A nurse is administering an enteric-coated medication to an adult client who has right-sided weakness and is having difficulty swallowing tablet. Which of the following actions should the nurse take?

Administer the tablet to the client with applesauce.

Position the client at a 45 angle

Crush the tablet and mix it in pudding for the client.

Instruct the client to tilt their head back when swallowing

Answer and Explanation

The Correct Answer is A

A. Administer the tablet to the client with applesauce: Administering the tablet with a small amount of soft food like applesauce can help facilitate swallowing without altering the integrity of the enteric coating. This method eases the swallowing process while ensuring the medication is delivered properly.

B. Position the client at a 45-degree angle: Clients who have difficulty swallowing should be positioned in an upright 90-degree sitting position, not at 45 degrees, to reduce the risk of aspiration and promote safer swallowing mechanics.

C. Crush the tablet and mix it in pudding for the client: Enteric-coated tablets should never be crushed, as crushing destroys the protective coating designed to prevent the medication from being released in the stomach, potentially causing irritation or reducing drug effectiveness.

D. Instruct the client to tilt their head back when swallowing: Tilting the head back increases the risk of choking and aspiration, especially in clients with swallowing difficulties. It is safer to encourage tucking the chin slightly down when swallowing to help protect the airway.

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Correct Answer is C

Explanation

A. Remind the client that they have been refusing the medication for 5 days: Pointing out the duration of refusal may come across as confrontational and does not respect the client's right to refuse treatment. It can also damage the therapeutic relationship without addressing the underlying concerns about the medication.

B. Inform the client that their provider will contact them to discuss their refusal of the medication: While involving the provider may eventually be necessary, the immediate nursing action should be to document the refusal accurately. The nurse can then inform the provider if needed based on facility policy.

C. Document the client's refusal in the medication administration record: Clients have the legal right to refuse medication, and it is the nurse’s responsibility to document the refusal clearly and objectively. Accurate documentation ensures legal protection for the client and the healthcare team and maintains the integrity of the medical record.

D. Notify the pharmacy about the client's refusal of the medication: Notifying the pharmacy about a single medication refusal is unnecessary unless there are repeated refusals requiring a change in the medication order. The pharmacy’s role is not to manage client compliance but to dispense prescribed medications.

A. Ask the client to identify what made them upset B. Assist the client with understanding their needs. C. Place the client in seclusion. D. Administer lorazepam IM.

Correct Answer is A

Explanation

A. Ask the client to identify what made them upset: The first action should be to assess and de-escalate the situation using therapeutic communication. Asking the client to verbalize their feelings can help reduce agitation, promote self-awareness, and prevent escalation.

B. Assist the client with understanding their needs: Helping the client understand their needs is important but comes after first addressing and calming their immediate emotional agitation through assessment and supportive conversation.

C. Place the client in seclusion: Seclusion is a last-resort intervention when the client poses a danger to themselves or others and less restrictive measures have failed. It should not be the first action without attempting de-escalation techniques.

D. Administer lorazepam IM: Administering medication is appropriate if non-pharmacological interventions fail. However, medication should not be the first response before attempting verbal de-escalation strategies in an agitated client.

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A nurse is administering an enteric-coated medication to an adult client who has right-sided weakness and is having difficulty swallowing tablet. Which of the following actions should the nurse take?

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