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?

Administer liquids to the client using a syringe.

Elevate the head of the client's bed to 45° during meals.

Instruct the client to tilt their head back when swallowing.

Request a speech therapist consult from the provider.

Answer and Explanation

The Correct Answer is D

A) Administer liquids to the client using a syringe:

Administering liquids using a syringe may not address the underlying issue of food pocketing in the client's cheeks during meals. While syringe feeding may be necessary for clients with severe dysphagia, it does not address the need for comprehensive evaluation and intervention by a speech therapist.

B) Elevate the head of the client's bed to 45° during meals:

Elevating the head of the bed during meals is a standard intervention to help prevent aspiration in clients with dysphagia. While this intervention may be appropriate, it may not directly address the issue of food pocketing in the client's cheeks. Therefore, it is not the most comprehensive intervention for this specific problem.

C) Instruct the client to tilt their head back when swallowing:

Tilting the head back when swallowing is not a recommended intervention for clients with dysphagia. In fact, this maneuver can increase the risk of aspiration, as it can cause food or liquid to enter the airway. Therefore, this intervention would not be appropriate and could potentially exacerbate the client's swallowing difficulties.

D) Request a speech therapist consult from the provider:

This is the most appropriate intervention for addressing the client's dysphagia and food pocketing. Speech therapists are trained to assess and treat swallowing disorders, including pocketing of food in the cheeks. They can conduct a comprehensive evaluation of the client's swallowing function and develop individualized interventions to address the underlying causes of dysphagia. Therefore, requesting a speech therapist consult is the most effective way to manage this issue and improve the client's swallowing safety and efficiency.

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Correct Answer is D

Explanation

A) Incorporate the process change into daily practice within the facility: While incorporating process changes is an essential step in quality improvement, it should not be the first action taken. Before implementing changes, it is crucial to gather data and identify areas for improvement to ensure that interventions are targeted and effective.

B) Determine if the implemented change has lowered the current infection rate: Assessing the effectiveness of interventions is an important aspect of quality improvement, but it should occur after identifying baseline data and implementing interventions. Without baseline data, it is challenging to determine the impact of changes accurately.

C) Select a potential intervention to lower the current infection rate: While selecting interventions is a necessary step in quality improvement, it should follow the identification of current infection rates and areas for improvement. Without data on current infection rates, it is difficult to select appropriate interventions.

D) Identify current infection rates from facility data: This is the correct first action when initiating a quality improvement program to address healthcare-associated infections. Gathering data on current infection rates provides a baseline for assessing the problem's magnitude and identifying areas for improvement. It allows healthcare providers to target interventions effectively and evaluate their impact over time.

A. I will take chemotherapy since my family wants me to B. I will discuss treatment options next week after thinking about this." C. I do not want to have any surgery for my cancer. D. I have contacted another surgeon to get a second opinion."

Correct Answer is A

Explanation

A) I will take chemotherapy since my family wants me to:

This statement indicates a potential lack of autonomy and decision-making by the client. The nurse should act as a client advocate by ensuring that the client's decisions regarding treatment are based on their own wishes, values, and preferences, rather than solely on the desires of others.

B) I will discuss treatment options next week after thinking about this:

This statement demonstrates the client's intent to participate in the decision-making process regarding their treatment options. While it indicates autonomy and contemplation, it does not necessarily require the nurse to act as a client advocate at this time.

C) I do not want to have any surgery for my cancer:

This statement reflects the client's autonomy and preference regarding their treatment plan. While the nurse should respect the client's decision, it does not directly prompt the nurse to act as a client advocate.

D) I have contacted another surgeon to get a second opinion:

This statement shows the client's proactive approach to gathering additional information about their treatment options, which is commendable. However, it does not specifically indicate a need for the nurse to advocate for the client's rights or preferences.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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