Certified Rehabilitation Registered Nurse (CRRN) Practice Exam

Which intervention is NOT recommended for a patient at risk for aspiration due to an absent swallow reflex?

1. Sitting the patient at 90 degrees with his head flexed slightly forward

2. Placing the patient on a special diet that offers crumbly foods, which are easier to chew

3. Controlling the size of the bolus by offering only a ½ teaspoon at a time

4. Suggesting that the patient avoid water and drink nectar instead

The correct answer is: Placing the patient on a special diet that offers crumbly foods, which are easier to chew

The intervention that is not recommended for a patient at risk for aspiration due to an absent swallow reflex is placing the patient on a special diet that offers crumbly foods, which are easier to chew. Patients with impaired swallow reflex are at a high risk of aspiration because their ability to effectively manage food and liquids in their mouth is compromised. Crumbly foods can pose a significant risk to this population; they may break apart too easily and create a greater chance of particles becoming lodged in the airway or being swallowed incorrectly. The goal is to provide options that are safer and easier to swallow, typically focusing on foods that have the appropriate texture and consistency to minimize the risk of aspiration. In contrast, sitting the patient at 90 degrees with their head flexed slightly forward, controlling the size of the bolus with small amounts, and suggesting modifications to liquids (like recommending nectar over water) are all interventions aimed at enhancing safety during swallowing. The forward head posture helps to close the airway by positioning the epiglottis to protect against aspiration, smaller boluses reduce the risk of overwhelming the swallow reflex, and thicker liquids can help improve control and prevent aspiration compared to thin liquids.