CH 17

The nurse is caring for a client who has experienced a stroke. The client has aphasia. The nurse recognizes that aphasia is a a. neurological linguistic deficit. b. cognitive comprehension deficit. c. sensory deprivation deficit. d. mental disorder deficit.

ANS: A Aphasia is defined as a neurological linguistic deficit. There may be no cognitive, sensory, or mental impairment. While there may be no cognitive impairment, the client may need more "think time" for cognitive processing during a conversation.

The nurse is caring for an older adult client who is recovering from a stroke. When the nurse speaks to the client, the client nods her head and responds using incoherent words. Which type of aphasia does this client exhibit? a. Expressive b. Receptive c. Global d. Cognitive

ANS: A The client with expressive aphasia can understand what is being said but cannot express thoughts or feelings in words. Receptive aphasia creates difficulties in receiving and processing written and oral messages. With global aphasia, the client has difficulty with both expressive language and reception of messages. A client may have feelings of loss and social isolation imposed by the communication impairment. While there may be no cognitive impairment, the client may need more "think time" for cognitive processing during a conversation.

Which of the following clients with a communication deficit requires the use of touch during a therapeutic encounter? a. Vision-impaired client b. Client with a hearing loss c. Mentally ill client d. Client with schizophrenia

ANS: A The social isolation experienced by blind clients can be profound, and the need for human contact is important. Touching the client lightly as the nurse speaks alerts the client to the nurse's presence. For vision-impaired clients, the nurse should let the person know when approaching by a simple touch, and always indicate when leaving. The nurse should use touch and close physical proximity while with the client, and give the client something substantial to touch when leaving the client. The nurse should tap on the floor or table to get the client's attention via vibration. Other communication problems occur with different mental disorders. As an example, some clients with mental disorders can have intact sensory channels, but they cannot process and respond appropriately to what they hear, see, smell, or touch. In some forms of schizophrenia, there are alterations in the biochemical neurotransmitters in the brain that normally conduct messages between nerve cells and help orchestrate the person's response to the external environment. Messages have distorted meanings.

Which of the following is true in relation to communication deficits? a. Communication deficits occur only as a result of physical disabilities. b. Communication deficits can arise from sensory deprivation. c. Individuals who are equally impaired are equally disabled. d. The primary nursing goal is to minimize the client's independence.

ANS: B Communication deficits can arise from the kind of sensory deprivation that occurs in some agencies and units such as intensive care units. A communication disability definition includes any client who has any impairment in body structure or function that interferes with communication. Specifically, the client has a communication difficulty due to impaired functioning of one or more of his five senses or he has impaired cognitive processing functioning. Communication deficits can arise from the kind of sensory deprivation that occurs in some agencies and units such as intensive care units. Two individuals can have the same sensory impairment but not be equally communication disabled. Each person compensates for their impairment in different ways. The primary nursing goal is to maximize the client's ability to successfully interact with the health care system.

The nurse is caring for an older adult client who has recently withdrawn from relationships, appears depressed, and appears reluctant to seek information from the nurse. The nurse suspects the client is experiencing hearing loss. The nurse recognizes that a. the client will readily acknowledge that this is the problem if asked. b. the client may try to hide deficits and withdraw from relationships. c. decreased hearing ability is not related to conversational style. d. older adults, as a group, have better consonant discrimination.

ANS: B Deprived of a primary means of receiving signals from the environment, clients with hearing loss may try to hide deficits, may withdraw from relationships, become depressed, or be less likely to seek information from health care providers.

When caring for a hearing-impaired client, the nurse should a. face the interpreter when speaking to the client. b. use gestures that reinforce verbal content. c. speak distinctly while exaggerating words. d. communicate in a dimly-lit room.

ANS: B For hearing-impaired clients, the nurse should use facial expressions and gestures that reinforce verbal content. The nurse should always face the client when communicating, so the client can see the nurse's lips move. The nurse should speak distinctly without exaggerating words. Partially deaf clients respond best to well-articulated words spoken in a moderate, even tone. The nurse should stand or sit to face the client and allow the client to see facial expressions and mouthing of words. The nurse should also communicate in a well-lighted room.

The nurse is caring for an unconscious client. The client's family member reports that a nurse at the client's bedside stated, "I wouldn't want to live in this condition." What did this nurse not realize about the client's capabilities? a. The client can read lips b. Hearing can remain acute in clients who are not fully alert c. The client can respond to statements through written communication d. The client can be sensitive to the nurse's nonverbal behavior

ANS: B When a client is not fully alert, it is not uncommon for nurses to speak in their presence in ways they would not if they thought the client could fully understand what is being said, forgetting that hearing can remain acute. Good clinical practice suggests never saying anything the nurse would not want the client to hear. The ability to read lips, respond to written communication, or be sensitive to nonverbal behavior does not relate to the verbal statement made by the nurse.

When caring for the client with macular degeneration, the nurse should a. face the client directly. b. stand to the client's side. c. hold the client's arm when walking. d. refrain from touching the client.

