Nursing 2026 |
Comprehensive Nursing
Study Guide, Practice
Questions, Answers &
Exam Review | Complete
Ethics Study Guide
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales
Included
,Dysphagia and Other Eating Incidences of swallowing, increasing as the elder population grows.
eating, and nutritional problems are
Chronic medical conditions that influence the ability to feed arthritis, hypertension, heart disease, hearing impairment, mobility, diabetes, and
oneself include visual impairments.
Lack of assistance for financial support, shopping, cooking, and so on
Malnutrition Insufficient amount or types of nutrients supplied to or absorbed by the body
Undernourishment Taking in less nutrition than needed
May occur in elders who need assistance feeding
Dehydration Taking in less or excreting more fluids than needed
May occur in elders who need assistance to drink or obtain fluids
Role of COTA in Dysphagia 1.Collect data to identify the strengths and weaknesses of elders in feeding and
drinking.
2.Provide quality care to elders with swallowing problems.
3.Activities
4.Meal preparation, money management, shopping, oral-facial exercises, assistive
devices
Normal Swallowing-Phases Oral preparatory phase
Oral phase
Pharyngeal phase
Esophageal phase
Changes to Swallowing Structures Occur naturally as we age
Compensations : Adaptations to swallow
Smaller bits, more chewing time, softer food
May need soft diets, liquid diets, and so on to prevent choking or aspiration
Dysphagia Inability to swallow
Etiology of Dysphagia Neurologic, structural, systemic
Aspiration pneumonia Inhaling food or fluids into the lungs, resulting in a life-threatening form of
pneumonia
Silent aspiration: Aspirating food or fluids without coughing or choking and later developing
pneumonia or other conditions
Intervention Strategies for Dysphagia Establish a therapeutic relationship with the elder.
Focus attention on every aspect of the mealtime experience.
Position the elder, use his or her assistive devices, address his or her dietary
concerns, and take necessary precautions.
,Preparation Checklist for Dysphagia and Self-feeding Collect information and review the chart.
Interventions Inform the elder of the treatment goals.
Create the right environment for eating.
Ensure proper fit of dentures, glasses, and so on.
Asses the patient for readiness to eat.
Position the elder safely.
Complete oral preparation exercises.
Check the food tray for the correct diet.
Intervention Strategies-Environmental concerns Eating is part of socialization and quality of life.
The eating experience should be as aesthetically pleasing as possible.
Ensure good lighting with no distracting noises.
Allow plenty of time to eat.
Make sure the table is at the appropriate height.
Provide comfortable positioning.
Sit with pleasant table mates if the elder lives in a residential community or nursing
home.
Positioning-Dysphagia Safe positioning prevents food from entering the trachea (airway).
Proper positioning increases alertness, normalizes muscle tone, provides comfort,
and helps with digestion.
Preferred position is in a dining chair rather than a wheelchair.
The elder should sit upright wit the feet on the floor and head and neck in
alignment.
The extremities should be fully supported on the table or tray.
The hips and knees should be flexed 80 to 90 degrees.
Feeding in Bed-Dysphagia Position as close to the headboard as possible.
Elevate the head of bed 45 degrees or more.
Flex the knees to prevent sliding down in bed.
Use pillows to position if needed.
Positioning devices may be used in chairs or beds.
Assistive Devices-Dysphagia Straws
Built-up handles for silverware
Universal cuff
Swivel spoon or long-handled spoon
Nonslip placemats or plates with suction cups
Spouted lids on cups
Rubber-coated spoons
Rocker knives for one-handed cutting
Direct Intervention-Dysphagia Learning how to feed someone well takes practice.
Provide a large napkin (not called a "bib") to catch stray food
Bring food to mouth slowly and watch for cues that the person is ready to take a
mouthful of food.
Learn how much food the person will take in one mouthful.
Watch for chewing and swallowing; wait for the patient to swallow and clear the
mouth before giving another spoonful.
Provides fluids to wash down the food bolus.
Coordinate eating and breathing.
Feeding Patients with Dementia Provide finger foods if they can feed themselves.
Decrease environmental stimulation.
Reduce verbal communication to ease distractions.
Monitor so the patient with dementia does not eat "nonfood" items on the tray.
General Problems to Avoid-Dysphagia Food too hot or too cold
Ill-fitting dentures
Not allowing enough time for chewing and swallowing
Not monitoring a patient at risk for aspiration while he or she is eating
Stopping the feeding before the elder has had time to consume the nutrition needed
Dietary Concerns-Dysphagia Elders prefer softer, sweeter, easy-to-prepare foods.
Elders often drink fewer fluids.
Learn how liquid intake is measured in each health care facility so you will record
the correct amounts of oral fluid intake.
