A client complains of difficulty swallowing when the nurse tries to administer capsule medication. Which of the following measures should the nurse take?

Correct Answer: C

Rationale: When addressing a client's difficulty swallowing capsules, the nurse must consider medication safety, absorption, and client comfort. The correct approach is to check the availability of a liquid preparation (Option C), as this is the safest and most effective alternative. Liquid medications are specifically formulated for easy swallowing and ensure accurate dosing without altering the drug's pharmacokinetics. Many medications come in liquid forms, suspensions, or orally disintegrating tablets, which are ideal for clients with dysphagia. This option avoids the risks associated with tampering with the capsule's integrity, such as altered absorption or irritation of the gastrointestinal tract. Option A, dissolving the capsule in water, is incorrect because not all capsules are designed to be dissolved. Some medications are encapsulated to protect them from stomach acid, control release rates, or prevent irritation of the esophageal or gastric lining. Dissolving them may lead to rapid absorption, reduced efficacy, or local irritation. For example, enteric-coated or extended-release capsules must remain intact to function as intended. Option B, breaking the capsule and mixing the contents with applesauce, is inappropriate unless specifically permitted by the pharmacist or drug manufacturer. Many capsules contain powders or granules that are bitter, unstable in food, or require precise dosing. Mixing with food can result in incomplete ingestion, altered absorption, or even toxicity if the drug is not meant to be taken this way. Additionally, some medications (e.g., cytotoxic drugs) pose a safety risk if handled outside their original form. Option D, crushing the capsule and placing it under the tongue, is dangerous and incorrect. Most medications are not formulated for sublingual administration, which bypasses the digestive system and liver metabolism, potentially leading to erratic absorption or adverse effects. Crushing can also compromise the drug's stability or cause mucosal irritation. Only drugs specifically designed for sublingual use (e.g., nitroglycerin) should be administered this way. In summary, the nurse must prioritize methods that preserve the medication's intended action while accommodating the client's needs. Liquid formulations are the gold standard for dysphagia management unless contraindicated, whereas modifying capsules without proper guidance risks therapeutic failure or harm. Always consult the pharmacist or prescribing information before altering medication administration routes.

Correct Answer: A

Rationale: The correct answer is A, "Three times a day orally," because the prescription "TID p.o." is a standard medical abbreviation that clearly defines the frequency and route of administration. "TID" stands for "ter in die," a Latin phrase meaning "three times a day," while "p.o." is the abbreviation for "per os," meaning "by mouth" or orally. This combination of terms explicitly instructs the healthcare provider to administer the medication three times daily via the oral route. There is no ambiguity in this interpretation, as these abbreviations are universally recognized in medical practice and documented in clinical guidelines. Choice B, "Three times a day after meals," is incorrect because it introduces an additional instruction not specified in the original order. While some medications are best taken after meals to reduce gastrointestinal irritation or enhance absorption, the prescription does not include this detail. Assuming administration timing without explicit instructions could lead to improper dosing intervals or unintended side effects. Unless the healthcare provider specifies "after meals" or "postprandial," the default interpretation should strictly follow the written order. Choice C, "Two times a day by mouth," is incorrect because it misinterprets the frequency of administration. "TID" explicitly means three times a day, not two. The abbreviation for twice daily is "BID" (bis in die). Misreading the frequency could result in subtherapeutic dosing, potentially reducing the medication's efficacy or leading to treatment failure. Additionally, while "p.o." is correctly interpreted as "by mouth," the incorrect frequency undermines the intended dosing schedule. Choice D, "Two times a day before meals," is incorrect for two reasons. First, as with choice C, it misinterprets "TID" as two doses instead of three. Second, it assumes administration "before meals," which is not indicated in the original order. Pre-meal dosing is typically specified when medications require an empty stomach for optimal absorption (e.g., some antibiotics or thyroid medications). Without such a directive, adding this condition could alter the drug's pharmacokinetics unnecessarily. In summary, the correct interpretation must adhere strictly to the abbreviations provided without making assumptions about timing relative to meals or altering the prescribed frequency. The use of standardized medical terminology ensures clarity and prevents medication errors, making "Three times a day orally" the only correct choice.

Correct Answer: A

Rationale: Back Care involves caring for the back through activities such as massage, exercises, proper posture, and ergonomic practices to maintain spinal health and prevent injuries. Massage helps relieve muscle tension, improve circulation, and promote relaxation, making it an effective method for back care.

