Answer:
Option b.
Explanation:
In order to show it indicates that a nursing student who is listing the steps to be followed when communicating with older adults with hearing problems is learning efficiently; the nursing student should not at all list option 'b' among the steps to be followed when communicating with older adults with hearing problems.
If the student list option A which says; ''Speak clearly, slowly, distinctly, but naturally'' . That means that the Nursing student does not need additional training.
If the student list option 'c'; ''Avoid using sentences that are too complex'' also, shows that the Nursing student does not need additional training.
====> But, if the Nursing student list option 'b'; '' Shouting and exaggerating exaggerating mouth movements'', it show that the student needs additional training.