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 can be due to physical blockages, structural abnormalities, or conditions affecting the ear's conductive pathway. **Otitis media (D)**, an infection or inflammation of the middle ear, is a classic cause of conductive hearing loss. Fluid buildup or pus in the middle ear space impedes the movement of the ossicles (tiny bones) and eardrum, disrupting sound conduction. This is particularly common in children due to their shorter, more horizontal Eustachian tubes, which are prone to blockages. The fluid's presence dampens vibrations, leading to temporary hearing impairment until the infection resolves or is treated. **Prolonged exposure to loud noises (A)** typically causes sensorineural hearing loss, not conductive. This type of damage affects the hair cells in the cochlea or the auditory nerve, impairing the conversion of sound vibrations into neural signals. While noise-induced hearing loss is a leading cause of auditory deficits, it doesn’t involve the mechanical obstruction characteristic of conductive loss. **Medications (B)**, particularly ototoxic drugs like certain antibiotics (e.g., gentamicin) or chemotherapy agents, also cause sensorineural hearing loss. These substances damage the inner ear’s delicate structures or the auditory nerve, disrupting neural signal transmission. Unlike conductive loss, this damage is often irreversible and doesn’t involve physical barriers in the outer or middle ear. **Presbycusis (C)** is age-related hearing loss and is exclusively sensorineural. It results from degenerative changes in the cochlea, auditory nerve, or brain’s auditory processing centers over time. While it shares symptoms like difficulty hearing high frequencies with some conductive losses, the underlying mechanism is entirely different—no physical blockage or middle ear dysfunction is involved. The key distinction lies in the affected anatomical region: conductive loss involves the outer/middle ear’s mechanical pathway, while sensorineural loss stems from inner ear or neural damage. Otitis media directly interferes with conduction, making it the only correct choice here. The other options, while significant causes of hearing impairment, belong to a separate category of auditory dysfunction. Understanding these differences is critical for accurate diagnosis and treatment, as conductive losses (e.g., from infections or earwax) are often treatable, whereas sensorineural losses may require hearing aids or cochlear implants.

Correct Answer: C

Rationale: Immobility significantly increases the risk of pressure injuries (pressure ulcers) due to prolonged pressure on bony prominences, reduced blood flow, and potential shear forces from sliding or improper repositioning. The skin integrity of an immobile client must be inspected frequently—ideally every 2 hours—because early signs of injury (e.g., erythema, blisters, or tissue breakdown) require immediate intervention to prevent progression to severe wounds. Pressure injuries can develop rapidly (within hours) and lead to infections, prolonged hospitalization, or systemic complications. This makes skin inspection the **priority** assessment, as it addresses the most immediate and preventable threat to the client’s well-being. **Why other options are incorrect:** - **A: Palpate for edema** While edema assessment is important (e.g., for detecting DVT or fluid retention), it is not the **priority** for an immobile client. Edema may develop over time and is less immediately life-threatening than skin breakdown. Additionally, edema alone does not guide urgent interventions unless paired with other symptoms (e.g., pain or asymmetry suggesting thrombosis). - **B: Auscultate for bowel sounds** Immobility can slow gastrointestinal motility (leading to constipation or ileus), but bowel sounds are not the **first** priority. Bowel dysfunction typically develops over days and is not as immediately harmful as skin compromise. Monitoring bowel function is important but secondary to preventing pressure injuries. - **D: Auscultation of lung sounds** While immobility increases the risk of atelectasis or pneumonia due to shallow breathing, lung sounds are not the **priority** in the initial assessment. Respiratory complications usually manifest later (e.g., after 48–72 hours of immobility). Skin inspection takes precedence because it can prevent irreversible damage with early detection. In summary, **C** is correct because skin inspection directly addresses the most urgent and preventable complication of immobility (pressure injuries), while the other assessments are important but secondary in the immediate context. The rationale aligns with nursing priorities: preventing harm that is both rapid in onset and high in severity.

