Iggy Chapter 43: Assessment and Care of Patients With Ear and Hearing Problems

An older adult in the family practice clinic reports a decrease in hearing in one ear for 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 would take is to look for cerumen buildup, which can decrease hearing in the older adult. If this is normal, medications would be assessed for ototoxicity. Further auditory testing may be needed for this patient.

A nurse is teaching a community group about preventing hearing loss. What instruction is appropriate? a. "Always wear a bicycle helmet." b. "Avoid swimming in ponds or lakes." c. "Don't attend fireworks shows." d. "Use a cerumen spoon to clean ears."

ANS: A Avoiding head trauma is a practical way to help prevent hearing loss. Swimming can lead to hearing loss only if the client has repeated infections. Fireworks displays/shows are loud, but usually brief and only occasional. A cerumen spoon is only used by primary health care providers to remove ear wax from in the ear canal.

A nurse is teaching a client about ear hygiene and health. Which statement by the client 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 hearing."

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.

A client has mastoiditis and is prescribed antibiotics. What health teaching 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 mastoiditis. 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.

A client is scheduled to have a tumor of the middle ear removed. Which perioperative health teaching is most important for the nurse to include? 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.

A client had a myringotomy. What would the nurse include as part of 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.

The nurse is teaching a family member who is caring for a client who is hearing impaired. What health teaching would the nurse include about communicating with the client? (Select all that apply.) a. "Make sure that the room is well lighted." b. "Speak slowly and clearly." c. "Do not shout but you may need to speak loudly." d. "Have conversations in a quiet room with minimal noise." e. "Get the client's attention before you begin to speak." f. "Move closer to the better hearing ear if possible."

ANS: A, B, C, D, E, F All of these recommendations are useful when communicating with clients who are hearing impaired.

The nurse is caring for a client after ear surgery. What health teaching instruction(s) would the nurse provide for this client to promote healing? (Select all that apply.) a. "Avoid straining when having a bowel movement." b. "Avoid drinking through a straw for 2 to 3 weeks." c. "Avoid air travel for 2 to 3 weeks after surgery." d. "Avoid crowds and people with infection, especially respiratory infection." e. "Avoid moving your head quickly, jumping, or bending over for 2 to 3 weeks." f. "Blow your nose very gently without blocking either nostril and keep your mouth open."

ANS: A, B, C, D, E, F It is imperative that the patient having ear surgery is free from ear infection. The other precautions help to prevent increased intra-ear pressure which can affect the surgical procedure.

A client has a hearing aid. What care instructions does the nurse provide the assistive personnel (AP) 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." f. "Avoid using hair or cosmetic products near the hearing aid."

ANS: A, C, D, F All these actions except using water are proper instructions for the nurse to give to the AP.

The nurse is teaching a client about factors that can cause external otitis. Which of these factors would the nurse emphasize as the highest risk? a. Excess cerumen b. Swimming c. Sinus congestion d. Meniere disease

ANS: B External otitis is often called "swimmer's ear" because it is most often caused by swimming in lakes, ponds, and untreated pools.

The nurse is assessing a client's medication profile to determine risk for tinnitus. Which drug classification is most likely to cause this health problem? a. Cephalosporins b. NSAIDs c. Beta-adrenergic blockers d. Osmotic diuretics

ANS: B None of these drug classifications except for NSAIDs pose a risk to clients for tinnitus as a side effect.

A hospitalized client has a new diagnosis of Ménière disease. What would the nurse include in health teaching to reduce symptoms for this disorder? (Select all that apply.) a. "Apply heat to the ear for 20 minutes three times a day." b. "Move the head slowly to prevent worsening of the vertigo." c. "Avoid food additives such as monosodium glutamate (MSG)." d. "Quit smoking to increase blood flow to the inner ear." e. "Avoid caffeinated beverages." f. "Avoid standing on chairs, step stools, or ladders."

