eating. What nursing assessment best indicates that the expected outcome for this problem has been met?

Gains 2 lbs (1 kg) after 1 week.

Chooses preferred items from the menu.

Clearly understands and articulates.

Eats 75 to 100% of all meals and snacks.

Answer and Explanation

The Correct Answer is J

Choice A Reason:

Gaining weight can be an indicator of improved nutrition, but it does not directly address the client’s ability to swallow safely and effectively. Weight gain could be due to other factors such as fluid retention or changes in metabolism. Therefore, while it is a positive outcome, it is not the best indicator of improved swallowing function.

Choice B Reason:

Choosing preferred items from the menu indicates that the client is engaged in their meal planning and has an appetite. However, it does not directly measure the client’s ability to swallow safely. The client might still have difficulty swallowing even if they are choosing their preferred foods.

Choice C Reason:

Clear understanding and articulation are important for communication and can indicate cognitive improvement. However, this choice does not directly relate to the client’s swallowing ability. The primary concern in this scenario is the client’s ability to swallow safely, not their communication skills.

Choice D Reason:

Eating 75 to 100% of all meals and snacks is the best indicator that the client has improved their swallowing ability. This choice directly measures the client’s ability to consume food and liquids safely and effectively. It shows that the client can manage their meals without significant difficulty, which is the primary goal of the intervention.

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Correct Answer is A

Explanation

Choice A: Ammonia

Lactulose is administered to patients with hepatic encephalopathy to reduce the levels of ammonia in the blood. Hepatic encephalopathy occurs due to the liver’s inability to detoxify ammonia, a byproduct of protein metabolism. Lactulose works by converting ammonia into ammonium, which is then excreted in the stool. This helps to lower blood ammonia levels and alleviate the symptoms of hepatic encephalopathy.

Choice B: Dysarthria

Dysarthria, or difficulty in articulating words, is a common symptom of Parkinson’s disease. It results from the muscle rigidity and bradykinesia (slowness of movement) that affect the muscles involved in speech. Patients with Parkinson’s often have a soft, monotone voice and may struggle with the clarity of their speech.

Choice C: Muscle Rigidity

Muscle rigidity is one of the hallmark symptoms of Parkinson’s disease. It refers to the stiffness and inflexibility of the muscles, which can affect any part of the body. This rigidity can lead to discomfort and pain, and it contributes to the characteristic stooped posture and shuffling gait seen in Parkinson’s patients.

Choice D: Seizures

Seizures are not typically associated with Parkinson’s disease. While Parkinson’s affects the central nervous system, it primarily impacts motor function rather than causing seizure activity. Therefore, this is not a common finding in Parkinson’s patients.

Choice E: Drooling at Times

Drooling, or sialorrhea, is a common symptom in Parkinson’s disease. It occurs due to the decreased ability to swallow saliva, which can result from muscle rigidity and bradykinesia affecting the muscles involved in swallowing. This can be particularly bothersome for patients and may require management strategies.

Choice F: Mask-like Facial Expression

A mask-like facial expression, also known as hypomimia, is a common feature of Parkinson’s disease. It results from the rigidity and bradykinesia affecting the facial muscles, leading to reduced facial expressions and a fixed, staring appearance.

Choice G: Shuffled Gait

A shuffled gait is a characteristic feature of Parkinson’s disease. Patients often take small, shuffling steps and may have difficulty initiating movement. This gait pattern is due to the combination of muscle rigidity, bradykinesia, and postural instability.

Choice H: Stooped Posture

Stooped posture is another common symptom of Parkinson’s disease. It results from the muscle rigidity and postural instability that affect the patient’s ability to maintain an upright position. This can lead to a forward-leaning posture and balance issues.

A. Nonfat milk B. Apple C. Chocolate

Correct Answer is C

Explanation

Choice A Reason:

Nonfat milk is generally considered safe for individuals with GERD. While full-fat dairy products can exacerbate GERD symptoms due to their high-fat content, nonfat milk does not have this effect. It is low in fat and unlikely to trigger acid reflux. Therefore, nonfat milk is not a food that needs to be avoided by someone with GERD.

Choice B Reason:

Apples are typically safe for individuals with GERD. In fact, non-citrus fruits like apples are often recommended as part of a GERD-friendly diet. They are low in acid and unlikely to cause reflux symptoms. Therefore, apples do not need to be avoided by someone with GERD.

Choice C Reason:

Chocolate is a common trigger for GERD symptoms. It contains caffeine and theobromine, both of which can relax the lower esophageal sphincter (LES), allowing stomach acid to escape into the esophagus and cause reflux. Additionally, chocolate is high in fat, which can further exacerbate GERD symptoms. Therefore, it is advisable for individuals with GERD to avoid chocolate to prevent worsening of their symptoms.

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A client experiences impaired swallowing after a stroke and has worked with speech-language pathology on eating. What nursing assessment best indicates that the expected outcome for this problem has been met?

Nursing Test Bank

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Correct Answer is A

Explanation

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Correct Answer is C

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