An employee presents to an occupational health nurse with concerns that their hearing is worse on one side. Which of the following actions should the nurse take first to address the employee's concern?

Conduct a physical examination.

Irrigate the ear to remove any obstruction.

Advise the client on the use of ear plugs.

Refer the client to an audiologist.

Answer and Explanation

The Correct Answer is A

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.

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Correct Answer is A

Explanation

Choice A Reason:
Identifying a support system to prevent the client from giving into the urge to smoke is crucial during the preparation phase of the Transtheoretical Model. In this phase, the client is ready to take action within the next 30 days and may start taking small steps towards quitting smoking. A support system, which can include family, friends, or support groups, provides the necessary encouragement and accountability to help the client stay committed to their goal. This support can significantly increase the chances of successful smoking cessation by offering emotional and practical assistance².

Choice B Reason:
Giving literature to the client who has expressed wanting to quit but is not yet ready to do so aligns more with the contemplation phase of the Transtheoretical Model. In the contemplation phase, individuals are considering quitting within the next six months but are not yet ready to take immediate action. Providing educational materials can help them understand the benefits of quitting and the steps involved, but it is not as relevant for someone in the preparation phase who is already planning to quit soon.

Choice C Reason:
Consoling the client for smoking a cigarette after having quit smoking 4 months ago is more appropriate for the maintenance phase. In the maintenance phase, individuals work to sustain their behavior change and prevent relapse. While offering support after a relapse is important, it does not align with the preparation phase, where the focus is on planning and preparing to quit smoking.

Choice D Reason:
Teaching the client who refuses to quit smoking about fire safety and cigarette smoking is not relevant to the preparation phase. This intervention might be more suitable for individuals in the precontemplation phase, where they are not yet considering quitting and need to be made aware of the risks associated with smoking. In the preparation phase, the client is already motivated to quit, so the focus should be on supporting their efforts to take action.

A. Team member instinct should drive decisions made throughout the process. B. Different steps of the framework should be assigned to specific subgroups. C. During the assessment phase, the team should consider the available resources. D. The process is circular, steps may be revisited, and more than one step may be happening at the same time.

Correct Answer is D

Explanation

Choice A Reason:
Team member instinct should drive decisions made throughout the process. This statement is incorrect because the Strategic Prevention Framework (SPF) emphasizes data-driven decision-making rather than relying on instinct. The SPF process involves systematic assessment, planning, implementation, and evaluation based on evidence and community needs.

Choice B Reason:
Different steps of the framework should be assigned to specific subgroups. While it is beneficial to have subgroups focus on different aspects of the framework, the SPF encourages collaboration and integration across all steps. Assigning specific steps to subgroups can lead to a fragmented approach, which is not in line with the holistic and iterative nature of the SPF.

Choice C Reason:
During the assessment phase, the team should consider the available resources. This statement is true but not specific to the SPF. Considering available resources is a standard practice in many planning and implementation frameworks. The unique aspect of the SPF is its circular and iterative process, which allows for continuous improvement and adaptation.

Choice D Reason:
The process is circular, steps may be revisited, and more than one step may be happening at the same time. This is the correct answer because it accurately describes the nature of the Strategic Prevention Framework. The SPF is designed to be flexible and iterative, allowing for ongoing assessment, planning, implementation, and evaluation. This approach ensures that the prevention efforts can adapt to changing circumstances and new information, making it more effective in addressing community needs.

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An employee presents to an occupational health nurse with concerns that their hearing is worse on one side. Which of the following actions should the nurse take first to address the employee's concern?

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