ANS: B, C, D, E, F Ménière disease is an excess of endolymphatic fluid that distorts the entire inner-canal system causing vertigo, tinnitus, and unilateral hearing loss. Applying heat or irrigating the ear canal will not alleviate symptoms. Moving the head slowly will prevent worsening of the vertigo. The diet recommendations for Ménière disease include avoiding caffeine and certain food additives. Smoking causes constriction of blood vessels and decreased blood flow to the inner ear. Clients should also avoid standing on high surfaces to prevent vertigo and falls.

A client has external otitis. About what comfort measure would 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 appropriate.

A client with Ménière disease is in the hospital when the client has an episode of this disorder. What action by the nurse is appropriate? a. Assess vital signs every 15 minutes. b. Dim or turn off lights in the client's room. c. Place the client in bed with the upper side rails up. d. Provide a cool, wet cloth for the client's face.

ANS: C Clients with Ménière disease can have vertigo so severe that they can fall. The nurse would assist the client into bed and put the side rails 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 Ménière disease.

A client has severe tinnitus that has not responded to treatment. What action by the nurse is appropriate? 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. Refer the client to a mental health professional.

ANS: C If the client's tinnitus cannot be treated, he or she will need to learn how to cope with it. Referring the client to tinnitus support groups can be helpful. The other options are not warranted.

The nurse is teaching new assistive personnel (AP) about caring for older adults. Which statement would the nurse include about hearing ability of this client group? a. "You need to talk very loudly when communicating with these clients." b. "You always need to check each client's ears for excess ear wax." c. "Remember to face the client when talking with him or her." d. "Assess each client's hearing ability using the voice or whisper test."

ANS: C Losing one's hearing is not a normal change of aging although high frequency sounds may be more difficult to hear. AP does not perform assessments and it is not necessary to talk loudly or shout unless a hearing impairment exists. Therefore, facing the client is the best strategy when communicating with most older adults.

A client is scheduled for a tympanoplasty. What action(s) by the nurse are (is) most appropriate? (Select all that apply.) a. Administer preoperative opioids. b. Assess for allergies to local anesthetics. c. Ensure that informed consent is on the health record. d. Give prescribed antivertigo medications. e. Teach that hearing improves immediately.

ANS: C Preoperatively, the nurse ensures that informed consent is in the health record. 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.

The client's electronic health record 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 don't 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 are related to conductive hearing loss.

A nurse is teaching a community group about noise-induced hearing loss. Which client who does not use ear protection would the nurse refer to an audiologist as the priority? a. Client with an hour car commutes 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 several hours of exposure without hearing protection. This client needs to be referred as the priority. Normal car traffic and motorcycle noise is safe unless for a very long time. Although a client was at a rock concert, he or she was in the back row and had less exposure. In addition, a one-time exposure is less damaging than chronic exposure.

The nurse is teaching an older adult how to prevent buildup of ear wax. Which statement by the nurse is most appropriate? a. "Visit your primary health care provider each month for wax removal." b. "Drink plenty of water and other liquids to prevent hardening of the ear wax." c. "Irrigate each ear once a month to remove wax and prevent was buildup." d. "Put one drop of mineral oil in each ear once a week at bedtime."

ANS: D Mineral oil provides lubrication to soften cerumen so that it flows out of the ears to prevent buildup. It is a safer method than irrigating the ears. If needed, the client would need to go to a primary health care provider for removal of impaction. Drinking water helps prevent hardening of wax but does not necessarily prevent wax buildup.

A client who has had cold symptoms for a week visits the local urgent care center with report of left ear discomfort, dizziness, and decreased hearing. What additional assessment findings would the nurse expect? a. High fever b. Nausea and vomiting c. Elevated blood pressure d. Purulent ear drainage

ANS: D The client presents with symptoms that indicate possible serous otitis or otitis media. In either case, the client would not have a high fever or blood pressure. Nausea and vomiting are not common with either diagnosis, but purulent ear drainage is likely to occur if the tympanic eardrum perforates. The client's decreased hearing could indicate that perforation already occurred.