A nurse is teaching a client who has dysphagia. Which of the following instructions should the nurse include

"Tilt your chin up when swallowing."

"Clear your mouth with fluids after swallowing."

"Rest for 30 minutes before eating."

"Plan to eat three large meals a day."

Answer and Explanation

The Correct Answer is B

A. "Tilt your chin up when swallowing. Tilting the chin up while swallowing increases the risk of aspiration in clients with dysphagia. This position can cause food or liquid to enter the airway more easily by opening the trachea, especially in individuals with poor swallowing coordination.
B. "Clear your mouth with fluids after swallowing." Using fluids to clear the mouth after swallowing helps to ensure that no food residues remain in the oral cavity, reducing the risk of choking or aspiration. This technique supports safer swallowing and is a standard recommendation in dysphagia management to aid in clearing the pharynx and preventing residue buildup.
C. "Rest for 30 minutes before eating." While conserving energy is important for clients with dysphagia, resting before meals does not directly improve swallowing safety or technique. Energy conservation is more applicable to clients with fatigue or respiratory compromise. The priority with dysphagia is modifying swallowing techniques and diet to prevent aspiration.
D. "Plan to eat three large meals a day." Large meals can be overwhelming and increase the risk of aspiration or fatigue during eating. Clients with dysphagia should eat smaller, more frequent meals to manage their swallowing abilities better and reduce the risk of complications. Smaller meals allow for better control and easier management of each bite or sip.

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Correct Answer is A

Explanation

A. Muscle weakness: Potassium is essential for normal neuromuscular function, and a low serum potassium level disrupts muscle cell excitability and contractility. As a result, clients may present with generalized weakness, particularly in the lower extremities, and may have difficulty with mobility or respiration if the weakness progresses.
B. Hyperreflexia: Hyperreflexia is more commonly associated with elevated calcium or magnesium imbalances rather than decreased potassium. Hypokalemia typically causes reduced neuromuscular excitability, which would result in diminished or absent reflexes rather than increased reflex activity. Therefore, hyperreflexia is not an expected finding in a client with low potassium.
C. Chvostek's sign: Chvostek’s sign is associated with hypocalcemia, not hypokalemia. It is elicited by tapping the facial nerve, resulting in twitching of the facial muscles. This sign indicates increased neuromuscular excitability due to low calcium levels, which is unrelated to potassium regulation. It is not expected in cases of decreased potassium.
D. Seizures: Seizures are more commonly linked with abnormalities in sodium or calcium levels, particularly hyponatremia or severe hypocalcemia. While severe hypokalemia can lead to cardiac arrhythmias and muscle paralysis, it is not typically associated with seizures. Therefore, seizures are not a standard finding in clients with hypokalemia.

A. Increased thirst B. Urinary frequency C. Weakness D. Skin flushing

Correct Answer is C

Explanation

A. Increased thirst: This is typically a manifestation of hyperglycemia rather than hypoglycemia. Hyperglycemia can lead to dehydration due to the body’s attempt to flush out excess glucose through urine, which then causes increased thirst.
B. Urinary frequency: Urinary frequency is also a symptom commonly associated with hyperglycemia rather than hypoglycemia. When blood sugar levels are too high, the kidneys try to remove excess glucose, leading to frequent urination causing polyuria and is typically seen in hyperglycemic states, not in low blood sugar situations.
C. Weakness: Weakness is a classic symptom of hypoglycemia. When blood glucose levels drop too low, the body does not have enough fuel to function properly, leading to fatigue and weakness. This symptom is often experienced as one of the early signs of hypoglycemia and should be closely monitored in diabetic patients.
D. Skin flushing: Flushed skin is not a typical feature of hypoglycemia. Hypoglycemia more commonly causes cool, pale, and clammy skin due to sympathetic nervous system activation.

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A nurse is teaching a client who has dysphagia. Which of the following instructions should the nurse include

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has a decreased potassium level. Which of the following findings should the nurse expect?

Correct Answer is A

Explanation

A nurse is assessing a client who has diabetes mellitus. The nurse should identify that which of the following findings are manifestations of hypoglycemia? (Select all that apply.)

Correct Answer is C

Explanation

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