A nurse is caring for a client who has dysphagia. Which of the following actions should the nurse take?
Alternate the client's liquids and solids during meals.
Elevate the client's head of the bed to 45 degrees during meals.
Instruct the client to tilt their head back while swallowing.
Turn on the client's television during meals.
The Correct Answer is B
Choice A reason: Alternating liquids and solids is not a specific intervention for dysphagia management.
Choice B reason: Elevating the head of the bed to 45 degrees or higher during meals can help prevent aspiration in
clients with dysphagia.
Choice C reason: Telling a client with dysphagia to tilt their head back while swallowing can increase the risk of aspiration.
Choice D reason: Turning on the television is not a recommended practice as it can distract the client from focusing
on safe swallowing techniques.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Tachycardia, or an abnormally rapid heart rate, is a common finding in circulatory overload due to
the increased volume of blood the heart must pump.
Choice B reason: Weight loss is not typically associated with circulatory overload. In fact, weight gain may occur due
to fluid retention.
Choice C reason: Diaphoresis, or excessive sweating, can be associated with circulatory overload as the body attempts to cool down due to the increased blood volume and workload on the heart.
Choice D reason: Hypotension, or low blood pressure, is not a usual finding in circulatory overload. Instead, hypertension may be more likely due to the increased volume of fluid in the blood vessels.
Correct Answer is B
Explanation
Choice A reason: While it is important to save the specimen in a clean container, this is not a preparatory action for
obtaining the specimen.
Choice B reason: Rinsing the client's mouth before collecting the specimen is the correct answer because it helps to remove food particles and bacteria that could contaminate the sample.
Choice C reason: Collecting a sputum specimen after a meal is not recommended as it may be contaminated by food particles.
Choice D reason: The time of day is less important than the preparation of the client; however, early morning is usually preferred for collecting a sputum specimen as it tends to be more concentrated after a night's rest.
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