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 D

Explanation

A. Ecchymosis: Ecchymosis refers to bruising or discoloration of the skin due to bleeding under the skin. While it may indicate a bleeding tendency or trauma, it is not a common symptom associated with anaphylaxis or severe allergic reactions. This finding does not signal an immediate threat to the airway or circulatory system and does not require epinephrine administration.
B. Atopic dermatitis: Atopic dermatitis is a chronic inflammatory skin condition characterized by itching and rashes. It is often linked with allergies but is not a sign of acute anaphylaxis. The presence of atopic dermatitis suggests a predisposition to allergic conditions but does not indicate the need for emergency epinephrine treatment.
C. Double vision: Double vision, or diplopia, is a neurological symptom that may be associated with various conditions, including migraines or head injuries. It is not a classic symptom of anaphylaxis and does not indicate airway compromise or circulatory collapse. Therefore, it does not warrant epinephrine administration in this scenario.
D. Hoarseness: Hoarseness may indicate laryngeal edema, which is a sign of upper airway swelling and potential airway obstruction. In a suspected peanut allergy, this symptom is a critical warning sign of anaphylaxis. Immediate intramuscular epinephrine is required to reduce airway inflammation, improve breathing, and prevent progression to full airway obstruction or cardiovascular collapse.

A. Remove the solution from the refrigerator 1 hr before infusing. B. Increase the rate of the infusion as needed to keep it on schedule. C. Weigh the client every other day. D. Change the client's TPN catheter tubing every 72 hr. E. Infuse TPN through a central venous line.

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.

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

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