A nurse is caring for a client who has dysphagia and is receiving oral medications. Which of the following actions should the nurse take?
Administer the client's medications one at a time.
Encourage the client to use a straw to take the medications.
Give the client's medications between meals.
Assist the client into semi-Fowler's position.
The Correct Answer is A
A. Administer the client's medications one at a time:
This is the correct action. Administering medications one at a time allows the nurse to monitor the client's ability to swallow each medication safely. It minimizes the risk of aspiration and ensures that each medication is swallowed effectively.
B. Encourage the client to use a straw to take the medications:
Using a straw may not be recommended for clients with dysphagia, as it can alter the normal swallowing process and increase the risk of aspiration. The focus should be on safe administration of medications without compromising the client's ability to swallow.
C. Give the client's medications between meals:
The timing of medication administration is important, but the priority is the safe administration of medications, especially for clients with dysphagia. Administering medications between meals may not directly address the safety concerns related to swallowing.
D. Assist the client into semi-Fowler's position:
While positioning is important, especially for clients with dysphagia, the administration of medications one at a time (Option A) takes precedence in ensuring the safety of the client's swallowing. Semi-Fowler's position may be beneficial, but it is not the primary action related to medication administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","E"]
Explanation
A. "I need to set my hot water heater to 140 degrees Fahrenheit":
This statement is incorrect. The recommended safe temperature for a hot water heater is generally set to 120 degrees Fahrenheit (49 degrees Celsius) to prevent scalds and burns. A setting of 140 degrees Fahrenheit increases the risk of burns, especially for vulnerable populations such as children and the elderly.
B. "I will use the grab bars when getting in and out of the bathtub":
This statement indicates an understanding of the importance of using safety features, such as grab bars, to prevent falls in the bathroom. Using grab bars provides support and stability during activities like getting in and out of the bathtub, reducing the risk of accidents.
C. "I will apply tape over frayed areas of electrical cords":
This statement is incorrect. Using tape on frayed electrical cords is not a safe or effective solution. Frayed cords should be replaced to avoid the risk of electrical shock or fire. Using tape may not adequately address the underlying safety issue and can be a hazard itself.
D. "I need to check my medications for expiration dates":
This statement reflects an understanding of the importance of medication safety. Checking medication expiration dates is crucial to ensure the efficacy and safety of the medications. Expired medications may be less effective or potentially harmful.
E. "I need to have a fire escape plan with my family":
This statement shows awareness of the importance of having a fire escape plan at home. Having a plan in place helps ensure that everyone in the household knows what to do in case of a fire, improving overall safety.
Correct Answer is D
Explanation
A. Administer an antiemetic:
Administering an antiemetic might be necessary to relieve nausea and vomiting, but it is not the first action. Before administering medications, it is essential to assess the client's condition and gather information about the underlying cause of the symptoms.
B. Offer pain medication:
Offering pain medication is not the first action. The nurse needs to assess the client's condition, determine the cause of the pain, and gather more information before administering pain relief. Administering pain medication before a thorough assessment can mask important clinical signs and symptoms.
C. Palpate the abdomen:
Palpating the abdomen is an important step in the assessment, but it should follow auscultation of bowel sounds. Palpation can be deferred if there is concern about possible inflammation (as in suspected appendicitis) to avoid causing further irritation.
D. Auscultate bowel sounds:
This is the correct action. Auscultating bowel sounds is the first step in assessing the gastrointestinal (GI) function. The reported symptoms of right lower quadrant pain, nausea, and vomiting could be indicative of various GI issues, such as appendicitis. Assessing bowel sounds helps the nurse gather information about the status of peristalsis and potential obstructions.
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