The nurse is precepting a new nurse who is caring for a patient with a history of Huntington’s disease. The new nurse is preparing to feed the patient lunch.
What action by the new nurse would cause the precepting nurse to intervene?
The patient is lying in bed with their head elevated to 35 degrees.
The nurse provides thickened liquids per the orders.
The nurse does not rush the patient in eating each bite.
The nurse ensures that the patient’s food is minced.
The Correct Answer is A
Choice A rationale
The patient lying in bed with their head elevated to 35 degrees while eating could pose a risk for aspiration, especially for a patient with Huntington’s disease. Huntington’s disease is a neurodegenerative disorder that can cause difficulties with swallowing and motor control.
Therefore, it is recommended that the patient be as upright as possible, ideally in a seated position, during meals to reduce the risk of aspiration.
Choice B rationale
Providing thickened liquids is a common intervention for patients with Huntington’s disease who have difficulty swallowing. Thickened liquids are easier to control and swallow, reducing the risk of aspiration.
Choice C rationale
Not rushing the patient in eating each bite is a recommended practice. Patients with Huntington’s disease often have difficulty with motor control, including swallowing. Allowing the patient to take their time can help prevent choking and aspiration.
Choice D rationale
Ensuring that the patient’s food is minced is another recommended practice for patients with Huntington’s disease. Minced food is easier to chew and swallow, which can help prevent choking and aspiration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.9 "]
Explanation
Step 1: We are instructed to administer tobramycin 35mg IM every 8 hours. The available supply is 40mg in a 1 mL vial.
Step 2: We need to find out how many mL’s should the nurse administer. Step 3: We can set up a proportion to solve this.
Step 4: If 40mg is equivalent to 1mL, then 35mg is equivalent to x mL. Step 5: Solving for x gives us x = (35mg ÷ 40mg) × 1mL.
Step 6: Calculating the above expression gives us x = 0.875 mL.
Step 7: Rounding our answer to the nearest tenth, we get 0.9 mL. So, the nurse should administer 0.9 mL.
Correct Answer is ["2 "]
Explanation
Step 1 is: To calculate the rate at which the IV pump should be set to deliver the PRBCs, we need to divide the total volume of PRBCs by the total time for administration.
Step 2 is: Convert the time for administration from hours to minutes because the rate is typically set in mL/min. So, 3 hours is equivalent to 180 minutes.
Step 3 is: Now, divide the total volume of PRBCs (350 mL) by the total time for administration (180 min). So, the calculation is 350 mL ÷ 180 min.
Step 4 is: The final calculated answer is approximately 1.94 mL/min. However, IV pumps typically only allow whole numbers, so we would round this to 2 mL/min.
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