A nurse is supervising an assistive personnel (AP) who is feeding a client who has dysphagia. Which of the following actions by the AP should the nurse identify as correct technique?

Withholding fluids until the end of the meal

Elevating the head of the client's bed to 30 degrees during mealtime

Providing a 10-minute rest period prior to meals

Instructing the client to place her chin toward her chest when swallowing

Answer and Explanation

The Correct Answer is D

Choice A reason: This is not a correct technique for feeding a client who has dysphagia. Withholding fluids until the end of the meal can increase the risk of dehydration and aspiration. Fluids should be offered throughout the meal to help moisten and thin the food.

Choice B reason: This is not a correct technique for feeding a client who has dysphagia. Elevating the head of the client's bed to 30 degrees during mealtime is not enough to prevent aspiration. The client should be in an upright position, preferably at 90 degrees, to facilitate swallowing and gravity.

Choice C reason: This is not a correct technique for feeding a client who has dysphagia. Providing a 10-minute rest period prior to meals is not necessary and may delay the feeding. The client should be fed when they are alert and hungry, and not too tired or sleepy.

Choice D reason: This is a correct technique for feeding a client who has dysphagia. Instructing the client to place her chin toward her chest when swallowing can help close the airway and prevent food from entering the lungs. This can reduce the risk of aspiration and choking.

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Correct Answer is D

Explanation

Choice A reason: I should discard personal health information documents in the trash before leaving the unit is not a correct statement, as it violates the client's privacy and the Health Insurance Portability and Accountability Act (HIPAA). I should shred or dispose of personal health information documents in a secure container or according to the facility's policy.

Choice B reason: I can post the client's vital signs in the client's room is not a correct statement, as it exposes the client's health information to unauthorized persons. I should keep the client's vital signs confidential and only share them with the client and the health care team.

Choice C reason: I can use another nurse's password as long as I log off after using the computer is not a correct statement, as it compromises the security and integrity of the electronic health record. I should use my own password and never share it with anyone else.

Choice D reason: I should encrypt personal health information when sending emails is a correct statement, as it protects the client's privacy and the HIPAA. I should use encryption or other secure methods when transmitting personal health information electronically.

A. A client who has a red tag B. A client who has a green tag C. A client who has a yellow tag D. A client who has a black tag

Correct Answer is A

Explanation

Choice A reason: A client who has a red tag is the first priority for the nurse, as it indicates that the client has life-threatening injuries that require immediate attention and treatment. The nurse should assess and stabilize the client as soon as possible.

Choice B reason: A client who has a green tag is the last priority for the nurse, as it indicates that the client has minor injuries that do not require urgent care. The nurse should assess and treat the client after all other clients have been attended to.

Choice C reason: A client who has a yellow tag is the second priority for the nurse, as it indicates that the client has serious injuries that require timely care but can wait for a short period of time. The nurse should assess and treat the client after the red-tagged clients have been stabilized.

Choice D reason: A client who has a black tag is not a priority for the nurse, as it indicates that the client is deceased or has fatal injuries that are beyond the scope of care. The nurse should not attempt to resuscitate or treat the client, but rather focus on the clients who have a chance of survival.

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A nurse is supervising an assistive personnel (AP) who is feeding a client who has dysphagia. Which of the following actions by the AP should the nurse identify as correct technique?

Nursing Test Bank

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