# A nurse is caring for a client with conductive hearing loss caused by otosclerosis. Which nursing intervention should be the priority when communicating with this client?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541647  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a client with conductive hearing loss caused by otosclerosis. Which nursing intervention should be the priority when communicating with this client?

## 보기

1. Face the client directly and speak clearly at a normal volume **✔ 정답**
2. Speak loudly and use exaggerated lip movements
3. Use only written communication to avoid confusion
4. Stand behind the client when speaking to reduce distractions

**정답: 1**

## 해설

For conductive hearing loss, facing the client directly and speaking clearly at normal volume is priority to utilize visual cues and clear articulation. Other options may distort communication or be less effective.

## 심화 해설

Clinical Judgment
This question addresses the Core Concept of effective communication with a patient who has conductive hearing loss. The key is Clinical Judgment in selecting the appropriate intervention based on the type of hearing loss. Otosclerosis is a classic cause of conductive hearing loss, where the stapes bone in the middle ear becomes fixed, hindering sound transmission. Unlike sensorineural hearing loss, a patient with conductive hearing loss has a relatively preserved ability for the brain to process sound, provided the sound reaches the inner ear. Therefore, the core principles are to transmit sound clearly and maximize visual cues. The Critical Cue is the word "Conductive." This signifies a problem with 'transmission,' so methods that deliver sound clearly without distortion take priority.

Memory Tip: Think of **F**ace, **C**learly, **N**ormal (**FCN**) to remember the communication principles for conductive hearing loss. **F**ace the client, speak **C**learly, at a **N**ormal volume.

KR vs US: The principles of communicating with a hearing-impaired patient are essentially the same in both Korea and the US. However, the US NCLEX tends to place greater emphasis on patient-centered communication, maintaining dignity, and selecting interventions based on scientific pathophysiology. Speaking at a "normal volume" is presented as a standard intervention grounded in physiological rationale (overly loud speech distorts sound waves), transcending cultural dimensions.

## 임상 시나리오

Clinical Practice Guide
When communicating with a patient with conductive hearing loss:
1. Create a quiet environment.
2. Face the patient at the same eye level, at a distance of 1-2 meters.
3. Be careful not to cover your mouth.
4. Speak at a normal speed and volume, with clear but not exaggerated pronunciation.
5. If necessary, repeat key words or rephrase using simple sentences.

Caution: In SATA (Select All That Apply) questions, physical contact such as "approaching the patient and tapping their shoulder" may be appropriate as a way to initiate communication, but it can be a trap when paired with clearly inappropriate options like "standing behind the patient and speaking." Always approach within the patient's field of vision and in a respectful manner.

## 핵심 개념

- **Conductive Hearing Loss** — Conductive hearing loss. Hearing loss caused by sound not being efficiently transmitted to the inner ear due to problems in the outer or middle ear. The main characteristic is a reduction in sound volume (loudness), and when clearly amplified, comprehension is relatively good.
- **Otosclerosis** — Otosclerosis. A condition where abnormal bone growth occurs in the middle ear cavity, particularly fixing the stapes so it cannot vibrate normally. It is a common cause of conductive hearing loss.
- **Sensorineural Hearing Loss** — Sensorineural hearing loss. Hearing loss caused by damage to the inner ear (cochlea) or auditory nerve. Along with sound volume, clarity (discrimination) also decreases, so even when sounds are louder, speech may be heard as distorted.
- **Speech Reading (Lip Reading)** — Lip reading. A technique for understanding speech by observing the speaker's lip movements, facial expressions, and gestures. It is a very useful aid for patients with conductive hearing loss.
- **Stapes** — Stapes. One of the three small bones (ossicles) in the middle ear, which transmits vibrations from the eardrum to the inner ear. In otosclerosis, this bone becomes fixed.

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