Ear NCLEX-PN Review

A perforated eardrum is suspected in a client who was hit in the ear with a basketball. A tympanoplasty was performed. The nurse is giving the client discharge instructions. Which client statement indicates a need for further teaching?

"I will drink from the plastic bottle mouth since I can't use drinking straws."

The nurse provides discharge instructions to the client who was hospitalized for an acute attack of Ménière's disease. Which statement made by the client indicates a need for further teaching?

"It is not necessary to restrict salt in my diet."

The nurse is reinforcing discharge instructions to a client who just underwent a myringotomy with placement of a polyethylene tube in the left ear. Which statement by the client indicates a need for further teaching? Select all that apply.

1."I may wash my hair tomorrow." 4."I will irrigate the ear with gentle pressure." 5."I can expect to feel pressure inside the ear."

A client with a history of ear problems telephones the ambulatory care nurse to cancel an appointment because he will be away on business. The client mentions that he will be flying during this trip. The nurse advises the client to engage in which activities to prevent barotrauma during takeoff and landing? Select all that apply.

1.Chewing gum 2.Yawning occasionally 3.Swallowing a few times 5.Sucking on a piece of hard candy

The nurse is reviewing the health care record of a client with a diagnosis of otosclerosis. Which signs and symptoms should the nurse note? Select all that apply.

1.Tinnitus 4.Difficulty hearing voices of others 5.Bone conduction better than air conduction

The nurse administers meclizine hydrochloride to a client diagnosed with an attack of Ménière's disease. Which observations demonstrate to the nurse that the medication is effective? Select all that apply.

2.Decrease in nausea 3.Decrease in vertigo

The nurse is reinforcing home care instructions to a client following a fenestration procedure for the treatment of otosclerosis. Which instruction should the nurse give the client?

Increase fluids and take a stool softener daily.

The nurse is reviewing the primary health care provider's prescriptions for a client admitted to the hospital with a diagnosis of an acute attack of Ménière's disease. Which prescription noted on the client's chart should the nurse question?

The administration of a vasoconstrictor

Which intervention should be implemented for the older client with presbycusis who has a hearing loss?

Use low-pitched tones.

An adult client with a history of ear infections reports a right earache accompanied by a sensation of fullness. The client also reports nausea and has a temperature of 100.6° F. The nurse questions the client about which aspect of the client's history?

Whether the client has had a recent upper respiratory infection (URI)

A client has been diagnosed with a hearing loss caused by age-related changes in the ear. The nurse reinforces information about obtaining and learning to use a hearing aid. Which statement by the client indicates understating of the information?

"I should obtain a hearing aid as soon as possible."

The nurse is reinforcing instructions to a client regarding the use of a hearing aid. Which statement by the client indicates a need for further teaching?

"I should turn the hearing aid off after removing it from my ear."

The nurse is assigned to care for a client with a diagnosis of Ménière's disease. After reinforcing discharge instructions, which client statement indicates a need for further teaching?

"I will become totally deaf if I don't follow instructions."

The nurse is providing discharge instructions for a client who has had a fenestration procedure for the treatment of otosclerosis. Which statement by the client indicates an understanding of the instructions?

"I will take stool softeners as prescribed by my doctor."

The nurse determines that the client diagnosed with Ménière's disease understands the reinforced dietary instructions when the client states that which food will be avoided in the diet?

Hot dogs

A client is diagnosed with labyrinthitis. Which are signs and symptoms of labyrinthitis? Select all that apply.

1.Severe dizziness 4.Nausea and vomiting 5.Abnormal jerking movement of eyes

The nurse notes that the primary health care provider (PHCP) has documented a diagnosis of presbycusis on the client's chart. Which explanation should the nurse give to the client to explain this condition?

A sensorineural hearing loss that occurs with aging

The nurse is reviewing the medication list for an assigned client. Which medication is the only one on the client's prescription sheet that does not have an ototoxic effect?

Acetaminophen

A client was just admitted to the hospital to rule out a gastrointestinal bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication should the nurse determine to be the cause of the client's complaint?

Acetylsalicylic acid

A client has a diagnosis of presbycusis. The nurse interprets that which behavior indicates that the client has successfully adapted to this disorder?

Agrees to use a prescribed hearing aid especially when home alone

The nurse is caring for a client following craniotomy for removal of an acoustic neuroma. The nurse understands that assessment of which cranial nerve should identify a complication specifically associated with this surgery?

Cranial nerve VII, facial nerve

The nurse is assisting in preparing a teaching plan for a client with Ménière's disease. The nurse places highest priority on teaching the client information related to which information?

Safety

The nurse is attempting to communicate with a hearing-impaired client. Which strategy by the nurse would be least helpful when talking to this client?

Smiling continuously during conversation

The nurse is caring for a client who is hearing-impaired and should take which approach to facilitate communication?

Speak in a normal tone.

A caloric test is prescribed for a client suspected of having a disease of the labyrinth. The nurse obtains which essential item in preparation for this test?

An otoscope

A client is experiencing blockage of the eustachian tubes. The nurse teaches the client that which activities by the client may forcibly open the eustachian tube?

