Author Question: The most appropriate entry for documentation of a client's intake is: A. 1 = 12 oz B. Ate entire ... (Read 27 times)

armygirl · **on:** Jul 24, 2018

The most appropriate entry for documentation of a client's intake is:

A. 1 = 12 oz
B. Ate entire breakfast
C. Nutritional intake appropriate for needs
D. Consumed 8 oz milk, 2 waffles, 4 oz orange juice

Question 2

Before the insertion of a nasogastric tube, the physician should be notified of:

A. Patent nares
B. Absent bowel sounds
C. Evident gag reflex
D. Impaired swallowing

Sierray · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

D
D. The use of exact measurements establishes accuracy. For example, a description such as Intake, 360 ml of water is accurate. These measurements can later be used as a means to determine whether a client's condition has changed.
A. There is no reference to what is 12 oz.
B. There is no means of accurately assessing the total intake.
C. This entry does not provide a specific amount the client ate. Stating appropriate is subjective, not objective.

Answer to Question 2

B
B. Absent bowel sounds may indicate decreased or absent peristalsis and increased risk of aspiration.
A. Assess client for patent nares to rule out obstruction or irritated nares, septal defect, or facial fractures.
C. Assess client for gag reflex to identify client's ability to swallow and determine if a greater risk of aspiration exists.
D. Impaired swallowing may pose a greater risk for aspiration.