Chapter 50: PrepU - Nursing Management: Patients With Hearing and Balance Disorders

Which nursing suggestion would be most helpful to the client with recurrent otitis externa? 1- Use a cotton applicator to ensure that the ear canal is dry. 2- Place ear plugs into the ears before swimming 3- Flush the ear with hydrogen peroxide 4- Avoid lying on the side of the affected ear

2

When discussing diseases of the middle ear, the nursing instructor distinguishes the different types of otitis media. What generally causes purulent otitis media? 1- Irritation associated with respiratory allergies and enlarged adenoids 2- Bronchial tree 3- Outer ear 4- Upper respiratory infections

4

You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis? 1- The client being distressed in the mornings 2- A progressive, bilateral loss of hearing 3- A red and swollen ear drum 4- The client describing a history of having had a recent upper respiratory infection

2

A patient is participating in aural rehabilitation. The nurse understands that this type of training emphasizes which of the following? 1- Listening skills 2- Social skills 3- Occupational skills 4- Functional skills

1

A patient with significant and increasing sensorineural hearing loss has opted not to have surgery and has chosen instead to focus on aural rehabilitation with an emphasis on auditory training. What will be the primary focus of the patient's rehabilitation? 1- Developing effective skills and strategies for listening 2- Learning to use sign language effectively 3- Developing coping techniques for dealing with a lack of communication 4- Developing nonverbal communication techniques

1

Which terms refers to the progressive hearing loss associated with aging? 1- Presbycusis 2- Exostoses 3- Otalgia 4- Sensorineural hearing loss

1

A nursing instructor is preparing a class on air and bone conduction of sound. When describing the transmission of sounds by air conduction, which of the following would the instructor include? 1- Vibrations bypass the tympanic membrane to reach the inner ear. 2- Sounds travel through the external and middle ears. 3- It is a less efficient pathway for sound. 4- Vibration of the tympanic membrane diverts sound away from the ossicles.

2

After thorough diagnosis and screening, a 9-year-old boy has been scheduled for a cochlear implant. The nurse who will be contributing to this child's care should recognize that: 1- The boy's hearing deficit will be considered normal within 24 to 48 hours after surgery. 2- A lengthy period of learning may be required before he can accurately interpret sounds. 3- The boy will achieve hearing through bone conduction. 4- The cochlear implant will provide a beneficial, but temporary, solution to the boy's hearing loss.

2

The nurse identifies the nursing diagnosis of deficient knowledge related to a new hearing aid for a client. After teaching a client about caring for his new hearing aid, the nurse determines that the outcome has been achieved when the client states which of the following? 1- "I need to wipe the ear mold daily with a moist washcloth." 2- "I need to keep my ear canal clean and dry." 3- "I should wash the receiver with soap and water once a week." 4- "I should insert the ear mold when it is wet."

2

Which nursing goal is a priority when caring for a client newly diagnosed with vertigo? 1- Client will maintain therapeutic medication schedule. 2- Client will remain safe while ambulating in the home. 3- Client will have a caretaker with him or her in the home. 4- Client will close eyes as needed to reduce symptoms.

2

Which precaution should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance? 1- Recommend that the client keep his or her eyes closed 2- Have the client wait for help before moving 3- Restrict the client from focusing on one spot 4- Encourage the client to move the head slowly

2

A nurse is aware of the significant potential benefits of cochlear implants for certain individuals. Which one of the following individuals is the most appropriate candidate for a cochlear implant? 1- An individual who has not yet experienced hearing loss but who possesses multiple risk factors 2- An individual who has been diagnosed with presbycusis 3- An individual who has longstanding and severe conductive hearing loss 4- An individual who has profound, bilateral, sensorineural hearing loss

4

A nurse is preparing a presentation for a local community about hearing loss and prevention. Which of the following would the nurse integrate into the presentation as the most effective preventive measure? 1- Maintaining daily hygiene for the ears 2- Having yearly audiometric testing 3- Obtaining prompt treatment for ear infections 4- Wearing ear protection when exposed to noise

4

A nurse practitioner in an emergency room receives a telephone call from a mother whose 4-year-old child has a mosquito stuck in his external ear canal. Which of the following is the best information the nurse could give the mother? 1- Irrigate the ear canal with warm water to flush out the insect. 2- Use an aural suction cup to pull out the insect. 3- Insert a cotton-tipped applicator (e.g., Q-tip) to trap the insect and slowly pull the applicator backward. 4- Instill a few drops of warmed mineral oil to cover the insect.