Correct Answer: D

Rationale: Administering eye drops correctly is critical to ensuring medication efficacy and preventing contamination or injury. The correct technique involves strict hygiene and avoiding direct contact between the dropper and the eye. **Why D is correct (the action needing further education):** Touching the dropper to the eye introduces a high risk of contamination. The dropper tip can pick up bacteria or debris from the eye, eyelashes, or surrounding skin, which may then contaminate the entire bottle of medication. Additionally, physical contact can cause microabrasions to the cornea or lead to accidental injury if the patient moves suddenly. Proper technique requires holding the dropper slightly above the eye (about 1-2 cm) to allow the drop to fall into the conjunctival sac without contact. **Why A is incorrect (acceptable action):** Setting the cap down in a non-contaminated manner (e.g., placing it on a clean tissue or holding it with the inner side facing upward) prevents exposure to dirt or microbes. Since the cap must be removed to administer drops, ensuring it remains clean is part of proper sterile technique. This action does not require correction. **Why B is incorrect (proper technique):** Instilling drops directly into the conjunctival sac (the pocket between the lower eyelid and eyeball) ensures optimal absorption and minimizes spillage. This area is less sensitive than the cornea, reducing discomfort. Dropping medication onto the cornea directly can cause irritation or reflexive blinking, leading to wasted medication. The client’s action here is correct. **Why C is incorrect (essential step):** Handwashing before handling eye drops is a fundamental infection control measure. Pathogens from unwashed hands can transfer to the eye or dropper, increasing the risk of infection (e.g., conjunctivitis). This step is non-negotiable in eye care and does not indicate a need for further teaching. **Key Takeaways for Proper Eye Drop Administration:** - Avoid dropper-to-eye contact to prevent contamination and injury. - Target the conjunctival sac for comfortable and effective delivery. - Maintain sterility by washing hands and handling the cap carefully. - Never touch the tip of the dropper to any surface, including the eye. Missteps like touching the dropper to the eye (D) compromise both safety and sterility, making it the clear indicator for additional client education. The other options (A, B, C) reflect correct practices that align with standard protocols for ophthalmic medication administration.

Correct Answer: D

Rationale: The correct answer is D because sudden increases in drainage from a cast are **never** expected and indicate a potential complication, such as infection or bleeding. A new cast may have minimal moisture initially from the casting material, but any sudden or significant increase in discharge is abnormal and requires immediate medical evaluation. This would suggest wound deterioration or infection beneath the cast, which could compromise healing and require intervention. **Why the other options are incorrect:** - **A (Use a sling to alleviate fatigue):** This is correct teaching. A sling helps support the arm, reducing muscle strain and discomfort, especially in the early stages of healing. It prevents excessive movement that could disrupt the cast or underlying injury. While it does not replace elevation for swelling, it is a valid recommendation for comfort and stability. - **B (Elevate the arm above the heart to reduce swelling):** This is appropriate post-cast care. Elevation minimizes edema by promoting venous return and reducing fluid accumulation in the injured area. Persistent swelling can cause pressure under the cast, leading to impaired circulation or compartment syndrome, so this instruction is essential. - **C (Report 'hot spots' felt under the cast):** This is critical teaching. A localized burning or "hot spot" may indicate pressure ulcers, infection, or tissue necrosis developing beneath the cast. Early reporting allows for timely assessment and cast adjustment to prevent further tissue damage. Ignoring this symptom could lead to serious complications. In contrast, **D** is dangerously incorrect because drainage should decrease over time, not increase. New drainage—especially if purulent, bloody, or foul-smelling—signals an active problem. The nurse must educate the client to recognize abnormal signs and seek care rather than dismissing them as expected. Proper monitoring prevents avoidable complications like osteomyelitis or delayed healing. Understanding these distinctions ensures safe post-cast management.

Correct Answer: A

Rationale: **Rationale:** **Choice A (Avoid home modification)** is the correct answer because it actively opposes measures that protect older adults from musculoskeletal injuries. Home modifications—such as installing grab bars, improving lighting, removing tripping hazards, and using non-slip mats—are essential for reducing fall risks and creating a safer living environment. Avoiding these modifications increases the likelihood of falls, fractures, and other musculoskeletal injuries, making this choice counterproductive to injury prevention. **Choice B (Wear a helmet when riding a bicycle)** is incorrect because helmet use is crucial for preventing head injuries, which can indirectly protect against musculoskeletal trauma. While the primary benefit of helmets is reducing traumatic brain injuries, they also minimize the risk of cervical spine and facial fractures. Encouraging protective gear aligns with injury prevention strategies, even if the direct focus is not solely on the musculoskeletal system. **Choice C (Osteoporosis screening)** is incorrect because osteoporosis screening is a proactive measure to identify bone density loss early, allowing for interventions like calcium supplementation, weight-bearing exercises, and medications to strengthen bones. Weak bones are more susceptible to fractures, even from minor falls. Early detection and management reduce fracture risk, directly supporting musculoskeletal health. **Choice D (Fall prevention)** is incorrect because fall prevention strategies—such as balance exercises, proper footwear, and assistive devices—are foundational to avoiding musculoskeletal injuries in older adults. Falls are a leading cause of fractures, sprains, and soft tissue damage in this population. Teaching fall prevention methods is evidence-based and directly supports musculoskeletal safety. **Conclusion:** The key distinction lies in recognizing that **Choice A** is the only option that actively undermines injury prevention, while the others promote protective measures. Home modifications are a well-documented, effective intervention, and discouraging them would leave older adults vulnerable to avoidable harm. The incorrect choices either directly or indirectly contribute to musculoskeletal safety, reinforcing their validity as helpful health teachings.