The nurse is reviewing a client's electronic health record before assessing her mouth. Which of the following diagnoses would the nurse recognize as an indication for immediate medical follow up?

Choice A reason: Ear candles are unsafe, risking burns or wax deeper in the canal. They don’t effectively remove cerumen and can perforate the eardrum, contradicting evidence-based hygiene practices for preventing ear infections or blockages entirely in this context.

Choice B reason: Irrigation with saline is for impacted cerumen, not routine hygiene. It’s a clinical procedure, not a daily prevention measure, and risks pushing wax further or damaging the canal if done improperly, making it less suitable here.

Choice C reason: Washing the pinna with a warm, moist washcloth safely cleans the outer ear, preventing debris buildup without risking the canal or eardrum. This simple, effective hygiene step aligns with illness prevention goals for routine ear care perfectly.

Choice D reason: Cotton swabs can push cerumen deeper, causing impaction or eardrum perforation. This unsafe practice increases infection risk, opposing hygiene goals, and is widely discouraged in favor of external cleaning for safe ear maintenance consistently.

Choice A reason: Angle closure glaucoma causes peripheral vision loss and pain from pressure, not central loss. This acute condition contrasts with the client’s central vision complaint, excluding it as the suspected diagnosis in this scenario entirely here.
Choice B reason: Presbyopia blurs near vision from lens stiffness, not central loss. This age-related change affects focus, not macular function, making it unrelated to the specific central vision impairment the client reports fully and accurately here.
Choice C reason: Macular degeneration degrades central vision via retinal damage, common in older adults. This matches the client’s loss, as the macula processes sharp central sight, making it the likely suspect for this visual complaint comprehensively here.
Choice D reason: Cataracts cause diffuse blurriness, not isolated central loss. Lens opacity scatters light broadly, differing from macular-specific damage, rendering this less likely than macular degeneration for the client’s central vision issue fully here.