Exam 1: Hearing Loss Questions

A nurse anticipates that an 18-month-old child who does not have hearing loss has acquired a vocabulary sufficient to enable him to communicate. What communication behavior should the nurse expect when assessing the 18-month-old toddler? 1. saying about 10 words 2. pointing while grunting 3. using four-word sentences 4. making babbling sounds

1 rationale: A vocabulary consisting of 8 to 10 words with telegraphic speech is expected of an 18-month-old toddler. Children with a hearing impairment communicate by pointing and grunting because they have not acquired the rudiments of language. Using four-word sentences is typical of a 3-year-old child. Babbling is the expected communication for an 8-month-old infant, even one with moderate hearing loss.

A nurse in the pediatric clinic is testing a 4-year-old child with recurrent otitis media for signs of hearing loss. The child's parent asks what can be done if there is a hearing loss. The nurse responds that the most common treatment is what? 1. Myringotomy 2. Adenoidectomy 3. Neomycin ear drops 4. systemic steroid therapy

1 rationale: Myringotomy is surgical incision of the eardrum to permit drainage of infected middle ear fluid and thus improve hearing. Removal of the adenoids will not relieve the pressure from inflamed ears. Antibiotics are administered systemically, not locally, if needed. Systemic antibiotics, not steroids, are prescribed; a myringotomy is performed if antibiotics are ineffective.

A client has sensorineural hearing loss. Which finding in the client's history will alert the nurse to the most likely cause of the sensorineural hearing loss? 1. Prolonged exposure to noise 2. Buildup of cerumen in the ear 3. Blockage of the ear from a foreign body 4. Perforation of the tympanic membrane

1 rationale: Sensorineural hearing loss occurs due to damage to the auditory nerve in the inner ear. Prolonged exposure to noise can cause damage to the cochlea. Cerumen in the ear can cause obstruction in the ear and lead to a conductive hearing loss. Foreign bodies can cause infection and inflammation in the ear, thereby leading to a conductive hearing loss. Perforation of the tympanic membrane leads to an increased risk of ear infections, which can cause conductive hearing loss.

A nurse is caring for four clients. Which client is at risk of meningitis, hearing loss, and generalized paresis? 1. A 2. B 3. C 4. D

1 rationale: Gummas on the skin, nose, mouth, and bones are associated with the third stage of syphilis. A client in the third stage of syphilis is at a higher risk for neurosyphilis, which may lead to central nervous system problems. Therefore client A is more prone to meningitis, hearing loss, and generalized paresis. Client B (with painless, indurated, smooth, and weeping skin lesions) has a highly infectious primary stage of syphilis. Client C (with diffuse reddish-brown macules and papules 3 mm in size near the genitalia) may have secondary syphilis. Client D (with malaise, muscular aches, condylomata lata, and a moth-eaten appearance of the scalp) may have highly contagious secondary syphilis.

The nurse is assessing an older adult client with suspected hearing loss. Which observations made by the nurse in the client indicates a decrease in hearing acuity? Select all that apply. 1. frequent usage of words such as "what" 2. postural changes while listening to the speaker 3. bending towards the other person while talking 4. mismatch in the questions asked and the responses given 5. startled expression when there is any unexpected sound in the environment

1, 2, 3, 4 rationale: Hearing assessment begins while observing the client listening to and answering the questions asked by the nurse. Indicators of hearing difficulty in the client frequently include asking the speaker to repeat statements or frequently saying "What?" or "Huh?" Changes in the client's posture, such as leaning forward when listening to the speaker or tilting the head to one side, can provide information about hearing acuity. The nurse should also assess whether the client's responses match the questions asked; mismatch in the client's responses may indicate a decrease in hearing acuity. Startling to an unexpected sound in the environment determines no loss in hearing acuity.

A nurse is caring for an older adult with a hearing loss secondary to aging. What can the nurse expect to identify when assessing this client? Select all that apply. 1. dry cerumen 2. tears in the tympanic membrane 3. difficulty hearing high pitched voices 4. decrease of hair in the auditory canal 5. overgrowth of the epithelial auditory lining

1, 3 rationale: Cerumen (ear wax) becomes drier and harder as a person ages. Generally, female voices have a higher pitch than male voices; older adults with presbycusis (hearing loss caused by the aging process) have more difficulty hearing higher pitched sounds. There is no greater incidence of tympanic tears caused by the aging process. The hair in the auditory canal increases, not decreases. The epithelium of the lining of the ear becomes thinner and drier.

The nurse is teaching a client about caring for a hearing aid. Which statements made by the patient indicates the need for further learning? Select all that apply. 1. "i should always keep my hearing aid on" 2. "i can adjust the volume of my hearing aid" 3. "i should check and replace the battery frequently" 4. "i can use hair sprays and hair oil while wearing a hearing aid" 5. "i can clean the ear mold with a soap and water with limited wetting"

1, 4 rationale: A hearing aid is a small electronic amplifier which assists clients with conductive hearing loss. The hearing aid should be turned off when not in use. Hair sprays and hair oils can cause damage when they come in contact with the hearing aid. The volume of the hearing aid can be adjusted to prevent feedback squeaking. Batteries should be checked and replaced frequently. The ear mold of the hearing aid can be cleaned with soap and water; excessive wetting should be avoided.

