EAR AH2
The nurse caring for a client with Ménière's disease needs to assist with what when the client is experiencing an attack?
ADLs p. 1897
External otitis
Allergic response, inflammation Symptoms: red, swollen tender, temporary hearing loss, "swimmer's ear"
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?
Arrange for audiograms twice a week. p. 1902
An initial, convenient assessment of an older adult client's complaint of hearing loss would be inspection, using an otoscope, for the presence of impacted cerumen. Which of the following is a primary cause of an external ear disorder in the elderly?
Conduction problem pg. 1888
Which type of hearing loss is most likely to be reversible when treated appropriately? Conductive hearing loss Sensorineural hearing loss Mixed conductive-sensorineural hearing loss Central hearing loss
Conductive hearing loss
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?
Conductive pg. 1880
Acoustic neuromas are benign tumors of which of the following cranial nerves?
Cranial Nerve VII pg. 1902
Loud, persistent noise has what effect on the body?
Increased B/P pg. 1888
A client is diagnosed with an exudative retinal detachment. When reviewing the client's history, the nurse would identify which of the following as a possible underlying cause?
Macular degeneration pg. 1864
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?
Meclizine (Antivert) pg. 1898
Which characteristic feature of the tympanic membrane should a nurse anticipate finding in a client with acute otitis media?
Red, bulging, with an absent light reflex
Which action by the nurse is consistent with the Rinne test?
The nurse strikes the tuning fork and places it on the patient's mastoid process to measure bone conduction.
A client is diagnosed with Meniere's disease. The nurse would most likely expect the client to report which of the following?
Vertigo pg. 1897
Which manifestation is most problematic for the client diagnosed with Ménière disease?
Vertigo pg. 1897
acoustic neuroma
benign tumor on the auditory nerve (CN VII) that causes vertigo, tinnitus, and hearing loss
presbycusis
hearing impairment occurring with age
A nurse is performing an eye examination. Which question would not be included in the examination?
"Are you able to raise both eyebrows?" pg. 1843
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." pg. 1896
The nurse is preparing a client for electronystagmography. Which statement by the client indicates that teaching was effective? "I can't drink caffeine 24 to 48 hours before the test." "I should drink more fluids 4 hours before the test." "I'll be placed in a soundproof booth for the test." "I'll be sedated for the test."
"I can't drink caffeine for 24-48 hours before the test"
A patient calls the clinic and tells the nurse that the doctor told her that she has "otalgia." The patient cannot remember what the doctor explained this to be. How would the nurse most appropriately respond?
"Otalgia is pain in the ear."
The nurse is teaching a client with vertigo about safety precautions for fall prevention. Which statement by the client indicates a need for further instruction? "I may need to use a cane." "I should keep my grandkids' toys out of the hallway." "Moving more slowly may help the vertigo subside." "Taking my medication will allow me to drive my car again."
"Taking my medication will allow me to drive my car again"
The results of a client's Rinne test are as follows: bone condcution > air conduction. How should the nurse explain these findings to the client?
"You have a conductive hearing loss."
A client has undergone tonometry to evaluate for possible glaucoma. Which result would the nurse record as abnormal?
25 mm Hg pg. 1856
3. The clients chart indicates a sensorineural hearing loss. What assessment question does the nurse ask to determine the possible cause? a. Do you feel like something is in your ear? b. Do you have frequent ear infections? c. Have you been exposed to loud noises? d. Have you been told your ear bones dont move?
ANS: C Sensorineural hearing loss can occur from damage to the cochlea, the eighth cranial nerve, or the brain. Exposure to loud music is one etiology. The other questions relate to conductive hearing loss.
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?
7 to 10 days pg. 1891
A dietary modification for a patient with Ménière's disease would be:
A decrease in sodium intake to 2,000 mg daily. p. 1898
The nurse notes a tophus of the ear of an older adult. Which assessment data is consistent with a tophus?
A hard nodule composed of uric acid crystals
A nurse is reviewing the health record of a client who has sever otitis media. Which of the following are expected findings? (Select all that apply) A. Enlarged adenoids B. Report of recent colds C. Client prescription for daily furosemide D. Light reflex visible on the otoscopic exam in affected ear E. Ear pain relieved by Meclizine
A. B. E.
13. A nurse is teaching a community group about preventing hearing loss. What instruction is best? a. Always wear a bicycle helmet. b. Avoid swimming in ponds or lakes. c. Dont go to fireworks displays. d. Use a soft cotton swab to clean ears.
