Prep U pathopharmacology

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 will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming."

An adult client has presented to the emergency department reporting symptoms of vertigo. Further assessment reveals that the client is ataxic and has facial weakness. The care team should consider which possible cause of this client's health problem?

Brain stem ischemia

For which type of hearing loss should the nurse assess in a child who has had recurrent otitis media since birth?

Conductive loss

The nurse understands that vestibular rehabilitation includes:

exercises in balance retraining.

The nurse is teaching a client who has tinnitus about suggested dietary modifications. The most important information for the nurse to include would be:

"Cut down on takeout meals because of high amounts of monosodium glutamate."

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?

"Ensure that the hearing aid is in place, turned on, and properly functioning."

An adult client has undergone testing for otosclerosis. Which interview question is most appropriate to the pathophysiology of this disease?

"Has anyone else in your family been diagnosed with this disease?"

Otitis externa is an inflammation of the outer ear. What fungi cause otitis externa?

Aspergillus

What is the nursing focus when the nurse performs a hearing test on a newborn infant?

Preventing developmental delays

Acoustic neuroma tumors affect cranial nerve VIII and are made up of which type of cells?

Schwann cells

A client has been diagnosed with sensorineural hearing loss. What should the care team assess to determine a plausible cause?

The client's recent medication use

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?

"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo."

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?"

A new mother brings her infant to the clinic reporting that the child is not sleeping or eating much. Upon assessment, the health care provider notes that the infant's ear canal is reddened with a bulging tympanic membrane. Which other data collected would lead to the diagnosis of acute otitis media (AOM)? Select all that apply.

"Yes, he has been pulling at his ear." "He's been very irritable and fussy the past couple of days."

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)

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?

Acute otitis media

The nurse understands that an antimicrobial drug is most likely to be prescribed for which condition?

Acute otitis media

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?

Assess for build up of 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

Which interventions will the nurse reinforce when preparing to discharge a client being treated for Ménière's disease?

Compliance with prescribed prednisone therapy

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

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

The nurse is conducting a Weber test on a client diagnosed with a conductive hearing loss. The nurse anticipates that the client will report that the sound has what qualities?

Is louder on the side with the 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.

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 can be caused by a bacterial infection.

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 caring for a client undergoing hyperbaric oxygen therapy to promote wound healing. The nurse understands that the client may experience which condition related to this treatment?

Middle ear barotrauma

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

A 38-year-old client who has begun to develop hearing loss is being evaluated by the nurse practitioner. The client tells the nurse that hearing improves when she is on the telephone and that chewing sounds very loud. What does the nurse practitioner suspect?

Otosclerosis

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

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

The nurse is evaluating a client's hearing using the Weber test. Which explanation about this test should be included during this examination?

Placing a vibrating tuning fork on the forehead or vortex of the head

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

Presbycusis is degenerative hearing loss associated with aging. What is the first symptom of this disorder?

Reduction in ability to understand speech

Which diagnostic test results indicate a client has a vestibular disturbance?

Romberg test response shows increased swaying with arm drift to one side.

A client expresses concern about feeling fullness in the ear. Which additional manifestation leads the health care provider to suspect Ménière disease?

Rotary vertigo and tinnitus

Acoustic neuroma tumors affect cranial nerve VIII and are made up of which type of cells??

Schwann cells

A client with rheumatoid arthritis has taken high doses of aspirin for several years. Which type of hearing loss is this client at high-risk of developing due to ototoxicity?

Sensorineural hearing loss

The nurse is assessing a steel mill worker who suffers from hearing loss related to exposure to loud, occupational noise. The nurse understands that this type of hearing loss is classified as which of the following?

Sensorineural hearing loss

Hearing loss in older adults occurs at various rates in different people. Which sign in the older adult is indicative of hearing impairment?

Speech discrimination is difficult

When a client reports that he feels like he is spinning but the room is stable, the nurse should document the finding as:

Subjective vertigo

The nurse is preparing a pediatric client for insertion of a tympanostomy tube. The nurse will give which instruction to the parents postprocedure?

