A community health nurse is establishing a care plan for a 12-year-old client who is disruptive in school. The nurse includes a referral for a mentorship program as one of the interventions in the care plan. Which of the following rationales should the nurse include to support the referral?

Choice A: Community Health Workers are Paid or Unpaid Individuals Active in Promoting the Health of a Community
This statement accurately describes community health workers (CHWs). CHWs can be either paid or unpaid and are often members of the communities they serve. They play a crucial role in promoting health, providing education, and connecting individuals to health care services. Their work is essential in improving health outcomes and reducing health disparities within communities.

Choice B: A Community Health Worker Should be a Public Health Nurse
This statement is incorrect. While public health nurses can work as community health workers, the role of a CHW is not limited to nurses. CHWs come from various backgrounds and do not necessarily have formal medical training. Their primary qualification is their close connection to the community and their ability to build trust and provide culturally appropriate health education and services.

Choice C: Community Health Workers are Unpaid Residents Within a Community Who Volunteer Their Services
This statement is partially correct but incomplete. While many CHWs volunteer their services, others are paid for their work. The key aspect of a CHW's role is their active involvement in promoting community health, regardless of whether they are paid or unpaid.

Choice D: Paid Employees Within the Community Comprise the Role of a Community Health Worker
This statement is incorrect. While some CHWs are paid, the role is not exclusively filled by paid employees. Many CHWs volunteer their time and efforts to support their communities. The defining characteristic of a CHW is their dedication to improving community health, not their employment status.

Choice A Reason:
Conducting a physical examination is the first step in addressing the employee's concern about hearing loss. This examination allows the nurse to assess the ear for any visible issues, such as earwax buildup, infection, or structural abnormalities. A thorough physical examination can help identify the cause of the hearing loss and determine the appropriate next steps. It is essential to rule out any immediate and easily treatable conditions before proceeding with more specialized interventions.

Choice B Reason:
Irrigating the ear to remove any obstruction, such as earwax, can be an effective treatment for hearing loss caused by cerumen impaction. However, this should only be done after a physical examination confirms that earwax is the cause of the hearing loss. Irrigation without proper assessment can potentially cause harm, especially if there is an underlying infection or perforation of the eardrum.

Choice C Reason:
Advising the client on the use of ear plugs is a preventive measure to protect hearing, particularly in noisy environments. However, this advice does not address the immediate concern of unilateral hearing loss. Ear plugs are more relevant for preventing further hearing damage rather than diagnosing or treating existing hearing issues.

Choice D Reason:
Referring the client to an audiologist is an important step if the initial physical examination does not reveal the cause of the hearing loss or if the hearing loss persists despite initial treatment. Audiologists specialize in diagnosing and treating hearing disorders and can perform comprehensive hearing tests. However, this referral should come after the nurse has conducted a preliminary assessment to rule out any obvious and treatable causes.