ANS: B When caring for clients with macular degeneration, the nurse should remember to stand to their side, an exception to the "face them directly" rule applied with hearing loss clients. Macular degeneration clients often still have some peripheral vision. For vision-impaired clients, the nurse should not lead or hold the client's arm when walking; instead, the nurse should allow the person to take her arm. The nurse should use touch and close physical proximity while with the client, and the nurse should give the client something substantial to touch when leaving the client.

The nurse is caring for a client who is nonverbal. When caring for this client, the nurse should a. insist the client communicate in a two-way mode. b. continue to initiate communication in a one-way mode. c. refrain from explaining procedures because the client will not understand. d. limit orienting cues in order to reduce environmental stimuli.

ANS: B When clients are unable or unwilling to engage in a dialogue, the nurse should continue to initiate communication in a one-way mode. Giving orienting cues is recommended, such as labeling of meals as breakfast, lunch, or dinner; and linking events to routines (e.g., saying, "The x-ray technician will take your chest x-ray right after lunch") helps secure the client in time and space.

The nurse is caring for a client who has experienced global aphasia secondary to a stroke. Which of the following interventions is most appropriate for this client? a. Refrain from exploiting any language skills that are preserved b. Frequently remind the client they cannot be understood c. Encourage short, positive sessions to communicate d. Spend long periods of time talking with the client to provide stimulation

ANS: C Clients who lose both expressive and receptive communication abilities have global aphasia. These clients can become frustrated when they are not understood. Struggling to speak causes fatigue. Short, positive sessions are used to communicate. Otherwise, the client may become nonverbal as a way of regaining energy and composure. Any language skills that are preserved should be exploited.

The nurse is caring for a client who is hearing-impaired and legally blind in his right eye. The client has just returned from cataract surgery on his left eye. The nurse recognizes that a. the client's arm should be held when walking. b. verbal speech is useless in this situation. c. signals should be developed to indicate changes in pace or direction while walking. d. the client should be discouraged from reading lips.

ANS: C For vision-impaired clients, the nurse should develop and use signals to indicate changes in pace or direction while walking. The nurse should not lead or hold the client's arm when walking, but instead allow the client to take the nurse's arm. The nurse should speak distinctly without exaggerating words. Partially deaf clients respond best to well-articulated words spoken in a moderate, even tone. The client with hearing loss should be encouraged to verbalize speech, even if they only use a few words or the words are difficult to understand at first. The nurse should always face the client when communicating so the client can see the nurse's lips move.

When attempting to communicate a procedure to a Spanish-speaking client, a strategy that the nurse could use to facilitate understanding would be a. speak distinctly while exaggerating words. b. attempt to use sign language. c. use pictographs. d. explain what is happening in complex terms.

ANS: C Pictographs are one of many tools recommended for communicating within nursing. For hearing-impaired clients, the nurse should speak distinctly without exaggerating words. There is no mention in the question of this client being hearing-impaired. American Sign Language has been a standard communication tool for many years; however, few care providers were able to use it. Even when a client appears not to understand, the nurse should explain in very simple terms what is happening.

The nurse understands that as clients age, they are more likely to have vision problems that may interfere with the communication process, including the lens of the eyes becoming less flexible, making it difficult to accommodate shifts from far to near vision. The nurse recognizes that this condition is known as a. receptive aphasia. b. autism. c. presbycusis. d. presbyopia.

ANS: D As clients age, they are more likely to have vision problems that may interfere with the communication process because the lens of the eyes become less flexible, making it difficult to accommodate shifts from far to near vision. This is a condition known as presbyopia. Receptive aphasia creates difficulties in receiving and processing written and oral messages. Atypical communication is often the first behavioral clue to cognitive impairment in young children, associated with conditions such as mental retardation, autism, and affective disorders. Presbycusis, or degeneration of ear structures, is a sensorineural dysfunction that normally occurs as one ages.

When communicating with a client diagnosed with a serious mental disorder, it is important for the nurse to recognize which of the following? a. Clients with mental disorders never have intact sensory channels b. Clients with a 'flat affect' are easier to understand c. Clients with mental disorders are always very talkative d. Clients with mental disorders may suffer from social isolation and impaired coping

ANS: D Clients with serious mental disorders may have a different type of communication deficit resulting from a malfunctioning of the neurotransmitters that normally transmit and make sense out of messages in the brain. Social isolation and impaired coping may accompany the client's inability to receive or express language signals. Other communication problems occur with different mental disorders. As an example, some clients with mental disorders can perhaps have intact sensory channels, but they cannot process and respond appropriately to what they hear, see, smell, or touch. The nurse may notice a lack of vocal inflection and an unchanging facial expression. A 'flat affect' makes it difficult to truly understand the client. Some clients with mental disorders present with a poverty of speech and limited content. Speech appears blocked; reflecting disturbed patterns of perception, thought, emotions, and motivation.