The nurse is doing an intake history on a 30-year-old with bilateral progressive hearing loss. Which finding in the client's history is significant? A. The client had several bouts of otitis media as an infant. B. The client has a history of "ribbon bones" that repeatedly fractured. C. The client had hypertrophied tonsils that necessitated their removal. D. The client has problems of otitis externa that were caused by swimming.

The main issue in this exercise is to identify which factor in the client's medical history could be the most significant concerning their progressive hearing loss. It is important to have a basic understanding of the potential causes of hearing loss and analyze each option in terms of its relevance to the problem.

Now, let's analyze each option and determine its relevance to the problem: A. Otitis media is an infection of the middle ear and can cause temporary or permanent hearing loss. It is important to consider this factor as a possible cause of the hearing loss. B. Ribbon bones repeatedly fracturing might indicate an underlying medical condition, but it is not directly related to the ears and hearing loss. Thus, it is less likely to be the most significant finding regarding the hearing loss. C. Hypertrophied tonsils might cause breathing or swallowing problems, but it is not directly related to the ears and hearing loss. This factor is also less likely to be the most significant finding. D. Otitis externa is an infection of the external ear canal, typically caused by water and bacteria getting trapped in the ear. Although it could cause temporary hearing loss, it is less likely to cause progressive bilateral hearing loss.

After analyzing all available options, it seems that option A (multiple bouts of otitis media as an infant) is the most relevant finding to the client's progressive hearing loss. This is because otitis media has a direct impact on the ears and can potentially cause permanent hearing loss or contribute to its progression.

The nurse should consider the client's history of multiple bouts of otitis media during infancy as the most significant finding for their progressive hearing loss. This is because otitis media, particularly when it occurs multiple times, can cause damage to the middle ear structures responsible for sound conduction, leading to permanent hearing loss. The other factors may have some relationship to the client's overall health, but they are not directly linked to hearing loss as in the case of otitis media.