The ears must be kept out of water.

The nurse observes nystagmus in a client sitting quietly without head movement. The nurse interprets this finding in which way?

This is a pathological finding.

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

An 18-month-old has been diagnosed with acute otitis media (AOM) and the parents are confused as to why the health care provider (HCP) has not prescribed antibiotics. How should the nurse respond to the parents' question about this treatment decision?

Waiting 2 or 3 days in uncomplicated AOM and observing for improvement is accepted practice.

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?

decongestant nasal spary such as phenylephrine

The nurse is caring for a client who is hearing impaired. The nurse understands that effective communication with the client includes:

facing the client so that the client can visualize the lips.

A nurse is caring for a client in the medical intensive care unit who suffered a massive cerebral hemorrhage and has been comatose for the past week. The family has decided that the client should not be resuscitated and would like the client taken off the ventilator. The nurse prepares for an electronystagmography (ENG) with caloric stimulation to be done to determine brain death and knows that the presence of nystagmus lasting 2-3 minutes indicates:

function in the vestibulocochlear and oculomotor nerves.

The nurse is caring for a client diagnosed with labrynthitis. The nurse explains that manifestations of this disorder are generally expected:

to resolve in 10 to 14 days.

The nurse understands that movement of otoliths may result in:

vertigo and nystagmus.

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

A client tells the nurse that he has hearing loss due to otosclerosis. The nurse realizes that the client has which of the following?

Conductive hearing loss

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 sodium

The nurse is describing to a new mother the health screening actions that will be performed on her infant. The client states, "I'm sure my baby's exhausted. I'd prefer to do this in a few weeks." What rationale for early hearing testing should the nurse describe?

"If there is a hearing problem, it can be addressed right away before your baby starts to adapt to it."

Frustrated by her worsening tinnitus, a 55-year-old female client has sought care. Which teaching point should the clinician provide with regard to tinnitus?

"Initially, there are some changes in your diet that you should implement."

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?

"Let's keep a close eye on his condition for a couple of days before starting antibiotics."

Which hearing test would be prescribed to help differentiate conductive from sensorineural hearing loss?

A Weber (tuning fork) test

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?

A baby aspirin is a low dose that is considered to be safe."

The nurse is developing a plan of care for a 65-year-old client who has significant hearing loss. The nurse will include which suggestions that can assist this older adult with hearing loss? Select all that apply.

Being evaluated for hearing aids/devices Investigating TV stations with closed captioning available Flashing alarms instead of high-frequency warning sounds

The nurse suggests which action to a mother who is taking her 2-month-old infant on an airplane ride?

Breast-feed or bottle feed the infant during the airplane's ascent or descent.

Which cranial nerve is designated as the vestibulocochlear nerve?

Cranial nerve VIII

The nursing handoff report includes that a client has presbycusis. Which intervention should the nurse include in the plan of care?

Face the client when speaking

A nurse caring for a client in the hospital with new onset of Ménière disease reviews the treatment options with the client. Which medication will the nurse teach the client about to decrease the volume of endolymph?

Furosemide

What is the major cause of sensorineural hearing loss in children?

Genetic causes

The nurse is assisting with a client who is undergoing caloric testing. The nurse expects which action will be needed to complete the test?

Have ice water available.

The nurse who works at a clinic for pediatric clients observes that a frequent reason for client visits is acute otitis media (AOM). The nurse understands that which structural characteristic of the ear in infants and children increases the potential for AOM?

Less efficient tensor muscle to open the Eustachian tube

A client reports feeling like the room is spinning around him when standing still. Which diagnosis is this client likely experiencing?

Objective vertigo

The nurse is providing education to a client with otosclerosis. Which statement by the client would cause the nurse to decide that the client needs further education?

Otosclerosis usually appears prior to puberty.

