A nurse in a long-term care facility is managing the care of an older adult client who has difficulty swallowing and occasional choking during meals. The nurse should initiate a referral to which of the following members of the interprofessional care team?

Choice A reason: Urine output of 20 mL/hr is below the desired 30 mL/hr during magnesium sulfate therapy, indicating potential toxicity or renal issues, not a therapeutic effect. Absence of eclampsia is the goal. Monitoring for low output risks missing seizure prevention, critical for maternal safety in preeclampsia management.

Choice B reason: Fetal heart rate of 116/min is within normal (110-160/min) but not a direct therapeutic effect of magnesium sulfate, which prevents seizures. Absence of eclampsia is key. Assuming heart rate is the focus risks overlooking maternal neurological status, critical for ensuring seizure prevention in preeclampsia treatment.

Choice C reason: Blood pressure of 150/92 mm Hg, while elevated, is not the primary therapeutic effect of magnesium sulfate, which targets seizure prevention, not hypertension. Absence of eclampsia is priority. Focusing on blood pressure risks neglecting seizure monitoring, critical for maternal safety in preeclampsia management with magnesium.

Choice D reason: Absence of eclampsia (seizures) is the primary therapeutic effect of magnesium sulfate in preeclampsia, stabilizing neuronal excitability, preventing life-threatening convulsions. Monitoring this ensures maternal safety, critical for preventing neurological damage, supporting fetal well-being, and guiding therapy adjustments in high-risk obstetric care.

Choice A reason: A speech-language pathologist assesses swallowing difficulties, recommending safe feeding techniques for dysphagia, critical for preventing choking and aspiration in older adults. This referral ensures tailored interventions, essential for nutritional safety, reducing pneumonia risk, and supporting quality of life in long-term care settings.

Choice B reason: Occupational therapists address functional skills, not primarily swallowing, which is managed by speech-language pathologists for dysphagia. Assuming their role risks delayed swallowing assessment, potentially increasing choking risk, critical to avoid in ensuring safe eating for older adults in long-term care facilities.

Choice C reason: Respiratory therapists manage breathing issues, not swallowing difficulties, which require a speech-language pathologist for dysphagia. Assuming their involvement risks missing specialized swallowing care, potentially leading to aspiration, critical to prevent in ensuring safe nutrition for older adults with choking risks.

Choice D reason: Social workers address psychosocial needs, not swallowing issues, managed by speech-language pathologists for dysphagia. Assuming their role risks neglecting physical swallowing assessment, increasing choking or aspiration risk, critical to avoid in ensuring safe meal management for older adults in long-term care.