ANS: A Avoiding head trauma is a practical way to help prevent hearing loss. Swimming can lead to hearing loss if the client has repeated infections. Fireworks displays are loud, but usually brief and only occasional. Nothing smaller than the clients fingertip should be placed in the ear canal.
1. A nurse is teaching a client about ear hygiene and health. What client statement indicates a need for further teaching? a. A soft cotton swab is alright to clean my ears with. b. I make sure my ears are dry after I go swimming. c. I use good earplugs when I practice with the band. d. Keeping my diabetes under control helps my ears.
ANS: A Clients should be taught not to put anything larger than their fingertip into their ears. Using a cotton swab, although soft, can cause damage to the ears and cerumen buildup. The other statements are accurate.
15. A client has labyrinthitis and is prescribed antibiotics. What instruction by the nurse is most important for this client? a. Immediately report headache or stiff neck. b. Keep all follow-up appointments. c. Take the antibiotics with a full glass of water. d. Take the antibiotic on an empty stomach.
ANS: A Meningitis is a complication of labyrinthitis. The client should be taught to take all antibiotics as prescribed and to report manifestations of meningitis such as fever, headache, or stiff neck. Keeping follow-up appointments is important for all clients. Without knowing what antibiotic was prescribed, the nurse cannot instruct the client on how to take it.
4. A client has a hearing aid. What care instructions does the nurse provide the unlicensed assistive personnel (UAP) in the care of this client? (Select all that apply.) a. Be careful not to drop the hearing aid when handling. b. Soak the hearing aid in hot water for 20 minutes. c. Turn the hearing aid off when the client goes to bed. d. Use a toothpick to clean debris from the device. e. Wash the device with soap and a small amount of warm water.
ANS: A, C, D, E All these actions except soaking the hearing aid are proper instructions for the nurse to give to the UAP. While some water is used to clean the hearing aid, excessive wetting should be avoided.
2. A client has Mnires disease with frequent attacks. About what drugs does the nurse plan to teach the client? (Select all that apply.) a. Broad-spectrum antibiotics b. Chlorpromazine hydrochloride (Thorazine) c. Diphenhydramine (Benadryl) d. Meclizine (Antivert) e. Nonsteroidal anti-inflammatory drugs (NSAIDs)
ANS: B, C, D Drugs such as chlorpromazine, diphenhydramine, and meclizine can all be used to treat Mnires disease. Antibiotics and NSAIDs are not used.
16. A client with Mnires disease is in the hospital when the client has an attack of this disorder. What action by the nurse takes priority? a. Assess vital signs every 15 minutes. b. Dim or turn off lights in the clients room. c. Place the client in bed with the upper siderails up. d. Provide a cool, wet cloth for the clients face.
ANS: C Clients with Mnires disease can have vertigo so severe that they can fall. The nurse should assist the client into bed and put the siderails up to keep the client from falling out of bed due to the intense whirling feeling. The other actions are not warranted for clients with Mnires disease.
Which statement describes benign paroxysmal positional vertigo (BPPV)?
The vertigo is usually accompanied by nausea and vomiting; generally, however, hearing is not impaired. pg. 1898
Which of the following findings from the health history of a 70-year-old woman with tinnitus is likely most significant to her diagnosis?
The woman takes aspirin 4 times daily to treat her rheumatoid arthritis.
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
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?
To reduce the production of fluid in the inner ear pg. 1898
When discussing diseases of the middle ear, the nursing instructor distinguishes the different types of otitis media. What generally causes purulent otitis media?
Upper respiratory infections pg.1892
When caring for a client after ear surgery, what is an important aspect of nursing care?
Validate client's feelings of discomfort. pg. 1894
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 p. 1897
Which manifestation is the most problematic for the client diagnosed with Ménière disease?
Vertigo pg. 1897
A nurse needs to change a dressing on an abdominal wound for a patient who is hearing-impaired and whose speech is difficult to understand. Which of the following is the best approach for the nurse?
