# A client with a traumatic brain injury is preparing for inpatient rehabilitation. For each finding or plan, select the best classification. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=393416&lang=en > language: en > subject: Collaboration with Multidisciplinary Team > category: MOC ## Question A client with a traumatic brain injury is preparing for inpatient rehabilitation. For each finding or plan, select the best classification. | | Priority rehabilitation concern | Appropriate interdisciplinary referral or intervention | Unsafe fragmented or delayed plan | | --- | --- | --- | --- | | Coughing and a wet voice after oral intake following traumatic brain injury | | | | | Request speech-language pathology evaluation of swallowing and cognitive-communication before unrestricted oral intake | | | | | Use physical therapy for gait and balance and occupational therapy for activities of daily living and executive compensation | | | | | Coordinate neuropsychology and social work or case management for cognition, behavior, caregiver readiness, and community discharge needs | | | | | Continue unassessed oral intake despite coughing and a wet voice | | | | | Discharge using separate discipline-only plans without reassessing caregiver readiness or home barriers | | | | ## Explanation Coughing and a wet voice after oral intake are priority swallowing-safety cues and require speech-language pathology evaluation before unrestricted intake. Physical therapy addresses gait and balance, occupational therapy addresses activities of daily living and compensatory strategies, neuropsychology addresses cognitive and behavioral function, and social work or case management coordinates caregiver and community needs. Rehabilitation planning must be integrated and reassessed rather than divided into isolated discipline-only plans. ## In-depth explanation Quick answer Protect swallowing first, then coordinate speech-language pathology, physical therapy, occupational therapy, neuropsychology, nursing, and social work around shared functional goals and a safe discharge plan. Why this is correct Coughing and a wet voice after water can signal impaired airway protection. Traumatic brain injury can also affect mobility, activities of daily living, executive function, behavior, communication, and caregiver readiness, so no single discipline can safely manage the whole plan. Easy analogy or mental picture Think of rehabilitation as one bridge supported by several pillars. If swallowing, mobility, cognition, or home readiness is ignored, the bridge is not safe for discharge. Memory hook Wet voice: pause intake and assess. TBI recovery: one team, shared goals. NCLEX decision rule Match each deficit to the appropriate discipline while prioritizing airway and aspiration risk. Communicate findings across the team, include the caregiver, and reassess the environment and functional plan before discharge. Why the other choices are wrong Continuing oral intake without assessment can increase aspiration risk. A fragmented plan that excludes caregiver training, home barriers, or cross-disciplinary communication can miss interacting safety needs. Source 1ASHA Practice Portal: Traumatic Brain Injury in Adults 2CDC Report to Congress on Traumatic Brain Injury Rehabilitation 32026 NCLEX-RN Test Plan ## Clinical scenario The client coughs and develops a wet voice after sips of water, needs two-person assistance for transfers, cannot sequence dressing, and has impaired memory and judgment. The caregiver reports feeling unprepared for discharge and the home has stairs. ## Key concepts - **Dysphagia** — Impaired swallowing that can compromise safe and efficient oral intake and increase aspiration risk. - **Cognitive-communication disorder** — A communication impairment related to deficits in attention, memory, organization, problem-solving, or executive function. - **Interdisciplinary rehabilitation** — Coordinated care in which multiple disciplines share goals, findings, and a unified functional plan with the client and caregiver. ## Related questions - [A nurse is taking a verbal medication order during a code blue from the resident physician…](https://mymerci.kr/pages/nclex_q.php?qn_id=368265&lang=en) - [A 78-year-old woman with stage IV lung adenocarcinoma and multiple bone metastases reports…](https://mymerci.kr/pages/nclex_q.php?qn_id=372704&lang=en) - [A nurse is preparing discharge plans for several patients on the medical-surgical unit. 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