# Place the actions in order when a client with an acute stroke coughs during a bedside dysphagia screen.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395492&lang=en  
> language: en  
> subject: Nutrition and Oral Hydration  
> category: BCC

## Question

Place the actions in order when a client with an acute stroke coughs during a bedside dysphagia screen.

Stop the screen and withhold food, fluids, and oral medications.

Document the failed screen, the client's response, and the notifications made.

Notify the provider and request a formal swallowing evaluation according to the stroke protocol.

Keep the client upright and suction oral secretions if the client cannot clear them.

Assess airway patency, oxygen saturation, respiratory effort, voice quality, and lung sounds.

## Explanation

Coughing and a wet voice indicate a failed screen. Stop oral intake, assess and protect breathing, keep the client upright with suction available, arrange formal evaluation, and document the findings and communication.

## In-depth explanation

Correct sequence
Stop PO → assess breathing → upright and clear secretions → obtain formal evaluation → document.

Why this is correct
A failed dysphagia screen means the client has not demonstrated that oral intake is safe. Food, fluid, and oral medications remain withheld while the nurse assesses for aspiration and supports airway clearance. The provider and swallowing specialist are then engaged according to protocol.

NCLEX decision rule
After a failed swallow screen, do not repeat oral trials or give pills to test tolerance. Protect the airway and move from screening to formal assessment.References
1American Heart Association: dysphagia screening
2AHA/ASA 2026 acute ischemic stroke guideline summary

## Clinical scenario

Failed dysphagia screen
The client is awake and sitting upright but coughs and develops a wet voice after the test swallow. No food, fluid, or oral medication has otherwise been given.

## Key concepts

- **Dysphagia** — Impaired swallowing that can allow food, fluid, or medication to enter the airway.
- **NPO** — Nothing by mouth, including food, fluids, and oral medication unless specifically authorized.
- **Speech-Language Pathology** — A discipline that evaluates swallowing and communication problems.

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