NUR 4135 PrepU Chapter 20

Which cranial nerve is designated as the vestibulocochlear nerve? Cranial nerve III Cranial nerve IV Cranial nerve VI Cranial nerve VIII

Cranial nerve VIII Explanation: The vestibulocochlear nerve is cranial nerve VIII.

The nurse is teaching a client who has tinnitus about suggested dietary modifications. The most important information for the nurse to include would be: "There are no dietary restrictions that you have to follow." "You can drink one serving of caffeine a day and one cola." "Cut down on takeout meals because of high amounts of monosodium glutamate." "Increase intake of red wine to two glasses per day twice a week."

"Cut down on takeout meals because of high amounts of monosodium glutamate." Explanation: Tinnitus can be caused by some cheeses, red wine, monosodium glutamate, and caffeine. These items should be reduced in the diet to help control the symptom.

The educator of a geriatric unit is orienting new staff and is teaching strategies on communicating with older adults with impaired hearing. Which teaching point is most appropriate? "Choose simple, short words to minimize confusion." "Ensure that the hearing aid is in place, turned on, and properly functioning." "Increase the volume of your speech as much as possible." "Avoid complex or abstract ideas when you are talking."

"Ensure that the hearing aid is in place, turned on, and properly functioning." Explanation: Slow, direct speech is a useful communication technique when dealing with clients who are hard of hearing. The most effective treatment is hearing amplification with hearing aids, lip-reading, and assistive listening devices. One should ensure that this equipment is turned on and functioning properly. It is not necessary to avoid complex ideas or always utilize short, simple vocabulary, since hearing deficits are not synonymous with cognitive deficits. Speaking too loudly is counterproductive.

The nurse is teaching a teenaged client strategies to avoid recurrent ear infections. The nurse understands that further teaching is required when the client states: "I'll wear ear plugs each time I swim." "I will take my allergy medication as it has been prescribed." "I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming." "I will use the eardrops as prescribed for me."

"I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming." Explanation: Otitis externa treatment usually includes the use of eardrops containing an appropriate antimicrobial or antifungal agent. Use of ear plugs is recommended to prevent moisture. Cotton-tipped applicators and other devices should be avoided.

A client with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond? "Unfortunately there aren't any proven treatments for your condition." "Although they involve some risks, there are some options for ear surgery that can prevent future vertigo." "We usually don't actively treat BPPV unless it starts to affect your hearing." "There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo."

"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." Explanation: Nondrug therapies for BPPV using habituation exercises and canalith repositioning are successful in many people. Canalith repositioning involves a series of maneuvers in which the head is moved to different positions in an effort to reposition the free-floating debris in the endolymph of the semicircular canals. Surgery is not a noted treatment option and even in the absence of hearing loss, treatment is warranted.

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?" "Have you had any recent respiratory infections?" "Do you use Q-tips in your ears?' "How often do you clean your ears?"

"What prescription medication and over-the-counter medication do you take?" Explanation: 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.

The nurse is caring for a client who reports, "My ears are constantly ringing!" The nurse will evaluate the client further for the use of which medication? Acetylsalicylic acid (aspirin) Vitamin C Potassium chloride Acetaminophen

Acetylsalicylic acid (aspirin) Explanation: Several classes of drugs have been identified as having ototoxic potential, including aminoglycosides, antimalarials, some chemotherapeutic drugs, loop diuretics (e.g., furosemide [Lasix]), and salicylates (e.g., aspirin). This hearing loss is considered sensorineural and my be temporary or permanent. Acetaminophen, potassium, and vitamin C are not associated with ototoxicity.

A 72-year-old client admitted with congestive heart failure tells the nurse that lately he has been having difficulty hearing in the left ear. Which intervention should the nurse implement? Refer the client to an audiologist Assess client for signs and symptoms of a stroke Assess for build up of cerumen Assess the client for signs and symptoms of digoxin toxicity

Assess for build up of cerumen Explanation: The nurse should assess the client for cerumen buildup in the left ear. This is commonly seen in the older adult and can impair hearing due to atrophy of cerumen glands and the production of drier cerumen.

A 26-year-old client who has recently traveled by airplane complains of pain in his right ear. The nurse suspects which condition? Barotrauma Otitis externa Cerumen accumulation Otitis media

Barotrauma Explanation: Considering the client's age and recent air travel, a likely diagnosis would be barotrauma. The other options are not affected by age and changes in pressure experienced during air travel.

