According to the Ecological Model, which of the following factors affect healthy behavior at multiple levels of society? (Select all that apply.)

Choice A: Make a Report to Child Protective Services (CPS)
This is the correct action for the nurse to take. Nurses are mandated reporters, meaning they are legally required to report any suspected cases of child abuse or neglect to the appropriate authorities. Child Protective Services (CPS) is the agency responsible for investigating reports of child abuse and ensuring the safety and well-being of children. Reporting to CPS ensures that the case is handled by professionals trained to investigate and intervene in such situations.

Choice B: Call the Police and Report the Suspected Abuse
While calling the police may seem like a logical step, it is not the primary action a nurse should take in this situation. The police may become involved later in the process, especially if there is an immediate threat to the child's safety. However, the initial report should be made to CPS, as they are the designated agency for handling child abuse cases.

Choice C: Call the Child's Guardian to Have the Child's Pediatrician Confirm the Suspected Abuse
This action is not appropriate because it could potentially place the child in further danger. If the guardian is the abuser, notifying them could lead to retaliation against the child or attempts to cover up the abuse. Additionally, it is not the role of the pediatrician to confirm abuse; this is the responsibility of CPS and law enforcement.

Choice D: Alert the School Principal of the Situation
While it is important to keep school officials informed, the nurse's primary responsibility is to report the suspected abuse to CPS. The school principal can be informed after the report has been made, but the immediate priority is to ensure the child's safety by contacting the appropriate authorities.

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.