# The nurse observes care for a client with post-stroke dysphagia. Which actions require follow-up? Highlight the actions that increase aspiration risk.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=494273&lang=en  
> language: en  
> subject: Mobility/Immobility  
> category: BCC

## Question

The nurse observes care for a client with post-stroke dysphagia. Which actions require follow-up? Highlight the actions that increase aspiration risk.

| Current care plan | Observed action |
| --- | --- |
| The client was admitted after a stroke and remains nothing by mouth. | Water is offered before the initial swallowing screen is completed. |
| The head and trunk are supported in a midline position. | The client sits upright at 90 degrees before the meal begins. |
| Right facial weakness and reduced right-sided sensation are documented. | Food is placed on the weaker side of the client's mouth. |
| The client remains alert and follows one-step directions. | Small spoonfuls are offered slowly with time between swallows. |
| The caregiver says reclining will reduce the client's fatigue. | The head of the bed is lowered to 30 degrees during feeding. |
| The speech-language pathologist's current plan is visible at bedside. | The prescribed texture and liquid consistency are verified first. |
| Oral care is planned after the meal and again before sleep. | The mouth is checked for pocketed food before another bite. |
| The caregiver waits for the coughing to stop before the next spoonful. | Feeding continues after coughing begins and the voice sounds wet. |
| The nurse reassesses swallowing safety before intake resumes. | The meal is paused when the client becomes tired or less attentive. |

## Explanation

Oral intake before screening, placing food on the weak side, reclining during feeding, and continuing after coughing with a wet voice increase aspiration risk. Positioning, prescribed textures, small amounts, pocket checks, and oral care support safer intake.

## In-depth explanation

Quick answer
Follow up on giving water before swallowing clearance, placing food on the weak side, feeding while the client is reclined, and continuing the meal after coughing and a wet voice appear.

Why this is correct
Post-stroke dysphagia raises the risk of aspiration pneumonia, dehydration, and malnutrition.[2] Feeding should follow screening and the individualized swallowing plan; coughing or a wet voice during intake signals that the trial should stop for reassessment.

Easy analogy or mental picture
Think of swallowing as a railroad switch that must send food toward the esophagus instead of the airway. Upright posture, the correct texture, and slow small amounts help the switch; rushing or feeding through warning signs sends traffic toward the wrong track.

Memory hook
Screen, sit up, prescribed texture, small bites, stop at cough.

NCLEX decision rule
Before feeding a neurologically impaired client, verify swallowing status and the specific plan. During intake, monitor voice, cough, breathing, fatigue, and oral pocketing rather than assuming that one successful swallow makes the whole meal safe.

Why the other choices are wrong
Upright positioning, small amounts at a slow pace, prescribed texture, checking for pocketed food, and oral care are protective actions when they match the speech-language pathology plan.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]NCBI Bookshelf: Swallowing After StrokeNational Library of Medicine

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