NU272 PrepU Week 1 (Hearing Impairment)

A client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?

"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days." - The nurse should instruct the client to avoid air travel, sudden movements that may cause trauma, and exposure to loud sounds and pressure changes (such as from high altitudes) for 30 days after a stapedectomy. Immediately after surgery, the client should lie flat with the surgical ear facing upward; nose blowing is permitted but should be done gently and on one side at a time. The client's first attempt at postoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness. The client must avoid shampooing and swimming to keep the dressing and the ear dry.

A client reports occasional ringing in the ears that worsens toward the end of the day. The most important question for the nurse to ask would be:

"What prescription medication and over-the-counter medication do you take?" - Medications and stimulants, such as aspirin, caffeine, and nicotine, can cause tinnitus. The client should be questioned to determine if this is a potential cause. Impacted cerumen is a benign cause of tinnitus, which resolves after the earwax is removed. Respiratory infections may cause fluid in the ears and decreased hearing.

A client who is taking salicylates comes to the emergency department for evaluation. What assessment findings should lead the nurse to suspect salicylate toxicity? Select all that apply.

- Respiratory rate of 38 breaths per minute - muscle spasms - agitation - tinnitus - diarrhea

A client reports a sudden onset of tinnitus, hearing loss, and vertigo. The nurse carefully reviews the client's medication list to determine whether the client is taking a medication that might cause ototoxicity. Which medications would the nurse be most concerned with? Select all that apply.

- aspirin - lasix - cisplatin

The nurse is teaching a class on diseases of the ear. What would the nurse teach the class is the most characteristic symptom of otosclerosis?

A progressive, bilateral loss of hearing - A progressive, bilateral loss of hearing is the characteristic symptom of otosclerosis. Tinnitus appears as the loss of hearing progresses; it is especially noticeable at night, when surroundings are quiet, and may be quite distressing to the client. The eardrum appears pinkish-orange from structural changes in the middle ear. The client often describes a history of having had a recent upper respiratory infection in case of otitis media, not otosclerosis.

You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis?

A progressive, bilateral loss of hearing - A progressive, bilateral loss of hearing is the characteristic symptom of otosclerosis. Tinnitus appears as the loss of hearing progresses; it is especially noticeable at night, when surroundings are quiet, and may be quite distressing to the client. The eardrum appears pinkish-orange from structural changes in the middle ear. The client often describes a history of having had a recent upper respiratory infection in case of otitis media, not otosclerosis.

The nurse is discussing communication options with the parents of a 2-year-old girl with congenital hearing loss. The nurse integrates knowledge of what form of communication as having no verbal component?

American Sign Language

High doses of which medication can produce bilateral tinnitus?

Aspirin - At high doses, aspirin toxicity can produce bilateral tinnitus. Meclizine and dimenhydrinate are used for nausea and vomiting related to motion sickness. Antiemetics, such as promethazine suppositories, help control nausea and vomiting and vertigo through an antihistamine effect.

A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication?

Assess how the client would like to communicate - Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important. For example, if a deaf client can read and write, writing can facilitate communication. If the client knows sign language, the nurse could use a person trained in sign language. Using hand gestures and exaggerated facial movements does not allow for adequate acquisition of knowledge.

A client has been prescribed primaquine to prevent a relapse of malaria and is nearing the end of the prescribed course of treatment. During the nurse's most recent assessment, the client reports "I'm feeling dizzy and nauseous a lot, with ringing in my ears." What is the nurse's best action?

Communicate these assessment findings to the provider promptly. - The combination of dizziness, tinnitus and nausea during primaquine treatment suggests cinchonism, which should be reported to the provider. The presence of tinnitus suggests adverse effects rather than a relapse. Adverse effects are not necessary worst near the end of treatment.

Select the statement that best describes Meniere disease.

Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing hearing loss, vertigo, and tinnitus.

The nurse is assessing the hearing of a 25-year-old client who reports chronic painless tinnitus and difficulty hearing. The nurse suspects the client may have which diagnosis?

Otosclerosis - Otosclerosis may begin at any time in life but usually does not appear until after puberty, most frequently between the ages of 20 and 30 years. The symptoms of otosclerosis involve an insidious hearing loss, tinnitus, and vertigo. Acute otitis media is characterized by otalgia, fever, hearing loss, and inflammation. Otitis media effusion is an accumulation of fluid in the middle ear without signs of infection. It may cause hearing loss. Mastoiditis can occur when tympanic membranes perforate.

A client is newly diagnosed with otitis externa. Which information should the nurse teach the client before the client leaves the clinic?

