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: Speaks in a normal tone is an approach that can best facilitate communication with a 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: Speaks frequently is not an approach that can best facilitate communication with a client who is hearing-impaired. Speaking frequently can overwhelm or fatigue the client, and reduce their ability to process or retain the information. Speaking frequently can also interrupt the client’s thoughts or responses, and prevent them from expressing their needs or concerns. Speaking clearly and concisely, and allowing pauses or breaks, can enhance communication with a client who is hearing-impaired. Therefore, this choice is incorrect.

Choice C reason: Speaks directly into the unaffected ear is not an approach that can best facilitate communication with a client who is hearing-impaired. Speaking directly into the unaffected ear can create an uncomfortable or unnatural position for the client and the nurse, and interfere with eye contact or facial expressions. Speaking directly into the unaffected 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: Speaks in a normal volume is an approach that can best facilitate communication with a client who is hearing-impaired. Speaking in a normal volume can help the client to hear the voice without difficulty or strain, and to avoid embarrassment or irritation. Speaking in a loud volume can make the voice harder to hear or understand, as it can cause background noise, echo, or feedback. Speaking in a loud volume can also imply shouting or anger, which can be disrespectful or offensive to the client. Therefore, this choice is correct.

Choice A reason: Ineffective thermoregulation is a nursing diagnosis that indicates a problem with the body’s ability to maintain a normal temperature range. It can be caused by factors such as infection, inflammation, or environmental exposure. It can result in symptoms such as fever, chills, sweating, or shivering. The client’s temperature of 102oF (38.9oC) suggests that they have ineffective thermoregulation, but it is not the highest priority nursing diagnosis, as it is not immediately life-threatening. Therefore, this choice is incorrect.

Choice B reason: Decreased cardiac output is a nursing diagnosis that indicates a problem with the amount of blood pumped by the heart per minute. It can be caused by factors such as arrhythmias, heart failure, or shock. It can result in symptoms such as hypotension, tachycardia, dyspnea, or oliguria. The client’s heart rate of 144 beats/minute and irregular suggests that they have decreased cardiac output, which is the highest priority nursing diagnosis, as it can lead to organ failure or death if not treated promptly. Therefore, this choice is correct.

Choice C reason: Ineffective breathing patern is a nursing diagnosis that indicates a problem with the rate, rhythm, depth, or quality of respirations. It can be caused by factors such as airway obstruction, lung disease, or anxiety. It can result in symptoms such as dyspnea, cyanosis, or hypoxia. The client’s respiratory rate of 22 breaths/minute is within the normal range and does not indicate an ineffective breathing patern. Therefore, this choice is incorrect.

Choice D reason: Ineffective renal tissue perfusion is a nursing diagnosis that indicates a problem with the blood flow to the kidneys. It can be caused by factors such as renal artery stenosis, dehydration, or sepsis. It can result in symptoms such as oliguria, hematuria, or azotemia. The client’s vital signs do not indicate an ineffective renal tissue perfusion, and there is no evidence of renal impairment or dysfunction. Therefore, this choice is incorrect.