A patient is admitted to the hospital with a left hemiplegia. To determine the size and location and to ascertain whether a stroke is ischemic or hemorrhagic, the nurse anticipates that the health care provider will request a:

Clients with global aphasia have both receptive (understanding) and expressive (speaking) language impairments, so communication strategies must address both comprehension and expression. Interventions should emphasize clear, simple language, supportive nonverbal cues, and techniques that reduce processing demands. Techniques such as speaking at a slower rate, maintaining direct eye contact, allowing extra time for responses, and providing one-step instructions help the client understand and participate. Approaches that take over the client’s speech or finish statements for them can increase frustration and reduce their sense of autonomy.

Rationale for correct answers:
1. Speak to the client at a slower rate. Speaking more slowly and using short, simple phrases gives the client extra processing time and increases the likelihood that receptive language will be understood. A slower rate also allows the nurse to observe nonverbal cues and confirm comprehension before proceeding. This approach reduces communication breakdowns and frustration for both the client and caregiver.

2. Look directly at the client when speaking. Direct eye contact provides important nonverbal cues and helps focus the client’s attention on the speaker, which supports comprehension. Visual attention can augment limited auditory processing in receptive aphasia and helps the client pick up facial expressions and gestures. Maintaining eye contact also builds rapport and conveys that the nurse is engaged and patient.

3. Allow extra time for the client to answer. Clients with global aphasia often require prolonged time to comprehend questions and formulate responses, so allowing extra time prevents interruption and reduces anxiety. Rushing the client can increase errors, withdrawal, or agitation, and may obscure their true abilities. Patience during response time encourages attempts at communication and helps the nurse accurately assess function.

5. Give instructions one step at a time. One-step commands reduce cognitive load and make it more likely the client will understand and carry out directions safely. Multi-step instructions can overwhelm processing and lead to incomplete or incorrect responses. Providing a single, clear action at a time also allows the nurse to offer immediate feedback and reinforcement.

Rationale for incorrect answer:
4. Complete sentences that the client cannot finish. Finishing the client’s sentences removes their opportunity to attempt expression and undermines autonomy and self-esteem. It also makes it difficult to assess the client’s residual language abilities and progress in therapy. Instead, the nurse should offer supportive cues (gestures, written words, yes/no choices) and allow the client to attempt completion with encouragement.

Take-home points:

• Use slow, simple speech, direct eye contact, and one-step instructions to maximize comprehension and participation.
• Allow extra time for responses and avoid finishing the client’s sentences to preserve autonomy and accurately assess ability.
• Involve speech-language pathology and consider alternative communication aids when needed to support long-term communication.

Clients with left homonymous hemianopsia lose vision in the left half of the visual field of both eyes, making it difficult for them to perceive objects on that side. An effective nursing intervention is to orient the client to food using the clock method, which provides a structured way for them to identify items despite visual field loss. This technique promotes independence, safety, and adequate nutrition. While other strategies may assist clients with visual deficits, the clock method directly compensates for hemianopsia during meals.

Rationale for correct answer:
3. Orient the client to the food on her plate using the clock method. This intervention allows the client to compensate for visual field loss by knowing the location of food items relative to a clock face. It enhances independence by reducing frustration and ensuring proper intake during meals. The clock method is a widely recommended strategy for patients with hemianopsia because it is both practical and safe.

Rationales for incorrect answers:
1. Teach the client to scan to the right to see objects on the right side of her body. This intervention would benefit a client with right homonymous hemianopsia, not left. Teaching scanning is helpful, but in this case, the deficit is on the left, so scanning should focus on that side. Using it incorrectly could result in continued neglect of the affected field.

2. Place the client’s bedside table on the right side of the bed. Since the client cannot see objects on the left side, placing the bedside table on the right would reinforce neglect of the affected field. Nursing interventions should encourage use of the impaired side to promote awareness and prevent accidents. This option does not support functional independence for left-sided visual loss.

4. Place the client’s wheelchair on her left side. Positioning mobility aids on the side of the visual deficit increases the risk of collisions or falls, since the patient may not notice them. Wheelchairs and other essential equipment should be placed on the unaffected (right) side for easier access and safety. This makes the option inappropriate for managing left homonymous hemianopsia.

Take-home points:

• Left homonymous hemianopsia causes loss of vision in the left visual field of both eyes.
• The clock method is a practical and effective way to improve independence during meals.
• Nursing interventions must encourage safe compensation for visual field loss and prevent neglect of the affected side.