a nurse is caring for a client who is receiving continuous enteral feedings which of the following interventions should the nurse implement
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Nursing Elites

ATI LPN

LPN Fundamentals of Nursing Quizlet

1. A client is receiving continuous enteral feedings. Which of the following interventions should the nurse implement?

Correct answer: B

Rationale: The correct answer is B: Flush the feeding tube every 4 hours. Flushing the feeding tube every 4 hours is essential to maintain patency and prevent clogging, ensuring the client receives the prescribed enteral nutrition without interruption. This intervention helps prevent complications such as tube occlusion. Monitoring intake and output is important for assessing the client's hydration status but does not directly address tube patency. Measuring the client's temperature is essential for monitoring for signs of infection but is not directly related to tube maintenance. Changing the feeding bag and tubing every 72 hours is important for infection control but does not address tube patency.

2. When should discharge planning begin for a client admitted to a long-term care facility for rehabilitation after a total hip arthroplasty?

Correct answer: B

Rationale: Discharge planning should begin upon the client's admission to the care facility. This early start allows the healthcare team to conduct assessments, set goals, and coordinate services for a smooth transition back home or to the community. Initiating discharge planning early ensures timely arrangements, leading to optimal outcomes and continuity of care. Choices A, C, and D are incorrect because waiting until one week before discharge, after the discharge date is identified, or until the client brings up the topic may lead to rushed decision-making, inadequate arrangements, and a less effective transition process.

3. When caring for a client with a hearing impairment, which of the following actions should the nurse take when speaking with the client?

Correct answer: C

Rationale: When caring for a client with a hearing impairment, it is essential for the nurse to face the client when speaking. By facing the client, the nurse allows the individual to read lips and see facial expressions, which can significantly improve communication effectiveness. This approach facilitates better understanding and helps the client feel more connected during interactions. Speaking in a high-pitched voice (Choice A) is not recommended as it may distort speech sounds. Exaggerating lip movements (Choice B) can be patronizing and ineffective. Using a monotone voice (Choice D) lacks intonation that helps convey meaning and emotions in speech, making it harder for the client to understand.

4. A client is experiencing dysphagia. Which of the following actions should the nurse take?

Correct answer: D

Rationale: When caring for a client with dysphagia, placing food on the unaffected side of the mouth can help them chew and swallow more effectively. This technique can assist in minimizing the risk of aspiration and improve the client's ability to manage food safely. Providing small food pieces, offering thickened liquids, and encouraging the client to sit upright after meals are also important interventions in managing dysphagia, but placing food on the unaffected side of the mouth is a specific technique that directly addresses the swallowing difficulty associated with dysphagia.

5. A client has a new diagnosis of osteoarthritis and is being taught about dietary management. Which of the following statements should be included in the teaching?

Correct answer: C

Rationale: The correct statement to include in the teaching is to increase the intake of vitamin D-rich foods. Vitamin D helps improve calcium absorption, which is beneficial for bone health and may help alleviate symptoms of osteoarthritis. Option A is incorrect because while calcium is important for bone health, the focus should be on vitamin D for calcium absorption. Option B is incorrect as potassium is generally not restricted in osteoarthritis. Option D is also incorrect as sodium restriction is more relevant for conditions like hypertension or heart failure, not specifically for osteoarthritis.

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