, National Dysphagia Diet Levels Level I: Puree consistency diet (homogenous, very cohesive, pudding-like, requiring
very little chewing ability)
Level 2: Mechanically Altered (cohesive, moist, semisolid foods, requiring some
chewing)
Level 3: Dysphagia-Advanced (soft foods that require more chewing ability)
Regular (all foods allowed)
Fluid Consistencies-Dysphagia Thin - regular consistency with no alterations
Nectar - slightly thicker than water
Honey - consistency of honey; trickles slowly off spoon
Spoon-thick - consistency of pudding
Precautions-Dysphagia Observe the patient's level of alertness, orientation, cognitive status, positioning,
general endurance, and ability to self-feed.
Observe the presence of delayed swallowing, food pocketing (food retained
between the gums and cheeks), choking, and a wet-sounding voice.
Be prepared to assist with choking using the American Heart Association methods
for a choking person and CPR.
Signs and Symptoms of Aspiration Coughing, gagging, or choking during mealtimes and immediately afterward
Rapid breathing, fatigue, or bubbly respirations during and immediately after meals
Intermittent elevated temperatures
Vomiting small amounts after meals and at night (spitting up)
Needing to take multiple swallows to clear food from the mouth
Drooling or having food fall out of the mouth
Eating or drinking rapidly and stuffing food in the mouth
Appearing fearful and reluctant to eat
Unexplained weight loss or being underweight
Ideas for Managing a Feeding Program Get elders out of bed at mealtimes.
Ensure a pleasant dining environment without loud noise and distraction.
Set up each resident's trays, dishes, and assistive devices so they are within easy
reach.
The program should address all meals and include members of the interdisciplinary
team.
Safety first!
Part I: Restraint Reduction-COTA role Role of COTAs in restraint reduction
Assessment
Consultation
Environmental adaptations
Psychosocial approaches
Activity alternatives
Treatment
History of restraints Physical restraints have been used since the 1700s in the United States to manage
psychotic behavior.
Until the late 1980s, restraints were almost universally used in nursing homes.
Restraints continue to be used today in hospitals with a physician's order.
Nursing homes have almost universally eliminated restraints.
Consequences of Using Restraints-Psychosocial Depression, withdrawal, anxiety, fear, panic, and so on
Less social contact, humiliation, decreases in dignity and self-esteem
Consequences of Using Restraints-Physical Hazards of immobility, incontinence, constipation
Loss of balance, falls, pressure ulcers
Pneumonia, infection, dehydration, impaired circulation, respiratory problems
Abrasions, cuts, loss of freedom
Death by suffocation or strangulation
Comprehensive Nursing
Study Guide, Practice
Questions, Answers &
Exam Review | Complete
Ethics Study Guide
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales
Included
,Dysphagia and Other Eating Incidences of swallowing, increasing as the elder population grows.
eating, and nutritional problems are
Chronic medical conditions that influence the ability to feed arthritis, hypertension, heart disease, hearing impairment, mobility, diabetes, and
oneself include visual impairments.
Lack of assistance for financial support, shopping, cooking, and so on
Malnutrition Insufficient amount or types of nutrients supplied to or absorbed by the body
Undernourishment Taking in less nutrition than needed
May occur in elders who need assistance feeding
Dehydration Taking in less or excreting more fluids than needed
May occur in elders who need assistance to drink or obtain fluids
Role of COTA in Dysphagia 1.Collect data to identify the strengths and weaknesses of elders in feeding and
drinking.
2.Provide quality care to elders with swallowing problems.
3.Activities
4.Meal preparation, money management, shopping, oral-facial exercises, assistive
devices
Normal Swallowing-Phases Oral preparatory phase
Oral phase
Pharyngeal phase
Esophageal phase
Changes to Swallowing Structures Occur naturally as we age
Compensations : Adaptations to swallow
Smaller bits, more chewing time, softer food
May need soft diets, liquid diets, and so on to prevent choking or aspiration
Dysphagia Inability to swallow
Etiology of Dysphagia Neurologic, structural, systemic
Aspiration pneumonia Inhaling food or fluids into the lungs, resulting in a life-threatening form of
pneumonia
Silent aspiration: Aspirating food or fluids without coughing or choking and later developing
pneumonia or other conditions
Intervention Strategies for Dysphagia Establish a therapeutic relationship with the elder.
Focus attention on every aspect of the mealtime experience.
Position the elder, use his or her assistive devices, address his or her dietary
concerns, and take necessary precautions.
,Preparation Checklist for Dysphagia and Self-feeding Collect information and review the chart.
Interventions Inform the elder of the treatment goals.
Create the right environment for eating.
Ensure proper fit of dentures, glasses, and so on.
Asses the patient for readiness to eat.
Position the elder safely.
Complete oral preparation exercises.
Check the food tray for the correct diet.
Intervention Strategies-Environmental concerns Eating is part of socialization and quality of life.
The eating experience should be as aesthetically pleasing as possible.
Ensure good lighting with no distracting noises.
