A nurse in a critical care unit is caring for a client who is postoperative following a right pneumonectomy. After extubation from the ventilator, in which of the following positions should the client be placed?

Choice A reason: Administering the medication 2 hr before exercise is a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast is a leukotriene modifier that helps to prevent asthma attacks and exercise induced bronchoconstriction. It is taken once a day in oral form and may cause side effects such as stomach pain, diarrhea, or mood changes. For children who have exercise induced asthma, an additional dose of montelukast may be taken 2 hr before exercise.

Choice B reason: Giving the medication at the onset of wheezing is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast is not a fast acting rescue medicine for asthma attacks and needs to be taken daily. It does not work quickly enough to relieve the symptoms of an acute asthma attack, such as wheezing, coughing, or shortness of breath. For an asthma attack, the child should use a short acting beta agonist inhaler, such as albuterol, as prescribed by the provider.

Choice C reason: Administering the granules mixed with 20 oz of water is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast granules come in a sachet with 4 mg of granules inside (one dose). They can be placed directly on the child's tongue or mixed with a spoonful of cold or room temperature soft food, such as applesauce, mashed carrots, rice, or ice cream. They can also be mixed with 1 teaspoonful (5 mL) of cold or room temperature baby formula or breast milk. They should not be mixed with any other liquid drink other than baby formula or breast milk. The mixture should be taken within 15 minutes after opening the packet.

Choice D reason: Giving the medication in the morning daily is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast works best when taken in the evening, as it can improve the symptoms of asthma and allergic rhinitis that occur at night or early in the morning. Taking it at the same time every day can also help to maintain a steady level of the drug in the body and prevent missed doses.

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.