A nurse is caring for a client who is postoperative. Vital Signs 0800: BP 118/72 mm Hg, Heart rate 82/min, Respiratory rate 16/min, Temperature 36.7° C (98° F), SaO2 98 Vital Signs 1000: BP 128/82 mm Hg, Heart rate 94/min, Respiratory rate 18/min, Temperature 36.7° C (98° F), SaO2 98 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. Nurses' Notes 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. Nurses' Notes 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. Nurses' Notes 1300: Ate 75 Several visitors at bedside. Which of the following factors could present a barrier to the nurse effectively communicating with the client? Select all that apply.