Patho Ch 20 Hearing/Vestibular Function
The nurse is performing a health history for a 72-year-old client. When reviewing the client's medications, the client states, "I take a baby aspirin every day, but I'm worried. I heard that aspirin can cause hearing problems!" What is an appropriate response by the nurse? "The benefits of baby aspirin outweigh the risk." "If your doctor ordered you to take it, I'm sure he has considered that." "Perhaps a better alternative would be Plavix [clopidogrel]." "A baby aspirin is a low dose that is considered to be safe."
"A baby aspirin is a low dose that is considered to be safe." Explanation: A frequently overlooked ototoxic agent is aspirin. Little is known about what level of dosage causes ototoxicity, but it is generally believed that 81 mg of aspirin on a daily basis is safe.
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.
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 media Otitis externa Cerumen accumulation
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 assessing a client's risk for sensorineural hearing loss. Which condition or situation places the client at greatest risk? Chronic noise exposure Impacted earwax Otitis media Nystagmus
Chronic noise exposure Explanation: Chronic exposure to noise is a risk factor for sensorineural hearing losss. Impacted earwax and otitis media are risk factors for conductive hearing loss.
A client who has just been admitted to the hospital with heart failure and pulmonary edema begins complaining of dizziness and tinnitus while the nurse is administering IV furosemide via bolus. How can the nurse minimize the risk of ototoxicity during future administration of this medication? Discontinue the furosemide immediately. Administer meclizine with the furosemide. Reduce the concentration and administer slower. Administer the furosemide in the evening.
Reduce the concentration and administer slower. Explanation: Dizziness and tinnitus are symptoms of ototoxicity affecting the vestibule and may also include sensorineural hearing loss, which may be transient or permanent. Several medications can cause ototoxicity, and furosemide is one of them. The ototoxicity can be avoided by decreasing the amount of drug in the bloodstream at any given time; that can be accomplished by slowing the infusion rate. This client has pulmonary edema which can be life-threatening; therefore, discontinuing the furosemide could cause harm to the client. The time the medication is administered is not the problem in this situation; giving furosemide in the evening is not recommended if avoidable. Administering meclizine is not addressing the problem, which is ototoxicity.
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? "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." "Unfortunately there aren't any proven treatments for your condition." "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
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? Breast-fed babies have a higher incidence of this condition. The tympanic membrane appears cloudy. It can be caused by a bacterial infection. It is another name for swimmer's ear.
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.
Acoustic neuroma tumors affect cranial nerve VIII and are made up of which type of cells?? Schwann cells Inner ear Labyrinth Organ of Corti
Schwann cells Explanation: Acoustic neuromas are benign Schwann cell tumors affecting cranial nerve VIII.
The nurse understands that an antimicrobial drug is most likely to be prescribed for which condition? Acute otitis media Otosclerosis Otitis media with effusion Barotrauma SUBMIT ANSWER
Acute otitis media Explanation: Otitis media with effusion does not usually require treatment with antimicrobial agents; however, acute otitis media is treated with antimicrobials. Barotrauma and otosclerosis are not treated with antimicrobials.
A 2-year-old child has been diagnosed with uncomplicated acute otitis media by a nurse practitioner. When explaining the plan of care, which description is most appropriate? "Rinsing out his ears two or three times a day will actually be more effective than antibiotics." "Let's keep a close eye on his condition for a couple of days before starting antibiotics." "I'll give you a prescription for two different antibiotics and a decongestant." "I'll prescribe an antiviral medication and it's important that he finish the whole course."
"Let's keep a close eye on his condition for a couple of days before starting antibiotics." Explanation: Observation without antimicrobial agents is an option in a child over 6 months of age with uncomplicated AOM. These approaches involve waiting for 24 hours to 72 hours (greater than 6 months of age) to see if symptoms improve before institution of antibiotic therapy. Antiviral medications and decongestants are ineffective and rinsing of the ears is not curative.
