A nurse is caring for a client who has dysphagia and is receiving oral medications. Which of the following actions should the nurse take?
Administer the client's medications one at a time.
Encourage the client to use a straw to take the medications.
Give the client's medications between meals.
Assist the client into semi-Fowler's position.
The Correct Answer is A
A. Administer the client's medications one at a time:
This is the correct action. Administering medications one at a time allows the nurse to monitor the client's ability to swallow each medication safely. It minimizes the risk of aspiration and ensures that each medication is swallowed effectively.
B. Encourage the client to use a straw to take the medications:
Using a straw may not be recommended for clients with dysphagia, as it can alter the normal swallowing process and increase the risk of aspiration. The focus should be on safe administration of medications without compromising the client's ability to swallow.
C. Give the client's medications between meals:
The timing of medication administration is important, but the priority is the safe administration of medications, especially for clients with dysphagia. Administering medications between meals may not directly address the safety concerns related to swallowing.
D. Assist the client into semi-Fowler's position:
While positioning is important, especially for clients with dysphagia, the administration of medications one at a time (Option A) takes precedence in ensuring the safety of the client's swallowing. Semi-Fowler's position may be beneficial, but it is not the primary action related to medication administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Whisper a series of words softly into one ear.
Explanation: Whispering words into one ear is not part of Weber's test. This action is more relevant to the assessment of hearing acuity and not the lateralization of sound. Weber's test focuses on the perception of sound in relation to both ears, not the ability to hear whispered words.
B. Place an activated tuning fork in the middle of the client's forehead.
Explanation: In Weber's test, a tuning fork is placed in the middle of the client's forehead. The test is designed to assess whether sound lateralizes (moves) to one ear or is heard equally in both ears. If the client perceives the sound more in one ear than the other, it may indicate a hearing imbalance or issue.
C. Deliver a series of high-pitched sounds at random intervals.
Explanation: Delivering high-pitched sounds at random intervals is not part of Weber's test. Weber's test involves a single action – placing an activated tuning fork in the middle of the client's forehead. The purpose is to determine if the client perceives the sound equally in both ears or if there is lateralization. Random intervals and high-pitched sounds are not specified components of this test.
D. Hold an activated tuning fork against the client's mastoid process.
Explanation: While holding a tuning fork against the mastoid process is part of another hearing test called the Rinne test, it is not the appropriate action for the Weber's test. The Rinne test compares air conduction (using the tuning fork near the ear) to bone conduction (using the tuning fork against the mastoid process) to evaluate hearing in each ear. In Weber's test, we are specifically interested in lateralization of sound, not comparing air and bone conduction.
Correct Answer is B
Explanation
A. "Increase intake of vitamin B12":
Vitamin B12 is important for various bodily functions, including the health of nerves and red blood cells, but it is not directly associated with osteoporosis prevention. Calcium and vitamin D are more critical nutrients for bone health.
B. "Walk for 30 minutes three to five times each week":
Weight-bearing exercises, such as walking, are beneficial for preventing osteoporosis. Weight-bearing activities stimulate bone formation and help maintain bone density. Regular walking for 30 minutes, three to five times per week, can contribute to overall bone health and reduce the risk of osteoporosis.
C. "Perform water aerobics three times each week":
While water aerobics is a beneficial exercise for cardiovascular health and joint flexibility, it is not as effective as weight-bearing exercises for preventing osteoporosis. Weight-bearing activities put stress on bones, promoting bone density.
D. "Maintain a lean body mass":
Maintaining a healthy body weight and lean body mass is important for overall health, but it is not a direct preventive measure for osteoporosis. Weight-bearing exercises and adequate intake of calcium and vitamin D are more specific recommendations for preventing osteoporosis.
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