The nurse frequently provides care for clients with hearing aids. Which condition does the nurse recall responds best to hearing aids? 1. destruction of the auditory nerve 2. diminished sensitivity of the cochlea 3. perforation of the tympanic membrane 4. immobilization of the auditory ossicles

2 rationale: Because hearing aids use the person's own middle ear, they increase hearing acuity in cases of diminished sensitivity of the cochlea; the amplified signal from the hearing aid gives the cochlea greater stimulation and promotes hearing. Destruction of the auditory nerve results in deafness because impulses cannot be transmitted to the brain's auditory center. Perforation of the tympanic membrane prevents ossicular conduction, which involves transmission of resonant vibrations from the tympanic membrane to the ossicles to the cochlea. Hearing aids will not correct this type of hearing loss; surgery is preferred. Immobilization of the ossicles prevents conduction of resonant vibrations from the tympanic membrane to the cochlea. Hearing aids may help but will not correct this problem; surgery is preferred.

The nurse is assessing the clinical data of four clients. Which client is characterized with mixed conductive-sensorineural type of hearing loss? 1. Client A 2. Client B 3. Client C 4. Client D

2 rationale: Client B is diagnosed with a retraction in the tympanic membrane, causing obstruction to sound wave transmission. Damaged cochlear hair results in decreased sensory perception. Therefore, this client is characterized by a mixed conductive-sensorineural type of hearing loss. Client A is diagnosed with inflammation in the tympanic membrane resulting in retraction or bulging of the tympanic membrane, leading to obstruction of sound wave transmission thereby causing conductive hearing loss. The type of hearing loss diagnosed in client C is characterized as sensorineural hearing loss, as there is damage to the vestibulocochlear cranial nerve. Client D is diagnosed with fused bony ossicles, which obstructs sound wave transmission thereby causing conductive hearing loss.

A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend? 1. ear drops 2. myringotomy 3. mastoidectomy 4. steroid therapy

2 rationale: Myringotomy is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Ear drops are not used because they will obscure the view of the tympanic membrane. Removal of the mastoid will not relieve pressure within inflamed ears. Antibiotics, not steroids, are used for an infectious process.

Which test helps a primary healthcare provider distinguish between conductive and sensorineural hearing loss? 1. Whisper test 2. Weber test 3. Tympanometry 4. electrocochleography

2 rationale: Tuning fork tests help in differentiating conductive and sensorineural hearing loss. The Weber test and the Rinne test are two of the most common tuning fork tests performed to make this distinction. The whisper test provides general information about the client's hearing ability. Tympanometry is used to diagnose middle ear effusions. An electrocochleography is used to record electric activity in the cochlea and the auditory nerve.

The school nurse is working with a child with a hearing deficit. The child arrives at school today without hearing aids. When the nurse talks with the child about the reasons for not wearing the aids, the nurse will need to ensure that the child hears what is being said. What actions by the nurse will promote effective communication? Select all that apply. 1. speaking slower and louder than normal 2. facing the child directly when talking to the child 3. avoiding chewing gum while communicating with the child 4. avoiding using facial expressions that could interfere with lip reading 5. moving from side to side while talking to the child to keep the child looking at the nurse

2, 3 rationale: Many hearing-impaired children have some degree of lip reading skills. This will help the child understand what is being said. Chewing gum alters speech sounds and may alter lip movement, adding to the child's confusion. The nurse should speak slowly but not excessively, because this modifies speech. Speaking louder than normal may distort speech. Facial expressions can add meaning to the spoken word. Standing still while speaking to the child ensures that the speaker's face remains clearly visible.

If hearing loss is detected early, proper intervention can help a child achieve normal language development. What is the latest age that hearing loss should be detected to ensure that a child achieves normal language development? Record your answer using a whole number. ______________ months

3 rationale: If a healthcare provider detects hearing loss before the child is three months old and an intervention is initiated within six months, the child can achieve normal language development.

Which action of the nurse would be most important to convey interest in starting a conversation with a client who has hearing loss? 1. smiling while seeing the client 2. nodding head in front of the client 3. making eye contact with the client 4. leaning forward towards the client

3 rationale: The nurse should make eye contact with the client to show interest in starting a conversation with a client with hearing loss. Smiling while seeing the client would help to build a positive relationship. Nodding in front of the client helps to regulate the conversation. Leaning forward towards the client shows attention and awareness.

During a well-child visit the parents tell a nurse, "Our 3-year-old doesn't listen to us when we speak and ignores us!" An auditory screening reveals that the child has a mild hearing loss. What should the nurse explain to the parents about this degree of hearing loss? 1. a severe hearing deficit may develop 2. it will not interfere with progress in school 3. an immediate follow-up visit is not necessary 4. speech therapy in addition to hearing aids may be required

4 rationale: A mild degree of hearing loss causes the child to miss approximately 25% to 40% of conversations; it may result in speech deficits and interfere with the child's educational progress if it is not corrected. Hearing aids usually help improve function. There is no evidence that this child's hearing loss is progressive. The significance of the hearing loss requires further analysis and intervention.