Certified Nursing Assistant Exam Prep

Category - Physical Care

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Mr. Tomas Tau, 53 years old, suffered from stroke and has now manifested dysphagia. Which nursing action is most appropriate for this client?

Monitor intake and output, and encourage fluid intake.
Elevate the head of bed, and observe for signs of aspiration.
Ensure an emesis basin is available, and refer to the nurse so that the client will be given an antiemetic medication.
Prepare to assist in the insertion of subclavian venous catheter for parenteral nutrition.

Explanation

Answer: B - Dysphagia is the medical term for difficulty swallowing. The head of the bed should be elevated, and the client should be observed for signs of aspiration.

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