# A nurse is preparing a client for a Weber test. Which instruction should the nurse provide to the client? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541639 > language: ko > subject: Adult Health ## 문제 A nurse is preparing a client for a Weber test. Which instruction should the nurse provide to the client? ## 보기 1. Indicate when you hear the sound and identify which ear hears it louder **✔ 정답** 2. Raise your hand when you can no longer hear the tuning fork 3. Tell me when the sound changes from loud to soft 4. Point to the ear that feels the vibration first **정답: 1** ## 해설 The Weber test assesses bone conduction by placing a tuning fork on the skull midline. The client should indicate when they hear the sound and which ear hears it louder to differentiate conductive or sensorineural hearing loss. Other instructions are for different hearing tests. ## 심화 해설 Understanding the Weber Test The Weber test is a quick, bedside hearing assessment using a vibrating tuning fork placed on the midline of the skull. It helps differentiate between conductive hearing loss and sensorineural hearing loss in one ear. The test relies on a principle called lateralization, where the sound is perceived louder in the ear with better bone conduction. In a normal ear or with symmetrical hearing, the sound is heard equally in both ears or "in the middle of the head." [1] Analyzing the Correct Instruction The correct answer is to instruct the client to "Indicate when you hear the sound and identify which ear hears it louder." This instruction directly assesses lateralization, which is the core diagnostic purpose of the Weber test. The nurse needs to know two things: first, that the client perceives the sound, and second, where the sound localizes. This is a standard, validated approach used in clinical practice and research. For example, a recent study on the diagnostic accuracy of the tuning fork Weber test in school-aged children described the procedure as placing the vibrating tuning fork on the forehead and asking the child to report which ear the sound was heard in. [1] Similarly, a prospective study on the smartphone Weber test instructed participants to indicate whether the sound was heard in the right ear, left ear, or the middle. [2] Why Other Options Are Incorrect - **Option 2: "Raise your hand when you can no longer hear the tuning fork."** This instruction is for the Rinne test, not the Weber test. The Rinne test compares air conduction (AC) to bone conduction (BC) by placing the tuning fork on the mastoid bone and then next to the ear canal, asking the client to signal when the sound disappears. - **Option 3: "Tell me when the sound changes from loud to soft."** This is not a standardized instruction for any specific tuning fork test. The Weber test is a qualitative assessment of lateralization, not a measure of the sound's intensity change over time. - **Option 4: "Point to the ear that feels the vibration first."** The Weber test assesses the perception of *sound*, not the tactile sensation of vibration. Asking about "feeling" the vibration would introduce a confounding variable and does not measure auditory lateralization, which is the objective of the test. Clinical Application and Pathophysiology The nurse's instruction is critical for obtaining accurate results. If a client has conductive hearing loss (e.g., from cerumen impaction or otitis media), the sound will lateralize to the poorer-hearing ear. This occurs because the conductive deficit blocks ambient room noise, making the bone-conducted signal from the tuning fork seem louder in that ear. Conversely, in sensorineural hearing loss (e.g., from inner ear or auditory nerve damage), the sound lateralizes to the better-hearing ear because the affected cochlea or nerve cannot process the signal effectively. The nurse must ensure the client understands the task of comparing loudness between the ears, as the accuracy of the test depends on the client's ability to comprehend and report this lateralization. [1]References (research sources) - [1]Diagnostic accuracy of tuning fork weber test and audiometric weber test in school-aged children with conductive hearing loss.Research articlePeng TS, Nik Othman NA, Zakaria MN, Nik Hassan NFH. (2026) · DOI: 10.1007/s00405-026-10325-6 - [2]A Prospective Study on the Diagnostic Accuracy of the Smartphone Weber Test in Unilateral Hearing Loss.Research articleYalçıner B, Kıraç NA, Büyükkoç O, Yalçıner G, Babademez MA. (2026) · DOI: 10.1159/000551906 ## 임상 시나리오 Weber Test ProcedureAssessing Sound Lateralization Place a vibrating 512-Hz tuning fork firmly on the midline of the patient's forehead or vertex. Instruct the patient to report which ear hears the sound louder or if it is heard equally in both ears. In conductive hearing loss, sound lateralizes to the poorer ear. In sensorineural hearing loss, sound lateralizes to the better ear. CautionDo not confuse with the Rinne test, which compares air and bone conduction by placing the fork on the mastoid process and then near the ear canal. ## 핵심 개념 - **Weber Test** — A test that evaluates which ear hears a sound transmitted through bone conduction louder (lateralization) by placing a tuning fork on the midline of the skull, to differentiate between types of hearing loss (conductive/sensorineural). - **Conductive Hearing Loss (전음성 난청)** — Hearing loss caused by problems in the ear canal, eardrum, or middle ear (ossicles) that disrupt air conduction. During the Weber test, the sound lateralizes to the affected ear. - **Sensorineural Hearing Loss (감각신경성 난청)** — Sensorineural hearing loss caused by damage to the cochlear organ of Corti, the auditory nerve, or the auditory pathways in the brainstem. On the Weber test, the sound lateralizes to the normal ear. - **Lateralization (편측화)** — A phenomenon in the Weber test where sound is perceived as louder in one ear. The direction of this phenomenon serves as a key clue for determining the type of hearing loss. - **Tuning Fork (소리굽쇠)** — A metal tool primarily used in hearing tests (Weber, Rinne). It is used to assess bone conduction by vibrating at a standard frequency (512Hz). ## 같은 주제 문제 - [A nurse is preparing a client for a Weber test. Which instruction should the nurse provide…](https://mymerci.kr/pages/nclex_q.php?qn_id=541638) - [A nurse is preparing a client for a tympanometry test. Which instruction should the nurse …](https://mymerci.kr/pages/nclex_q.php?qn_id=541640) - [A nurse is preparing a client for a tympanometry test to evaluate middle ear function. Whi…](https://mymerci.kr/pages/nclex_q.php?qn_id=541641) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._