The nurse is providing health education to an elderly client with dysphagia following a recent ischemic stroke. What would be most appropriate for the nurse to include in the education?

Drink fluids before and after, but not during, meals

Sit with the head of the bed at a 45-degree angle during meals

Thoroughly chew small amounts of food with each mouthful

Be aware of the possibility of temporomandibular joint pain

Answer and Explanation

The Correct Answer is C

A. Drinking fluids before and after meals but not during meals is incorrect. Clients with dysphagia may require thickened liquids and should sip fluids as needed to facilitate swallowing.
B. Sitting with the head of the bed at a 45-degree angle is incorrect. Clients with dysphagia should be positioned at a 90-degree angle (fully upright) during meals to reduce the risk of aspiration.
C. Thoroughly chewing small amounts of food with each mouthful is correct. Clients with dysphagia should eat slowly, take small bites, and chew food thoroughly to prevent choking and aspiration.
D. Temporomandibular joint pain is not a common issue associated with dysphagia following a stroke. The primary concern is the risk of aspiration.

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Correct Answer is D

Explanation

D. "Client denies recent constipation, diarrhea, bowel incontinence, or abdominal pain." is correct because it is the most specific and complete documentation of the client’s subjective report. It ensures clarity, accuracy, and thorough assessment.
A. This is incorrect because stating "within normal limits" is vague and does not specify what was assessed.
B. This is incorrect because stating "problems are not present" is too general and does not include specific symptoms the client was asked about.
C. This is incorrect because "denies gastrointestinal signs and symptoms" lacks specificity regarding which symptoms were assessed.

A. "You are probably sad about that." B. "Are you feeling sad, depressed, angry, or upset?" C. "How does that make you feel right now?" D. "What was the cause of your wife's death?"

Correct Answer is C

Explanation

A. "You are probably sad about that" assumes the client’s emotions rather than allowing them to express their own feelings.
B. "Are you feeling sad, depressed, angry, or upset?" is a closed-ended question that may limit the client’s ability to fully express emotions.
C. "How does that make you feel right now?" is correct because it is an open-ended question that encourages the client to explore and express their emotions in their own words.
D. "What was the cause of your wife's death?" shifts the focus away from the client’s emotions and may come across as insensitive.

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The nurse is providing health education to an elderly client with dysphagia following a recent ischemic stroke. What would be most appropriate for the nurse to include in the education?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While the nurse is assessing a client's gastrointestinal system, the nurse's findings are unremarkable and the client denies complications. How would the nurse best document the subjective portion of the assessment?

Correct Answer is D

Explanation

During the interview the client states, "Is today the 12th? My wife died two months ago today." Which of the following responses would be most appropriate?

Correct Answer is C

Explanation

The nurse is completing a health history on a client who is upset about having to answer questions. The client states, "Can't we just focus on my problem!" How should the nurse respond to the client regarding the need to gather this data?

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