An older adult client is referred to a rehabilitation facility following a cerebrovascular accident (CVA). The client is aphasic with left sided paresis and is having difficulty swallowing. Which intervention is most important for the nurse to include in the client's plan of care?

Facilitate a consultation for speech therapy.

Arrange for daily home care assistance.

Use pictures and gestures to communicate.

Initiate passive range of motion exercises.

Answer and Explanation

The Correct Answer is A

A. Facilitate a consultation for speech therapy: Aphasia and difficulty swallowing are common after a CVA. A speech therapist can assess and provide interventions to address both speech and swallowing issues, improving communication and reducing the risk of aspiration or choking.

B. Arrange for daily home care assistance: While home care assistance may be necessary later, the immediate priority is addressing the client's communication and swallowing difficulties through therapy and clinical interventions.

C. Use pictures and gestures to communicate: This is helpful for the client’s communication, but it should be seen as an adjunct to speech therapy, not a substitute. Speech therapy provides targeted interventions to improve both speech and swallowing.

D. Initiate passive range of motion exercises: Although range of motion exercises are important for preventing joint contractures and promoting mobility, addressing the client’s swallowing and communication issues is a more immediate priority.

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Correct Answer is A

Explanation

A. Demonstrate to the PN how to position the client more effectively for the procedure:
The correct position for a sigmoidoscopy is the left lateral or Sims' position to allow easier access to the sigmoid colon. Demonstrating the correct position supports patient safety and provides teaching for the PN.

B. Arrange for unlicensed assistive personnel to assist the PN during the procedure: Assistance is not the issue in this scenario; the problem lies in incorrect positioning. Assigning additional help does not address the need to correct the client's position.

C. Acknowledge that the PN has positioned the client safely and correctly: The flat prone position is not appropriate for a sigmoidoscopy. Acknowledging incorrect positioning would be unsafe and potentially delay the procedure or increase the risk of injury.

D. Assume care of the client and assign the PN to the care of a different client: This is an excessive response that undermines the PN’s role. The more constructive approach is to guide and support the PN through demonstration rather than reassignment.

A. Amiodarone. B. Propranolol. C. Furosemide. D. Losartan.

Correct Answer is B

Explanation

A. Amiodarone: Amiodarone can cause pulmonary toxicity, but it is not a beta blocker and is less likely to cause acute bronchoconstriction. It should still be used cautiously in clients with lung disease, but it is not the priority to withhold based on current symptoms.

B. Propranolol: Propranolol is a non-selective beta blocker that can worsen bronchospasm in clients with COPD by blocking beta-2 receptors in the lungs. Given the client’s shortness of breath and COPD history, the nurse should consult the HCP before administering this drug.

C. Furosemide: Furosemide is a loop diuretic that helps reduce fluid overload and edema. It is appropriate in the presence of pitting edema and respiratory symptoms, as it may relieve symptoms related to right-sided heart failure commonly associated with advanced COPD.

D. Losartan: Losartan is an angiotensin receptor blocker (ARB) used to manage hypertension and reduce cardiac workload. It does not typically worsen pulmonary function and is not contraindicated in COPD patients presenting with shortness of breath or edema.

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An older adult client is referred to a rehabilitation facility following a cerebrovascular accident (CVA). The client is aphasic with left sided paresis and is having difficulty swallowing. Which intervention is most important for the nurse to include in the client's plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is setting up the equipment to assist with a sigmoidoscopy while the practical nurse (PN) positions the client in a flat prone position. Which action should the nurse implement?

Correct Answer is A

Explanation

Correct Answer is B

Explanation

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Which assessment should the home health nurse include during a routine home visit for a client who was discharged home with a suprapubic catheter?

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