HCA - Health Care Assistant Nutrition and Hydration Questions and Answers 2 — Questions and Answers
Question 1: A resident with dysphagia has a care plan specifying 'minced and moist' texture. What should the HCA do if only regular-texture food is available on the tray?
- Do not serve the food; report to the nurse and dietary department and obtain the correct texture modification (Correct answer)
- Blend the food yourself to the closest possible consistency
- Allow the resident to eat the regular texture slowly with supervision
- Serve the food but tell the resident to chew very carefully
Correct answer: Do not serve the food; report to the nurse and dietary department and obtain the correct texture modification
Serving the wrong texture to a dysphagia resident poses a serious aspiration risk; the correct texture must be obtained before feeding proceeds.
Dysphagia (difficulty swallowing) is a serious clinical condition managed through texture-modified diets specified by the speech-language pathologist. The International Dysphagia Diet Standardization Initiative (IDDSI) framework (used in Canada) defines precise textures. Serving the wrong texture can cause aspiration (food/liquid entering the airway), leading to aspiration pneumonia or death. The HCA must never improvise texture modifications or proceed with incorrect food. This is reported immediately to the nurse and dietary.
Question 2: Which of the following signs may indicate dehydration in an elderly resident?
- Dry mucous membranes, concentrated dark urine, confusion, and skin tenting (Correct answer)
- Increased urine output and normal skin turgor
- Decreased blood pressure and flushed skin only in the morning
- Mild fatigue that resolves with a short rest
Correct answer: Dry mucous membranes, concentrated dark urine, confusion, and skin tenting
Dry mouth, dark urine, confusion, and skin tenting are classic signs of dehydration in elderly residents.
Elderly residents are at high risk for dehydration due to reduced thirst sensation, medication side effects (diuretics), cognitive impairment, and physical barriers to self-hydration. HCAs should monitor fluid intake and output, observe for dehydration signs: dark concentrated urine (normal is pale yellow), dry or sticky mucous membranes, skin tenting over the sternum (pinch test), sunken eyes, confusion, rapid weak pulse, and decreased blood pressure. Any suspected dehydration must be reported to the nurse promptly for clinical assessment.
Question 3: What is the most appropriate position for a resident during and after oral feeding to reduce aspiration risk?
- Upright at 90 degrees (sitting fully upright) during feeding and for at least 30 minutes after (Correct answer)
- Semi-reclined at 30 degrees to reduce fatigue during eating
- Lying flat to prevent choking by keeping food at the same level as the throat
- Position does not matter as long as the resident can swallow independently
Correct answer: Upright at 90 degrees (sitting fully upright) during feeding and for at least 30 minutes after
An upright 90-degree position uses gravity to direct food to the stomach, significantly reducing aspiration risk.
Gravity is a critical protective factor against aspiration. A fully upright seated position (90 degrees at the hip) directs bolus movement toward the esophagus rather than the airway. Research and BC/Ontario clinical nutrition guidelines recommend maintaining an upright position for at least 30 minutes post-feeding to allow gastric emptying and prevent reflux aspiration. Semi-reclined positions increase reflux risk; supine (flat) feeding is contraindicated for any resident with dysphagia risk.
Question 4: A resident being assisted with feeding consistently coughs or clears their throat after swallowing liquids. What should the HCA do?
- Stop feeding, keep the resident upright, and report the observation to the nurse immediately (Correct answer)
- Continue feeding but use a straw to control the speed of liquid intake
- Encourage the resident to eat and drink faster to reduce repeated exposure
- Thin the liquids with extra water to make them easier to swallow
Correct answer: Stop feeding, keep the resident upright, and report the observation to the nurse immediately
Coughing and throat clearing after swallowing are signs of possible aspiration; feeding must stop and the nurse must be notified.
Coughing and throat clearing post-swallow are clinical signs of possible pharyngeal dysphagia or aspiration. 'Silent aspiration' (no cough) is also possible and more dangerous. HCAs must stop feeding immediately, maintain the upright position, do not give more food or liquid, and report to the nurse for a swallowing assessment and possible speech-language pathology referral. Using a straw or continuing feeding in the presence of these signs increases aspiration risk.
Question 5: What is the HCA's role in completing a fluid balance record (intake and output chart)?
- Accurately measure and document all fluid intake (oral, IV if visible) and output (urine, emesis, drainage) in millilitres at the specified intervals (Correct answer)
- Record only oral fluid intake as IV fluids are managed by nursing
- Estimate fluid intake based on a visual assessment at the end of the shift
- Fluid balance records are completed only by the nurse; HCA role is verbal reporting only
Correct answer: Accurately measure and document all fluid intake (oral, IV if visible) and output (urine, emesis, drainage) in millilitres at the specified intervals
Accurate fluid balance documentation is an HCA responsibility; all measured intake and output must be recorded in millilitres.
Accurate intake and output (I&O) records are critical for managing fluid balance in residents with heart failure, renal disease, dehydration, or post-surgical status. HCA responsibilities include measuring (using calibrated cups and graduated urinals) and documenting all oral intake (water, juice, soup, ice chips) and all output (voided urine, ostomy output, wound drainage, emesis). Estimates are inaccurate and can lead to clinical errors. Discrepancies between intake and output must be reported to the nurse.
Question 6: Which food group is the most important source of protein for tissue repair and immune function in elderly residents?
- Meat, poultry, fish, eggs, legumes, and dairy products (Correct answer)
- Breads, cereals, and pasta as high-energy sources
- Fruits and vegetables as antioxidant sources
- Fats and oils as concentrated energy sources
Correct answer: Meat, poultry, fish, eggs, legumes, and dairy products
Protein-rich foods are essential for wound healing, immune function, and maintaining muscle mass in elderly residents.
Protein requirements actually increase in older adults due to reduced anabolic efficiency, increased catabolic stress from illness, and the need for wound healing and immune support. Canada's Food Guide recommends protein foods (plant-based and animal-based) at each meal. For residents with pressure injuries, protein intake may need to be increased per dietitian direction. HCAs support adequate protein intake by ensuring these foods are accessible, assisting with cutting or preparation, and monitoring and documenting intake levels.
HCA - Health Care Assistant Nutrition and Hydration Questions and Answers 2
A resident with dysphagia has a care plan specifying 'minced and moist' texture.
What should the HCA do if only regular-texture food is available on the tray?