The nurse is preparing to perform an initial assessment on an older adult client who is hard of hearing and speaks limited English, which of the following actions should the nurse take to promote therapeutic communication? (Select all that apply)

Choice A reason: Reducing environmental noise is critical for patients who are hard of hearing. Extraneous sounds can interfere with the patient's ability to process speech sounds and concentrate on the interaction. A quiet environment minimizes auditory competition, thereby enhancing the clarity of the communication process and reducing patient frustration. Choice B reason: Playing music, even if soft, is contraindicated for a client with hearing impairment. Background noise acts as a distraction and can mask the frequencies of human speech. For someone struggling to hear, any additional auditory input complicates the task of decoding verbal messages and should be avoided. Choice C reason: Utilizing a professional, licensed interpreter is the legal and clinical standard for patients with limited English proficiency. Licensed interpreters understand medical terminology and maintain neutrality, ensuring that clinical information is translated accurately without the risk of omission or personal bias often found with untrained translators. Choice D reason: Relying on family members to interpret is generally discouraged in clinical settings. Family members may lack knowledge of medical jargon, might omit sensitive information to protect the patient, or could misinterpret clinical instructions. Professional interpreters are required to ensure patient confidentiality, accuracy of data, and informed consent. Choice E reason: Nonverbal cues provide significant clinical data, especially when verbal communication is limited. Monitoring facial expressions, body language, and gestures helps the nurse gauge the patient's level of pain, comfort, or understanding. This holistic approach ensures that the nurse captures the patient's physiological and psychological state accurately.