A nurse is reinforcing teaching with a client who has low health literacy. Which of the following actions should the nurse take? (Select all that apply)

Choice A reason: Using gestures to communicate is less effective for a client with moderate vision impairment, as they may not clearly see hand movements. Visual cues are unreliable, and verbal communication is more effective. Gestures could lead to miscommunication or frustration, making this an inappropriate action for effective interaction.

Choice B reason: Facing the client when speaking enhances communication for those with moderate vision impairment, as it allows them to see lip movements and facial expressions, aiding comprehension. This approach leverages residual vision and supports clear verbal exchange, making it the most effective and appropriate action for the nurse to take.

Choice C reason: Speaking loudly is unnecessary unless the client has a hearing impairment, which is not indicated. Moderate vision impairment affects sight, not hearing, and loud speech may be perceived as condescending or disruptive, potentially hindering effective communication and rapport with the client.

Choice D reason: Opening shades to provide natural light may improve visibility but risks causing glare, which can worsen visual clarity for clients with moderate vision impairment. Controlled lighting, such as soft artificial light, is preferred to avoid discomfort, making this an inappropriate primary action compared to facing the client during communication.

Choice A reason: Advancing the cane 12 inches is not a universal rule, as the distance depends on the client’s stride length and balance needs. Typically, the cane advances 6-10 inches with the unaffected leg to provide optimal support. A fixed 12-inch instruction may lead to instability, making this an incorrect teaching statement.

Choice B reason: Holding the cane on the affected side reduces stability, as it fails to support the weaker leg during weight-bearing. The cane should be held on the unaffected side to provide a stable base, improving balance and reducing fall risk, making this an incorrect instruction for safe cane use.

Choice C reason: Keeping the cane at the same level as the affected leg when climbing stairs is incorrect. The cane moves with the unaffected leg first when ascending and with the affected leg when descending to ensure support. This vague instruction does not reflect proper stair-climbing technique, making it incorrect.

Choice D reason: Moving the unaffected leg first, alongside the cane, provides a stable base for the affected leg to follow, enhancing balance and reducing fall risk. This technique leverages the stronger leg’s strength and the cane’s support, making it the correct instruction for safe ambulation in clients with unilateral weakness.