The nurse is caring for a client diagnosed with a cholesteatoma. The nurse understands that the etiology of this condition may be which of the following? Select all that apply. A congenital condition A diet high in cholesterol A complication of otitis media Chronic inflammation with eardrum perforation
A congenital condition A complication of otitis media Chronic inflammation with eardrum perforation Explanation: Cholesteatomas are cystlike lesions of the middle ear, usually associated with chronic otitis media, which can be congenital or acquired. Although precise mechanisms involved in their development are unclear, it is proposed that chronic inflammation and perforation of the ear drum with ingrowth of squamous epithelium or metaplasia of the secretory epithelium of the middle ear are contributing factors.
The nurse is inspecting the tympanic membrane with the use of an otoscope. What would the nurse expect to see in a normal ear? Presence of an air-fluid level or bubble A small, whitish cord at the upper edge of the tympanic membrane Absence of mobility of the tympanic membrane Opacification of the tympanic membrane
A small, whitish cord at the upper edge of the tympanic membrane Explanation: When viewed through an otoscope, the tympanic membrane appears as a a shallow, oval cone pointing inward toward its apex. The tympanic membrane is semitransparent, and a small, whitish cord, which traverses the middle ear from back to front, can be seen just under its upper edge. Opacification of the tympanic membrane is indicative of an abnormality. Limited or absent mobility of the tympanic membrane and presence of an air-fluid level or bubble may indicate otitis media with effusion.
The nurse is caring for a pediatric client whose parent reports that the child has been pulling at her ears, has a fever, and has been crying more than usual. The nurse suspects the client may be experiencing which of the following? Otitis externa Acute otitis media Impacted cerumen Acute vestibular neuronitis
Acute otitis media Explanation: Acute otitis media is characterized by the following key criteria: acute onset of otalgia (or pulling of the ears in an infant), fever, hearing loss, evidence of middle ear inflammation, and middle ear effusion.
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 Mixed sensorineural and conduction disorder Infection Sensorineural disorder
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? Avoid crowds to reduce infection Decrease dietary intake of fats Decrease dietary intake of sodium Avoid acetaminophen
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? Fluid in the inner ear without infection Severe pain in the mastoid area Difficulty hearing high-pitched frequencies Chronic ear drainage
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.
Which nursing intervention is the highest priority intervention for a nurse caring for a 26-year-old client diagnosed with benign paroxysmal positional vertigo? Fall precautions Skin assessment Weber test Administer ordered antibiotic
Fall precautions Explanation: The client with benign paroxysmal positional vertigo (BPPV) experiences brief periods of vertigo when getting in and out of bed, bending over and straightening up, and extending head to look up. This places the client at increased risk for falls and necessitates implementation of fall precautions. The Weber test and administration of an antibiotic are not indicated when caring for a client with BPPV. Skin assessment, while always a part of the nursing assessment, has a lower priority than implementation of safety measures for this client.
What is the major cause of sensorineural hearing loss in children? Genetic causes Foreign bodies Paget disease Otosclerosis
Genetic causes Explanation: Causes of sensorineural hearing impairment include genetic, infectious (most common infectious cause is cytomegalovirus (CMV), traumatic, and ototoxic factors). Genetic causes are probably responsible for as much as 50% of sensorineural hearing loss in children. Foreign bodies, including pieces of cotton and insects, may impair hearing and result in conductive hearing loss.
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? Chlorpropamide Clopidogrel Pantoprazole Promethazine
Promethazine Explanation: Pharmacologic management includes suppressant drugs such as promethazine. The other medications are not used to treat Meniere disease.
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? Parkinson disease Paget disease Huntington disease Alzheimer disease
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? Irrigating the ear with ice water 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 Delivering pure tones of controlled intensity to one ear at a time
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 treating a client with a history of chronic alcohol abuse. The client's spouse tells the nurse that the client has no difficulty speaking and responds when spoken to but is having difficulty understanding what is being said. The spouse asks if the nurse believes the client needs a hearing aid. The nurse explains to the spouse that the client probably does not require a hearing aid but may be suffering from: Receptive aphasia Expressive aphasia Global aphasia Moderate hearing loss
Receptive aphasia Explanation: Chronic alcohol abuse causes damage to the Wernicke's area in the brain, which controls a person's ability to understand spoken language, and which is termed receptive aphasia. Clients who have receptive aphasia can speak without difficulty and hear words spoken, but cannot understand what is being said.
