A client diagnosed with moderate Alzheimer's has been admitted to a long-term care facility. Which of the following are appropriate activities for the nurse to include in the care plan?

Choice A reason: This is incorrect because laceration is not an acute traumatic brain injury, but a type of wound that involves tearing or cutting of the skin or other tissues. Laceration can occur as a result of a motor vehicle accident, but it does not cause changes in the GCS or pupil size. The nurse should assess the client's skin for any signs of laceration, such as bleeding, swelling, or infection.
Choice B reason: This is incorrect because acute subdural hematoma is not likely to cause a dilated pupil on the left side. Acute subdural hematoma is a type of traumatic brain injury that involves bleeding between the dura mater and the arachnoid mater, which are two layers of the meninges that cover the brain. An acute subdural hematoma can cause a rapid decrease in the GCS, but it usually causes a dilated pupil on the same side as the injury, not on the opposite side.
Choice C reason: This is incorrect because intracerebral hemorrhage is not likely to cause a dilated pupil on the left side. Intracerebral hemorrhage is a type of traumatic brain injury that involves bleeding within the brain tissue itself. Intracerebral hemorrhage can cause a gradual decrease in the GCS, but it usually causes neurological deficits that correspond to the location of the bleeding, such as weakness, numbness, or aphasia, not pupillary changes.
Choice D reason: This is correct because epidural hematoma can cause a dilated pupil on the left side. Epidural hematoma is a type of traumatic brain injury that involves bleeding between the dura mater and the skull. Epidural hematoma can cause a lucid interval, which is a period of normal consciousness followed by a sudden decrease in the GCS, and a dilated pupil on the opposite side of the injury, due to compression of the third cranial nerve. The nurse should notify the provider immediately and prepare for emergency surgery.

Choice A Reason: Providing written materials and visual aids is not necessary for a client who has hearing at 15 dB, which is considered normal hearing. Normal hearing ranges from 0 to 20 dB, meaning that the person can hear sounds that are as faint as 20 dB or less.

Choice B Reason: Using American Sign Language is not appropriate for a client who has hearing at 15 dB, which is considered normal hearing. American Sign Language is a form of communication that uses hand gestures, facial expressions, and body movements to convey meaning. It is mainly used by people who are deaf or hard of hearing.

Choice C Reason: Shouting at the client from 6 inches away is not advisable for a client who has hearing at 15 dB, which is considered normal hearing. Shouting can be perceived as rude or aggressive, and can damage the hearing of both the speaker and the listener.

Choice D Reason: Speaking to the client in an everyday conversational tone is the best action for a client who has hearing at 15 dB, which is considered normal hearing. Conversational speech ranges from 40 to 60 dB, meaning that the person can hear sounds that are as loud as 60 dB or less.