What nursing intervention is best to improve communication with a hearing-impaired client?

Correct Answer: A

Rationale: **Rationale:** **Correct Answer (A): Speaking slowly and clearly while facing the client** is the most effective nursing intervention for improving communication with a hearing-impaired individual. This approach leverages visual cues, such as lip-reading and facial expressions, which many hearing-impaired individuals rely on to supplement their auditory comprehension. Speaking slowly allows the client to process words more easily, while enunciating clearly minimizes ambiguity in sound recognition. Facing the client directly ensures they can see the speaker’s mouth movements and gestures, which are critical for understanding. This method is also non-invasive, respectful, and aligns with best practices for accommodating hearing impairments without unnecessary adjustments like assistive devices or written communication. **Incorrect Answers:** **B: Write down the message** – While written communication can be helpful in some cases, it is not the *best* intervention for all hearing-impaired clients. Many individuals with hearing loss can still process spoken language effectively with visual cues, and relying solely on writing may slow down conversation unnecessarily. Additionally, some clients may have limited literacy or vision issues that make this method ineffective. Writing should be a supplementary tool, not the primary method unless the client specifically requests it. **C: Talk in a regular voice in the good ear** – Assuming the client has a "good ear" oversimplifies hearing impairment, as hearing loss is often bilateral or varies in severity. Speaking in a regular voice may still be too soft or unclear, and turning to one side removes the visual component of communication (lip-reading and facial expressions). This approach can also come across as dismissive if the client feels the nurse is not making a full effort to accommodate their needs. **D: Shout in the impaired ear** – Shouting distorts speech, making it harder to understand even for individuals with some residual hearing. It can also appear aggressive or demeaning, negatively impacting the therapeutic relationship. Loud sounds may cause discomfort or pain for those with certain types of hearing loss (e.g., hyperacusis or recruitment). Effective communication requires clarity and patience, not increased volume. In summary, **A** is correct because it optimizes both auditory and visual communication strategies, while the other options either neglect key aspects of effective interaction (B, C) or introduce counterproductive methods (D). The best approach considers the client’s comfort, maximizes comprehension through multiple sensory inputs, and maintains dignity in communication.

Correct Answer: A

Rationale: To determine how many milligrams (mg) are in 5000 micrograms (mcg), it’s essential to understand the relationship between these units of measurement. The metric system uses a base-10 scale, making conversions straightforward once the prefixes are understood. The prefix "micro-" denotes one-millionth (10^-6), while "milli-" denotes one-thousandth (10^-3). This means that 1 milligram (mg) is equal to 1000 micrograms (mcg). The conversion from micrograms to milligrams involves dividing the number of micrograms by 1000 since there are 1000 mcg in 1 mg. Applying this to the question: 5000 mcg ÷ 1000 = 5 mg. This calculation confirms that 5000 mcg is equivalent to 5 mg, making **A (5)** the correct answer. Now, let’s examine why the other choices are incorrect: - **B (6)**: This is incorrect because dividing 5000 mcg by 1000 yields 5, not 6. A mistake here could stem from adding 1 erroneously or misplacing a decimal point. - **C (4)**: This is incorrect because 4000 mcg would be equivalent to 4 mg, but the given value is 5000 mcg. Choosing this suggests a subtraction error or confusion with the conversion factor. - **D (3)**: This is incorrect as it significantly underestimates the conversion. 3000 mcg would be 3 mg, but 5000 mcg is notably higher, meaning this choice reflects a misunderstanding of the relationship between the units or a calculation error. The key takeaway is that converting mcg to mg requires dividing by 1000 due to the metric system’s structure. Missteps in this process, such as multiplying instead of dividing or using an incorrect divisor, lead to the wrong selections. Mastery of metric unit conversions is foundational in fields like medicine and science, where precise measurements are critical.

Correct Answer: A

Rationale: The best initial action is to inquire about the frequency, quality, and location of the pain (Option A). Pain assessment is the first critical step in nursing care because it provides essential information needed to determine the appropriate intervention. Without a thorough understanding of the pain’s characteristics—whether it is sharp, dull, throbbing, localized, or radiating—the nurse cannot effectively advocate for the patient or make informed clinical decisions. Proper pain assessment also helps differentiate between expected cancer-related pain and potential complications, such as a new fracture or infection, which may require immediate medical attention. This step ensures that subsequent interventions, including medication administration, are tailored to the patient’s specific needs rather than being applied generically. Option B (Get the client pain medication) may seem urgent, but administering medication without a proper assessment risks inappropriate dosing, masking critical symptoms, or overlooking complications. Pain management is important, but it must be based on a clear understanding of the pain’s nature and severity. Blindly administering medication could delay identifying a more serious issue, such as pathological fracture or spinal cord compression, which requires additional interventions beyond analgesia. Option C (Ensure the client knows he will have negative effects from immobility) is inappropriate as an initial response. While immobility complications (e.g., muscle atrophy, pressure injuries, or thrombus formation) are legitimate concerns, they are secondary to addressing the patient’s acute pain. Educating the patient about immobility risks at this moment dismisses their immediate distress and fails to prioritize their most pressing need—pain relief. This approach could also erode trust, as the patient may perceive the nurse as minimizing their suffering. Option D (Review the client’s medication administration record) is a useful step but should follow, not precede, a pain assessment. Reviewing the MAR provides information on previously administered medications, scheduled doses, and potential gaps in pain management. However, without first assessing the current pain, the nurse lacks context for interpreting the MAR’s data. For example, if the pain is new or worsening despite recent medication, this could signal a need for reevaluation of the treatment plan rather than simply administering the next scheduled dose. In summary, pain assessment (Option A) is foundational. It ensures patient-centered care, guides safe and effective interventions, and prevents oversight of critical clinical changes. The other options, while relevant, should only be pursued after a thorough assessment or as part of a broader pain management strategy.

