A nurse is teaching the partner of a client who had a stroke about dysphagia. Which of the following statements by the client’s partner should indicate to the nurse that the teaching was effective?
My partner should place their food on the weaker side of their mouth when eating.
My partner should tilt their head forward when swallowing.
My partner should cough while swallowing food.
My partner should sit at a 30° angle while eating their meals.
The Correct Answer is B
Choice A reason: Placing food on the weaker side of the mouth when eating is not an effective strategy for a client who has dysphagia. This can increase the risk of choking or aspiration, as the food may not be chewed properly or may slip into the airway. The client should place food on the stronger side of the mouth and use the tongue to move it to the back of the throat for swallowing.
Choice B reason: Tilting the head forward when swallowing is an effective technique for a client who has dysphagia. This can help to close off the airway and prevent food or liquid from entering the lungs. The client should also tuck the chin down to the chest and swallow hard.
Choice C reason: Coughing while swallowing food is not a desirable outcome for a client who has dysphagia. This can indicate that the food is going into the wrong pipe and causing irritation or obstruction. The client should try to avoid coughing while swallowing and clear the throat after each bite or sip.
Choice D reason: Sitting at a 30° angle while eating meals is not a sufficient position for a client who has dysphagia. This can still allow food or liquid to flow back into the throat and cause choking or aspiration. The client should sit upright at a 90° angle and remain in that position for at least 30 minutes after eating.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This is incorrect. Right hemiparesis is not a common finding in clients who had a stroke involving the right hemisphere. Hemiparesis is the weakness or partial paralysis of one side of the body. It usually affects the opposite side of the body from the side of the brain that is damaged by the stroke. Therefore, a stroke in the right hemisphere would more likely cause left hemiparesis, not right hemiparesis.
Choice B reason: This is incorrect. Aphasia is not a common finding in clients who had a stroke involving the right hemisphere. Aphasia is the loss or impairment of language functions, such as speaking, understanding, reading, or writing. It usually affects the dominant hemisphere of the brain, which is the left hemisphere for most people. Therefore, a stroke in the right hemisphere would less likely cause aphasia, unless the person is lefthanded or ambidextrous.
Choice C reason: This is correct. Inability to recognize his family members is a common finding in clients who had a stroke involving the right hemisphere. This is a type of agnosia, which is the loss or impairment of the ability to recognize objects, people, sounds, shapes, or smells. The right hemisphere of the brain is responsible for processing visual and spatial information, as well as facial recognition. A stroke in this area can damage the ability to identify familiar faces, even those of close relatives or friends.
Choice D reason: This is incorrect. Difficulty reading is not a common finding in clients who had a stroke involving the right hemisphere. Reading is a language function that involves the recognition and comprehension of written words. It usually depends on the dominant hemisphere of the brain, which is the left hemisphere for most people. Therefore, a stroke in the right hemisphere would less likely cause difficulty reading, unless the person is lefthanded or ambidextrous.
Correct Answer is B
Explanation
The correct answer is: d. On the nonoperative side
Choice A: Prone
Reason: Placing a patient in the prone position (lying face down) after a pneumonectomy is generally not recommended. This position can compromise respiratory function by restricting chest expansion and increasing the risk of respiratory complications. Additionally, it can place undue pressure on the surgical site, potentially leading to complications such as impaired wound healing or increased pain.
Choice B: Semi-Fowler’s
Reason: The Semi-Fowler’s position (head of the bed elevated to 30-45 degrees) is often used to promote lung expansion and reduce the risk of aspiration. While it can be beneficial for general postoperative care, it is not the optimal position for a patient who has undergone a pneumonectomy. This position does not specifically address the need to prevent fluid accumulation in the remaining lung.
Choice C: Sims
Reason: The Sims position (lying on the side with one leg bent) is typically used for procedures such as enemas or to facilitate drainage of oral secretions. It is not suitable for a postoperative pneumonectomy patient because it does not provide the necessary support to the remaining lung and can increase the risk of fluid shifting to the nonoperative side.
Choice D: On the nonoperative side
Reason: Placing the patient on the nonoperative side is the correct position. This position helps to prevent fluid from accumulating in the remaining lung and reduces the risk of complications such as mediastinal shift or respiratory distress. By positioning the patient on the nonoperative side, gravity helps to keep the remaining lung expanded and functional.
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