# Situation: The occupational health nurse of a furniture factory with 300 workers on day and night shifts is asked to start a health education program on noise and hearing protection. What should the nurse do FIRST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627295  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The occupational health nurse of a furniture factory with 300 workers on day and night shifts is asked to start a health education program on noise and hearing protection.

What should the nurse do FIRST?

## 보기

1. Schedule a lecture on noise-induced hearing loss for each shift
2. Survey the workers on the health topics they would like to learn
3. Walk through the work areas to identify noise sources and exposures **✔ 정답**
4. Distribute leaflets on the correct use of earplugs and earmuffs

**정답: 3**

## 해설

Health education starts with assessment, and for a workplace program the first step is to analyze the work environment and job hazards: where noise is produced, who is exposed, and for how long. A survey of preferred topics shows the learners' wants but not the hazards; lectures and leaflets are implementation and come after assessment and planning.

## 심화 해설

Clinical reasoning The question asks for the FIRST action, which places this squarely in the assessment phase of the nursing process. Before planning any lecture, survey, or leaflet distribution, the nurse must identify what the actual hazards are. In occupational health, this means a walk-through survey of the work environment.

Health education is not a standalone activity; it follows the same sequence as clinical care: assess first, then plan, then implement. The correct first step is to walk through the work areas to identify noise sources and exposures. This allows the nurse to see where machinery operates, which workers are nearby, and how long exposure lasts during a shift.

Watch out! Option 2, surveying workers about their preferred topics, sounds learner-centered but captures perceived wants, not actual hazards. A worker may not know that a particular machine exceeds safe noise limits. Options 1 and 4 are implementation strategies that cannot be appropriately selected until the assessment identifies the specific noise risks.

| Option | Nursing process phase | Why it is not first |
| --- | --- | --- |
| 1. Schedule a lecture | Implementation | Content must be based on assessed hazards; premature without data |
| 2. Survey workers on topics | Assessment of learner preference | Shows wants, not actual noise exposure or risk |
| 3. Walk through work areas | Assessment of environment and hazards | Correct first step; identifies noise sources, exposed workers, and duration |
| 4. Distribute leaflets | Implementation | Assumes earplugs or earmuffs are the right intervention before hazards are known |

The Cochrane reviews on preventing occupational noise-induced hearing loss support this reasoning indirectly. They evaluate hearing loss prevention programs (HLPP) as packages that include noise monitoring, engineering controls, and personal protective equipment [2]. However, the reviews consistently note that the quality of evidence is low to very low, meaning that simply handing out earplugs or giving a lecture has not been proven effective on its own [1][2][3]. Effective prevention begins with understanding the specific exposure, which is exactly what a walk-through assessment provides.

From a licensure exam perspective, any question that asks what to do FIRST in a community or occupational setting is testing whether you can resist jumping to action. Key point! The nursing process always starts with assessment, and in workplace health, the environment is a primary assessment target. A walk-through identifies not only noise sources but also workers who may need targeted follow-up, such as those on the night shift who may have different exposure patterns than day-shift workers.References (research sources)

- [1]Interventions to prevent occupational noise-induced hearing loss.Research articleTikka C, Verbeek JH, Kateman E, Morata TC, Dreschler WA, Ferrite S (2017) · DOI: 10.1002/14651858.CD006396.pub4

- [2]Interventions to prevent occupational noise-induced hearing loss: a Cochrane systematic review.Meta-analysis/systematic reviewVerbeek JH, Kateman E, Morata TC, Dreschler WA, Mischke C (2014) · DOI: 10.3109/14992027.2013.857436

- [3]Interventions to prevent occupational noise-induced hearing loss.Research articleVerbeek JH, Kateman E, Morata TC, Dreschler WA, Mischke C (2012) · DOI: 10.1002/14651858.CD006396.pub3

## 임상 시나리오

Occupational Noise Education: First StepAssess the work environment before any teaching or handout
Begin with a walk-through survey of all work areas to identify noise sources, which workers are exposed, and the duration of exposure per shift.

Use the nursing process: assessment comes before planning and implementation. Lectures, surveys, and leaflets are later steps that depend on the hazards found.

CautionA worker preference survey shows perceived wants, not actual risk. Do not distribute earplugs or schedule lectures until the specific noise hazards and exposed workers are identified.

## 핵심 개념

- **Walk-through survey** — A direct inspection of the work environment to identify hazards, exposed workers, and exposure duration.
- **Nursing process** — A systematic sequence of assessment, planning, implementation, and evaluation guiding nursing actions.
- **Noise-induced hearing loss** — Permanent sensorineural hearing damage caused by prolonged or repeated exposure to high noise levels.
- **Occupational health education** — Planned teaching based on workplace hazard assessment to prevent work-related injury or illness.

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