When a client reports that he feels like he is spinning but the room is stable, the nurse should document the finding as: Objective vertigo Subjective vertigo Fainting Blacking out
Subjective vertigo Explanation: The description of feeling like one is spinning but the room is stable is a common description of subjective vertigo. The description of the person remaining fixed and the environment spinning around is a common description of objective vertigo. The other options are characterized by losing consciousness.
The nurse is discussing measures that a client may take to prevent barotrauma related to airplane travel. Which measure will the nurse recommend during changes in air pressure? Cupping the ears with one's hands Forcefully coughing Mouth breathing Swallowing
Swallowing Explanation: Swallowing, yawning, and chewing gum are measures that open the Eustachian tube, which equalizes air pressure in the middle ear.
A young child is flying on a plane for the first time. As the plane begins its decent for landing, his ears begin to hurt. The flight attendant sees that he is in pain and tells him to swallow until the pain goes away. Which structure is the child using to equalize the pressure and relieve the pain? Swallowing pulls air through the eustachian tubes, allowing the air pressure to equalize in the inner ear. Movement of the temporomandibular joint forces air out of the inner ear. The auditory canal is being stretched by the distortion of the neck, which allows air pressure from the inner ear to equalize with the external pressure. Swallowing distracts the passenger until mechanisms in the inner ear can relax and change the air pressure.
Swallowing pulls air through the eustachian tubes, allowing the air pressure to equalize in the inner ear. Explanation: The Eustachian tube allows equalization of pressure between the middle ear and the atmosphere. The auditory canal and the temporomandibular joint have no effect on air pressure.
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? Tuning fork Audiometer Audioscope Tone analysis
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: The child will need a hearing aid. Monitoring for complications of OM Tympanostomy tube insertion Re-treating with a stronger antibiotic
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.
The nurse is preparing a client for a surgical procedure to create an endolymphatic shunt. The nurse understands that this procedure aims to relieve which symptom? Otalgia Diplopia Vertigo Strabismus
Vertigo Explanation: A surgical method to treat Meniere disease includes the creation of an endolymphatic shunt in which excess endolymph from the inner ear is diverted into the subarachnoid space or the mastoid area. This relieves symptoms associated with Meniere disease, such as vertigo. The other symptoms are not manifestations of Meniere disease.
A client is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is: Malleus Vestibular apparatus Tympanic membrane 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.
Although both vertigo and dizziness can result from peripheral or central vestibular disorders, vertigo is distinctly different because it causes: loss of consciousness. permanent hearing loss. light-headedness. an illusion of motion.
an illusion of motion. Explanation: Vertigo or dizziness 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.
The nurse is explaining to the parent of a 5-year-old that the child has otitis media with effusion (OME), noted by otoscopic exam, following an upper respiratory infection. Unlike acute otitis media (AOM), OME does not require treatment with antibiotics because it is usually: asymptomatic and requires the administration of antivirals. asymptomatic and often self-limiting. symptomatic and the tympanic membrane is blue. very symptomatic and requires immediate intervention.
asymptomatic and often self-limiting. Explanation: It is very important to distinguish appropriately AOM from OME to ensure the proper treatment and to avoid the unnecessary use of antimicrobials. AOM often presents with sudden onset of ear pain, fever, hearing loss, and middle ear infection, whereas OME often presents as an asymptomatic effusion of the middle ear.
A client's chart documents the finding of cholesteatoma. The nurse interprets this to mean that the client has: cystlike mass in the middle ear. pain in the middle ear. drainage from the ear. build-up of cerumen.
cystlike mass in the middle ear. Explanation: Cholesteatoma is a cystlike mass of the middle ear that often extends to involve the temporal bone.
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? oral corticosteroid, such as prednisone intranasal steroid such as fluticasone propionate decongestant nasal spary such as phenylephrine antihistamine nasal spray such as olopatadine
decongestant nasal spary 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.
The nurse understands that movement of otoliths may result in: permanent hearing loss. inability to hear high-pitched frequencies. vertigo and nystagmus. 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.