A 65-year-old client with presbycusis is being discharged from the hospital. Which safety instruction is most important for the nurse to emphasize?

1 Use bright lighting in all rooms to compensate for visual changes
2 Take medications only during daytime hours when family is present
3 Avoid using the telephone unless absolutely necessary
4 Install visual alert systems for smoke detectors and doorbells ✓ 정답

해설

Clients with presbycusis cannot hear high-frequency safety alerts like smoke alarms or doorbells, making visual alert systems the most critical safety instruction. Other options address visual changes, medication timing, or telephone use, which are less directly related to compensating for hearing loss.

같은 주제 다음 문제A 75-year-old client visits the clinic complaining of difficulty hearing conversations, es…

심화 해설

Understanding Presbycusis and Safety Risks

Presbycusis is a progressive, bilateral, sensorineural hearing loss associated with aging. It primarily affects the ability to perceive high-frequency sounds, which are critical for understanding speech and, importantly, for detecting environmental warning signals. The systematic review by Almutairi et al. highlights that this condition is substantially under-managed despite significantly impacting communication and quality of life ^[1]. For a client being discharged, the most immediate safety threat is the inability to hear alarms and alerts that signal danger, such as a smoke detector or a doorbell.

Analysis of the Correct Answer

The correct instruction is to install visual alert systems for smoke detectors and doorbells (Option 4). Standard auditory alarms operate at frequencies and volumes that are often precisely within the range lost in presbycusis. A client with this condition may not hear a smoke detector during sleep or a doorbell while awake, creating a critical safety risk for fire and delayed emergency response. Replacing or supplementing auditory signals with visual ones, such as flashing strobe lights, directly compensates for the sensory deficit. This intervention aligns with the review's emphasis on managing the functional impact of hearing loss in primary care and community settings to maintain safety and independence ^[1].

Why Other Options Are Incorrect

Option 1: Using bright lighting compensates for visual, not auditory, deficits. While important for clients with visual impairments like presbyopia, it does not address the specific safety risk of missed auditory alarms caused by presbycusis. This reflects a different, albeit common, age-related change.

Option 2: Timing medications only when family is present is restrictive and does not address a safety risk directly linked to the pathophysiology of hearing loss. Medication management strategies should be based on cognitive or physical limitations, not solely on hearing status. This instruction is not supported as a primary safety intervention for presbycusis.

Option 3: Avoiding telephone use promotes social isolation and is counterproductive. The review notes that hearing loss already impacts communication and quality of life ^[1]. The nursing goal is to enhance communication through assistive devices (e.g., amplified phones, captioned telephones), not to restrict it. This option represents a maladaptive coping strategy.

Clinical Reasoning and NCLEX Application

This question tests the nurse's ability to prioritize safety interventions based on the specific sensory deficit. The clinical reasoning process involves matching the deficit (high-frequency hearing loss) with the highest-risk scenario (missing an emergency alarm) and then selecting an intervention that directly mitigates that risk (visual alerting system). The evidence underscores that effective management of presbycusis must address its functional consequences to prevent harm ^[1]. The nurse's discharge planning must ensure the home environment is adapted to the client's sensory capabilities, making the installation of visual alerts a non-negotiable safety measure.

References (research sources)

[1]
Primary Care Screening and Management of Hearing Loss in Older Adults: A Systematic Review.Meta-analysis/systematic reviewAlmutairi LB, Ayoub AY, Nahari YY, Alameer HM, Alqesair MH, Alghamdi AS, Alalawi HA, Alhajji RK, Alfaya RF, Mawkili MH. (2026) · DOI: 10.7759/cureus.108230

임상 시나리오

Presbycusis Discharge SafetyPrioritizing Visual Alert Systems

The most critical safety risk for a client with presbycusis is the inability to hear high-frequency environmental alarms. Standard smoke detectors and doorbells often fall within the lost hearing range.

Nurses must emphasize installing visual alert systems, such as flashing strobe lights, to replace or supplement auditory signals. This directly compensates for the sensory deficit and ensures safety during sleep or when alone.

Caution

Do not rely solely on amplifying sound. Many clients with presbycusis cannot perceive high-frequency tones regardless of volume. A combined visual and low-frequency auditory approach is safest.

핵심 개념

Presbycusis — Progressive, bilateral, sensorineural hearing loss associated with aging, primarily affecting high-frequency sound perception.
Sensorineural hearing loss — Hearing loss resulting from damage to the inner ear (cochlea) or the nerve pathways to the brain.
Visual alert systems — Safety devices that use flashing lights or strobes to signal events like smoke alarms or doorbells for individuals with hearing loss.

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A 65-year-old client with presbycusis is being discharged from the hospital. Which safety instruction is most important for the nurse to emphasize?

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핵심 개념

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