Proper instillation of prescribed ear drops - Otitis externa is usually treated with antimicrobial otic drops. The nurse should anticipate teaching the client how to instill the ear drops properly. Otitis externa is usually not treated with oral antibiotics because it is not a systemic issue. A cotton-tipped applicator should not be used in the ear canal because it can cause trauma, which may lead to otitis externa. Otitis externa may cause temporary conductive, not sensorineural, hearing loss.

A nurse is assessing a client who is reporting hearing loss. Which test will the nurse use to assess for sensorineural and conductive deafness?

Rinne test - The nurse will assess for hearing loss by using a tuning fork and the Rinne test. The Ishihara test assesses for color vision, the Snellen test for sight and the acetylcysteine tests for anosmia.

A client who is receiving primaquine comes to the clinic with nausea, vomiting, and vertigo. What other finding would the nurse expect to assess if the client was experiencing cinchonism?

Tinnitus - Cinchonism, due to high levels of primaquine, is manifested by nausea, vomiting, vertigo, and tinnitus. Fever, dyspepsia, and rash are adverse effects associated with antimalarial therapy; they are not associated with cinchonism.

During a pharmacology class, the students are told that some drugs need to be closely monitored. What aspect should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?

Tinnitus and sensorineural hearing loss - It is important that nurses are knowledgeable about the ototoxic effects of certain medications such as salicylates, loop diuretics, quinidine, quinine, and aminoglycosides. Signs and symptoms of ototoxicity include tinnitus and sensorineural hearing loss. Hypotension, reduced urinary output, and impaired facial movement are not signs of ototoxicity.

The nurse is triaging victims after an explosion at an oil refinery. One victim reports tinnitus, dizziness, and otorrhea. For what probable condition should the nurse prepare care?

Tympanic rupture

The nurse is talking with a patient diagnosed with Ménière's disease about the patient's symptoms. What symptom does the patient inform the nurse is the most troublesome?

Vertigo

Which manifestation is the most problematic for the client diagnosed with Ménière disease?

Vertigo

The nurse is caring for a child whose mother is deaf and untrusting of staff. She frequently cries at the bedside, but refuses intervention from the social worker or the chaplain. Which issue is most important for the nurse to address with the mother to promote a trusting relationship?

communication barriers between the mother and staff - The communication barrier is the most significant and would require immediate attention. Strategies need to be implemented that include taking the time to share information via the written word with all new members of the healthcare team and the mother. Fear, loss of control, and lack of knowledge about the illness of the child may contribute to the overall stress of the situation.

Screening for this most common birth defect is required by law in most states. Each nurse should know the law for his or her state and the requirements for screening. The nurse would expect a newborn to be screened for which defect as the most common?

hearing - Hearing loss is the most common birth defect in the United States: one in 1,000 newborns are profoundly deaf, and 3 in 1,000 have some degree of hearing impairment. Newborn hearing screening is required by law in most states. Vision, genetic-linked, and skeletal malformations are other forms of birth defects that can occur.

A client with a severe staphylococcal infection is receiving the aminoglycoside gentamicin sulfate by the I.V. route. The nurse should assess the client for which adverse reaction?

ototoxicity - The most significant adverse reactions to gentamicin and other aminoglycosides are ototoxicity (indicated by vertigo, tinnitus, and hearing loss) and nephrotoxicity (indicated by urinary cells or casts, oliguria, proteinuria, and reduced creatinine clearance). These adverse reactions are most common in elderly and dehydrated clients, those with renal impairment, and those receiving concomitant therapy with another potentially ototoxic or nephrotoxic drug. Gentamicin isn't associated with aplastic anemia, cardiac arrhythmias, or seizures.

A patient enters the emergency room with reports of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to:

salicylate intoxication. - Salicylate intoxication may occur with an acute overdose of aspirin. Manifestations of salicylism include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, hyperventilation, and others. Acute acetaminophen toxicity results in potentially fatal hepatotoxicity. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.

A client with hypertension comes to the outpatient department for a routine checkup. Because hypertension is a risk factor for cerebral hemorrhage, the nurse questions the client closely about warning signs and symptoms of hemorrhage. Which complaint is a possible indicator of cerebral hemorrhage in this client?

tinnitus - Tinnitus is commonly a warning sign of cerebral hemorrhage. Other warning signs include vomiting (without nausea), a change in level of consciousness, and localized seizures. Vertigo isn't a common indicator of cerebral hemorrhage.

The nurse is a conducting discharge teaching to a client prescribed an ototoxic medication. Which signs and/or symptoms will the nurse ask the client to report? Select all that apply.

tinnitus hearing loss dizziness light-headedness - Ototoxic medications can cause damage to the inner ear structures leading to both cochlear and vestibular symptoms. The cochlear symptoms include tinnitus and hearing loss. Vestibular symptoms include dizziness or light-headedness.