# Situation: The nurse holds health teaching sessions at a barangay senior citizens' center. Several participants have hearing or vision problems, and one woman from an indigenous community speaks only her own language. Several participants have hearing loss. Which way of speaking should the nurse use during the session?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627195  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The nurse holds health teaching sessions at a barangay senior citizens' center. Several participants have hearing or vision problems, and one woman from an indigenous community speaks only her own language.

Several participants have hearing loss. Which way of speaking should the nurse use during the session?

## 보기

1. Speak louder and in a higher pitch so that every word is heard
2. Speak at a normal pace and repeat each sentence twice
3. Speak at a normal pitch while moving around among the participants
4. Face the participants and speak slowly in a lower pitch **✔ 정답**

**정답: 4**

## 해설

In age-related hearing loss, high-pitched sounds are lost first, so a lower pitch is heard better. Facing the listeners allows lip-reading and the use of facial cues, and slow speech helps processing. The nurse should also reduce background noise and use good lighting.

## 심화 해설

Clinical context

This question reflects a common community-health scenario: a nurse providing group education to older adults, some of whom have age-related hearing loss (ARHL). The central task is selecting a communication strategy that maximizes speech understanding without shouting or distorting sound.

Why option 4 is correct

In age-related hearing loss, the cochlear hair cells responsible for detecting high-frequency sounds deteriorate first. This means consonants such as /s/, /f/, /t/, and /sh/ become difficult to distinguish, while lower-frequency vowel sounds are relatively preserved. Speaking in a lower pitch places more speech energy in the frequency range the older ear can still access, improving clarity. Facing the participants supports speechreading through lip movements, facial expression, and gesture, which supplements degraded auditory input. A slower rate gives the listener more time to process what was heard and to fill in missed sounds from context .

For ARHL, the combination of face-to-face positioning, slower speech, and a lower-pitched voice is the most effective verbal communication strategy. The nurse should also minimize background noise and ensure the speaker’s face is well lit, because visual cues become more important as hearing declines .

Why the other options are less effective

Option 1 is incorrect because raising pitch pushes speech further into the high-frequency range that is already impaired in ARHL. Shouting also distorts the acoustic signal and can make speechreading harder because the mouth shape changes. Option 2 is only partially helpful: repeating sentences twice can aid comprehension, but a normal pace may still be too fast for older adults with slower auditory processing. Option 3 includes a useful element—moving among participants—but speaking at a normal pitch does not address the high-frequency loss, and moving around can reduce the visibility of the speaker’s face for lip-reading.

| Strategy | Effect on older adults with hearing loss | Appropriateness |
| --- | --- | --- |
| Louder and higher pitch | Emphasizes high-frequency sounds that are already lost; distorts speech | Not recommended |
| Normal pace, repeat twice | Repetition helps, but processing speed may still be insufficient | Partially helpful |
| Normal pitch while moving around | Does not compensate for high-frequency loss; reduces lip-reading access | Less effective |
| Face participants, slow and lower pitch | Preserves accessible frequencies; improves visual cues and processing time | Best choice |

Pathophysiology link

ARHL, or presbycusis, typically begins with high-frequency sensorineural loss caused by degeneration of outer hair cells in the basal turn of the cochlea. Because speech understanding depends heavily on high-frequency consonants, older adults often report that they can hear that someone is speaking but cannot understand the words. Lowering vocal pitch shifts the signal toward the apical, lower-frequency region of the cochlea, where function is better preserved .

Practical communication adjustments

Beyond pitch and pace, the nurse can improve comprehension by reducing environmental noise, using a clear but not exaggerated speaking style, and pausing between phrases rather than shouting. In group settings, seating participants close to the speaker and checking that hearing aids are functioning also improves accessibility. Training programs for staff in long-term care have shown that these communication techniques can be taught and sustained, and that staff often underestimate how much hearing loss affects participation .

Key point! High-frequency loss is the hallmark of age-related hearing loss, so a lower pitch is more intelligible than a higher pitch. Watch out! Speaking louder does not compensate for frequency loss and may make speech harder to understand by distorting the signal and reducing visual cues.

## 임상 시나리오

Communication with Older Adults with Hearing LossFace, slow down, and lower pitch for clearer speech
In age-related hearing loss, high-frequency sounds are lost first, so use a lower pitch rather than a higher one. Face the person directly to support lip-reading and speak at a slightly slower rate to improve processing.

Reduce background noise and ensure good lighting on the speaker's face. Visual cues such as facial expression and gestures become more important as hearing declines.

CautionDo not shout or raise pitch; this distorts speech and shifts sound into the frequency range that is already impaired in age-related hearing loss.

## 핵심 개념

- **Presbycusis** — Age-related sensorineural hearing loss in which high-frequency sounds are typically lost first, making lower-pitched speech clearer.
- **Speechreading** — Use of lip movements, facial expressions, and gestures to supplement auditory information during communication.
- **Cochlear hair cells** — Sensory cells in the inner ear; damage to those detecting high-frequency sounds contributes to age-related hearing loss.
- **Background noise reduction** — Minimizing competing sounds to improve the signal-to-noise ratio for older adults with hearing loss.
- **Low-frequency sounds** — Lower-pitched sounds that are relatively preserved in age-related hearing loss and easier for older adults to hear.

## 같은 주제 문제

- [Situation: A public health nurse at a Rural Health Unit (RHU) in an agricultural municipal…](https://mymerci.kr/pages/nclex_q.php?qn_id=627015)
- [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).The nu…](https://mymerci.kr/pages/nclex_q.php?qn_id=627057)
- [Situation: The public health nurse at a Rural Health Unit (RHU) is planning a series of he…](https://mymerci.kr/pages/nclex_q.php?qn_id=627095)
- [Situation: The public health nurse at a Rural Health Unit (RHU) is planning a series of he…](https://mymerci.kr/pages/nclex_q.php?qn_id=627096)
- [Situation: The public health nurse at a Rural Health Unit (RHU) is planning a series of he…](https://mymerci.kr/pages/nclex_q.php?qn_id=627097)
- [Situation: The public health nurse at a Rural Health Unit (RHU) is planning a series of he…](https://mymerci.kr/pages/nclex_q.php?qn_id=627098)
- [Situation: A nurse at a Barangay Health Station (BHS) runs a monthly health teaching class…](https://mymerci.kr/pages/nclex_q.php?qn_id=627099)
- [Situation: A nurse at a Barangay Health Station (BHS) runs a monthly health teaching class…](https://mymerci.kr/pages/nclex_q.php?qn_id=627100)

---

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

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