A nurse is caring for a client.

Vital Signs.

1600: Nurses' Notes.

Temperature 37.6°C (99.7°F). Blood pressure 110/58 mm Hg. Heart rate 72/min.

Respiratory rate 18/min.

Pulse oximetry 98% on room air.

1630: Temperature 37.5°C (99.5°F). Blood pressure 78/52 mm Hg. Heart rate 112/min.

Respiratory rate 26/min.

Pulse oximetry 92% on room air.

1600: Antibiotic administered as prescribed.

Bilateral breath sounds clear and present throughout.

1630: Client reports itching on the chest and has urticaria over the chest and trunk.

Client states they are having difficulty swallowing and feel as if there is a lump in their throat.

Bilateral breath sounds with scattered wheezing heard throughout.

Vital Signs.

Nurses' Notes.

Medication Administration Record.

Cefaclor 500 mg PO q8h.

Select the 3 findings that require immediate follow-up.

Choice A rationale:

SDOH are not determined by an individual's ethnic background. SDOH encompass a wide range of factors beyond ethnicity that affect an individual's well-being, including social, economic, and environmental factors.

Choice B rationale:

SDOH are conditions in an individual's environment that affect their well-being. This is the correct answer. Social Determinants of Health (SDOH) refer to the conditions in which people are born, grow, live, work, and age, and how these conditions impact their physical and mental well-being. These conditions include factors such as income, education, employment, social support, and access to healthcare.

Choice C rationale:

Identifying SDOH does not increase disparities in healthcare. In fact, recognizing and addressing SDOH can help reduce health disparities by providing more equitable access to resources and services for underserved populations.

Choice D rationale:

While psychological factors can be important determinants of health, they are not typically considered part of the social determinants of health. SDOH primarily focus on external factors related to an individual's environment and socioeconomic conditions.

This question evaluates communication adaptations for clients experiencing hearing impairment. The nurse must apply therapeutic communication principles that maximize auditory perception and minimize environmental interference. Knowledge of sensory deficits, lip-reading facilitation, sound discrimination, and appropriate assistive communication strategies is required to identify the safest intervention.

Choice A rationale: Reducing competing environmental sounds improves speech discrimination and auditory processing in hearing-impaired clients. Background noise interferes with interpretation of consonants and speech frequencies. Quiet environments enhance comprehension, decrease communication fatigue, and promote accurate understanding of discharge instructions and healthcare information.

Choice B rationale: Braille communication assists clients with severe visual impairment, not hearing impairment. Hearing loss primarily affects auditory sensory pathways involving cochlear hair cells or auditory nerve transmission. Providing Braille would not improve comprehension unless the client additionally has blindness or significant visual disability.

Choice C rationale: Standing directly beside the client limits visibility of facial expressions and lip movements essential for speech interpretation. Effective communication with hearing-impaired individuals requires face-to-face positioning, adequate lighting, and clear articulation to support residual hearing and visual speech cues simultaneously.

Choice D rationale: Repeating misunderstood phrases identically often fails because the original wording remains difficult to discriminate acoustically. Rephrasing sentences with different vocabulary improves semantic processing and contextual interpretation. Therapeutic communication emphasizes clarification rather than repetitive unchanged verbalization during hearing-related misunderstandings.