Performing the Valsalva maneuver

A nursing instructor asks a student about cochlear implants. The student understands that which clients are candidates for such a procedure? Select all that apply.

2.A client who has a profound hearing loss in both ears 4.A client who has received no benefit from conventional hearing aids

A client who frequently experiences hearing loss due to built-up cerumen in the ears asks the nurse about ways to deal with the problem including irrigating the ears. Which information is correct for the nurse to include in the teaching plan? Select all that apply.

2.Irrigate the ear canal with lukewarm tap water around 98° F. 4.The ear irrigation should be stopped if the client becomes dizzy or nauseous. 6.Instill drops of mineral oil and hydrogen peroxide for several days to soften dried cerumen before irrigation.

Which actions should be performed when communicating with a client with presbycusis? Select all that apply.

2.Speak slowly and distinctly. 3.Face client when speaking.5.Use short sentences and phrases.

The nurse assigned to care for a hearing-impaired client should use which approach to communication in order to enhance communication and preserve the client's self-esteem? Select all that apply.

2.Speaking slowly and clearly 3.Standing directly in front of the client while speaking 5.Turning down the volume on the radio or TV when talking

A client arrives at the emergency department with a foreign body in the left ear that has been determined to be an insect. Which initial intervention should the nurse anticipate to be prescribed?

Instillation of mineral oil or diluted alcohol

The nurse is assigned to care for a client hospitalized with Ménière's disease. The nurse expects that which would most likely be prescribed for the client?

Low-sodium diet

The nurse is caring for a client with acute otitis media. The nurse plans care knowing which treatment for this problem is likely to be included?

Myringotomy

An adult client has increased fluid in the middle ear that is causing vertigo. The nurse checks this client for which associated signs and symptoms of this condition?

Nausea and vomiting

The nurse is preparing to administer eardrops to an adult client. The nurse administers the eardrops by which technique?

Pulling the pinna up and back

A client has had same-day surgery to insert a ventilating tube in the tympanic membrane. The nurse reinforces to the client to be sure to perform which action until the postoperative assessment by the primary health care provider?

Use a shower cap to protect the ears if taking a shower.

The nurse assists with preparing the client for ear irrigation as prescribed by the primary health care provider (PHCP). Which action should the nurse plan to take?

Warm the irrigating solution to 98° F (36.6° C).

The nurse is reinforcing education to a client who has just obtained a hearing aid about its use and maintenance. The nurse tells the client that it is helpful to follow which practice?

Keep an extra battery readily available.

Surgery has been recommended for the client with otosclerosis. The client tells the nurse that she would prefer not to have surgery and asks the nurse about alternative methods to improve hearing. The nurse should make which appropriate response to the client?

"A hearing aid may improve your hearing."

A myringotomy is performed on a client in the ambulatory care center. The ambulatory care nurse calls the client 24 hours after the procedure to evaluate the status of the client. The client reports to the nurse that a small amount of brownish drainage has been coming from the ear. Which instruction should the nurse provide to the client?

"Continue to monitor the drainage because this is normal and may occur for 24 to 48 hours following the surgery."

A client with a diagnosis of otosclerosis is admitted to the ambulatory care unit for stapedectomy, and the nurse reinforces instructions to the client regarding home care following the procedure. Which statement by the client indicates a need for further teaching?

"I need to avoid air travel for at least 6 months."

The nurse is caring for a client hospitalized with an acute attack from Ménière's disease. The client verbalizes concern because the client has experienced a hearing loss as a result of the attack. Which response should the nurse make to the client regarding the hearing loss?

"The attack leaves a hearing loss in the involved ear."

The nurse is assisting a client who has just been given a hearing aid to wear for the first time. When reinforcing client teaching, the nurse should include which instruction?

"The hearing aid should not be worn if an ear infection is present."

The nurse is reinforcing discharge instructions with a client who is being discharged following a fenestration procedure for the treatment of otosclerosis. Which should be included on the list of instructions prepared for the client?

"You need to avoid air travel."

The nurse is assisting in developing a plan of care for a client following the surgical removal of an acoustic neuroma. Which assessment will be included in the plan of care for this specific intervention?

Assessment of cranial nerve VII (facial)

A client with Ménière's disease is experiencing severe vertigo. The nurse reinforces instructions to the client to do which to assist with controlling the vertigo?

Avoid sudden head movements.

The nurse is communicating with a client who is hard of hearing in both ears. To facilitate communication with this client, the nurse should perform which?

Lower the voice pitch and face the client when speaking.

The nurse is assisting the primary health care provider in performing a caloric test on a client. Following instillation of cool water into the ear, the nurse observes the presence of nystagmus. The nurse should document the findings of this test as indicative of which result?

Normal

The nurse is assisting the primary health care provider in performing a caloric test on a client. Following instillation of warm water into the ear, the client complains of vertigo. The nurse documents the findings of this test as indicative of which result?

Normal

The nurse is assisting a primary health care provider in performing a caloric test on a client. Following instillation of warm water into the ear, the nurse notes that nystagmus does not occur. The nurse should document the findings of this test as indicative of which result?

