A nurse is contributing to the plan of care for a client who has dysphagia and is pocketing food in their cheeks during meals. Which of the following interventions should the nurse recommend?
Elevate the head of the client's bed to 45" during meals.
Request a speech therapist consult from the provider.
Instruct the client to tilt their head back when swallowing.
Administer liquids to the client using a syringe.
The Correct Answer is B
A. Elevate the head of the client's bed to 45° during meals: The head should be elevated to 90° to reduce the risk of aspiration during meals.
B. Request a speech therapist consult from the provider: Speech therapists can assess swallowing difficulties and recommend appropriate strategies.
C. Instruct the client to tilt their head back when swallowing: This position increases the risk of aspiration by opening the airway during swallowing.
D. Administer liquids to the client using a syringe: Syringe administration can lead to choking or aspiration and is not a standard feeding practice for dysphagia clients.
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Related Questions
Correct Answer is A
Explanation
A. Establish eye contact with the other person: Maintaining eye contact demonstrates attentiveness and respect during communication, fostering trust.
B. Passively listen to the other party: Passive listening is ineffective and may lead to misunderstandings. Active listening is preferred for conflict resolution.
C. Use "you" rather than "I" statements to express thoughts: "You" statements can be perceived as accusatory and escalate conflicts. "I" statements help express concerns without blame.
D. Focus on the person, not the problem: Effective conflict resolution focuses on addressing the problem, not assigning blame or targeting individuals.
Correct Answer is D
Explanation
A. Makes reference in the nurses' notes of completing an incident report. Incident reports are internal documents and should not be referenced in the client's medical record.
B. Documents that the provider wrote an inaccurate prescription. Documentation should focus on facts, not subjective judgments. Notify the provider instead.
C. Remains logged in to the charting system throughout the shift. Leaving the system open poses a risk for a breach of confidentiality.
D. Includes quotes from the client. Documenting direct quotes ensures accurate representation of the client's statements.
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