A nurse is reinforcing teaching with a newly licensed nurse about caring for a client who has a history of dysphagia. Which of the following instructions should the nurse include in the teaching?
Give the client a straw to use for drinking.
Place oral suction equipment next to the client's bedside.
Provide thin liquids to help the client swallow.
Use a needleless syringe to instill feedings.
The Correct Answer is B
A. "Give the client a straw to use for drinking" is incorrect. Straws are not recommended for clients with dysphagia because they can increase the risk of aspiration. It is better to use a cup to control the amount of liquid ingested and reduce choking risk.
B. "Place oral suction equipment next to the client's bedside" is correct. For clients with dysphagia, having oral suction equipment readily available can help clear the airway quickly in case of aspiration or choking. It is an important safety measure in the management of dysphagia.
C. "Provide thin liquids to help the client swallow" is incorrect. Thin liquids can increase the risk of aspiration for clients with dysphagia. It is often recommended to provide thickened liquids, as they are easier to swallow and less likely to be aspirated.
D. "Use a needleless syringe to instill feedings" is incorrect. The use of a needleless syringe for feeding is generally not appropriate for clients with dysphagia unless specifically recommended for feeding via a tube. Otherwise, feeding should be done carefully with consideration for the type and consistency of the food.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "I can prevent nausea if I take the medication on an empty stomach." This is incorrect. Taking ferrous sulfate on an empty stomach may increase the risk of gastrointestinal upset, including nausea. It is typically recommended to take it with food to reduce these side effects, although it may be less effective if taken with certain foods or beverages.
B. "I can prevent constipation if I drink more milk while taking this medication." This is incorrect. Milk can actually worsen constipation, and clients taking ferrous sulfate should focus on increasing fiber intake and drinking plenty of fluids to prevent constipation.
C. "I will report black stools to my doctor." This is correct. Black stools are a common side effect of iron supplementation, but it is essential for the client to report it to the doctor if they are concerned, as it could also indicate gastrointestinal bleeding in some cases.
D. "I will mix the medication with a full glass of water." While taking the medication with a full glass of water is appropriate, it is not the most significant instruction regarding the use of the medication. Therefore, while the answer isn't wrong, it doesn't indicate the client's understanding of the most important aspects, such as monitoring for side effects like black stools.
Correct Answer is A
Explanation
A. Chadwick's sign is correct. Chadwick's sign refers to a purplish or bluish discoloration of the vagina and vulva that occurs early in pregnancy due to increased blood flow to the pelvic area. This is typically seen around the 8th week of gestation.
B. Hegar's sign is incorrect. Hegar's sign refers to the softening of the lower uterine segment, which is a physical change that can be felt during a pelvic examination. It is a sign of pregnancy but does not involve discoloration of the vaginal area.
C. Chloasma is incorrect. Chloasma, also called the "mask of pregnancy," refers to hyperpigmentation on the face, typically over the cheeks and forehead, not the vagina or vulva.
D. Ballottement is incorrect. Ballottement refers to a physical finding during a pelvic exam in which the examiner can feel the fetus floating in the amniotic fluid, typically observed after 16 weeks of pregnancy. It is unrelated to changes in vaginal or vulvar color.
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