What may be a cause of conductive hearing loss?

Correct Answer: D

Rationale: Conductive hearing loss occurs when sound waves cannot efficiently travel through the outer or middle ear to reach the inner ear. This type of hearing loss is often caused by mechanical blockages or malfunctions in the ear's conductive pathway. **Correct Answer: D (Otitis media)** Otitis media, an infection or inflammation of the middle ear, is a leading cause of conductive hearing loss. Fluid accumulation in the middle ear space due to infection or Eustachian tube dysfunction prevents the proper vibration of the ossicles (tiny bones in the ear), hindering sound transmission. This condition is particularly common in children and can be acute or chronic, often resolving with treatment but potentially leading to persistent hearing impairment if left untreated. **Incorrect Answer: A (Prolonged exposure to loud noises)** Prolonged exposure to loud noises typically causes **sensorineural hearing loss**, not conductive. This occurs due to damage to the hair cells in the cochlea (inner ear) or the auditory nerve, impairing the conversion of sound waves into neural signals. While noise-induced hearing loss is a significant concern, it does not involve mechanical obstruction or middle ear dysfunction, which are hallmarks of conductive hearing loss. **Incorrect Answer: B (Medications)** Certain medications, such as ototoxic drugs (e.g., aminoglycoside antibiotics, loop diuretics, chemotherapy agents), are known to cause **sensorineural hearing loss** by damaging the inner ear structures or auditory nerve. They do not affect the external or middle ear's ability to conduct sound, making this choice irrelevant to conductive hearing loss. **Incorrect Answer: C (Presbycusis)** Presbycusis is age-related hearing loss, which is **sensorineural** in nature. It results from the gradual degeneration of hair cells in the cochlea and other age-related changes in the auditory system. Unlike conductive hearing loss, presbycusis is not caused by physical blockages or middle ear issues but rather by the inner ear's diminished capacity to process sound. Conductive hearing loss is distinguished by its mechanical origins, such as earwax impaction, otitis media, or ossicular chain disruption, whereas sensorineural hearing loss involves nerve or cochlear damage. Understanding the anatomical and physiological differences between these types of hearing loss is crucial for accurate diagnosis and appropriate management.

Correct Answer: C

Rationale: Inspecting the skin for injury is the priority assessment for an immobile client because prolonged immobility significantly increases the risk of pressure injuries (formerly called pressure ulcers or bedsores). These injuries develop due to unrelieved pressure on bony prominences (e.g., sacrum, heels, elbows), which compromises blood flow to the tissues, leading to ischemia, necrosis, and potential infection. Early identification of skin breakdown—such as non-blanchable erythema, blisters, or open wounds—allows for timely interventions like repositioning, pressure-relieving devices, and wound care, preventing further complications. Immobility also reduces sensory feedback, meaning the client may not feel discomfort, making visual inspection critical. Palpating for edema (A) is important but not the priority. Edema can indicate fluid retention or circulatory issues, but it is a secondary concern compared to the immediate risk of skin breakdown. While edema may exacerbate pressure injuries, it does not pose as acute a threat as undetected tissue damage. Similarly, auscultating for bowel sounds (B) assesses gastrointestinal motility, which can be impaired in immobile clients (e.g., due to slowed peristalsis or constipation). However, bowel dysfunction is less urgent than preventing or addressing skin integrity issues, which can rapidly deteriorate and lead to systemic infections like sepsis. Auscultation of lung sounds (D) is crucial for detecting complications like atelectasis or pneumonia, which immobile clients are at higher risk for due to shallow breathing and poor secretion clearance. However, these respiratory issues typically develop over time, whereas skin breakdown can occur within hours of unrelieved pressure. While respiratory assessment is vital, it does not supersede the need for immediate skin inspection, as pressure injuries can progress quickly and are often preventable with prompt action. The incorrect choices (A, B, D) represent important but lower-priority assessments for an immobile client. They address potential complications of immobility but fail to target the most immediate and preventable risk. Skin inspection (C) is the priority because it directly addresses the client’s highest vulnerability—pressure injuries—which require proactive monitoring to avert severe consequences. This prioritization aligns with the nursing principle of addressing the most critical, life-altering risks first.