Write down the steps of the procedure for the patient to read before beginning the treatment. p. 1890
After examining the client's tympanic membranes, the nurse documents "Right tympanic membrane, red and bulging with no light reflex." The nurse recognizes that these are signs of
acute otitis media.
If a nurse needs to administer otic preparations in both of the client's ears, how long should the nurse wait to place drops in the second ear?
at least 5 minutes pg. 1102
The nurse has performed the Rinne test on an older adult client. After the test, the client reports that her bone conduction sound was heard longer than the air conduction sound. The nurse determines that the client is most likely experiencing
conductive hearing loss.
Meniere's disease
increased endolymph; tinnitus, vertigo, sensorineural hearing loss
A client has been treated several times for a recurring ear infection with ofloxacin. The nurse instructs the client to look for side effects from the prolonged use of the antibiotic and informs the client that this is known as:
super infection. pg. 1102
Which instructions regarding swimming should the nurse give to a client who is recovering from otitis externa? Select all that apply.
wear soft plastic earplugs p. 1891
11. A nurse is irrigating a clients ear when the client becomes nauseated. What action by the nurse is most appropriate for client comfort? a. Have the client tilt the head back. b. Re-position the client on the other side. c. Slow the rate of the irrigation. d. Stop the irrigation immediately.
ANS: D During ear irrigation, if the client becomes nauseated, stop the procedure. The other options are not helpful.
10. A nursing student is instructed to remove a clients ear packing and instill eardrops. What action by the student requires intervention by the registered nurse? a. Assessing the eardrum with an otoscope b. Inserting a cotton ball in the ear after the drops c. Warming the eardrops in water for 5 minutes d. Washing the hands and removing the packing
ANS: D The student should wash his or her hands, don gloves, and then remove the packing. The other actions are correct.
A mother of a small child calls the clinica and asks to schedule an appointment for ear tube removal. The call is transferred to the nurse. What is the nurse's best action?
Ask the mother how long the tubes have been in place.
High doses of which medication can produce bilateral tinnitus?
Aspirin pg. 1901
Audiometry is testing that measures hearing acuity precisely. Who does the nurse know can perform audiometric testing?
Audiologist p. 1886
A patient is to have an angiography done using fluorescein as a contrast agent to determine if the patient has macular edema. What laboratory work should the nurse monitor prior to the angiography?
BUN and creatinine pg. 1845
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?
Be forthright and inform others about the hearing deficit. p. 1888
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?
Dramamine pg. 1897
The nurse is caring for a client who just returned from a trip requiring an airline flight. The client commented on how his ears hurt upon descent. The nurse is correct in stating which site as being the pressure equalizer in the ear?
Eustachian tube pg. 1882
Which portion of the middle ear equalizes pressure?
Eustachian tube pp. 1881-1882.
A nures is performing an otoscopic examination on a client. Which finding would the nurse document as abnormal?
External auditory canal erythema pg. 1805
The nurse should monitor for which manifestation in a client who has undergone LASIK?
Halos and glare pg. 1863
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?
Hearing loss, vertigo, tinnitus pg. 1897
A client has undergone enucleation. What complication of enucleation should be addressed by the nurse?
Hemorrhage pg. 1876
A client with chronic open-angle glaucoma is now presenting with eye pain and intraocular pressure of 50 mm Hg. An immediate iridotomy is scheduled. Which of the following describes the desired effects of this procedure?
Improve outflow drainage pg. 1855
The client is having a Weber test. During a Weber test, where should the tuning fork be placed?
In the midline of the client's skull or in the center of the forehead p. 1885
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?
Instill a few drops of warmed mineral oil to cover the insect. pg. 1890
The nurse is developing a plan of care for a client with Meniere's disease and identifies a nursing diagnosis of excess fluid volume related to fluid retention in the inner ear. Which intervention would be most appropriate to include in the plan of care?
Limit foods that are high in sodium p. 1898
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?
Mineral oil pg. 1890
Which of the following describes vertigo? Select all that apply.
Misperception of motion -Objects are moving around him or her -Spinning sensation pg. 1897
The nurse is assisting with the administration of a caloric stimulation test. Which client response would the nurse document as an expected response?
Nystagmus p. 1886
Which condition is characterized by the formation of abnormal spongy bone around the stapes?
