Which of the following statements is incorrect about a patient with dysphagia?

Correct Answer: C

Rationale: The incorrect statement is that 'The patient should always feed himself.' Patients with dysphagia may require assistance with feeding due to difficulty in swallowing safely. It is essential to provide appropriate support and supervision during meal times to prevent complications such as aspiration or inadequate nutrition intake.

Correct Answer: A

Rationale: Caffeine-containing drinks like coffee and cola (Option A) act as diuretics, substances that promote diuresis—the increased production of urine. Caffeine inhibits the action of antidiuretic hormone (ADH), also called vasopressin, which normally signals the kidneys to reabsorb water and concentrate urine. By blocking ADH, caffeine reduces water reabsorption in the renal tubules, leading to higher urine output. Additionally, caffeine increases blood flow to the kidneys by dilating afferent arterioles, further enhancing filtration rates. This physiological mechanism is well-documented and explains why beverages containing caffeine are associated with frequent urination. Beets (Option B) do not increase urine production. While they contain nitrates and betalains, which may have vasodilatory or antioxidant effects, they lack diuretic properties. Beets can temporarily discolor urine (a harmless condition called beeturia) due to their pigments, but this does not correlate with increased urine volume. Their primary metabolic byproducts are excreted without altering kidney filtration or water reabsorption pathways. Urinary analgesics (Option C), such as phenazopyridine, are medications used to relieve pain, burning, or discomfort in the urinary tract. These drugs work by locally numbing the mucosa of the urinary tract, not by modifying kidney function. They do not influence urine volume, glomerular filtration rate, or ADH secretion. Their mechanism of action is entirely distinct from diuretics, making this option incorrect in the context of increasing urine output. Kaolin with pectin (Option D), commonly sold as Kaopectate, is an antidiarrheal agent. It works by adsorbing toxins and fluids in the gastrointestinal tract, reducing stool frequency and liquidity. While it affects fluid balance in the gut, it has no direct action on renal function. If anything, by reducing fluid loss through diarrhea, it may indirectly decrease the need for compensatory diuresis. Its mechanism is orthogonal to diuresis, rendering this choice irrelevant to the question. Thus, the only substance among the options that directly and significantly increases urine production is caffeine, due to its well-established diuretic effects mediated through ADH inhibition and renal vasodilation. The other choices either lack diuretic properties or function through unrelated mechanisms.

Correct Answer: C

Rationale: The rationale for the correct answer and incorrect choices is as follows: **C: Accompany the patient for his walk** This is the correct choice because, despite the patient appearing steady and having unaffected vision, he is still in the early postoperative phase (only two days after head and neck cancer surgery). Post-surgical patients, especially those recovering from procedures involving major anatomical areas like the head and neck, can experience sudden dizziness, fatigue, or hypotension due to anesthesia residuals, pain medications, or underlying medical conditions. The presence of a nurse ensures immediate assistance if the patient becomes weak, loses balance, or experiences complications. Additionally, the nurse can assess the patient’s endurance, gait stability, and any signs of distress during ambulation, providing real-time guidance and reassurance. **A: Encourage the patient to walk in the hall alone** This is incorrect because, although the patient may seem stable, early postoperative ambulation carries inherent risks, such as falls or syncopal episodes, which could lead to serious injury—particularly in a patient recovering from head and neck surgery. Allowing independent ambulation without supervision disregards the potential for unforeseen complications, such as orthostatic hypotension or sudden weakness. A fall could disrupt surgical sites, cause bleeding, or delay recovery. Nursing best practice involves monitoring high-risk patients during initial mobilization, even if they appear capable. **B: Discourage the patient from walking in the hall for a few more days** This is incorrect because early ambulation is generally encouraged in postoperative care to prevent complications like deep vein thrombosis (DVT), pneumonia, and muscle deconditioning. Unless there are specific contraindications (e.g., unstable vital signs, severe pain, or active bleeding), delaying ambulation unnecessarily can contribute to functional decline and prolonged recovery. The patient’s current assessment (steady gait and intact vision) suggests he is ready for supervised mobility. **D: Consult a physical therapist before allowing the patient to ambulate** While physical therapists play a crucial role in rehabilitation, immediate consultation is not necessary in this scenario. The patient is not exhibiting high-risk mobility limitations (e.g., severe weakness or balance deficits) that would require specialized assessment. Nurses are trained to assist with initial postoperative ambulation, and delaying mobility to wait for PT could hinder the patient's recovery progress. PT referral may be appropriate later if the patient demonstrates persistent difficulties, but routine first-time ambulation after surgery is within nursing scope. In summary, accompanying the patient ensures safety without unnecessarily restricting mobility or delaying recovery, while the other options either risk harm (A), inhibit progress (B), or introduce unnecessary delays (D) in care. The nurse’s role is to balance encouragement of activity with vigilant supervision to optimize recovery.

Correct Answer: A

Rationale: The patient's symptoms of shortness of breath, orthopnea, thick, tenacious secretions, and a dry hacking cough all point towards a potential airway clearance issue. This makes option A, 'Ineffective airway clearance related to thick, tenacious secretions,' the most appropriate nursing diagnosis. It directly addresses the thick secretions and suggests a potential cause of the breathing difficulty the patient is experiencing.

Correct Answer: D

Rationale: When a patient is emotionally affected, it is essential to acknowledge their feelings while providing reassurance and information. Option D demonstrates empathy by acknowledging the difficulty Mrs. Lim is facing and offers hope by reassuring her that her hair will grow back after chemotherapy, which can provide comfort and support during a challenging time.