When performing the Rinne test for hearing acuity, what action should the nurse take?

In the Rinne test, the nurse assesses a patient's hearing by comparing air conduction to bone conduction of sound. To perform the test correctly, it is essential to first strike a tuning fork to get it vibrating and then place it against the mastoid bone behind one ear. Once the patient can no longer hear the sound through bone conduction, the nurse will then position the vibrating prongs in front of the ear canal. This allows the nurse to compare how long the patient can hear the sound through air conduction versus bone conduction.

The correct action involves moving the vibrating tuning fork prongs in front of the client's ear canal after testing the bone conduction behind the ear. This method effectively assesses hearing acuity and helps in identifying any hearing loss, guiding further diagnostic steps if necessary.

In contrast, placing the tuning fork on the patient's forehead assesses hearing through the Weber test, which evaluates lateralization of sound rather than air versus bone conduction. Asking the client to cover one ear does not provide the necessary comparative data for the Rinne test. Using a standard whistle to test sound does not adhere to the specific protocols established for the Rinne test, which requires the use of a tuning fork to accurately assess the conduction pathways of sound.