Otosclerosis pg. 1896
Which condition refers to hearing loss associated with degenerative changes?
Presbycusis
An aging client is brought to the eye clinic by the son. The son states he has seen his parent holding reading materials at an increasing distance to focus properly. What age-related changes does this indicate?
Presbyopia pg. 1847
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 p. 1891
The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal?
Retinal Angiography pp. 1845-1846.
Which test uses a tuning fork shifted between two positions to assess hearing?
Rinne pg. 1886
The nurse is examining the area behind the patient's auricle and sees a flaky scaliness. What disorder does the nurse suspect the patient has?
Seborrheic dermatitis p. 1883
Postoperative nursing assessment for a patient who has had a mastoidectomy should include observing for facial paralysis, which might indicate damage to which cranial nerve?
Seventh p. 1894
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?
Slurred speech pg. 1895
A nurse is preparing to perform the whisper test to assess a client's gross auditory acuity. Which of the following would be most appropriate for the nurse to do?
Stand about 1 to 2 feet away from the ear to be tested. pg. 1923
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:
Stapes pg. 1896
Which of the following is the treatment of choice for acoustic neuromas?
Surgery pg. 1902
The nurse is assessing a client for objective symptoms of hearing difficulties. Which symptom leads the nurse to take alternate measures to ensure client understanding of teaching?
The client leans forward and turns the head p. 1888
The nurse is caring for a client who is admitted with mastoiditis. Which assessment data obtained by the nurse requires the most immediate action? The eardrum is red, thick-appearing, and immobile. The lymph nodes are swollen and painful to touch. The client reports a headache and a stiff neck. The client's oral temperature is 100.1° F (37.8° C).
The client reports a headache and a stiff neck
A nurse is assessing a client's tympanic membrane. The nurse suspects that the client may have otitis media. Which of the following findings would confirm this suspicion?
The membrane does not flutter upon pneumatic otoscopy with a bulb insufflator
Which action by the nurse is consistent with Weber's test?
The nurse activates the tuning fork and places it on the midline of the parietal bone in line with both ears.
A patient has Darwin tubercle. What is this?
A small painless nodule on the helix
The transmission of sound waves through the external ear and the middle ear is known as
conductive hearing.
A nurse is interviewing a client as part of a routine examination of his ears and hearing. The nurse notes that this client has high blood pressure. Which of the following questions regarding his hearing should the nurse ask that is associated with his high blood pressure?
"Do you experience any ringing, roaring, or crackling in your ears?"
The nurse is teaching a client with impaired hearing about audiometric testing. Which statement by the nurse effectively communicates information about the procedure to the client? A. "Here is a picture of how the test is done. See how your bad ear will be tested first? You will be alone in the soundproof booth, so you will need to watch for lights flashing on and off as your cues." B. "Here is a video of the procedure. Please watch and feel free to ask me any questions." C. "I will sit right in front of you in the soundproof booth and give you instructions on what types of sounds you will hear and how you'll need to respond." D. "You will be in a soundproof booth and the sounds will be piped in. When you first hear the loudest sound, put your hand down. When you stop hearing the sound, put your hand up to stop."
C
A nurse performs an inspection and palpation of the auricle when examining the ear of a client. Which documentation by the nurse demonstrates a normal finding?
Darwin's tubercle
The nurse is presenting an educational event for gardeners. When discussing the ears, what would be an important topic to cover?
Skin cancer prevention
The nurse is talking to a client about cerumen removal from the ear canal. Which statement by the client indicates a need for further teaching? "I dry my ears using my fingertip and a towel." "I may irrigate my ears with tap water." "I should not use an ear candle to soften the wax." "I use a cotton swab to remove earwax."
"I use a cotton swab to remove earwax"
The nurse is teaching a client about ear protection. Which statement by the client indicates that teaching was effective? "I wear foam ear inserts at works where it is noisy." "I listen to music with foam ear inserts." "My ears ring after a rock concert, but it goes away." "The machinery is loud at work, but I get used to it."
"I wear foam ear inserts at work where it is noisy"
The nurse is reviewing postoperative instructions with a client undergoing stapedectomy. Which statement by the client indicates a need for further teaching? "I may have problems with vertigo after the surgery." "I should not drink from a straw for several weeks." "I will have to take antibiotics after the surgery." "I will be able to hear as soon as my dressing is removed."
