A nurse is contributing to the plan of care for a client who has dysphagia and is pocketing food in their cheeks during meals. Which of the following interventions should the nurse recommend?

Elevate the head of the client's bed to 45" during meals.

Request a speech therapist consult from the provider.

Instruct the client to tilt their head back when swallowing.

Administer liquids to the client using a syringe.

Answer and Explanation

The Correct Answer is B

A.   Elevate the head of the client's bed to 45° during meals: The head should be elevated to 90° to reduce the risk of aspiration during meals.
B.   Request a speech therapist consult from the provider: Speech therapists can assess swallowing difficulties and recommend appropriate strategies.
C.   Instruct the client to tilt their head back when swallowing: This position increases the risk of aspiration by opening the airway during swallowing.
D.   Administer liquids to the client using a syringe: Syringe administration can lead to choking or aspiration and is not a standard feeding practice for dysphagia clients.

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Correct Answer is A

Explanation

A. Current medications: This is essential to ensure continuity of care and accurate medication administration at home.
B. Vital signs flow sheet: While helpful for inpatient monitoring, this is not typically critical for home health care.
C. Nurses' notes: These are primarily for internal documentation and are not always relevant for home health care providers.
D. Nursing admission assessment: The initial assessment is generally less relevant than current and ongoing care information.

A. Select the appropriate dressing. B. Document the dressing change. C. Change the dressing. D. Review available dressing types.

Correct Answer is D

Explanation

A. Select the appropriate dressing: Although selecting the right dressing is essential, it is not the initial step.
B. Document the dressing change: Documentation follows the intervention, not precedes it.
C. Change the dressing: Performing the dressing change without adequate preparation is not the first step.
D. Review available dressing types: Reviewing available dressing options ensures appropriate selection based on the wound's condition and treatment goals.

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A nurse is contributing to the plan of care for a client who has dysphagia and is pocketing food in their cheeks during meals. Which of the following interventions should the nurse recommend?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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