A nurse is caring for a client who had a stroke and is experiencing dysphagia. Which of the following actions should the nurse take when assisting the client to eat?
Offer meals to the client following physical activity.
Provide peanut butter on crackers as a snack choice.
Provide liquids in a cup with a straw.
Instruct the client to tilt his head forward when swallowing.
The Correct Answer is D
A. Offer meals to the client following physical activity: This is incorrect as eating after physical activity might be challenging for a client with dysphagia, and it is better to provide meals when the client is at rest.
B. Provide peanut butter on crackers as a snack choice: This is incorrect because peanut butter and crackers might be difficult to swallow and could pose a choking risk for someone with dysphagia.
C. Provide liquids in a cup with a straw: This is incorrect as straws can cause liquids to be aspirated more easily, which is a risk for clients with dysphagia.
D. Instruct the client to tilt his head forward when swallowing: This is correct because tilting the head forward can help prevent aspiration and facilitate safer swallowing in clients with dysphagia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","F","G"]
Explanation
A. Temperature: The temperature remains stable and within normal limits. A postoperative temperature range of 36.3° C (97.3° F) to 36.4° C (97.5° F) is not indicative of infection or other complications at this time.
B. Heart rate: The heart rate has increased from 84/min to 104/min, indicating sinus tachycardia. This could be a compensatory response to decreased blood volume or another underlying issue, necessitating further assessment.
C. Skin findings: The skin findings are described as warm and dry, which is normal. No abnormalities are noted, so this does not require follow-up.
D. Respiratory rate: The respiratory rate has increased slightly to 24/min but is not significantly abnormal. This may not be a priority for follow-up unless other symptoms are present.
E. Oxygen saturation: The oxygen saturation is within normal limits (96% on room air), suggesting adequate oxygenation. No immediate concerns are evident based on this measurement.
F. Blood pressure: The blood pressure has dropped from 106/74 mm Hg to 88/54 mm Hg, indicating possible hypotension. This drop could signal hypovolemia or bleeding, requiring prompt follow-up to investigate the cause.
G. Urinary output: The urinary output of 110 mL over 6 hours is low, which might indicate dehydration or renal issues. Monitoring and addressing this finding are important to ensure adequate fluid balance and kidney function.
Correct Answer is C
Explanation
A. Monthly vitamin B12 injections: This is incorrect as vitamin B12 injections are not associated with osteoporosis. They are often used to address vitamin B12 deficiency, which is not a direct risk factor for osteoporosis.
B. History of kidney stones: This is incorrect because while kidney stones can be associated with calcium metabolism issues, they are not a primary risk factor for osteoporosis.
C. Long-term use of prednisone: This is correct as long-term use of corticosteroids like prednisone can lead to decreased bone density and increased risk of osteoporosis due to their impact on bone metabolism.
D. Congenital heart murmur: This is incorrect as a congenital heart murmur is not related to the development of osteoporosis.
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