4

A nurse who is responsible for planning many of the aspects of care on a subacute geriatric unit is aware of the high incidence and prevalence of vestibular disorders among older adults. In individuals with these disorders, the nurse should identify what consequent nursing diagnosis? 1- Risk for impaired tissue integrity related to vestibular disorder 2- Risk for chronic confusion related to vestibular disorder 3- Risk for aspiration related to vestibular disorder 4- Risk for falls related to vestibular disorder

4

Audiometry confirms a client's chronic progressive hearing loss. Further investigation reveals ankylosis of the stapes in the oval window, a condition that prevents sound transmission. This type of hearing loss is called: 1- functional hearing loss. 2- fluctuating hearing loss. 3- sensorineural hearing loss. 4- conductive hearing loss.

4

Which nursing diagnosis takes highest priority for a client admitted for evaluation for Ménière's disease? 1- Acute pain related to vertigo 2- Imbalanced nutrition: Less than body requirements related to nausea and vomiting 3- Risk for deficient fluid volume related to vomiting 4- Risk for injury related to vertigo

4

Which test uses a tuning fork shifted between two positions to assess hearing? 1- Whisper 2- Watch tick 3- Rinne 4- Weber

3

Acoustic neuromas are benign tumors of which of the following cranial nerves? 1- VIII 2- VII 3- VI 4- V

1

Which symptoms may a client with Ménière disease report before an attack? 1- Nystagmus 2- Low blood pressure 3- Photosensitivity 4- A full feeling in the ear

4

The nurse is instructing the client with dried cerumen blocking the ear canal on potential methods to reduce symptoms. Which at-home methods of cerumen removal are discouraged? 1- Instilling 1 to 2 drops of half-strength peroxide in the ear 2- Using warm glycerin or mineral oil to soften the cerumen 3- Removing the cerumen by means of a cotton tip applicator 4- Irrigating the ear with warm water and a rubber-bulb syringe

3

A client is being prepared for a cochlear implant. Which client statement would alert the nurse to the need for additional teaching? 1- "I'm going to be able to hear normally again." 2- "I'll have a small incision behind my ear." 3- "I'll wear an external transmitter and microphone." 4- "I'll be able to hear medium and loud sounds for once."

1

A client comes to the emergency department, reporting that a bee has flown into his ear and is stuck. The client reports a significant amount of pain. Which of the following would be most appropriate to use to remove the bee? 1- Mineral oil 2- Irrigation 3- Hair pin 4- Tweezers

1

A client has been diagnosed with otosclerosis. The nurse explains to the client that this is a common cause of hearing impairment among adults and is the result of a bony overgrowth of the: 1- stapes 2- labyrinth 3- tympanic membrane 4- incus

1

A client undergoing mastoid surgery asks the nurse about the pain following the surgery. Which response by the nurse is appropriate? 1- "Usually the incisional pain is mild and controlled by the prescribed medication for the first 24 hours." 2- "The incisional pain usually last 3 weeks. The doctor will make sure you have enough pain medications." 3- "Most client report a sharp shooting pain for 1 to 2 months following the surgery from the eustachian tube opening." 4- "Usually there is a constant throbbing pain for the first week. Most client report no pain with the use of the pain medications."

1

A client who has a lengthy history of progressive hearing loss is very forthright about the condition, and the nurse wants to develop a communication strategy for this client's hospital stay. Which communication strategy has proven to be the most effective? 1- the one the client will use 2- speech reading 3- signing 4- writing

1

A dietary modification for a patient with Ménière's disease would be: 1- A decrease in sodium intake to 2,000 mg daily. 2- Fluid restriction to 2 L/day. 3- An increase in calcium to 1 g/day. 4- An increase in vitamin C to 1.5 g/day.

1

A nurse practitioner explains to a patient recently diagnosed with noise-induced hearing loss that the basic altered physiology in the ear is the result of: 1- Damage to the hair cells inside the cochlea. 2- Stenosis of the semicircular canals. 3- Hardening of the tympanic membrane. 4- Malfunctioning of the incus and the staples.

1

The nurse is instructing a client's family members on the most incapacitating symptom of Ménière's disease. Which nursing instruction associated with the symptom is most helpful? 1- Assist the client when ambulating. 2- Keep a bucket beside the bed. 3- Ensure low lighting in the room. 4- Sit in front of the client when speaking.