Correct Answer: C

Rationale: The client who is tilting their head (Choice C) is the correct answer because head tilting is a common compensatory behavior observed in individuals with visual impairments, particularly those with refractive errors, strabismus, or unilateral vision loss. Tilting the head adjusts the angle of gaze to optimize visual input, minimize double vision, or align the eyes to use the best-functioning part of the retina. For example, a person with astigmatism may tilt their head to reduce blur, while someone with a muscle imbalance (e.g., superior oblique palsy) may adopt an abnormal head posture to maintain binocular vision. This behavior is a clear clinical indicator of visual difficulty and warrants further assessment. Choice A (the client whose sclera is white) is incorrect because a normal, white sclera is a sign of ocular health, not impairment. Pathological conditions affecting vision—such as cataracts, glaucoma, or retinal disorders—do not typically alter scleral color. While abnormalities like jaundice (yellow sclera) or redness (indicating inflammation) may suggest systemic or localized issues, they are not direct markers of visual acuity loss. A white sclera alone provides no diagnostic value for visual impairment. Choice B (the client who has an intact blink reflex) is incorrect because the blink reflex is a protective, involuntary response mediated by cranial nerves (V and VII) and does not correlate with visual acuity. An intact blink reflex merely confirms normal corneal sensitivity and brainstem function. Individuals with severe visual impairments, including blindness, often retain this reflex. Conversely, its absence (e.g., in facial nerve palsy) does not imply vision loss. This choice distracts from genuine signs of visual dysfunction. Choice D (the client with equal pupils) is incorrect because pupil equality (isocoria) is a normal finding and does not rule out visual impairment. Pupillary size and symmetry assess the autonomic nervous system and optic nerve function but are unrelated to refractive errors, macular degeneration, or other common causes of vision loss. Unequal pupils (anisocoria) may indicate neurological issues (e.g., Horner’s syndrome) but are not specific to visual acuity deficits. Equal pupils lack relevance in identifying clients needing vision-related interventions. In summary, head tilting (C) is the only behavior directly linked to adaptive strategies for visual challenges, while the other options reflect normal physiological states or unrelated neurological functions. Recognizing such compensatory behaviors is critical for early detection and intervention in clients with visual impairments.

Correct Answer: B

Rationale: **Rationale:** **Correct Answer (B: Contractures):** Contractures are a direct and significant negative effect of immobility on the musculoskeletal system. Prolonged immobility leads to shortening and stiffening of muscles, tendons, and ligaments due to disuse and lack of stretching. This occurs because muscles and connective tissues adapt to the shortened position they are held in, losing elasticity and range of motion. For example, if a joint remains bent for an extended period (e.g., a knee or elbow), the surrounding tissues may permanently tighten, making it difficult or impossible to straighten the joint. Contractures can cause pain, limit mobility further, and require physical therapy or surgical intervention to correct. This musculoskeletal complication is distinct from other systems and directly tied to the lack of movement. **Incorrect Answers:** **A: Pressure injury** While pressure injuries (e.g., bedsores) are a serious complication of immobility, they primarily affect the integumentary system (skin and underlying tissues), not the musculoskeletal system. These injuries result from prolonged pressure on skin over bony prominences (e.g., heels, sacrum), reducing blood flow and causing tissue necrosis. Though immobility contributes to pressure injuries, they are not a musculoskeletal-specific effect like contractures. **C: Glucose intolerance** Glucose intolerance is a metabolic consequence of immobility, not a musculoskeletal one. Reduced physical activity decreases muscle mass and insulin sensitivity, impairing the body's ability to regulate blood sugar. However, this is a systemic metabolic issue involving hormonal and cellular processes, not a structural or functional change in muscles, bones, or joints. **D: Incontinence** Incontinence is a urinary or bowel dysfunction often associated with immobility but is unrelated to the musculoskeletal system. It arises from weakened pelvic floor muscles, nerve damage, or reduced mobility preventing timely bathroom access. While immobility can contribute to incontinence, the root cause lies in the urinary or digestive systems, not the muscles, bones, or joints. **Key Distinction:** The question specifically asks about the musculoskeletal system, and **contractures** are the only option directly involving muscles, tendons, and joints. The other choices are secondary effects of immobility but pertain to other body systems. Understanding this system-specific impact is critical for targeted interventions, such as range-of-motion exercises to prevent contractures, while pressure injuries require skin care, glucose intolerance demands metabolic management, and incontinence necessitates bladder or bowel retraining.