nerdexam
Test_Prep

NCLEX-RN · Question #485

A male client was diagnosed 6 months ago with amyotrophic lateral sclerosis (ALS). The progression of the disease has been aggressive. He is unable to maintain his personal hygiene without…

The correct answer is B. Aspiration and weight loss. (A) Loss of ability to speak is not dysphasia. Although the client may have difficulty communicating, alternative measures can be developed to enhance communication. This goal, while important, is of alesser priority. (B) Dysphasia is difficulty swallowing, which could result…

Physiological Integrity: Reduction of Risk Potential

Question

A male client was diagnosed 6 months ago with amyotrophic lateral sclerosis (ALS). The progression of the disease has been aggressive. He is unable to maintain his personal hygiene without assistance. Ambulation is most difficult, requiring him to use a wheelchair and rely on assistance for mobility. He recently has become severely dysphasic. Nursing interventions for dysphasia would be aimed toward prevention of:

Options

  • ALoss of ability to speak and communicate effectively
  • BAspiration and weight loss
  • CSecondary infection resulting from poor oral hygiene
  • DDrooling

How the community answered

(66 responses)
  • A
    8% (5)
  • B
    79% (52)
  • C
    11% (7)
  • D
    3% (2)

Explanation

(A) Loss of ability to speak is not dysphasia. Although the client may have difficulty communicating, alternative measures can be developed to enhance communication. This goal, while important, is of alesser priority. (B) Dysphasia is difficulty swallowing, which could result in aspiration of food and inability to eat, causing weight loss. (C) A secondary infection could result from poor oral hygiene, which could enhance the client's inability to eat, but this goal is of a lesser priority. (D) Drooling normally occurs in clients with amyotrophic lateral sclerosis and may require suctioning. Drooling, while aggravating for the client, does not pose an immediate danger.

Topics

#ALS#dysphasia#aspiration prevention#dysphagia management

Community Discussion

No community discussion yet for this question.

Full NCLEX-RN Practice