# A nurse is caring for a 65-year-old client with sensorineural hearing loss. Which nursing intervention is most appropriate to facilitate effective communication with this client?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541654  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a 65-year-old client with sensorineural hearing loss. Which nursing intervention is most appropriate to facilitate effective communication with this client?

## 보기

1. Speak loudly and slowly while facing away from the client
2. Use exaggerated lip movements and speak in a high-pitched voice
3. Face the client directly, speak clearly at normal volume, and reduce background noise **✔ 정답**
4. Write all communication on paper to avoid verbal interaction

**정답: 3**

## 해설

Face the client directly, speak clearly at normal volume, and reduce background noise to maximize residual hearing and lip-reading. Other options (speaking loudly away, exaggerated lip movements, or writing only) are ineffective or inappropriate for sensorineural hearing loss.

## 심화 해설

Understanding Sensorineural Hearing Loss

In sensorineural hearing loss (SNHL), damage occurs in the inner ear (cochlea) or along the vestibulocochlear nerve pathway. Unlike conductive hearing loss, where sound transmission is mechanically blocked, SNHL distorts sound perception. For a 65-year-old client, this distortion means that simply increasing volume is ineffective and often painful. The primary communication barrier is not just loudness, but clarity, especially in the presence of competing sounds. Research confirms that older adults with sensory impairment, including hearing loss, face substantial challenges in managing health information, which makes accurate communication a safety priority [1].

Analyzing the Correct Intervention

The most appropriate strategy is to face the client directly, speak clearly at normal volume, and reduce background noise. This approach addresses the core pathophysiology of SNHL by maximizing the signal-to-noise ratio. Speaking at a normal volume prevents sound distortion in the damaged cochlea, while facing the client provides visual cues like lip-reading and facial expression that supplement auditory input. Critically, reducing background noise eliminates competing auditory stimuli that the impaired ear cannot filter out. A systematic review on hearing aid users—a population that mirrors those with SNHL—highlights that even with amplification, supplementary environmental and communication strategies are necessary to improve outcomes [2]. For a client who may not use or fully benefit from a hearing aid, these behavioral modifications by the nurse are fundamental to effective interaction.

Why the Other Options are Incorrect

- Option 1 (Speak loudly while facing away): Shouting into a damaged cochlea causes sound distortion and discomfort, a phenomenon known as recruitment. Facing away removes all visual cues, which are essential for a person with SNHL to interpret distorted speech sounds.

- Option 2 (Exaggerated lip movements and high-pitched voice): Exaggerated lip movements distort normal speech patterns and make lip-reading more difficult. A high-pitched voice is particularly problematic because presbycusis, the most common form of SNHL in older adults, typically causes high-frequency hearing loss first. Raising the pitch targets the frequencies the client is least able to hear.

- Option 4 (Write all communication): While writing is a valid supportive tool, relying on it exclusively for all interactions is impractical, undermines the client’s remaining hearing ability, and can negatively impact psychosocial well-being. Evidence syntheses emphasize that interventions should aim to enhance quality of life, not simply replace one communication modality with a more restrictive one [2].References (research sources)

- [1]A scoping review of guidelines and resources to promote evidence based prescribing for older people with sensory impairment.GuidelineMorrison BC, Asante E, Lennon MR, Watson MC. (2025) · DOI: 10.1017/s1463423625100613

- [2]Additional interventions for enhancing the quality-of-life of older adults using hearing aids: a systematic review and narrative synthesis.Meta-analysis/systematic reviewKang M, Han Y, Kim H. (2026) · DOI: 10.1007/s11136-026-04219-7

## 임상 시나리오

Communicating with SNHL ClientsMaximizing Clarity, Not Just Volume
In sensorineural hearing loss, the primary deficit is sound distortion, not just loudness. Damaged cochlear hair cells cannot process amplified sound clearly, often making shouting painful and unintelligible.

Always face the client directly at eye level, 3-6 feet away. Speak at a normal, even volume with clear articulation. This provides essential visual cues for lip-reading and facial expression.

Critically reduce background noise (television, hallway chatter, equipment alarms). A high signal-to-noise ratio is essential because the impaired ear cannot filter competing sounds effectively.

CautionDo not use exaggerated lip movements or high-pitched voices; these distort visual cues and are often inaudible in age-related presbycusis. Verify understanding with teach-back, not just a nod.

## 핵심 개념

- **Sensorineural Hearing Loss (SNHL)** — Damage to the inner ear or auditory nerve causing distorted, unclear sound perception, not just reduced volume.
- **Signal-to-Noise Ratio** — The level of a desired signal (speech) compared to background noise; a higher ratio improves speech understanding.
- **Presbycusis** — Age-related sensorineural hearing loss, typically bilateral, affecting high-frequency sounds and speech clarity.
- **Aural Rehabilitation** — Strategies including communication tips, environmental modifications, and assistive devices to optimize residual hearing.
- **Lip-reading** — A visual communication technique relying on observing lip, facial, and tongue movements to supplement auditory input.

## 같은 주제 문제

- [A nurse is assessing a 65-year-old client who reports gradual hearing loss over the past 2…](https://mymerci.kr/pages/nclex_q.php?qn_id=541649)
- [A nurse is assessing a 65-year-old client who reports gradual hearing loss over the past s…](https://mymerci.kr/pages/nclex_q.php?qn_id=541650)
- [A nurse is assessing a 60-year-old client who reports gradual hearing loss over the past 2…](https://mymerci.kr/pages/nclex_q.php?qn_id=541651)
- [A 65-year-old client with sensorineural hearing loss is being discharged from the hospital…](https://mymerci.kr/pages/nclex_q.php?qn_id=541652)
- [A nurse is caring for a client with sensorineural hearing loss. Which intervention should …](https://mymerci.kr/pages/nclex_q.php?qn_id=541653)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._