A nurse is caring for a client who is postoperative. Nurses' Notes
0745:
Client awake and eating breakfast while watching the news on television. Client has hearing loss, does not wear hearing aid, and TV volume is loud. Rates pain as a 2 on a 0 to 10 pain scale.
Incisional dressing dry and intact. 1000:
Client ambulated in hallway with physical therapist. Client grimacing. appears upset and is guarding incisional site. Reports pain a 5 on a 0 to 10 pain scale. Opioid analgesic administered.
1045
Client resting with eyes closed and listening to music with earphones. Reports feeling "very sleepy after pain medication. Now rates pain as a 3 on a 0 to 10 pain scale.
Which of the following factors could present a barrier to the nurse effectively communicating with the client? (Select all that apply).
Client's hearing deficit
Volume of the client's television
Numerous visitors in the client's room
Increase in pain after ambulation
Adverse effects of opioid analgesic
Using earphones while listening to music
Correct Answer : A,C,D,E,F
The client's hearing deficit can certainly present a barrier to effective communication, as it may affect their ability to hear and understand verbal instructions or information provided by the nurse.
B. The loud volume of the client's television is not a barrier in this case as the client has hearing loss.
C. Having numerous visitors in the client's room can create distractions and make it challenging for the nurse to engage in private, focused communication with the client.
D. An increase in pain after ambulation can impact the client's ability to focus and engage in effective communication. The client may be preoccupied with managing their pain, which can hinder their receptiveness to communication from the nurse.
E. Adverse effects of opioid analgesic: Adverse effects of opioid analgesics, such as drowsiness or sedation, can impair the client's cognitive function and alertness, making it difficult for them to participate actively in communication with the nurse.
F. Using earphones while listening to music may create a physical barrier to communication, as it limits the nurse's ability to speak directly to the client or gain their attention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A Close friend may provide warm feeling of support due to their background knowledge of the client. It gives the client a sense of belonging and support.
B Social workers are trained to provide crisis intervention, advocacy, and support services tailored to the needs of survivors of sexual assault. However, thery might not be able to connect closely with the client like a close friend.
C. Chaplains may offer emotional and spiritual support to individuals in crisis situations, including survivors of sexual assault but are not trained to handle such cases.
D. While their expertise is valuable for long-term therapy and support, they may not be readily available for immediate crisis intervention in the emergency department.
Correct Answer is D
Explanation
The assessment phase of the nursing process involves gathering comprehensive data about the client's health status, including their medical history, current symptoms, and any factors that may impact their care.
A. The implementation phase of the nursing process involves carrying out the plan of care.
B. The planning phase involves developing a comprehensive plan of care based on the client's assessment data and identified needs.
C. The evaluation phase involves assessing the client's response to interventions and determining the effectiveness of the care provided.
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