A provider prescribes an oral medication for a client who is having some difficulty swallowing. What actions should the nurse take to prevent aspiration? Select All That Apply.

Crush tablets that are crushable and mix with a small amount of applesauce.

Have the client hyperextend the neck slightly when swallowing.

Stroke under the chin over the larynx.

Give water before, during, and after medication administration

Have the client use a straw.

Answer and Explanation

Correct Answer : A,C

Aspiration occurs when gastric contents or oropharyngeal secretions enter the larynx and lower respiratory tract. It results from impaired deglutition or protective airway reflexes, leading to chemical pneumonitis or bacterial pneumonia. Specific nursing interventions prioritize maintaining a protected airway by modifying bolus consistency and enhancing the swallowing reflex through physical stimulation.

Rationale:

A. Altering the texture of solid medications to a bolus consistency improves swallow control. Mixing crushed medication with thickened agents like applesauce prevents the fragmentation of particles in the pharynx. This reduces the risk of silent aspiration in patients with oropharyngeal dysphagia or delayed swallow initiation.

B. Hyperextending the neck is strictly contraindicated as it opens the airway and inhibits effective epiglottic closure. Safe swallowing requires the chin-tuck maneuver to narrow the laryngeal inlet and widen the vallecular space. Proper positioning is the most critical factor in preventing pulmonary aspiration during oral intake.

C. Gentle upward stroking of the submental muscles encourages laryngeal elevation and facilitates the pharyngeal phase of swallowing. This physical cue helps initiate the reflexive movement required to seal the glottis during the passage of a bolus. It is a recognized technique for patients with sensory deficits.

D. Excessive fluid administration increases the risk of thin liquids entering the trachea before the swallow reflex triggers. Thin water is the most difficult consistency for dysphagic patients to manage safely without coughing. Fluids should be thickened according to speech therapy recommendations rather than given freely during meds.

E. Using a straw often delivers a large volume of fluid to the posterior pharynx too quickly for the patient to control. Straw use bypasses the oral preparatory phase, significantly increasing the likelihood of penetration into the airway. Patients with swallowing difficulties should sip directly from a cup to regulate bolus size.

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Correct Answer is C

Explanation

Infective endocarditis involves a microbial infection of the endocardial surface, typically targeting the cardiac valves and resulting in the formation of friable vegetations. These lesions can lead to valvular incompetence, myocardial abscesses, or systemic septic embolization. Rapid initiation of high-dose intravenous therapy is mandatory to achieve bactericidal concentrations and prevent irreversible valvular destruction or sudden hemodynamic collapse.

Rationale:

A. Statin medications, or HMG-CoA reductase inhibitors, are utilized for the long-term management of hyperlipidemia and the stabilization of atherosclerotic plaques. While they are critical for preventing future cardiovascular events, they do not provide acute stabilization or immediate life-saving effects. Administering this medication is a routine task that can be deferred until after higher-priority treatments are completed.

B. Antiplatelet therapy is a standard secondary prevention strategy used to inhibit thrombocyte aggregation and reduce the risk of recurrent ischemic events following a myocardial infarction. Although essential for maintaining vascular patency, it is typically a daily maintenance medication in the post-acute phase. It does not take precedence over the first dose of a time-critical antibiotic for an active infection.

C. The first dose of an antibiotic for acute endocarditis is a medical priority to halt the progression of valvular damage and systemic sepsis. Early administration is linked to improved clinical outcomes and a reduction in the risk of embolic complications. This medication must be given immediately after admission to establish a therapeutic window and control the infectious process in the bloodstream.

D. Coronary vasodilator patches, such as nitroglycerin, are used for the prophylactic management of chronic stable angina by reducing myocardial oxygen demand. While important for managing coronary artery disease, the patch is a slow-release delivery system intended for long-term symptom control rather than acute intervention. It is a lower priority compared to the urgent antimicrobial needs of a newly admitted client.

Correct Answer is ["5"]

Explanation

Convert the concentration first:

8 mg = 8,000 mcg
8,000 mcg in 250 mL

Find mcg per mL:

8,000 ÷ 250 = 32 mcg/mL

Now calculate the volume needed for 152 mcg:

152 ÷ 32 = 4.75 mL

Round to the nearest whole number:

Final Answer:

5 mL

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A provider prescribes an oral medication for a client who is having some difficulty swallowing. What actions should the nurse take to prevent aspiration? Select All That Apply.

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Naxlex Comprehensive Predictor Exams

Which medication should the nurse administer first after receiving the morning shift report?

Correct Answer is C

Explanation

A client has been prescribed norepinephrine 152 mcg. The concentration of norepinephrine is 8 mg mixed in 250 mL of DSW. How many mL should the nurse administer? Round to the whole number.

Correct Answer is ["5"]

Explanation

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