The nurse is evaluating a client's hearing who reports hearing best in the left ear although words are muffled during conversation at a social gathering. Based on this finding, which assessment should the nurse implement?

Rationale: A. Inspect the external ear canals: Muffled hearing, especially if unilateral, may be due to cerumen impaction, swelling, or other obstructions in the external auditory canal. Visual inspection is a quick, non-invasive first step that can help identify mechanical causes of hearing difficulty before pursuing more complex diagnostic tests. B. Ask client if he has tinnitus: Tinnitus refers to ringing or buzzing in the ears and is often associated with sensorineural hearing loss rather than conductive hearing loss, which is more likely when hearing is muffled. While relevant for a full hearing evaluation, it does not address the immediate symptom of muffled hearing. C. Determine ability to maintain balance with eyes closed: Balance issues are more related to inner ear dysfunction, particularly involving the vestibular system. Since the client's primary complaint is muffled hearing and not dizziness or balance problems, this assessment is not the most appropriate first step. D. Differentiate ability to hear high and low pitched sounds: Differentiating pitch perception helps assess for specific types of sensorineural hearing loss. However, before conducting specialized auditory discrimination tests, it is more appropriate to first check for any external, easily correctable issues such as blockage or infection.