a nurse is planning care for a client who has acute dysphagia which of the following nursing interventions should be included in the plan of care
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1. A client has acute dysphagia. Which of the following nursing interventions should be included in the plan of care?

Correct answer: C

Rationale: Placing the client in semi-Fowler's position during meals is the correct intervention for a client with acute dysphagia. This position helps prevent aspiration by facilitating swallowing. Providing a straw for consumption of liquids (Choice A) can increase the risk of aspiration and is not recommended for clients with dysphagia. Encouraging larger bites (Choice B) can also increase the risk of choking and aspiration. Instructing the client to tilt the head forward when swallowing (Choice D) is not the recommended technique for managing dysphagia as it does not address the underlying issue effectively.

2. To prevent baby bottle tooth decay, what should the nurse instruct?

Correct answer: A

Rationale: The correct answer is A: Water. Water is the best choice to prevent baby bottle tooth decay as it does not cause tooth decay and is a good option for bedtime bottles. Milk (choice B) and iron-fortified formula (choice C) contain sugars that can contribute to tooth decay. Unsweetened fruit juice (choice D) also contains natural sugars that can be harmful to the baby's teeth.

3. You are to measure the client's initial blood pressure reading by doing all of the following EXCEPT:

Correct answer: B

Rationale: When measuring blood pressure, it is crucial to follow specific steps to obtain accurate readings. Taking the blood pressure on both arms for comparison helps assess any variations. Pumping the cuff to around 50 mmHg above the point of pulse obliteration ensures accurate measurements. Observing procedures for infection control is vital to prevent the spread of infections. Listening to and identifying the phases of Korotkoff sounds are associated with auscultatory blood pressure measurements, not the initial blood pressure reading process.

4. The past history of Camila would most probably reveal that her premorbid personality is:

Correct answer: D

Rationale: Understanding the underlying pathology and therapeutic techniques ensures that nursing care is not only reactive but also preventative, reducing the risk of complications.

5. The small intestine is comprised of the cecum, colon, and rectum. The large intestine includes the duodenum, jejunum, and ileum.

Correct answer: B

Rationale: Both statements are false. The small intestine consists of the duodenum, jejunum, and ileum, while the large intestine includes the cecum, colon, and rectum.

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