"I will b able to hear as soon as my dressing is removed"
The nurse is teaching a client who will soon be fitted for a hearing aid about proper care and use. Which statement by the client indicates that teaching was effective? "Background noises will be difficult for me to hear." "I should wear my hearing aid only to work at first." "I should just get a smaller hearing aid because I don't have much money." "Listening to the radio and television will help me get used to new sounds."
"Listening to the radio and television will help me get used to new sounds"
A nurse is completing discharge teaching to a client following middle ear surgery. Which of the following statements by the client indicates understanding of the teaching? A. "I should restrict rapid movements and avoid bending from the waist for a couple of weeks" B. "I should wait until the day after surgery to wash my hair" C. "I will remove the dressing behind my ear in 7 days" D. "My hearing should be back to normal right after my surgery"
A
What is the priority nursing intervention when providing care to a patient with hearing loss? a. Creating a safe environment b. Providing written information regarding medications and disease processes c. Having the patient repeat instructions to evaluate additional teaching needs d. Ensuring that the patient can directly visualize you when you provide instructions
A
Which clients are at high risk for developing hearing problems? Select all that apply. A. Airline mechanic B. Client with Down syndrome C. Drummer in a rock band D. Teenager listening to music using ear buds E. Telephone operator
A. B. C. D.
A nurse in a clinic is caring for a client who has been experiencing mild to moderate vertigo due to benign paroxysmal vertigo for several weeks. Which of the following actions should the nurse recommend to help control the vertigo? (Select all that apply) A. Reduce exposure to bright lighting B. Move head slowly when changing positions C. Do not eat fruit high in potassium D. Plan evenly spaced daily fluid intake E. Avoid fluids containing caffeine
A. B. D. E.
6. An older adult in the family practice clinic reports a decrease in hearing over a week. What action by the nurse is most appropriate? a. Assess for cerumen buildup. b. Facilitate audiological testing. c. Perform tuning fork tests. d. Review the medication list.
ANS: A All options are possible actions for the client with hearing loss. The first action the nurse should take is to look for cerumen buildup, which can decrease hearing in the older adult. If this is normal, medications should be assessed for ototoxicity. Further auditory testing may be needed for this client.
17. A client is scheduled to have a tumor of the middle ear removed. What teaching topic is most important for the nurse to cover? a. Expecting hearing loss in the affected ear b. Managing postoperative pain c. Maintaining NPO status prior to surgery d. Understanding which medications are allowed the day of surgery
ANS: A Removal of an inner ear tumor will likely destroy hearing in the affected ear. The other teaching topics are appropriate for any surgical client.
12. A client hospitalized for a wound infection has a blood urea nitrogen of 45 mg/dL and creatinine of 4.2 mg/dL. What action by the nurse is best? a. Assess the ordered antibiotics for ototoxicity. b. Explain how kidney damage causes hearing loss. c. Use ibuprofen (Motrin) for pain control. d. Teach that hearing loss is temporary.
ANS: A Some medications are known to be ototoxic. Diminished kidney function slows the excretion of drugs from the body, worsening the ototoxic effects. The nurse should assess the antibiotics the client is receiving for ototoxicity. The other options are not warranted.
7. A client had a myringotomy. The nurse provides which discharge teaching? a. Buy dry shampoo to use for a week. b. Drink liquids through a straw. c. Flying is not allowed for 1 month. d. Hot water showers will help the pain.
ANS: A The client cannot shower or get the head wet for 1 week after surgery, so using dry shampoo is a good suggestion. The other instructions are incorrect: straws are not allowed for 2 to 3 weeks, flying is not allowed for 2 to 3 weeks, and the client should not shower.
3. A client is scheduled for a tympanoplasty. What actions by the nurse are most appropriate? (Select all that apply.) a. Administer preoperative antibiotics. b. Assess for allergies to local anesthetics. c. Ensure that informed consent is on the chart. d. Give ordered antivertigo medications. e. Teach that hearing improves immediately.
ANS: A, C Preoperatively, the nurse administers antibiotics and ensures that informed consent is on the chart. Local anesthetics can be used, but general anesthesia is used more often. Antivertigo medications are not used. Hearing will be decreased immediately after the operation until the ear packing is removed.
