A nurse is contributing to the plan of care of a client who is in a long-term care facility.
To improve the client's nutritional status, which of the following nursing interventions should the nurse recommend adding to the plan? Provide soft foods.

Minimize the use of seasoning.

Limit finger foods.

Serve small, frequent meals.

Offer three large meals daily.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Minimizing the use of seasoning can decrease palatability and potentially reduce the client's food intake, negatively impacting their nutritional status. Flavorful foods can stimulate appetite and encourage better nutrient consumption.

Choice B rationale

Limiting finger foods may restrict autonomy and reduce intake for clients who have difficulty using utensils. Finger foods can provide independence and increase caloric intake for some individuals in long-term care.

Choice C rationale

Serving small, frequent meals can improve nutritional intake by preventing early satiety and providing a consistent supply of nutrients throughout the day. This approach is often beneficial for individuals with decreased appetite or difficulty tolerating large meals.

Choice D rationale

Offering three large meals daily might be overwhelming for some clients in long-term care who may have reduced appetites, slower digestion, or other medical conditions that make it difficult to consume large quantities of food at once.

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Correct Answer is ["A","D"]

Explanation

Choice A rationale

Vanilla pudding is often restricted in dysphagia diets due to its smooth, slippery texture, which can be difficult to control in the oral cavity and increases the risk of aspiration into the airway. Individuals with dysphagia may have impaired swallowing mechanisms, making thin, liquid-like consistencies particularly hazardous.

Choice B rationale

Cranberry juice is a thin liquid and poses a significant aspiration risk for a patient with dysphagia. Thin liquids are difficult to manage in the mouth and throat, increasing the likelihood of the liquid entering the trachea instead of the esophagus. Patients with swallowing difficulties often require thickened liquids to improve bolus control.

Choice C rationale

Beef broth is a clear liquid and, similar to cranberry juice, presents a high risk of aspiration for a patient with dysphagia. Its thin consistency makes it challenging for individuals with impaired swallowing to control its movement, potentially leading to it entering the airway and causing respiratory complications.

Choice D rationale

Orange gelatin, while seemingly semi-solid, often melts into a thin liquid in the mouth due to body temperature. This change in consistency makes it difficult to control and increases the risk of aspiration in patients with dysphagia. Gelatin's slippery texture further compounds this risk.

A. Verify tube placement. B. Check the residual feeding contents. C. Administer the feeding. D. Evaluate tolerance to the feeding.

Correct Answer is A,B,C,D

Explanation

Choice A rationale

Verifying tube placement is the initial critical step to ensure the feeding is delivered into the gastrointestinal tract and not the respiratory system, thereby preventing aspiration. Methods for verification include pH testing of aspirate (target pH ≤ 5.5), and radiographic confirmation is the gold standard, especially after initial placement.

Choice B rationale

Checking the residual feeding contents before administering a new feeding is essential to assess the client's tolerance to the previous feeding and prevent overfeeding, which can lead to complications like abdominal distension, nausea, vomiting, and aspiration. A high residual volume may indicate delayed gastric emptying.

Choice C rationale

Administering the feeding follows confirmation of tube placement and assessment of residual volume. The feeding should be administered at the prescribed rate and volume, ensuring the client receives adequate nutrition and hydration. The client should be positioned with the head of the bed elevated at least 30-45 degrees during and for at least 30-60 minutes after feeding to minimize aspiration risk.

Choice D rationale

Evaluating the client's tolerance to the feeding is an ongoing process that involves monitoring for signs and symptoms such as abdominal distension, pain, nausea, vomiting, diarrhea, or aspiration. This evaluation helps determine if the feeding regimen needs adjustment in terms of rate, volume, or formula.

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A nurse is contributing to the plan of care of a client who is in a long-term care facility.To improve the client's nutritional status, which of the following nursing interventions should the nurse recommend adding to the plan? Provide soft foods.

Nursing Test Bank

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Which of the following items on the tray should the nurse remove?

Correct Answer is ["A","D"]

Explanation

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Correct Answer is A,B,C,D

Explanation

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A nurse is contributing to the plan of care of a client who is in a long-term care facility.
To improve the client's nutritional status, which of the following nursing interventions should the nurse recommend adding to the plan? Provide soft foods.