A nurse is planning care for a client who is to have a mechanically altered diet following a stroke. Which of the following foods should the nurse recommend to include in the client's diet? (Select all that apply.)

Ground meat

Raw broccoli

Strawberries

Mashed potatoes

Ice cream

Answer and Explanation

Correct Answer : A,D,E

A. Ground meat: Ground meat is good for a mechanically altered diet because it can be easily chewed and swallowed compared to whole cuts of meat. The texture is soft and can be modified further if necessary, making it suitable for clients with difficulty chewing or swallowing. It provides a good source of protein, essential for recovery and tissue repair.
B. Raw broccoli: Raw broccoli is not suitable for a mechanically altered diet, as it can be difficult for a client to chew properly and may pose a choking hazard. Vegetables with tough, fibrous textures require further modification, such as cooking or pureeing, to ensure safe consumption for individuals with swallowing difficulties.
C. Strawberries: Strawberries, although soft, are not ideal for a mechanically altered diet, particularly if they are whole or in large pieces. The seeds and texture may still pose a risk for choking or difficulty swallowing. To include strawberries safely, they would need to be pureed or cut into very small pieces, which is not the most efficient choice for a mechanically altered diet.
D. Mashed potatoes: Mashed potatoes are a good choice for a mechanically altered diet because they are soft, smooth, and easy to swallow, which helps prevent choking or aspiration. Mashed potatoes can also be flavored with various ingredients, providing nutritional value and palatability while adhering to the requirements for a mechanically altered diet.
E. Ice cream: Ice cream can be included in a mechanically altered diet because it has a soft, smooth texture that is easy to swallow. Additionally, it can provide a source of calories and protein, which may be especially beneficial for clients who have difficulty maintaining adequate nutrition after a stroke. However, it should be offered in moderation, as it is high in sugar and fat.

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

Explanation

A. Remove the solution from the refrigerator 1 hr before infusing: Allowing the TPN solution to warm to room temperature helps reduce the risk of vein irritation and discomfort. Cold solutions can cause venospasm or systemic reactions when infused into the bloodstream.
B. Increase the rate of the infusion as needed to keep it on schedule: TPN must be administered at a consistent prescribed rate. Increasing the rate without orders can lead to hyperglycemia, fluid overload, or metabolic complications. Any delays should be reported to the healthcare provider.
C. Weigh the client every other day: Daily weight monitoring is essential in TPN therapy to assess fluid balance and nutritional status. Weighing the client only every other day may delay the recognition of fluid overload or dehydration.
D. Change the client's TPN catheter tubing every 72 hr: TPN tubing should be changed every 24 hours to reduce the risk of catheter-related bloodstream infections. Extending beyond this time frame increases the likelihood of microbial contamination.
E. Infuse TPN through a central venous line: Due to its high glucose and osmolarity content, TPN must be administered via a central line to prevent phlebitis and allow for rapid, well-tolerated infusion. Peripheral administration is not suitable for long-term TPN.

A. Offer the client thickened liquids to drink. B. Monitor the client for indications of fatigue during meals. C. Check the client's gag reflex. D. Monitor the client's ability to speak consistently.

Correct Answer is C

Explanation

A. Offer the client thickened liquids to drink: Offering thickened liquids can help reduce the risk of aspiration in clients with dysphagia, which is common after a stroke. However, this should be done after confirming that the client has a safe swallowing mechanism, such as an intact gag reflex. Administering liquids before assessing swallowing safety can increase the risk of aspiration pneumonia.
B. Monitor the client for indications of fatigue during meals: Fatigue can compromise the client’s ability to chew and swallow effectively, increasing the risk of aspiration. Monitoring for this is important but is not the immediate priority when the client is already drooling, a sign that they may be unable to manage their oral secretions. Ensuring safe swallowing should be addressed before monitoring meal-time fatigue.
C. Check the client's gag reflex: Checking the gag reflex is the most important initial action because it directly assesses the client’s ability to swallow safely. Drooling after a stroke often indicates impaired neuromuscular control, which puts the client at high risk for aspiration. The gag reflex gives immediate information on whether oral intake is safe.
D. Monitor the client's ability to speak consistently: Monitoring speech consistency can provide insights into neurological recovery and motor control, but it is not the first concern in a drooling stroke patient. The primary danger is aspiration due to impaired swallowing. Speaking ability does not directly reflect swallowing safety.

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A nurse is planning care for a client who is to have a mechanically altered diet following a stroke. Which of the following foods should the nurse recommend to include in the client's diet? (Select all that apply.)

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