Allow plenty of time to eat.
Make sure the table is at the appropriate height.
Provide comfortable positioning.
Sit with pleasant table mates if the elder lives in a residential community or nursing
home.
Positioning-Dysphagia Safe positioning prevents food from entering the trachea (airway).
Proper positioning increases alertness, normalizes muscle tone, provides comfort,
and helps with digestion.
Preferred position is in a dining chair rather than a wheelchair.
The elder should sit upright wit the feet on the floor and head and neck in
alignment.
The extremities should be fully supported on the table or tray.
The hips and knees should be flexed 80 to 90 degrees.
Feeding in Bed-Dysphagia Position as close to the headboard as possible.
Elevate the head of bed 45 degrees or more.
Flex the knees to prevent sliding down in bed.
Use pillows to position if needed.
Positioning devices may be used in chairs or beds.
Assistive Devices-Dysphagia Straws
Built-up handles for silverware
Universal cuff
Swivel spoon or long-handled spoon
Nonslip placemats or plates with suction cups
Spouted lids on cups
Rubber-coated spoons
Rocker knives for one-handed cutting
Direct Intervention-Dysphagia Learning how to feed someone well takes practice.
Provide a large napkin (not called a "bib") to catch stray food
Bring food to mouth slowly and watch for cues that the person is ready to take a
mouthful of food.
Learn how much food the person will take in one mouthful.
Watch for chewing and swallowing; wait for the patient to swallow and clear the
mouth before giving another spoonful.
Provides fluids to wash down the food bolus.
Coordinate eating and breathing.
Feeding Patients with Dementia Provide finger foods if they can feed themselves.
Decrease environmental stimulation.
Reduce verbal communication to ease distractions.
Monitor so the patient with dementia does not eat "nonfood" items on the tray.
General Problems to Avoid-Dysphagia Food too hot or too cold
Ill-fitting dentures
Not allowing enough time for chewing and swallowing
Not monitoring a patient at risk for aspiration while he or she is eating
Stopping the feeding before the elder has had time to consume the nutrition needed
Dietary Concerns-Dysphagia Elders prefer softer, sweeter, easy-to-prepare foods.
Elders often drink fewer fluids.
Learn how liquid intake is measured in each health care facility so you will record
the correct amounts of oral fluid intake.
, National Dysphagia Diet Levels Level I: Puree consistency diet (homogenous, very cohesive, pudding-like, requiring
very little chewing ability)
Level 2: Mechanically Altered (cohesive, moist, semisolid foods, requiring some
chewing)
Level 3: Dysphagia-Advanced (soft foods that require more chewing ability)
Regular (all foods allowed)
Fluid Consistencies-Dysphagia Thin - regular consistency with no alterations
Nectar - slightly thicker than water
Honey - consistency of honey; trickles slowly off spoon
Spoon-thick - consistency of pudding
Precautions-Dysphagia Observe the patient's level of alertness, orientation, cognitive status, positioning,
general endurance, and ability to self-feed.
Observe the presence of delayed swallowing, food pocketing (food retained
between the gums and cheeks), choking, and a wet-sounding voice.
Be prepared to assist with choking using the American Heart Association methods
for a choking person and CPR.
Signs and Symptoms of Aspiration Coughing, gagging, or choking during mealtimes and immediately afterward
Rapid breathing, fatigue, or bubbly respirations during and immediately after meals
Intermittent elevated temperatures
Vomiting small amounts after meals and at night (spitting up)
Needing to take multiple swallows to clear food from the mouth
Drooling or having food fall out of the mouth
Eating or drinking rapidly and stuffing food in the mouth
Appearing fearful and reluctant to eat
Unexplained weight loss or being underweight
Ideas for Managing a Feeding Program Get elders out of bed at mealtimes.
Ensure a pleasant dining environment without loud noise and distraction.
Set up each resident's trays, dishes, and assistive devices so they are within easy
reach.
The program should address all meals and include members of the interdisciplinary
team.
Safety first!
Part I: Restraint Reduction-COTA role Role of COTAs in restraint reduction
Assessment
Consultation
Environmental adaptations
Psychosocial approaches
Activity alternatives
Treatment
History of restraints Physical restraints have been used since the 1700s in the United States to manage
psychotic behavior.
Until the late 1980s, restraints were almost universally used in nursing homes.
Restraints continue to be used today in hospitals with a physician's order.
Nursing homes have almost universally eliminated restraints.
Consequences of Using Restraints-Psychosocial Depression, withdrawal, anxiety, fear, panic, and so on
Less social contact, humiliation, decreases in dignity and self-esteem
Consequences of Using Restraints-Physical Hazards of immobility, incontinence, constipation
Loss of balance, falls, pressure ulcers
Pneumonia, infection, dehydration, impaired circulation, respiratory problems
Abrasions, cuts, loss of freedom
Death by suffocation or strangulation