1. A nursing student studying the auditory system learns about the structures of the inner ear. What structures does this include? (Select all that apply.) a. Cochlea b. Epitympanum c. Organ of Corti d. Semicircular canals e. Vestibule
ANS: A, C, D, E The cochlea, organ of Corti, semicircular canals, and vestibule are all part of the inner ear. The epitympanum is in the middle ear.
2. The student nurse is performing a Weber tuning fork test. What technique is most appropriate? a. Holding the vibrating tuning fork 10 to 12 inches from the clients ear b. Placing the vibrating fork in the middle of the clients head c. Starting by placing the vibrating fork on the mastoid process d. Tapping the vibrating tuning fork against the bridge of the nose
ANS: B The Weber tuning fork test includes placing the vibrating tuning fork in the middle of the clients head and asking in which ear the client hears the vibrations louder. The other techniques are incorrect.
6. A client is scheduled for a stapedectomy in 2 weeks. What teaching instructions are most appropriate? (Select all that apply.) a. Avoid alcohol use before surgery. b. Blow the nose gently if needed. c. Clean the telephone often. d. Sneeze with the mouth open. e. Wash the external ear daily.
ANS: B, C, D, E It is imperative that the client having a stapedectomy is free from ear infection. Teaching includes ways to prevent such infections, such as blowing the nose gently, cleaning objects that come into contact with the ear, sneezing with the mouth open, and washing the external ear daily. Avoiding alcohol will not help prevent ear infections.
7. A client is admitted to the nursing unit after having a tympanoplasty. What activities does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Administer prescribed antibiotics. b. Keep the head of the clients bed flat. c. Remind the client to lie on the operative side. d. Remove the iodoform gauze in 8 hours. e. Take and record postoperative vital signs.
ANS: B, E The UAP can keep the head of the clients bed flat and take/record vital signs. The nurse administers medications. The client should lie flat with the head turned so the operative side is up. The nurse or surgeon removes the gauze packing.
5. A hospitalized client has Mnires disease. What menu selections demonstrate good knowledge of the recommended diet for this disorder? (Select all that apply.) a. Chinese stir fry with vegetables b. Broiled chicken breast c. Chocolate espresso cookies d. Deli turkey sandwich and chips e. Green herbal tea with meals
ANS: B, E The diet recommendations for Mnires disease include low-sodium, caffeine-free foods and fluids distributed evenly throughout the day. Plenty of water is also needed. The broiled chicken breast and herbal tea are the best selections. The stir fry is high in sodium and possibly monosodium glutamate (MSG, also not recommended). The cookies have caffeine, and the sandwich and chips are high in sodium.
5. A client has external otitis. On what comfort measure does the nurse instruct the client? a. Applying ice four times a day b. Instilling vinegar-and-water drops c. Use of a heating pad to the ear d. Using a home humidifier
ANS: C A heating pad on low or a warm moist pack can provide comfort to the client with otitis externa. The other options are not warranted.
4. The nurse works with clients who have hearing problems. Which action by a client best indicates goals for an important diagnosis have been met? a. Babysitting the grandchildren several times a week b. Having an adaptive hearing device for the television c. Being active in community events and volunteer work d. Responding agreeably to suggestions for adaptive devices
ANS: C Clients with hearing problems can become frustrated and withdrawn. The client who is actively engaged in the community shows the best evidence of psychosocial adjustment to hearing loss. Babysitting the grandchildren is a positive sign but does not indicate involvement outside the home. Having an adaptive device is not the same as using it, and watching TV without evidence of other activities can also indicate social isolation. Responding agreeably does not indicate the client will actually follow through.
14. A client has severe tinnitus that cannot be treated adequately. What action by the nurse is best? a. Advise the client to take antianxiety medication. b. Educate the client on nerve cutting procedures. c. Refer the client to online or local support groups. d. Teach the client side effects of furosemide (Lasix).
ANS: C If the clients tinnitus cannot be treated, he or she will have to learn to cope with it. Referring the client to tinnitus support groups can be helpful. The other options are not warranted.
