# A client admitted with an acute stroke coughs and develops a wet voice during the initial dysphagia screen. Complete the priority response. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395564&lang=en > language: en > subject: Potential for Alterations in Body Systems > category: ROR ## Question A client admitted with an acute stroke coughs and develops a wet voice during the initial dysphagia screen. Complete the priority response. The nurse should recognize ::선택::expected fatigue without airway riska failed dysphagia screen with aspiration riska normal response to oral fluidsstable expressive aphasia only, first ::선택::give small sips of water and crushed oral medicationstart a regular diet while sitting uprightselect thickened liquids without further assessmentstop oral trials and keep the client NPO, including oral medications, and then ::선택::obtain a formal swallowing assessment and use the recommended diet and medication routeplace the client flat and repeat the water testresume unrestricted intake when coughing stopsoffer a straw to reduce swallowing effort. ## Explanation Coughing and a wet voice indicate a failed dysphagia screen. Stop oral intake, keep the client NPO, and obtain formal swallowing assessment before food, fluids, or oral medications. After evaluation, use the recommended diet consistency and prescribed safe medication route. ## In-depth explanation Quick answer Recognize a failed dysphagia screen, stop all oral intake, and obtain a formal swallowing assessment before giving food, fluids, or oral medications. Why this is correct Acute stroke can impair airway protection. Coughing and a wet voice during screening suggest unsafe swallowing, so further oral trials can cause aspiration. The swallowing assessment guides diet texture, liquid consistency, and medication route. Easy analogy or mental picture The screen is a gate, not a meal trial. When the gate does not open safely, nothing goes by mouth until the swallowing pathway is evaluated. Memory hook Failed stroke swallow screen: NPO before food, fluid, and oral medication. NCLEX decision rule Screen swallowing before any oral intake after acute stroke. A failed screen calls for NPO status and formal assessment by a trained professional; then follow the prescribed route and consistency rather than improvising thickened liquids. Why the other choices are wrong Giving water, crushed pills, or a regular diet continues the aspiration risk. Placing the client flat does not make swallowing safer, and choosing a modified diet before assessment can be inappropriate. Source 12026 AHA/ASA Acute Ischemic Stroke Guideline 2AHA Stroke Dysphagia Screening Criterion 32026 NCLEX-RN Test Plan ## Clinical scenario The client has not yet received food, fluid, or oral medication. The nurse recognizes the failed screen as an aspiration-risk signal and coordinates a formal swallowing assessment and a safe route for hydration, nutrition, and medications. ## Key concepts - **Dysphagia** — Difficulty swallowing that can impair airway protection and increase aspiration risk. - **Wet voice** — A gurgling vocal quality after swallowing that may indicate material near the airway. - **Aspiration** — Entry of food, fluid, saliva, or gastric contents below the vocal cords into the airway. ## Related questions - [For each clinical scenario, select the corresponding 2022 ACC/AHA/HFSA heart-failure stage…](https://mymerci.kr/pages/nclex_q.php?qn_id=393413&lang=en) - [An adult is 2 hours post-tenecteplase for acute ischemic stroke. Classify each action for …](https://mymerci.kr/pages/nclex_q.php?qn_id=393414&lang=en) - [An immobile adult with dysphagia is on hospital day 4 after acute ischemic stroke. Classif…](https://mymerci.kr/pages/nclex_q.php?qn_id=393415&lang=en) - [Two hours after a lower-leg fracture is immobilized, the client reports escalating pain de…](https://mymerci.kr/pages/nclex_q.php?qn_id=395612&lang=en) - [A hospitalized client develops early acute kidney injury after several days of vomiting an…](https://mymerci.kr/pages/nclex_q.php?qn_id=396180&lang=en) - [Two days after a femur fracture, a client develops sudden hypoxemia, confusion, and a pete…](https://mymerci.kr/pages/nclex_q.php?qn_id=397278&lang=en) - [A client with a lower-leg fracture in a cast reports rapidly worsening pain despite analge…](https://mymerci.kr/pages/nclex_q.php?qn_id=497750&lang=en) - [Place the nursing actions in order for an adult client who arrives with an acute onset of …](https://mymerci.kr/pages/nclex_q.php?qn_id=568361&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=395564&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=395564&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=395564&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=395564&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=395564&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._