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

The nurse is caring for a client who has suffered a stroke affecting the Wernicke area. The nurse expects the client to exhibit:

Receptive aphasia

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

A nurse is working with a 76-year-old client with a hearing deficit. Which interventions can facilitate communication with this client? Select all that apply.

Speaking slowly Facing the client when speaking Using a lower tone of voice

Otosclerosis is a condition where spongy, pathologic bone grows around the stapes and oval window. Which surgical treatment may be performed for otosclerosis?

Stapedectomy

A nurse working in a clinic performs screening tests for hearing loss. Which result indicates the client has hearing loss?

The client heard bone conduction longer than air conduction in the Rinne test.

Which condition or situation is a risk factor for the development of acute otitis media in a child?

Upper respiratory infection

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?

Vertigo

A client is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is:

Vestibular apparatus

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 often self-limiting.

The nurse is examining a pediatric client who reports ear pain. As the nurse inserts the otoscope, the child begins to cough and gag. The nurse understands that this behavior is most likely related to:

stimulation of the vagus nerve.

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 complication of otitis media Chronic inflammation with eardrum perforation

The nurse is inspecting the tympanic membrane with the use of an otoscope. What would the nurse expect to see in a normal ear?

A small, whitish cord at the upper edge of the tympanic membrane

To diagnose a vestibular disorder, which test would be used that assesses the eye movements in response to vestibular, visual, and positional stimulation?

Electronystagmography

A client has been diagnosed with conductive hearing loss. Which issue can cause this type of hearing loss?

Excess middle ear wax

The parents of a 1-month-old child are concerned because the child does not always look toward them when they speak. What assessment does the nurse expect the provider to conduct?

Hearing screening

The nurse is making a plan of care for a client in the initial stage of otosclerosis. Which assessment finding correlates to the early development of this diagnosis?

Inability to hear whispering.

The nurse is caring for a pediatric client who has a diagnosis of acute otitis media (AOM). Which option for pain management should the nurse educate the family about related to AOM?

Incision of the tympanic membrane

A 5-month-old infant is being treated for acute otitis media (AOM) for the second time in the past 10 weeks. Which action should the nurse recommend to prevent future recurrences?

Limiting the infant's exposure to large group settings

To maintain fixation on stable objects during head rotation, the eyes slowly drift in the opposite direction and then jump rapidly back toward the direction of rotation. This process is known by what term?

Nystagmus

The nurse is assessing a client who came into the physician's office complaining of the room spinning every time the he lies down in bed and also after head movement. The physician suspects the client is suffering from benign paroxysmal positional vertigo (BPPV). The nurse prepares the client for canalith repositioning. Which of the following does this involve?

Several repositioning maneuvers to reposition the otoliths

What are the clinical manifestations of Ménière disease? Select all that apply

Severe ringing in the ear(s) Feeling of fullness in the ear(s) Episodes of disabling vertigo Dizziness triggered by turning the head

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.

The nurse working in a pediatric clinic is caring for a school age-child with a report of right ear pain. Which assessment data correlate with a diagnosis of acute otitis media? Select all that apply.

White tympanic membrane Hearing loss

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 nurse is assisting a client who is undergoing the Romberg test. The nurse understands that the client will be asked to:

close the eyes.

The Eustachian tube connects the nasopharynx and the middle ear. In infants and children with abnormally patent tubes, what enters the Eustachian tube when the infant or child cries or blows his or her nose?

Air and secretions

A parent of a child with otitis media with effusion (OME) asks, "How is this different from typical acute otitis media (AOM)?" Which response by the nurse correctly identifies the main difference?

Excess middle ear fluid

The nurse is conducting hearing evaluation of a group of preschool children. The nurse understands that failure to recognize hearing loss in children can result in impairment of which of the following? Select all that apply.

Language development Cognitive development Emotional development

The nurse is caring for an older adult client with a suspected diagnosis of presbycusis. Select the most likely manifestation.

Sensorineural hearing loss caused by natural aging

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?

Swallowing