The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to: Conduction disorder Sensorineural disorder Mixed sensorineural and conduction disorder Infection

Conduction disorder Explanation: Impacted earwax is one cause for conductive hearing loss. It is not a cause of the other answer choices.

The nurse is educating a client diagnosed with Meniere disease on lifestyle modifications to reduce the frequency and/or intensity of exacerbations. Which should the nurse include? Decrease dietary intake of fats Avoid acetaminophen Decrease dietary intake of sodium Avoid crowds to reduce infection

Decrease dietary intake of sodium Explanation: A lifestyle change that would be recommended for a client with Meniere disease is to consume a low sodium diet, related to the medication treatment (diuretics). The other modifications are not relevant to Meniere disease.

The nurse is caring for a client who has been diagnosed with presbycusis. The nurse understands that with this disorder, the client experiences which of the following? Difficulty hearing high-pitched frequencies Chronic ear drainage Fluid in the inner ear without infection Severe pain in the mastoid area

Difficulty hearing high-pitched frequencies Explanation: Presbycusis is used to describe degenerative hearing loss that occurs with advancing age. It is characterized by high-frequency hearing loss.

While performing a Romberg test on a client, the client asks, "What is the purpose of this test?" Which response by the nurse is most accurate? It assesses for static vestibular function. It assesses for transient ischemic attacks. It assesses for conductive hearing loss. It assesses for neurologic weakness.

It assesses for static vestibular function. Explanation: The Romberg test is used to demonstrate disorders of static vestibular function. It is done by having a person stand with his or her feet together and arms extended forward so that the degree of sway and arm stability can be observed.

Select the statement that best describes Meniere disease. A) Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear; the client will be asymptomatic. B) Meniere disease is a bacterial infection of the outer inner ear due to distention of the endolymphatic compartment. C) 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. D) Meniere disease is a disorder of the middle ear due to constriction of the endolymphatic compartment of the inner ear, causing hearing loss.

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

A client reports feeling like the room is spinning around him when standing still. Which diagnosis is this client likely experiencing? Nystagmus Subjective vertigo Syncopal episodes Objective vertigo

Objective vertigo Explanation: Objective vertigo is the sensation of the person being stationary and the environment in motion. Subjective vertigo is a sensation of a person who may be in motion and the environment stationary. Nystagmus refers to the involuntary rhythmic and oscillatory eye movements that preserve eye fixation on stable objects in the visual field during angular and rotational movements of the head. Syncope is "fainting."

Conductive hearing loss can occur for a variety of reasons, including foreign bodies in the ear canal, damage to the ear drum, or disease. What disease is associated with conductive hearing loss?

Paget disease Explanation: More permanent causes of hearing loss are thickening or damage of the tympanic membrane or involvement of the bony structures (ossicles and oval window) of the middle ear due to otosclerosis or Paget disease. Huntington, Alzheimer, and Parkinson diseases are not associated with conductive hearing loss.

The nurse is conducting the Rinne test. What is included in this test? Placing a vibrating tuning fork on the client's mastoid bone and in front of the ear in an alternating fashion Irrigating the ear with ice water Delivering pure tones of controlled intensity to one ear at a time Placing a vibrating tuning fork on the client's forehead

Placing a vibrating tuning fork on the client's mastoid bone and in front of the ear in an alternating fashion Explanation: The Rinne test compares air and bone conduction. The test is done by alternately placing the tuning fork on the mastoid bone and in front of the ear canal. In conductive losses, bone conduction exceeds air conduction. In sensorineural losses, the opposite occurs.

The nurse is caring for a client who has been diagnosed with Meniere disease. The nurse expects which medication will be prescribed to manage the symptoms? Promethazine Clopidogrel Chlorpropamide Pantoprazole

Promethazine Explanation: Pharmacologic management includes suppressant drugs such as promethazine. The other medications are not used to treat Meniere disease.

Presbycusis is degenerative hearing loss associated with aging. What is the first symptom of this disorder? Reduction in ability to understand speech Reduction in ability to identify sounds Inability to detect sound Inability to localize sounds

Reduction in ability to understand speech Explanation: The disorder first reduces the ability to understand speech and, later, the ability to detect, identify, and localize sounds.

