A client with chronic renal failure is admited with a heart rate of 122 beats/minute; a respiratory rate of 32 breaths/minute, a blood pressure of 190/110 mm Hg, neck vein distention, and bibasilar crackles. Which nursing diagnosis takes highest priority for this client? Select one answer

Choice A reason: Counteract shyness in the client is not the major effect of maintaining eye contact for 2 to 6 seconds during communication. Eye contact is a nonverbal cue that involves looking at the other person’s eyes or face while communicating. It can have different meanings and effects depending on the culture, context, and relationship of the communicators. Maintaining eye contact for 2 to 6 seconds can help to establish rapport, show interest, or convey sincerity, but it may not necessarily counteract shyness in the client. In fact, some clients may feel uncomfortable, intimidated, or threatened by too much eye contact, especially if they are shy, anxious, or from a different cultural background. Therefore, this choice is incorrect.

Choice B reason: Keep the Practical Nurse’s atention on the conversation is not the major effect of maintaining eye contact for 2 to 6 seconds during communication. Eye contact is a nonverbal cue that involves looking at the other person’s eyes or face while communicating. It can have different meanings and effects depending on the culture, context, and relationship of the communicators. Maintaining eye contact for 2 to 6 seconds can help to keep the

Practical Nurse’s atention on the conversation, but it is not the main purpose or outcome of doing so. The main purpose or outcome of maintaining eye contact is to communicate with the other person effectively and respectfully, not to focus on oneself or one’s own behavior. Therefore, this choice is incorrect.

Choice C reason: Assess if the client is involved in the conversation is not the major effect of maintaining eye contact for 2 to 6 seconds during communication. Eye contact is a nonverbal cue that involves looking at the other person’s eyes or face while communicating. It can have different meanings and effects depending on the culture, context, and relationship of the communicators. Maintaining eye contact for 2 to 6 seconds can help to assess if the client is involved in the conversation, but it is not the only or most reliable way of doing so. The Practical Nurse should also pay atention to other verbal and nonverbal cues from the client, such as their tone of voice, facial expressions, body language, or feedback. Therefore, this choice is incorrect.

Choice D reason: Indicate continuous focused atention is the major effect of maintaining eye contact for 2 to 6 seconds during communication. Eye contact is a nonverbal cue that involves looking at the other person’s eyes or face while communicating. It can have different meanings and effects depending on the culture, context, and relationship of the communicators. Maintaining eye contact for 2 to 6 seconds can indicate continuous focused atention, which means that the Practical Nurse is listening actively, understanding empathetically, and responding appropriately to the client’s message. It can also show respect, interest, or sincerity to the client, and enhance rapport and trust between them. Therefore, this choice is correct.

Choice A reason: The nursing assistant is speaking in a normal tone is an action that the PN should not intervene in during communication with the client who is hearing impaired. Speaking in a normal tone can help the client to hear the natural variations and inflections of the voice, and to avoid distortion or confusion. Speaking in a high-pitched or

low-pitched tone can make the voice harder to hear or understand, especially if the client has a hearing loss in a specific frequency range. Therefore, this choice is correct.

Choice B reason: The nursing assistant is facing the client while speaking is an action that the PN should not intervene in during communication with the client who is hearing impaired. Facing the client while speaking can help the client to see the facial expressions and lip movements of the speaker, and to enhance visual cues and feedback. Facing away from the client while speaking can make the voice muffled or unclear, and can interfere with eye contact or rapport. Therefore, this choice is correct.

Choice C reason: The nursing assistant is speaking directly into the impaired ear is an action that the PN should intervene in during communication with the client who is hearing impaired. Speaking directly into the impaired ear can create an uncomfortable or unnatural position for the client and the speaker, and interfere with eye contact or facial expressions. Speaking directly into the impaired ear can also create a loud or distorted sound that may be unpleasant or painful for the client. Speaking face-to-face, and slightly toward the unaffected ear, can improve communication with a client who is hearing impaired. Therefore, this choice is incorrect.

Choice D reason: The nursing assistant is speaking clearly to the client is an action that the PN should not intervene in during communication with the client who is hearing impaired. Speaking clearly to the client can help the client to hear and understand the words and sentences of the speaker, and to avoid miscommunication or misunderstanding. Speaking unclearly to the client can make the voice garbled or incomprehensible, and can cause frustration or confusion. Therefore, this choice is correct.