A Practical Nurse (PN) is observing a nursing assistant talking to a client who is hearing impaired. The PN should not intervene if which of the following were performed by the nursing assistant during communication with the client: (Select all that apply)

Choice A reason: Maslow’s hierarchy of needs is a framework for prioritizing human needs, but it is not an organized approach for performing a physical examination. A physical examination should be systematic and comprehensive, not based on subjective preferences or assumptions. Therefore, this choice is incorrect.

Choice B reason: A head-to-toe assessment is an organized approach for performing a physical examination that covers all the major body systems and regions. It allows the nurse to identify any abnormalities or changes in the client’s health status and to document the findings in a consistent manner. Therefore, this choice is correct.

Choice C reason: Subjective data collection is the process of obtaining information from the client about their symptoms, feelings, beliefs, and preferences. It is an important part of the nursing assessment, but it is not an organized approach for performing a physical examination. A physical examination requires objective data collection, which involves observing, measuring, and testing the client’s physical signs. Therefore, this choice is incorrect.

Choice D reason: Review of systems is an organized approach for performing a physical examination that focuses on each body system separately and asks specific questions related to its function and problems. It helps the nurse to elicit relevant information from the client and to detect any abnormalities or deviations from normal. Therefore, this choice is correct.

Choice A reason: Providing open-ended questions and silence is a communication technique that can encourage the client to eat dinner. Open-ended questions can invite the client to share their thoughts and feelings about food and eating, and can help the nurse to explore the client’s perception of reality and identify any distorted thinking. Silence can give the client time to process and respond, and can show respect and acceptance. Therefore, this choice is correct.

Choice B reason: Focusing on self-disclosure of own food preferences is not a communication technique that can encourage the client to eat dinner. Self-disclosure can be appropriate in some situations, but it should be used sparingly and only when it benefits the client. Focusing on the nurse’s own food preferences can be irrelevant, distracting, or imposing, and it can shift the atention away from the client’s needs and concerns. Therefore, this choice is incorrect.

Choice C reason: Atempting to show empathy by suggesting reasons why the client may not want to eat is not a communication technique that can encourage the client to eat dinner. Empathy is a valuable skill, but it should be based on understanding and reflecting the client’s feelings, not on assuming or guessing them. Suggesting reasons why the client may not want to eat can be inaccurate, patronizing, or discouraging, and it can reinforce the client’s resistance or mistrust. Therefore, this choice is incorrect.

Choice D reason: Telling the client of the importance of eating is not a communication technique that can encourage the client to eat dinner. Telling or lecturing the client can be perceived as authoritative, judgmental, or condescending, and it can increase the client’s defensiveness or anxiety. It can also ignore the client’s perspective or experience, and fail to address the underlying causes of their disordered thinking. Therefore, this choice is incorrect.