1

The parent of a young client with severe hearing loss is quite concerned about the child's future independence because of impaired hearing. Which type of hearing loss is usually irreversible? 1- sensorineural 2- conductive 3- tinnitus 4- noise exposure

1

The physician suggests that a client use meclizine as treatment for his motion sickness. The nurse explains the rationale for this drug based on an understanding of which of the following as the drug's action? 1- Blocks conduction of the vestibular pathways 2- Antagonizes the response of histamine 3- Depresses the central nervous system 4- Lowers endolymphatic system pressure

1

Health teaching for a patient who suffers from motion sickness would include recommending the use of which one of the following over-the-counter drugs? 1- Scopolamine 2- Phenergan 3- Dramamine 4- Ephedrine

3

A 70-year-old patient with severe presbycusis is weighing the possibility of getting hearing aids. The nurse who is contributing to this patient's care should be aware that the patient's potential benefit of using hearing aids will depend upon which of the following factors? 1- The patient's ability to supplement the hearing aid with speech reading 2- The patient's ability to adequately discriminate sounds 3- The patient's level of motivation to hear more clearly 4- The patient's level of personal hygiene

2

A client who has been fitted with a hearing aid comes for a follow-up evaluation. During the visit, the client states, "I've noticed that I still don't seem to hear well enough. The hearing aid doesn't seem to make the sounds louder." Which of the following might the nurse determine as the possible cause? 1- Ear mold is loose. 2- Client has cerumen in the ear. 3- The mold is not properly fitted. 4- The client has an ear infection.

2

High doses of which medication can produce bilateral tinnitus? 1- Meclizine 2- Aspirin 3- Promethazine 4- Dimenhydrinate

2

The nurse is assisting the client in planning care during exacerbations of Ménière's disease. Which diet would the nurse identify as appropriate at this time? 1- A high-protein diet 2- A low-sodium diet 3- A low-fat diet 4- A calorie-controlled diet

2

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? 1- The client being distressed in the mornings 2- A progressive, bilateral loss of hearing 3- A red and swollen ear drum 4- The client describing a recent upper respiratory infection

2

The nurse on a cruise ship is assessing clients for motion sickness. Which of the following is a common misconception? 1- Repeated motion is the cause. 2- Once symptoms occur, they will always be present. 3- Medications help the symptoms. 4- Pallor and diaphoresis is a first symptom.

2

There are several types of hearing loss. Which type of hearing loss benefits most from the use of a hearing aid? 1- Sensorineural 2- Conductive 3- Genetic 4- Acquired

2

What inner ear structure is affected when a patient is diagnosed with otosclerosis? 1- Malleus 2- Stapes 3- Incus 4- Tympanic membrane

2

Which is a correct rationale for encouraging a client with otitis externa to eat soft foods? 1- Chewy foods, such as red meat, may react with prescribed analgesics and antibiotics. 2- Chewing may cause discomfort. 3- Chewing may lead to further complications, such as otitis media. 4- Chewing may cause excessive drainage.

2

What kind of otitis media is a pathogen-free fluid behind the tympanic membrane, resulting from irritation associated with respiratory allergies and enlarged adenoids? 1- Purulent otitis media 2- Infectious otitis media 3- Serous otitis media 4- Sterile otitis media

3

When preparing a teaching plan for a client diagnosed with otitis externa, the nurse instructs the client to avoid any water sport for which duration? 1- 3 to 5 days 2- 5 to 7 days 3- 7 to 10 days 4- 10 to 14 days

3

Which of the following nursing interventions would be most likely to facilitate effective communication with a hearing impaired patient? 1- Ask the patient to repeat what was said in order to evaluate understanding. 2- Stand directly in front of the patient to facilitate lip reading. 3- Reduce environmental noise and distractions before communicating. 4- Raise the voice to project sound at a higher frequency.

3

The nurse is doing discharge teaching with a client newly diagnosed with Ménière's disease. Why would the nurse advise a low-sodium diet to this client? 1- To minimize the adverse effects of drug therapy 2- To reduce the magnitude of the hearing deficit 3- To minimize the risk of a tumor that involves the vestibulocochlear nerve 4- To reduce the production of fluid in the inner ear

4

Which of the following describes vertigo? Select all that apply. 1- Misperception of motion 2- Spinning sensation 3- Objects are moving around him or her 4- Syncope 5- Fainting

1,2,3

The nurse is working in the emergency department when a physician asks for help as the client is performing a Romberg test. In which position would the nurse stand to be most helpful? 1- The nurse would stand directly in front of the client. 2- The nurse would stand between the client and physician. 3- The nurse would stand across the room but in direct alignment from the client. 4- The nurse would stand laterally to the client, opposite side to where the physician is standing.