Positive

The nurse is preparing to communicate with an older client who is hearing impaired. Which intervention should be implemented initially?

Stand in front of the client.

The nurse provides dietary instructions to a client with Ménière's disease. The nurse tells the client that which food or fluid item is acceptable to consume?

Sugar-free Jell-O

A client susceptible to motion sickness asks the nurse about the use of medication to prevent an occurrence. The nurse plans to incorporate into the discussion that the medication works effectively if which guideline is followed?

Taking the medication 1 hour before a triggering event

The nurse is caring for a client who will be undergoing surgical treatment for Ménière's disease. The nurse plans care based on which expected outcome?

The surgery relieves pressure from accumulation of inner ear fluid in the endolymphatic sac.

The nurse is assisting the primary health care provider with performing a Rinne tuning fork test on a client. The nurse expects that the steps of the testing will be performed in which priority order? Arrange the actions in the order that they would be performed. All options must be used.

1 Tap tuning fork to activate. 2 Place base of tuning fork on the mastoid bone. 3 Have client indicate when the sound disappears. 4 Move the tuning fork close to the ear canal. 5 Ask the client if he or she hears the sound and to indicate when the sound disappears. 6 Document whether bone or air conduction is better.

The nurse is reviewing the record of a client with mastoiditis. The nurse should expect to note which signs and symptoms? Select all that apply.

1.Headache 2.Swelling directly behind the ear 5.Red and immobile tympanic membrane

The nurse is reviewing the health care record of a client suspected of having mastoiditis. Which documented findings should the nurse expect to note if this disorder is present? Select all that apply.

1.Headache 3.Elevated white blood cell count 5.Swelling behind the ear on affected ear

The primary health care provider will perform a caloric test. Which is the priority order of the actions to perform this test? Arrange the actions in the order that they should be performed. All options must be used.

1.Explain the purpose and procedure to the client 2.Note if the client has had central nervous system depressants, alcohol, or barbiturates 3. Check for the presence of nystagmus, postural deviation (Romberg sign), and past-pointing 4. Examine and clean the ear canal. 5. Place emesis basin under ear to be tested then irrigate the suspected ear with hot or cold water 6. Irrigate until the client complains of nausea and dizziness or nystagmus is observed

Which medications cause ototoxicity? Select all that apply.

1.Ibuprofen 3.Furosemide 4.Vancomycin

The nurse is speaking with a client with a hearing impairment. The nurse refrains from doing which least likely helpful action when communicating with this client?

Using many exaggerated hand gestures while talking

When reinforcing information to a client regarding how to appropriately care for a new hearing aid, the nurse should provide the client with which instruction?

To check the battery regularly to ensure that it is working before use

The nurse is explaining how sound is conducted from the middle ear to the inner ear in teaching a client who is experiencing hearing loss. What is the order of structures conducting sound waves from the middle ear to the inner ear? Arrange the structures in the order that they should occur. All options must be used.

Tympanic membrane 1 Malleus, incus, stapes 2 Oval window 3 Cochlea 4 Organ of Corti 5

Which instruction is appropriate for the nurse to provide to a client who reports via telephone that he is certain an insect has flown into his ear because he can hear it "buzzing"?

Use a flashlight to coax the insect out of the ear.

The nurse is observing an unlicensed assistive personnel (UAP) talk to a client who is hearing impaired. The nurse should intervene if which actions are performed by the UAP during communication with the client? Select all that apply.

1.The UAP speaks in a very loud voice.3.The UAP speaks while cleaning the room. 4.The UAP speaks directly into the impaired ear.

The nurse has been assigned to a client with a hearing impairment. To enhance nurse-client communication, the nurse should plan to communicate with the client by speaking in which manner?

In a normal tone while facing the client

The nursing student is developing information for use in a clinical conference about hearing disorders. In the presentation, the student plans to include the statement that the ear is housed in which bones of the skull?

Temporal

A nursing student is preparing to assist with an ear irrigation on an assigned client who has a buildup of cerumen in the left ear. The nursing instructor asks the student about the procedure for the irrigation. The student nurse should perform the procedure in which correct order? Arrange the actions in the order that they should be used. All options must be used.

1 Warm the prescribed solution to body temperature (95° F to 105° F). 2 Have the client sit up holding an emesis basin under the ear to be irrigated with a drape under the basin. 3 Straighten the external canal of an adult by pulling the auricle up and back. 4 Select an irrigating syringe or bulb syringe with a tip that is smaller than the canal. 5 Direct the solution toward the top of the canal in a steady stream, not toward the eardrum.

The nurse is preparing to instill an otic solution into the adult client's right ear. The nurse should include which action while performing this procedure? Select all that apply.

1.Pulling the auricle of the right ear upward 2.Pulling the auricle of the right ear backward 3.Warming the solution to room temperature 4.Placing the client in a left side-lying position

A client has sought treatment in the ambulatory care clinic after an insect has become trapped in the external ear canal. The nurse prepares to assist the primary health care provider to instill which acceptable solutions into the ear to remove the insect? Select all that apply.

1.Lidocaine 2.Mineral oil 3.Ether solution