Correct Answer: B

Rationale: **Rationale:** **Correct Answer (B: Bed Making):** Bed making refers to the process of preparing a bed with fresh linens, ensuring it is clean, comfortable, and properly arranged for the patient or individual. This involves tasks such as removing used linens, smoothing out the mattress protector (if present), tucking in fitted or flat sheets, arranging pillows, and ensuring the bed is free of wrinkles or creases that could cause discomfort. Bed making is a standard procedure in healthcare settings, hospitality, and home care, emphasizing hygiene, patient comfort, and prevention of pressure injuries. The term is widely recognized in nursing and caregiving contexts, making it the most accurate description of the process. --- **Incorrect Answers:** **A: Bed Bath** A bed bath is a hygiene procedure where a caregiver cleans a patient who is unable to bathe themselves, typically using a basin of water, soap, and towels. It does not involve changing linens or preparing the bed structure, but rather focuses on personal hygiene. This term is unrelated to the arrangement or replacement of bed linens, so it is incorrect in this context. **C: Bed Shampoo** This term is misleading and not a recognized phrase in healthcare or housekeeping. "Shampoo" typically refers to cleaning hair or carpets, not bed linens or mattress preparation. It may be a distractor meant to confuse those unfamiliar with proper terminology, as it has no relevance to the process of changing or arranging bed linens. **D: Bed Lining** While "lining" might seem related to bed linens, the term "bed lining" is not standard terminology in nursing or hospitality. It could be misinterpreted as referring to waterproof mattress protectors or underlays, but it does not encompass the full process of making a bed with sheets, blankets, and pillows. The correct term for the overall task is "bed making," making this option incorrect. **Conclusion:** The distinction between these terms lies in their specific applications. "Bed making" is the only choice that accurately describes the comprehensive process of preparing a bed with fresh linens, while the other options either describe unrelated tasks or are not standard terms. Understanding these differences is crucial for clarity in caregiving, housekeeping, and healthcare documentation.

Correct Answer: B

Rationale: Handwashing serves a critical role in infection control and public health, with its primary purpose being to prevent the transfer of microorganisms. This is supported by extensive medical and scientific evidence demonstrating that proper hand hygiene significantly reduces the transmission of pathogens, including bacteria, viruses, and other harmful agents. Microorganisms accumulate on hands through direct contact with contaminated surfaces, bodily fluids, or other individuals, and handwashing with soap and water or alcohol-based sanitizers disrupts their ability to spread. The mechanical action of scrubbing, combined with the chemical action of soap, effectively removes or destroys these pathogens, thereby breaking the chain of infection. This is particularly vital in healthcare settings, food handling, and everyday activities where contamination risks are high. Choice A, "To promote hand circulation," is incorrect because handwashing is not primarily a circulatory exercise. While the physical motion of washing hands may temporarily increase blood flow to the area, this is a negligible and unintended side effect, not the core objective. The circulatory benefits are minimal compared to the profound impact handwashing has on microbial reduction. Hand circulation is better improved through dedicated exercises, massage, or warmth, not hygiene practices. The main physiological effects of handwashing relate to cleansing, not vascular stimulation. Choice C, "To avoid touching the client with a dirty hand," is partially related to hygiene but misrepresents the broader purpose. While it is true that clean hands prevent contamination of others, this phrasing frames handwashing as a superficial act of courtesy rather than a scientifically grounded infection-control measure. The concern is not merely about visible dirt but invisible pathogens that can cause disease. This option oversimplifies the rationale for handwashing by focusing on a situational application rather than the underlying principle of microbial transmission prevention. Choice D, "To provide comfort," is incorrect because comfort is a secondary benefit, not the primary purpose. While clean hands may feel more pleasant, especially if they were previously soiled, the act of handwashing is not fundamentally designed for sensory satisfaction. In many cases, frequent handwashing can even cause dryness or irritation, demonstrating that comfort is not the central goal. The primary motivation remains infection prevention, as discomfort is a minor consideration compared to the life-saving potential of reducing pathogen spread. Comfort-driven handwashing might occur in non-critical contexts, but it does not address the core public health rationale. The emphasis on preventing microbial transfer (Choice B) aligns with global health guidelines from organizations like the WHO and CDC, which prioritize hand hygiene as a cornerstone of disease prevention. The other choices either misinterpret the primary objective or focus on incidental outcomes, failing to capture the scientific and practical necessity of handwashing as a barrier to infection. The correct understanding of handwashing must center on its role in breaking the chain of infection through the elimination of harmful microorganisms.