9. A nurse is teaching a community group about noise-induced hearing loss. Which client who does not use ear protection should the nurse refer to an audiologist as the priority? a. Client with an hour car commute on the freeway each day b. Client who rides a motorcycle to work 20 minutes each way c. Client who sat in the back row at a rock concert recently d. Client who is a tree-trimmer and uses a chainsaw 6 to 7 hours a day
ANS: D A chainsaw becomes dangerous to hearing after 2 hours of exposure without hearing protection. This client needs to be referred as the priority. Normal car traffic is safe for more than 8 hours. Motorcycle noise is safe for about 8 hours. The safe exposure time for a front-row rock concert seat is 3 minutes, but this client was in the back, and so had less exposure. In addition, a one-time exposure is less damaging than chronic exposure.
8. A client is going on a cruise but has had motion sickness in the past. What suggestion does the nurse make to this client? a. Avoid alcohol on the cruise ship. b. Change positions slowly on the ship. c. Change your travel plans. d. Try scopolamine (Transderm Scop).
ANS: D Scopolamine can successfully treat the vertigo and dizziness associated with motion sickness. Avoiding alcohol and changing positions slowly are not effective. Telling the client to change travel plans is not a caring suggestion.
An older adult client comes in for a routine visit. During the assessment he is irritable and says, "Speak up and quit mumbling!" How will the nurse respond? Apologizes and speaks louder and clearer Asks whether the client has a hearing loss Shout to ensure that the client can hear Suggests that the client move to a soundproof examination room to improve his hearing
Apologize and speaks louder and clearer
Which test best determines hearing acuity? Audiometry Electronystagmography Otoscope Snellen test
Audiometry
During the physical assessment, the nurse notices that the patient's right external ear is deformed. What is the appropriate nursing action? a. Ask the patient about hearing deficits b. Assess the kidney or urinary tract problems c. Ask the patient to provide information a bout his or her hearing d. Speaking in a lower-toned voice and ensure good visual contact with the patient
B External ear develops at the same time as the kidneys and urniary tract in the embryo.
The nurse understands that a patient with a long history of heart failure is at risk for developing hearing loss if: a. Heart failure alters tissue perfusion, which may affect hearing b. The patient uses topical medications, which may be ototoxic c. The patient has received multiple doses of furosemide d. There is a genetic predisposition to developing hearing loss
C Furosemide is a common medication for those with heart failure. It is alo ototoxic
The nurse has just received change-of-shift report about these clients. Which client needs to be assessed first? A. Client with Ménière's disease who is reporting severe nausea and is requesting an antiemetic B. Client who has had removal of an acoustic neuroma and has complete hearing loss on the surgical side C. Client with labyrinthitis who has a temperature of 102.4° F (39.1° C) and a headache D. Client who has acute otitis media and is reporting drainage from the affected ear
C.
The nurse is assessing a client with recent changes in hearing. After taking a medication history, which drugs does the nurse identify as possible causes of the client's hearing change? Select all that apply. A. Acetaminophen (Tylenol) B. Beta blockers C. Erythromycin D. Ibuprofen (Advil) E. Insulin F. Furosemide (Lasix)
C. D. F
An older adult client reports ear pain. Otoscopic examination for otitis media by the nurse practitioner (NP) reveals a dull and retracted membrane. What does the NP do next? Continues further assessment Irrigates the ear Prescribes antibiotics for probable otitis media Tests hearing acuity
Continues further assessment
A nurse is caring for a client who has suspected Meniere's disease. Which of the following is an expected finding? A. Presence of a purulent lesion in the external ear canal B. Feeling of pressure in the ear C. Bulging, red bilateral tympanic membranes D. Unilateral hearing loss
D.
A nurse is performing an otoscopic examination of a client. Which of the following is an unexpected finding? A. Pearly, gray tympanic membrane (TM) B. Malleus visible behind the TM C. Presence of soft cerulean in the external canal D. Fluid bubble seen behind the TM
D. Indicates possible otitis media
The nurse is performing an otoscopic examination of a client's ear and notes greenish-white drainage. What does the nurse do next? Disposes of the otoscope tip and washes the hands before examining the other ear Reports the finding to the health care provider immediately Sends a specimen for culture Suctions out the drainage
Disposes of the otoscope tip and washes the hands before examining the other ear
Which type of drug therapy does the nurse anticipate giving to a client with Ménière's disease to decrease endolymph volume? Antihistamines Antipyretics Diuretics Nicotinic acid
Diuretics
An older adult client reports ear pain. To differentiate the cause, which clinical manifestation is more indicative of otitis media? Dry, flaky cerumen Pain on movement of the tragus Ringing in the ears Dizziness
Dizziness
When preparing to examine an ear with drainage, what does the nurse do first? Begins testing at 1000 Hz Reassures the client that the ear drainage is normal Tilts the client's head away slightly Dons clean gloves
Dons clean gloves
Otitis media
Ear infection
The nursing student hopefuls are taking a pre-nursing anatomy and physiology class. What will they learn is the anatomical feature that equalizes air pressure in the middle ear?
