A nurse is planning care for a client who had a stroke and is having difficulty eating. Which of the following interventions should the nurse include in the plan?
Place the head of the client's bed to 30° for meals.
Encourage the client to chew on both sides of their mouth.
Describe food locations as if the client's plate were a clock.
Provide the client with wide-grip adaptive utensils.
The Correct Answer is C
A. Place the head of the client's bed to 30° for meals: Elevating the head of the bed to 30° is not sufficient to prevent aspiration in a client who has difficulty eating after a stroke. A 90° angle or as high as tolerated is typically recommended during meals to reduce the risk of aspiration and ensure safe swallowing. A lower elevation increases the chance of food or liquid entering the airway.
B. Encourage the client to chew on both sides of their mouth: Clients who have had a stroke often experience unilateral weakness, including facial and oral muscle weakness. Encouraging them to chew on both sides may not be feasible and can increase the risk of choking if one side of the mouth is significantly paralyzed. Instead, focusing on the stronger side for chewing is safer.
C. Describe food locations as if the client's plate were a clock: This technique is especially helpful for clients with visual field deficits, such as hemianopia, which is common after a stroke. Describing food using the clock method helps orient the client to the location of items on the plate, promoting independence and reducing frustration during meals.
D. Provide the client with wide-grip adaptive utensils: Wide-grip adaptive utensils are beneficial for clients with impaired fine motor skills or limited hand strength, which may occur after a stroke. However, while helpful, this intervention does not directly address the primary issue of difficulty eating due to perceptual or cognitive deficits.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Instruct the client to avoid salty foods: There is no direct link between salty foods and worsening of hyperemesis gravidarum. Some clients may even tolerate salty snacks better, as they can help settle the stomach when eaten in small amounts.
B. Encourage the client to drink fluids with their meals: Fluids with meals can distend the stomach and worsen nausea in clients with hyperemesis gravidarum. It is often better tolerated when fluids are taken separately from meals, in small sips throughout the day.
C. Tell the client to consume foods served at cold temperatures: Cold or room-temperature foods emit less odor, which reduces nausea and vomiting. Hot foods may trigger stronger smells that increase the likelihood of nausea in hyperemesis gravidarum.
D. Increase the client's intake of high-fat foods: High-fat foods are harder to digest and can linger in the stomach longer, exacerbating nausea and vomiting. These should be limited, especially during acute phases of hyperemesis gravidarum.
Correct Answer is A
Explanation
A. "I will eat something when I feel hungry." Responding to true physical hunger is a principle of mindful eating, which supports weight loss by preventing overeating due to emotional or external cues. Recognizing and honoring hunger promotes better portion control and sustainable eating habits.
B. "I will peel apples before I eat them." Apple peels contain fiber, which increases satiety and supports digestive health. Removing the peel reduces fiber content, which may make the snack less filling and hinder weight management efforts.
C. "I will eliminate carbohydrates from my diet." Eliminating carbohydrates completely is not recommended for healthy weight loss. Balanced diets that include whole grains, fruits, and vegetables support long-term weight management and provide essential nutrients.
D. "I will use corn oil when frying foods." Frying foods, regardless of the type of oil, increases calorie density and may not support weight loss. Healthier cooking methods like baking, steaming, or grilling are preferred for reducing fat intake and promoting weight control.
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