# Situation: A 70-year-old retired factory worker is admitted to the medical ward with pneumonia and is started on intravenous gentamicin. His daughter says his hearing has worsened over several years, especially in noisy rooms. Which approach should the nurse use when giving him instructions?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630543  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 70-year-old retired factory worker is admitted to the medical ward with pneumonia and is started on intravenous gentamicin. His daughter says his hearing has worsened over several years, especially in noisy rooms.

Which approach should the nurse use when giving him instructions?

## 보기

1. Face him in good light and speak loudly at a higher pitch
2. Stand at his better ear and speak slowly at a lower pitch
3. Face him in good light and repeat the same words slowly
4. Face him in good light and speak slowly at a lower pitch **✔ 정답**

**정답: 4**

## 해설

Age-related hearing loss affects high frequencies first, so speech sounds mumbled, especially in noise. The nurse gets his attention, faces him in good light with the mouth visible, reduces background noise, speaks slowly and clearly at a lower pitch without shouting, rephrases when needed and confirms understanding.

## 심화 해설

Age-related hearing loss and speech
The client is 70 years old, his hearing has worsened gradually over several years, and he struggles especially in noisy rooms. This is the typical pattern of presbycusis, age-related sensorineural hearing loss. Presbycusis affects the high frequencies first. Many consonant sounds such as s, f, th, and sh are high-pitched, while vowels are lower. When consonants are lost, speech sounds loud enough but mumbled and unclear, and background noise makes it worse. His history as a factory worker may also include noise exposure, which damages the same high-frequency range.

Why facing him and speaking low and slow works
Facing him in good light lets him see the lips and facial expression, so he can lip-read and use visual cues to fill in missing sounds. Speaking slowly and clearly gives him time to process each word. A lower pitch places the voice in the range he still hears best. The nurse also gets his attention before speaking, reduces background noise such as the television, speaks at a normal or slightly raised volume without shouting, rephrases a sentence he does not understand, and confirms understanding with teach-back. Written instructions help for important information such as medication schedules.

| Approach | Helpful? | Reason |
| --- | --- | --- |
| Face him in good light | Yes | Allows lip-reading |
| Slow, clear speech at a lower pitch | Yes | Matches high-frequency loss |
| Loud, high-pitched speech | No | Distorts sound; in the range he hears worst |
| Speaking at his side | No | Hides the mouth |
| Repeating the same words | Less effective | Rephrasing uses sounds he may hear better |

Why the distractors fall short
Facing him is right in the first option, but shouting distorts speech and raising the pitch moves the voice into the range he hears worst. Standing at his better ear and using a lower pitch helps sound reach him, but he loses the visual information from the mouth. Facing him and repeating the same words slowly is close, but if he missed a word because of its consonants, saying it again will often fail; rephrasing with different words works better.

Why it matters here
He has pneumonia and is starting intravenous gentamicin, an ototoxic drug. Clear communication is needed for safe teaching, and he will need to report any new ear symptoms. A baseline understanding of his hearing helps the nurse notice changes during therapy.

Exam takeaway
Key point For presbycusis: face the client, good light, slow, clear, lower-pitched speech, no shouting, rephrase, and check understanding.

## 임상 시나리오

Talking With an Older Adult Who Has PresbycusisCommunication for high-frequency loss
Presbycusis affects high frequencies first, so speech sounds mumbled, especially in noise.

Face him in good light, get his attention, reduce background noise, and speak slowly and clearly at a lower pitch without shouting.

Rephrase when he does not understand, confirm with teach-back, and give written instructions for key information.

CautionHe is starting gentamicin, an ototoxic drug. Establish a baseline and ask about new ringing, fullness, or dizziness during therapy.

## 핵심 개념

- **Presbycusis** — Gradual, age-related sensorineural hearing loss that affects high frequencies first.
- **Sensorineural hearing loss** — Hearing loss from damage to the inner ear or auditory nerve.
- **Lip-reading** — Understanding speech by watching the movements of the speaker's lips and face.
- **Teach-back** — A method in which the client repeats information in his own words to confirm understanding.

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