A client expresses concern about feeling fullness in the ear. Which additional manifestation leads the health care provider to suspect Menière disease? Nausea and vomiting Otalgia and recurrent otitis media Rotary vertigo and tinnitus Progressive hearing loss and frequent falls

Rotary vertigo and tinnitus Explanation: Menière disease is characterized by fluctuating episodes of tinnitus, feelings of ear fullness, and violent rotary vertigo (room spinning) that often renders the person unable to sit or walk. Nausea and vomiting, hearing loss, and falls may accompany the disease, but these signs and symptoms are less definitive than frequent episodes of rotary vertigo accompanied by tinnitus.

The nurse is caring for an older adult client with a suspected diagnosis of presbycusis. Select the most likely manifestation. Buzzing or ringing in the ears Feeling a continuous drainage coming from both ears Sensorineural hearing loss caused by natural aging Feeling of continuous pressure in both ears

Sensorineural hearing loss caused by natural aging Explanation: Presbycusis is a common report among older adults. It is manifested by the inability to hear what is being said in a conversation. Pressure may result from increased fluid, and buzzing or ringing may be a complication of medication.

The nurse observes nystagmus in a client sitting quietly without head movement. The nurse interprets this finding in which way? This is a common finding in older adult clients. This is an emergency finding that requires immediate intervention. This is a pathological finding. This is a normal variation in all people.

This is a pathological finding. Explanation: Spontaneous nystagmus that occurs without head movement or visual stimuli is always pathologic and requires investigation, but is not an emergency situation.

A client with otosclerosis had a stapedectomy with reconstruction using a prosthesis. What is an expected outcome? The client is able to hear quiet sounds from a distance. The client states that tinnitus has increased in volume. The client speaks softly because his/her own voice is too loud. The client experiences exacerbation of vertigo.

The client is able to hear quiet sounds from a distance. Explanation: Clients with otosclerosis tend to speak softly as the conduction of sound through bone remains intact while nerve conduction of sound decreases. Otosclerosis can place pressure on the vestibulocochlear nerve, creating tinnitus, vertigo, and sensorineural hearing loss. A positive outcome of the surgery would be improved hearing as a result of conduction of sound transmitted via the restored stapes to the tympanic membrane.

The nurse is preparing a pediatric client for insertion of a tympanostomy tube. The nurse will give which instruction to the parents postprocedure? No special precautions are needed. The child should not ride in an airplane for at least 6 weeks. The ears must be kept out of water. The child should not be exposed to loud noises.

The ears must be kept out of water. Explanation: Tympanostomy tube insertion is a surgical procedure used to treat otitis media (OM). The ears of children with tubes must be kept out of water.

It is important to differentiate between the kinds of hearing loss so they can be appropriately treated. What is used to test between conductive and sensorineural hearing loss? Tone analysis Tuning fork Audiometer Audioscope

Tuning fork Explanation: Tuning forks are used to differentiate conductive and sensorineural hearing loss. Audioscope, audiometer, and tone analysis do not differentiate between conductive and sensorineural hearing loss.

A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be: Monitoring for complications of OM The child will need a hearing aid. Re-treating with a stronger antibiotic Tympanostomy tube insertion

Tympanostomy tube insertion Explanation: Tympanostomy tubes should be the next course of action with the child having hearing loss and OM persisting for 4 months or longer. The parents should be taught to continue to monitor for signs of OM.

A client is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is: Tympanic membrane Vestibular apparatus Malleus Cochlea

Vestibular apparatus Explanation: The vestibular system maintains and assists recovery of stable body and head position and balance through control of postural reflexes. The vestibular system includes the three semicircular canals.

The nurse is assisting a client who is undergoing the Romberg test. The nurse understands that the client will be asked to: keep the arms at the sides of the body. close the eyes. touch the nose with one finger. stand with feet broadly apart.

close the eyes. Explanation: The Romberg test is used to demonstrate disorders of static vestibular function. The person being tested is requested to stand with feet together and arms extended forward so that the degree of sway and arm stability can be observed. The person then is asked to close his eyes. When visual clues are removed, postural stability is based on proprioceptive sensation from the joints, muscles, and tendons and from static vestibular reception. Deficiency in vestibular static input is indicated by greatly increased sway and a tendency for the arms to drift toward the side of deficiency.

A client's chart documents the finding of cholesteatoma. The nurse interprets this to mean that the client has: build-up of cerumen. cystlike mass in the middle ear. pain in the middle ear. drainage from the ear.

cystlike mass in the middle ear. Explanation: Cholesteatoma is a cystlike mass of the middle ear that often extends to involve the temporal bone.