4

The nurse is working in the triage section of a walk-in clinic. Which triad of common symptoms, when placed together, indicate Ménière's disease? 1- Blurred vision, vertigo, nausea 2- Syncope, vertigo, ear pain 3- Disorientation, vertigo, nausea 4- Hearing loss, vertigo, tinnitus

4

When caring for a client after ear surgery, what is an important aspect of nursing care? 1- Assess social support. 2- Feed small frequent meals to minimize nausea. 3- Fit for a hearing aid. 4- Validate client's feelings of discomfort.

4

A young man has presented for care because he claims that he has experienced hearing loss that he attributes to a summer job at a gravel crusher. On questioning, the clinician learns that the man was provided with hearing protection but was "hit and miss" with using it. What should the clinician teach this patient about sensorineural hearing loss? 1- "Hearing loss like you've experienced is permanent because of the destruction of important cells in your ears." 2- "You'll likely find that your hearing will improve over the next several years." 3- "As long as you're very careful to avoid loud noises, your hearing will probably recover in the following few months." 4- "Unfortunately, your hearing loss is likely to get progressively worse because of the process that this damage started."

1

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone, causing which effect? 1- Facial nerve paralysis 2- Nystagmus 3- Motor impairment 4- Diplopia

1

The nurse is caring for a client experiencing hearing loss. The nurse uses the otoscope to assess the ear canal and tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be most accurate? 1- Conductive 2- Mixed 3- Central 4- Sensorineural

1

The nurse is caring for a patient with Ménière's disease who is hospitalized with severe vertigo. What medication does the nurse anticipate administering to shorten the attack? 1- Meclizine (Antivert) 2- Furosemide (Lasix) 3- Cortisporin otic solution 4- Gentamicin (Garamycin) intravenously

1

Which instructions regarding swimming should the nurse give to a client who is recovering from otitis externa? Select all that apply. 1- Wear soft plastic earplugs. 2- Wear a scarf. 3- Avoid cold water. 4- Insert a loose cotton earplug in the external ear.

1

Which of the following brain structures is responsible for equilibrium? 1- Cerebellum 2- Brainstem 3- Thalamus 4- Hypothalamus

1

Which of the following is an involuntary rhythmic movement of the eyes that is also associated with vestibular dysfunction? 1- Nystagmus 2- Vertigo 3- Tinnitus 4- Presbycusis

1

Which precautions should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance? 1- Grasp the siderails when rising to a standing position. 2- Keep his or her eyes closed. 3- Refrain from looking at one place. 4- Immobilize the head to reduce the risk of falling

1

A client with Meniere's disease has a nursing diagnosis of risk for injury related to gait disturbances and vertigo. Which of the following would be most appropriate to include in this client's plan of care? 1- Moving the head from side-to-side when vertigo occurs 2- Sitting down at the first sign of feeling dizzy 3- Closing the eyes when lying down during an episode of vertigo 4- Performing self-care activities when the vertigo first starts

2

A client with otosclerosis comes to the clinic for a follow-up. When assessing this client's hearing, which type of hearing loss would the nurse expect to find? 1- sensorineural 2- conductive 3- no hearing loss 4- loss of high frequency sounds

2

A mother brings her daughter to the clinic for an evaluation because the child is complaining of ear pain. Which of the following would lead the nurse to suspect that the child is experiencing otitis externa and not otitis media? 1- Fever 2- Aural tenderness 3- Bulging eardrum 4- Ear drainage

2

The nurse caring for a client with Ménière's disease makes which primary assessments? 1- Ability to function 2- Social support 3- Gross hearing 4- Level of disability

3

A client comes to the walk-in clinic complaining of a "bug in my ear." What action should be taken when there is an insect in the ear? 1- Instillation of mineral oil 2- Instillation of carbamide peroxide 3- Instillation of hot water 4- Use of a small forceps

1

A client has undergone a myringotomy. The nurse interprets this as which of the following? 1- Incision of the eardrum 2- Placement of ventilation tubes 3- Surgical reconstruction of the eardrum 4- Reconstruction of the middle ear bones

1

A female patient's severe ear infection has resulted in tympanic membrane perforation. The patient's care provider has concluded that surgical repair is unnecessary because the membrane is healing spontaneously. What health education should the nurse emphasize to this patient? 1- It is important to keep the ear canal dry until the membrane has healed. 2- Half-strength hydrogen peroxide should be instilled into the ear once a day. 3- The ear should be gently cleaned with a cotton swab once a day. 4- Purulent drainage should be expected for the first week after the injury.