Correct Answer: D

Rationale: Administering eye drops correctly is critical for both medication efficacy and infection prevention. The action described in **Choice D (touching the dropper to the eye)** clearly indicates a need for further education because it introduces contamination risks. The dropper tip should never contact the eye, eyelids, or any other surface, as this can introduce bacteria or other pathogens into the medication bottle, leading to potential infections like conjunctivitis or keratitis. Proper technique involves holding the dropper close to the eye (about an inch away) without making direct contact to maintain sterility. **Choice A (setting the cap down without contaminating it)** is correct and does not require additional teaching. Placing the cap in a clean, dry location (e.g., upside down on a tissue) prevents contamination, ensuring the medication remains sterile. This demonstrates the client’s understanding of aseptic technique. **Choice B (dropping medication into the conjunctival sac)** is also correct. The conjunctival sac, the pocket formed by pulling down the lower eyelid, is the ideal location for instilling drops. This ensures proper absorption and minimizes spillage. The client’s ability to target this area correctly shows they have been taught the proper administration technique. **Choice C (washing hands before instilling drops)** reflects proper hygiene and is essential to prevent transferring pathogens from the hands to the eye. Handwashing reduces the risk of infection, and the client’s adherence to this step indicates they are following best practices. In summary, **Choice D** is the only option that reveals a critical error in technique, as it compromises sterility and increases infection risk. The other choices (A, B, and C) demonstrate correct practices that align with standard eye drop administration protocols. Clients must be reminded to avoid touching the dropper to the eye or any surface to maintain medication safety and effectiveness. Correcting this behavior is crucial to ensure therapeutic outcomes and prevent complications.

Correct Answer: D

Rationale: Rationale: **Correct Answer: D – Sudden increase in drainage is expected** A sudden increase in drainage from under a cast is **not normal** and indicates a potential complication, such as infection, bleeding, or tissue breakdown. This requires immediate medical evaluation to prevent further harm. Teaching the client to expect increased drainage is incorrect because it could lead to delayed reporting of serious issues, worsening the condition. **Incorrect Choices:** **A: Use a sling to alleviate fatigue** Using a sling is correct teaching because it supports the immobilized arm, reduces strain on muscles and joints, and prevents unnecessary movement that could displace the cast. A sling also helps maintain proper positioning, minimizing discomfort. This is appropriate nursing advice, not incorrect teaching. **B: Elevate the arm above the heart to reduce swelling** Elevation is a standard intervention to minimize swelling by promoting venous return and reducing fluid accumulation in the injured area. Failure to elevate can lead to increased pain, compromised circulation, or even compartment syndrome. This instruction is correct and should be reinforced, not dismissed. **C: Report 'hot spots' felt under the cast** A "hot spot" (localized warmth) under the cast is a red flag for infection or pressure necrosis. Early reporting allows prompt intervention, such as cast removal or antibiotic treatment. Teaching the client to monitor and report this is essential for preventing complications, making this correct guidance, not incorrect. **Summary of Errors in Choices A-C:** These options are all **correct nursing instructions** and would not represent incorrect teaching. Only **D** inaccurately normalizes a concerning symptom, posing a risk to the client’s recovery. Recognizing abnormal vs. expected post-cast symptoms is critical for patient safety.

Correct Answer: A

Rationale: **Rationale:** **Correct Answer (A: Avoid home modification)** Avoiding home modifications is counterproductive to preventing musculoskeletal injuries in older adults. Home modifications—such as installing grab bars in bathrooms, improving lighting, removing tripping hazards, and adding stair railings—are proven strategies to reduce fall risks and subsequent fractures or sprains. Falls are a leading cause of musculoskeletal injuries in older adults, and modifications create a safer living environment. Ignoring these adaptations increases the likelihood of accidents, making this choice the least helpful advice. **Incorrect Answers:** **B: Wear a helmet when riding a bicycle** This is a valid preventive measure. While cycling, older adults are at risk of falls or collisions that could lead to fractures or traumatic injuries. A helmet protects against head injuries, which can indirectly prevent musculoskeletal harm by reducing the impact force transmitted to the neck, spine, and limbs. Though cycling may be less common in older adults, safety gear is still crucial for those who engage in such activities. **C: Osteoporosis screening** Osteoporosis screening is critical for older adults because it identifies bone density loss, a major risk factor for fractures. Early detection allows for interventions (e.g., calcium supplementation, weight-bearing exercises, or medications) that strengthen bones and reduce fracture risks. Since weakened bones exacerbate injury severity, screening directly contributes to musculoskeletal injury prevention. **D: Fall prevention** Fall prevention strategies (e.g., balance exercises, proper footwear, and medication reviews) are essential for older adults. Falls often result in fractures, dislocations, or soft tissue injuries, particularly in those with osteoporosis or muscle weakness. Proactive measures significantly lower injury risks, making this a highly effective teaching point. In summary, while options B, C, and D actively promote musculoskeletal safety, option A undermines injury prevention by discouraging necessary environmental adaptations.