The nurse understands that movement of otoliths may result in: vertigo and nystagmus. inability to hear high-pitched frequencies. permanent hearing loss. severe otalgia.

vertigo and nystagmus. Explanation: Movement of the otoliths or free-floating debris causes the vestibular system to become more sensitive, such that any movement of the head in the plane parallel to the posterior duct may cause vertigo and nystagmus.

The nurse is conducting a community education class on acute otitis media. Which statement by the participants indicates to the nurse that they understand the education? It is another name for swimmer's ear. Breast-fed babies have a higher incidence of this condition. The tympanic membrane appears cloudy. It can be caused by a bacterial infection.

It can be caused by a bacterial infection. Explanation: The nurse determines that the participants understand the information when they state that acute otitis media can be caused by a bacterial infection. Breast-fed babies have a lower incidence of acute otitis media. The tympanic membrane appears cloudy in otitis media with effusions. Acute otitis media is not another name for swimmer's ear.

On the first obstetric clinic visit, which client is at risk for delivering a child with sensorineural hearing loss? Select all that apply. - woman with a history of renal disease who regularly takes furosemide, a loop diuretic to control blood pressure - woman who is a business executive and regularly works 10 to 12 hours/day - woman who is an athlete and regularly receives traumatic kicks to the torso and abdomen during soccer matches - woman who works as a nurse on a busy intensive care unit where exposed to numerous infections - woman working in an industrial factory where exposed to toluene, a solvent in paints, and styrene in manufacturing plastics

- woman working in an industrial factory where exposed to toluene, a solvent in paints, and styrene in manufacturing plastics - woman with a history of renal disease who regularly takes furosemide, a loop diuretic to control blood pressure - woman who is an athlete and regularly receives traumatic kicks to the torso and abdomen during soccer matches Explanation: Early in pregnancy, the embryo is particularly sensitive to toxic substances, including ototoxic drugs such as the aminoglycosides and loop diuretics. Trauma, particularly head trauma, may also cause sensorineural hearing loss. Toluene and styrene are the most widely and extensively used aromatic solvents in industry and can cause ototoxicity. Toluene is a major component of adhesives, paints, lacquers, varnishes, printing inks, degreasers, fuel additives, glues and thinners, whereas styrene is present when manufacturing plastics, rubber articles, and glass fibers. The businesswoman working long hours is at no greater risk than any pregnant female. Nurses are exposed to numerous infections, but standard precautions recommended by the CDC provides good protection.

While on an ocean cruise, a person develops malaise and nausea/vomiting. The nurse notes the client's blood pressure is 88/52 mm Hg; pulse is 110 bpm; and skin is moist with perspiration. Which diagnosis is associated with these clinical manifestations? Motion sickness Syncope Light-headedness Dizziness

Motion sickness Explanation: Motion sickness is a form of normal physiologic vertigo. It is caused by repeated rhythmic stimulation of the vestibular system, such as that encountered in boat travel. Malaise, nausea, and vomiting are the principal symptoms. Autonomic signs, including lowered blood pressure, tachycardia, and excessive sweating, may occur. Vertigo can result from peripheral or central vestibular disorders (proprioception) unrelated to hearing loss. Vertigo is a vestibular disorder in which a unique illusion of motion occurs. Persons with vertigo frequently describe it as a sensation of spinning or tumbling, a "to-and-fro" motion, or falling forward or backward. Light-headedness, faintness, and unsteadiness are different in that the person perceives weakness yet still has a sense of balance. Syncope (loss of consciousness) is not directly associated with the sensation of vertigo. An inability to maintain normal gait may be described as dizziness despite the absence of objective vertigo.

A client, who travels frequently for work, reports intense ear pain during ascent from and descent into airports. The health care provider will recommend which category of medications to help alleviate this symptom? antihistamine nasal spray such as olopatadine intranasal steroid such as fluticasone propionate decongestant nasal spray such as phenylephrine oral corticosteroid, such as prednisone

decongestant nasal spray such as phenylephrine Explanation: Barotrauma most often occurs in people who travel while suffering from an upper respiratory tract infection. Decongestants, such as nose drops or nasal sprays, may be used 30 to 60 minutes prior to ascent or descent to reduce congestion and open the eustachian tubes. Steroids are not recommended for barotrauma. They are helpful for inflammation and nasal polyps. Antihistamines are helpful for tinnitus and vertigo.