The nurse is caring for an older adult client who is somewhat withdrawn and experiencing anorexia. What action should the nurse take to promote the client's appetite?
Request the client be placed on enteral feedings
Place the client on aspiration precautions
Engage them in conversation during mealtime
Tell the client they must eat or they will get sick
The Correct Answer is C
Rationale:
A. Requesting the client be placed on enteral feedings is not the first intervention for a client who is withdrawn and experiencing anorexia. Enteral nutrition is typically reserved for clients who cannot meet nutritional needs orally or are at risk of severe malnutrition.
B. Placing the client on aspiration precautions is important if there is a swallowing difficulty, but in this scenario, the client’s anorexia appears related to social withdrawal or low appetite, not dysphagia. Aspiration precautions alone will not promote appetite.
C. Engaging the client in conversation during mealtime is the correct action. Social interaction, a pleasant environment, and encouragement during meals can stimulate appetite, increase food intake, and improve the overall dining experience. Older adults often eat better when mealtimes are socially engaging and relaxed, which addresses the psychosocial component of anorexia.
D. Telling the client they must eat or they will get sick is inappropriate. This approach can increase anxiety, resistance, and further reduce appetite. Encouragement and positive reinforcement are more effective than coercion in promoting oral intake.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. An enlarged prostate can lead to urinary retention by obstructing the flow of urine through the urethra. This is a common cause in older male clients, as the prostate gland enlarges with age and compresses the urethra, making it difficult to empty the bladder completely.
B. High caffeine intake is a diuretic and can increase urine production, which may lead to increased frequency or urgency, but it does not cause urinary retention.
C. Increased fluid intake promotes urination by filling the bladder and stimulating normal voiding. It does not contribute to retention; in fact, it may help prevent it by maintaining bladder function.
D. Use of diuretics increases urine output, which can lead to more frequent urination or potential dehydration if fluids are not replaced, but it does not cause urinary retention. The bladder is typically emptied normally in response to diuretic-induced urine production.
Correct Answer is B
Explanation
Rationale:
A. Stopping the enteral feedings and calling the healthcare provider is appropriate. The client is showing signs of possible aspiration or fluid overload—tachypnea, hypoxia, and bilateral crackles—which require immediate intervention to prevent further complications.
B. Lowering the head of the bed is contraindicated. A supine or low position increases the risk of aspiration, especially in a client receiving enteral feedings. Keeping the head elevated helps prevent gastric contents from entering the lungs and worsening respiratory compromise.
C. Administering oxygen via nasal cannula is appropriate to address hypoxia and improve oxygen saturation. Oxygen therapy is a supportive measure while further evaluation and interventions are initiated.
D. Placing the client in high Fowler’s position is correct. Elevating the head of the bed to 60–90 degrees helps reduce the risk of aspiration, improves lung expansion, and facilitates safer administration of enteral nutrition.
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