An 87-year-old female previously independent comes to the ER with 2 days of difficulty swallowing, productive cough, and dyspnea. History includes hypertension and atrial fibrillation. She has a low-grade fever and increased blood pressure
Physical examination and chest radiography are consistent with consolidation in left lower lobe. On bedside testing, she immediately sputters and coughs after drinking a small amount of water from a cup. There are no other neurological signs. Labs: Mild dehydration and WBC increased. MRI reveals a new small brain-stem infarction and mild generalized cerebral atrophy. Treatment for aspiration pneumonia is instituted. Five days later a speech therapy consult was ordered to evaluate swallowing. No improvement has been noted and formal evaluation shows aspiration with most consistencies of food and liquid. Which of the following is the best recommendation?
A. Careful oral feeding
B. Hospice
C. Gastrostomy feeding
D. Nasogastric feeding
C
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The nurse is caring for a client with the diagnosis of colon cancer with metastasis to the liver. Which statement made by the client indicates an understanding of the diagnosis?
A) "Once the colon tumor is removed, I will be fine." B) "I will be happy once all the cancer is cut out." C) "How could I be so unlucky to get cancer twice?" D) "My cancer has now spread to my liver."
The nurse is caring for the following postoperative clients. Which of these clients is at highest risk for respiratory depression after receiving intravenous fentanyl for pain control?
a. the client with heart failure c. the client with diabetes b. the client with asthma d. the client with liver cancer
Advance care directives, or "living wills":
A) State what treatment should be omitted if the client is incapacitated. B) Require the client to sign the "living will" in front of an attorney. C) Must be witnessed by the client's physician. D) Are given to the client and family members by the attorney.
A nurse is applying a vaginal cream to a patient with a vaginal infection. Which of the following is a recommended guideline for this application?
A) Position the patient in the prone position. B) Cleanse area at vaginal orifice with washcloth and warm water. C) Wipe from the sacrum to the vaginal orifice upward (back to front). D) Spread the labia with dominant hand and introduce the applicator with the nondominant hand gently, using pushing motion.