1

A nurse is preparing a plan of care for a client with otitis externa. Based on the typical assessment findings, which of the following would the nurse most likely identify as the priority nursing diagnosis? 1- Acute pain related to inflammation 2- Risk for infection related to drainage from the ear canal 3- Disturbed sensory perception: auditory related to sensorineural hearing loss. 4- Hyperthermia related to elevated temperature secondary to infection

1

A nursing instructor is teaching pre-nursing students in a pathophysiology class. What would the instructor teach the students about Ménière's disease? 1- It is referred to as endolymphatic hydrops. 2- It originates in the middle ear. 3- It is referred to as lymphatic hydrops. 4- It originates in the outer ear.

1

Which statement describes benign paroxysmal positional vertigo (BPPV)? 1- The vertigo is usually accompanied by nausea and vomiting. 2- The onset of BPPV is gradual. 3- BPPV is caused by tympanic membrane rupture. 4- BPPV is stimulated by the use of certain medications, such as acetaminophen.

1

Loud, persistent noise has been found to have which of the following effects on the body? Select all that apply. 1- Constriction of peripheral blood vessels 2- Increased blood pressure 3- Increased heart rate 4- Decreased gastrointestinal motility 5- Dilation of peripheral blood vessels

1,2,3

A client is receiving long-term intravenous therapy with gentamicin for a chronic wound infection. Which of the following would be most important for the nurse to ensure? 1- Obtain specimens for wound cultures daily. 2- Arrange for audiograms twice a week. 3- Monitor complete blood counts every other day. 4- Assess intravenous access site daily.

2

A client who is a competitive swimmer is diagnosed with swimmer's ear (otitis externa). Which instruction would be least appropriate for the nurse to include when teaching the client about this condition? 1- Wear ear plugs when swimming, showering, or washing the hair. 2- Use a hair dryer set on high to dry the ear canal after swimming. 3- Instill alcohol drops into the external ear after swimming. 4- Avoid scratching or exposing the ear to scratching or trauma.

2

A client you are caring for has a hearing loss. The client tells you he is self-conscious about his hearing loss. What advice should the nurse give a self-conscious client with hearing loss to protect his self-esteem? 1- Pretend to follow conversations by nodding the head. 2- Be forthright and inform others about the hearing deficit. 3- Follow lip movements closely. 4- Avoid excess socializing.

2

A patient has been referred to a specialist by his primary care provider because he is suspected to have an acoustic neuroma. What signs and symptoms most likely prompted the care provider's referral? 1- A history of clear discharge from one of the patient's ears 2- Unilateral tinnitus and hearing loss 3- Vertigo that is unresponsive to medication 4- Chronic tympanic perforation

2

A 48-year-old woman has been diagnosed with Ménière's disease after several serious bouts of vertigo. The nurse is reviewing nutritional guidelines relevant to the management of the disease and should recommend which of the following? 1- A low-carbohydrate, high-protein diet 2- Eating several small meals each day rather than three larger meals 3- Limiting the amount of salt and sugar in the diet 4- A gluten-free diet emphasizing leafy green vegetables

3

A client has undergone a mastoidectomy. The nurse teaches the client about possible complications, instructing the client to notify the physician immediately if which of the following occur? 1- Aural fullnesss 2- Serosanguinous drainage 3- Slurred speech 4- Intermittent sharp, shooting pain

3

A patient has been diagnosed with a loss of hearing related to damage of the end organ for hearing. What term is used to describe this condition? 1- Exostoses 2- Otalgia 3- Sensorineural hearing loss 4- Presbycusis

3

Tap water irrigation of an older adult's ear canal has failed to dislodge the impacted cerumen that has been causing the patient to experience otalgia. In preparation for another attempt at relieving the patient's problem, what action should the nurse take? 1- Instill a hypertonic saline solution for 30 minutes prior to irrigating the patient's ear. 2- Attempt irrigation using a 10 mL syringe and higher pressure. 3- Put a small amount of mineral oil in the patient's ear before attempting removal. 4- Use a flexible suction catheter and 100 to 120 mm Hg of wall suction to remove the cerumen.

3