A nurse is caring for a client who has dysphagia due to decreased esophageal motility.
Which of the following actions should the nurse take?
Encourage the client to drink thin liquids.
Instruct the client to tuck their chin when swallowing.
Offer the client foods that are hot or spicy.
Elevate the head of the bed to 30 degrees during meals.
The Correct Answer is B
The correct answer is B.
Instruct the client to tuck their chin when swallowing.
This action helps to prevent aspiration by closing off the airway and directing food and liquid into the esophagus. It also reduces the risk of food getting stuck in the throat or chest .
Choice A is wrong because thin liquids are more difficult to swallow and control for clients who have dysphagia due to decreased esophageal motility. They can easily enter the airway and cause choking or pneumonia .
Choice C is wrong because hot or spicy foods can irritate the esophagus and worsen the symptoms of dysphagia. They can also trigger reflux, which can damage the esophageal lining and cause narrowing or inflammation .
Choice D is wrong because elevating the head of the bed to 30 degrees during meals is not enough to prevent aspiration or regurgitation. The client should be sitting upright at 90 degrees or higher to facilitate swallowing and gravity .
Normal ranges for esophageal motility are:.
• Lower esophageal sphincter pressure: 10 to 45 mm Hg.
• Peristaltic amplitude: 30 to 180 mm Hg.
• Peristaltic duration: 2.5 to 6 seconds.
• Peristaltic velocity: 2 to 4.5 cm/s .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
The correct answer is A, B, C, and E.These statements reflect the respiratory system changes that occur with aging, such as decreased respiratory muscle strength, decreased lung elasticity and recoil, decreased cough and gag reflexes, and decreased ciliary action and mucus production.
These changes can impair gas exchange, increase the risk of infections, and reduce exercise capacity.
Choice D is wrong because it states the opposite of what happens with aging.
Vital capacity is the maximum amount of air that can be exhaled after a maximum inhalation.
Residual volume is the amount of air that remains in the lungs after a maximum exhalation.With aging, vital capacity decreases and residual volume increases due to the loss of lung elasticity and airway closure.
This reduces the amount of fresh air that can enter the lungs and increases the amount of stale air that remains in the lungs.
Correct Answer is D
Explanation
The correct answer is D.
“You should apply moisturizer to your skin after bathing.” This statement is based on the fact that dry skin is a common problem among older adults, especially in cold or dry weather.Applying moisturizer after bathing can help to lock in the moisture and prevent further water loss from the skin.
Choice A is wrong because drinking more water may not be enough to hydrate the skin if the skin barrier is impaired or damaged.Drinking water is important for overall health, but it does not directly affect the moisture content of the skin.
Choice B is wrong because avoiding soap and hot water when bathing may not be sufficient to prevent dry skin.
Soap can strip the natural oils from the skin, but so can hot water.It is recommended to use mild, non-soap cleansers and warm water instead of hot water when bathing.
Choice C is wrong because wearing layers of clothing to keep warm may not address the underlying cause of feeling cold.Older adults may feel cold more than usual due to various factors, such as thinning of the skin, decreased blood circulation, reduced muscle mass, or hormonal changes.
Wearing layers of clothing may help to maintain body temperature, but it does not treat the cause of feeling cold.
Normal ranges for skin moisture and body temperature vary depending on individual factors, such as age, health status, environment, and activity level.
However, some general guidelines are:.
• Skin moisture: The skin should feel soft and smooth, not rough or scaly.
The skin should not have cracks, flakes, or redness.The skin should have a normal color, not pale or grayish.
• Body temperature: The normal body temperature for adults is around 98.6°F (37°C), but it can vary slightly depending on the time of day, activity level, and other factors.A body temperature below 95°F (35°C) is considered hypothermia and requires immediate medical attention.
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