A nurse is caring for a client who is receiving intermittent enteral tube feedings. Which of the following factors places the client at risk for aspiration?

A) Assist the client in expressing alternative behaviors: This action is more appropriate for later phases of the therapeutic relationship. During the orientation phase, the focus is on establishing rapport and trust rather than implementing behavioral changes.

B) Establish the responsibilities of the nurse and client: Clarifying the roles and responsibilities of both the nurse and the client is a critical task during the orientation phase. This step helps set clear expectations, promotes understanding, and creates a safe environment for the client, which is essential for effective therapeutic engagement.

C) Facilitate the client's problem-solving skills: While enhancing problem-solving skills is important in therapy, it typically occurs in later phases after trust and rapport have been established. The orientation phase is primarily about getting to know the client and their needs.

D) Determine previous coping skills used by the client: Understanding past coping mechanisms is valuable, but this exploration is more suitable for subsequent phases of the relationship. The orientation phase focuses on initial assessments and building a connection, rather than diving into the client's history of coping strategies.

A) Changes in appetite: While changes in appetite are important to assess, they are not the most immediate concern for a client with ALS who is experiencing weight loss. Appetite changes can contribute to weight loss, but other factors may be more critical.

B) Prescribed medications: Knowing the client’s prescribed medications is essential for overall care, but it is not the priority when addressing recent weight loss in a client with ALS. Medications can affect appetite and weight, but immediate physical concerns should be prioritized.

C) Daily fluid intake: Assessing daily fluid intake is important for hydration status, but it is not the priority in this scenario. Ensuring adequate fluid intake is necessary, but it does not directly address the potential complications related to weight loss in ALS.

D) Swallowing ability: Swallowing ability is the priority admission data to obtain for a client with ALS who has had recent weight loss. ALS can affect the muscles involved in swallowing, leading to dysphagia (difficulty swallowing). This can result in inadequate nutrition and hydration, as well as an increased risk of aspiration. Assessing swallowing ability helps identify the need for interventions such as dietary modifications, swallowing therapy, or alternative feeding methods to ensure the client’s safety and nutritional needs are met.