Eustachian tube
The nursing student hopefuls are taking a pre-nursing anatomy and physiology class. What will they learn is the anatomical feature that equalizes air pressure in the middle ear?
Eustachian tube pp. 1881-1882.
A client visits a community clinic reporting severe allergies causing a "crackling sensation" in the ear. The physician diagnoses serous otitis media. Which of the following is a characteristic of this condition?
Fluid collects in the middle ear causing an obstruction of the auditory tube.
Which finding should a nurse recognize as normal when assessing the ears of an elderly client?
High-tone frequency loss
Student nurses are spending time in the laboratory learning the proper use of an otoscope. What technique would these students learn for best visualization of the tympanic membrane in an adolescent?
Hold the ear at the helix and lift up and back
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?
I need to keep my ear canal clean and dry p. 1903
Mastoiditis
Infection of mastoid hair cells Caused by progressive otitis media Can lead to brain abscess, meningitis & death
Sensorineural hearing loss
Inner ear Defect in cochlea, cranial nerve or brain Caused by exposure to loud noise or music
Hearing aids help with which of the following problems?
Makes sound louder p. 1902
When teaching a class of school-age children about hygiene, the nurse should include which information about the ears?
Never put anything smaller than your elbow in your ears.
A patient comes to the clinic and reports pain when he touches his ear. With what is this finding most consistent?
Otitis externa
Conductive hearing loss
Outer ear Obstruction of soundwave transmission Cause: foreign body, fused bony ossicles, retracted tympanic membrane
Which technique is correct when instilling ear drops? Maintain the head in the same position for 2 minutes after instillation. Place the medication bottle in a bowl of warm water before instillation. Rinse the ear canal with hydrogen peroxide before instillation. Check to see whether the eardrum is intact before instillation.
Place medication bottle in a bowl of warm water before instillation
Which terms refers to the progressive hearing loss associated with aging?
Presbycusis
What is the proper technique for assessing an adult client's ear with an otoscope? Hold the otoscope right side up when inserting it into the ear canal. Maintain distance between the otoscope and the client's head. Place the otoscope in the nondominant hand. Pull the pinna up and back with the nondominant hand.
Pull the pinna up and back with the non dominant hand
A client recently diagnosed with Ménière's disease is struggling with tinnitus. How does the nurse provide support to this client? Provide further assessment. Suggest a quiet environment. Suggest temporary removal of a hearing aid. Refer the client to the American Tinnitus Association.
Refer the client to the American Tinnitus association
Tinnitus
Ringing in the ears Diagnostic test cannot confirm No cure
Which of the following is a symptom related to vertigo?
Spinning sensation
An older adult client reports nausea during irrigation of the ear canal to remove impacted cerumen. What does the nurse do next? Administer an antiemetic. Call the health care provider. Stop irrigation immediately. Use less water to irrigate.
Stop irrigation immediate
Which phrase defines ossiculoplasty?
Surgical reconstruction of the middle ear bones p. 1894
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 pp. 1889, 1901-1902.
When planning care for a client with an inner ear infection, the nurse will need to include interventions for which of the following potential problems?
Vertigo
A client is in the immediate postoperative period after tympanoplasty. How does the nurse position the client? On the affected side Supine, with eyes toward the ceiling With the head elevated 60 degrees With the affected ear facing up
With the affected ear facing up
A client is having a stapedectomy. Which form of postoperative communication is most effective for the nurse to use? Gesturing Sign language Speaking Writing
Writing
The nurse is planning to conduct the Weber test on an adult male client. To perform this test, the nurse should plan to
strike a tuning fork and place it on the center of the client's head or forehead.