The nurse is reviewing risk factors for cholelithiasis in a client’s history. Which factor most significantly increases the client’s risk for developing gallstones?

Choice A reason: Over-enunciating syllables emphasizes pronunciation, which may help with clarity but does not directly address hearing impairment. Age-related hearing loss (presbycusis) often involves difficulty processing rapid speech. Slowing speech is more effective, as over-enunciation may distort natural speech patterns, reducing comprehension in older adults with hearing deficits.

Choice B reason: Shouting increases volume but can distort speech and cause discomfort, worsening communication for those with presbycusis. High-frequency hearing loss in older adults makes loud sounds less effective, as they struggle with pitch discrimination. Slower, clear speech better facilitates understanding than shouting, which may also seem aggressive.

Choice C reason: Decreasing speaking speed enhances comprehension in older adults with hearing loss. Presbycusis impairs processing of rapid speech, particularly high-frequency sounds. Slow, clear speech allows more time for auditory processing, improving understanding without distorting sound or relying on less effective nonverbal cues, making it the optimal intervention.

Choice D reason: Exaggerating nonverbal expressions relies on visual cues, which does not address auditory comprehension. While gestures may supplement communication, they are insufficient for conveying detailed medical questions. Hearing-impaired clients primarily need auditory adjustments, like slower speech, to process verbal information effectively, making nonverbal exaggeration less appropriate.

Choice A reason: Diclofenac, an NSAID, can cause gastrointestinal bleeding, leading to anemia. Pale appearance and fatigue suggest blood loss. Reviewing hemoglobin levels is critical to confirm anemia, as low hemoglobin impairs oxygen delivery, exacerbating fatigue and requiring immediate intervention to address potential bleeding.

Choice B reason: Glucose levels are unrelated to diclofenac’s common side effects. Fatigue may occur in hypoglycemia, but diclofenac does not typically affect glucose metabolism. Pale appearance and fatigue are more indicative of anemia from NSAID-related bleeding, making hemoglobin a more urgent lab value to review.

Choice C reason: Total protein levels reflect nutritional status or liver function but are not directly linked to diclofenac’s side effects. Fatigue and pallor suggest anemia from gastrointestinal bleeding, a known NSAID risk. Hemoglobin is more critical to assess, as it directly correlates with the client’s symptoms.

Choice D reason: Sodium levels influence fluid balance but are not typically altered by diclofenac. Fatigue and pallor point to anemia from potential bleeding, not electrolyte imbalance. Hemoglobin review is prioritized, as diclofenac’s gastrointestinal side effects are more likely to cause blood loss than sodium disturbances.