A nurse is reinforcing teaching about activities of daily living with a client who had a stroke. Which of the following statements should the nurse include?

Rationale:

A. "Rest in supine position for 30 minutes after a meal.": Lying flat after a meal increases the risk of aspiration particularly in stroke clients who may have impaired swallowing. A more upright position should be encouraged during and after meals to reduce this risk.

B. "Dress the affected side first.": Dressing the affected side first promotes independence and makes the task easier by minimizing the need for fine motor coordination on the impaired side. It also reduces frustration and helps establish a safe, consistent dressing routine.

C. "Use the arm on your affected side to brush your hair.": Stroke often leads to muscle weakness or paralysis on one side, making it difficult or unsafe to perform tasks with the affected limb. Initially, clients should use their stronger arm while the affected side is supported and rehabilitated gradually.

D. "Use a straw when you drink liquids.": Using a straw can increase the risk of aspiration in clients with post-stroke dysphagia by promoting rapid fluid intake. It is generally contraindicated until a swallowing assessment confirms that it is safe.

Rationale:

A. Plan time to complete the task: While the nurse may need to complete the task if it remains undone, doing so without first addressing the AP’s refusal overlooks a potential communication or training issue and does not resolve the underlying problem.

B. Assign the task to another AP: Reassigning the task without understanding the reason for refusal may perpetuate noncompliance and disrupt team dynamics. It is important to first clarify why the AP is unwilling before redirecting the task.

C. Notify the charge nurse immediately: Escalating to the charge nurse is appropriate if the issue cannot be resolved directly. However, the first action should be to attempt communication and resolution with the AP to encourage accountability and collaboration.

D. Discuss the AP's concerns about the task: This is the most appropriate initial response. By opening a discussion, the nurse can identify whether the refusal stems from a misunderstanding, lack of training, or legitimate concern, allowing for timely correction or education.