A nurse is caring for a client who has dysphagia and has difficulty swallowing during meals. Which of the following actions should the nurse take to reduce the client's risk of aspiration?

Add liquid to foods to thin consistency.

Tilt the client's head slightly backward.

Encourage socialization with others during meals.

Provide mouth care before the client eats.

Answer and Explanation

The Correct Answer is D

A. Add liquid to foods to thin consistency.: Thin liquids are actually the most difficult to swallow and increase the risk of aspiration. Foods should be thickened to a "nectar" or "honey" consistency as prescribed.

B. Tilt the client's head slightly backward.: This opens the airway. For safe swallowing, the client should use the "chin-tuck" method (tilting the head forward/down) to help close the trachea and open the esophagus.

C. Encourage socialization with others during meals.: Clients with dysphagia should focus entirely on chewing and swallowing to prevent aspiration; talking while eating increases risk.

D. Provide mouth care before the client eats.: Oral hygiene before meals stimulates the appetite and removes bacteria from the mouth. If a client does aspirate, they are less likely to develop pneumonia if their oral cavity is clean.

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Correct Answer is C

Explanation

A. Clinical breast examination: This usually begins in a woman's 20s or 30s as part of routine wellness exams.

B. Fasting blood glucose: Screening for Diabetes/Prediabetes is currently recommended to begin at age 35 for most adults.

C. Colonoscopy: While some guidelines have recently moved the start age to 45 for average-risk individuals, age 50 has long been the traditional benchmark for beginning colorectal cancer screenings via colonoscopy.

D. Testicular examination: This is a screening that should be performed regularly by males starting in adolescence/young adulthood.

A. Tongue depressor B. Syringe C. Cotton-tipped applicator D. Adhesive tape

Correct Answer is C

Explanation

A. Tongue depressor: This is typically used for oral examinations or as a splint for small digits, not for wound assessment.

B. Syringe: While a syringe might be used for wound irrigation, it is not the primary tool for collecting data or measuring the wound's physical characteristics.

C. Cotton-tipped applicator: A stage 4 pressure injury involves full-thickness tissue loss with exposed bone, tendon, or muscle. A cotton-tipped applicator is used to measure the depth of the wound and to check for tunneling or undermining.

D. Adhesive tape: This is used to secure a dressing but does not assist in the data collection/assessment of the wound itself.

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A nurse is caring for a client who has dysphagia and has difficulty swallowing during meals. Which of the following actions should the nurse take to reduce the client's risk of aspiration?

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