MSII Prep U Ch. 64: Assessment and Management of Patients With Hearing and Balance Disorders

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?

sensorineural Sensorineural hearing loss usually is irreversible.

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." The client demonstrates understanding of the care of a hearing aid when stating the need to keep the ear canal clean and dry. The ear mold is the only part of the hearing aid that can be washed frequently, that is daily with soap and water. It should be allowed to dry completely before it is snapped into the receiver or inserted into the ear.

The nurse is supervising a family member who instilling ear drops into the client's ear. Which of the following statements, made by the family member, would require further nursing instruction?

"These drops are cold from being on the window sill." When the family member states that the drops are cold, the nurse would encourage the family member to place the bottle in a warm bath or warm the bottle in their hands. Cold or hot liquids, instilled in the ear, may cause dizziness and potential for injury.

A client is diagnosed as having serous otitis media. When describing this condition to the client, which of the following would be most accurate?

"You have some fluid that has collected in your middle ear but no infection." Serous otitis media involves fluid, without evidence of active infection, in the middle ear. Recurrent episodes of acute otitis media leads to chronic otitis media. An infection of the temporal bone (temporal bone osteomyelitis) is a serious but rare external ear infection called malignant external otitis. Rupturing of the eardrum refers to tympanic membrane perforation.

A dietary modification for a patient with Ménière's disease would be:

A decrease in sodium intake to 2,000 mg daily. Patients with Ménière's disease can be successfully treated by adhering to a low-sodium (2000 mg/day) diet, with no caffeine and alcohol.

Which of the following preattack symptoms may a patient with Meniere's disease report prior to an attack?

A full feeling in the ear Patients with Meniere's disease experience the preattack symptoms of headache and a full feeling in the ear prior to an attack. Nystagmus is an episodic symptom that occurs during an attack and, at times, the patient is symptom free. Meneire's disease does not cause low blood pressure or photosensitivity.

You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis?

A progressive, bilateral loss of hearing A progressive, bilateral loss of hearing is the characteristic symptom of otosclerosis. Tinnitus appears as the loss of hearing progresses; it is especially noticeable at night, when surroundings are quiet, and may be quite distressing to the client. The eardrum appears pinkish-orange from structural changes in the middle ear. The client often describes a history of having had a recent upper respiratory infection in case of otitis media, not otosclerosis.

Vestibular suppressants used in the treatment of vertigo originate from which of the following drug classifications? Select all that apply.

Anticholinergics Antihistamines Benzodiazepines Commonly used vestibular suppressants originate from classes of anticholinergics, antihistamines, and benzodiazepines. Cholinergic and aminoglycosides are not vestibular suppressants.

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. Although obtaining wound cultures and intravenous site assessment would be important, the most important action would be to ensure that the client has arrangements for audiograms twice a week while receiving intravenous gentamicin because of the increased risk for toxicity from long-term use. Wound cultures would not be needed daily. Blood levels of gentamicin would need to be monitored. Complete blood counts may be ordered but they would not be as important as monitoring the client for possible ototoxicity.

High doses of which of the following medications can produce bilateral tinnitus?

Aspirin At high doses, aspirin toxicity can produce bilateral tinnitus. Antivert and Dramamine are used for nausea and vomiting related to motion sickness. Antiemetics, such as promethazine (Phenergan) suppositories, help control the nausea and vomiting and the vertigo because of the antihistamine effect.

Audiometry is testing that measures hearing acuity precisely. Who does the nurse know can perform audiometric testing?

Audiologist Audiometry is done by an audiologist. Audiometric testing measures hearing acuity precisely. Options A, B, and D can screen hearing but they cannot do audiometric testing.

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?

Aural tenderness A client with otitis externa typically experiences aural tenderness. This finding is usually absent in clients with otitis media. Fever and ear drainage may be present with either otitis externa or otitis media. A bulging eardrum would suggest otitis media.

A patient is diagnosed with otitis externa. Which of the following instructions is most appropriate for the nurse to give?

Avoid swimming for 7 to 10 days. The nurse should advise the patient to avoid swimming for 7 to 10 days to allow the ear canal to heal completely. Keeping the ear covered with a scarf is not necessary. Keeping a dry cotton ball in the ear may cause further trauma to the ear canal. A cotton ball covered in a water-soluble solution can be used to keep water out while showering or washing hair. Avoiding cold water does not help to improve the patient's condition.

A client you are caring for has a hearing loss. The client tells you they are self-conscious about their hearing loss. What advice should the nurse give a self-conscious client with hearing loss to protect his or her self-esteem?

Be forthright and inform others about the hearing deficit. The nurse should encourage clients with a hearing loss to be forthright and inform others about their hearing deficit. Clients should be advised not to hide the fact that they do not understand what has been said and should be encouraged to maintain friendships because a physical impairment is unlikely to affect genuine friendships.

An initial, convenient assessment of an elderly patient'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 Conductive hearing loss usually results from an external ear disorder, such as impacted cerumen, or a middle ear disorder, such as otitis media or otosclerosis. In such instances, the efficient transmission of sound by air to the inner ear is interrupted.

Which of the following is consistent with acute otitis media?

Conductive hearing loss may occur. Approximately three of four children experience an ear infection by the time they are 3 years of age. The infection usually lasts less than 6 weeks. Conductive hearing loss may occur due to a purulent exudate. Bacteria and viruses are the most common causes of otitis media, not fungi. Reference:

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 eustachian tube extends from the floor of the middle ear to the pharynx and is lined with mucous membrane. It equalizes air pressure in the middle ear. Options B, C, and D do not equalize pressure in the middle ear.

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 The eustachian tube extends from the floor of the middle ear to the pharynx. It equalizes air pressure in the middle ear. The auricle is the fleshy portion of the outer ear which funnels sound waves to the inner ear. The tympanic membrane is the eardrum. The labyrinth is the inner ear which contains fluid

A nures is performing an otoscopic examination on a client. Which finding would the nurse document as abnormal?

External auditory canal erythema An erythematous external auditory canal would be considered an abnormal finding. The tympanic membrane is normally pearly gray and translucent. The umbo, which is located in the center of the eardrum, extends from the superior manubrium.

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone causing which of the following?

Facial nerve paralysis If untreated, squamous cell carcinomas of the ear can spread through the temporal bone, causing facial nerve paralysis and hearing loss.

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 The Weber test is performed by striking the tuning fork and placing its stem in the midline of the client's skull or in the center of the forehead. In the Rinne test, the tuning fork is struck and placed on the mastoid process behind the ear. The tuning fork is not placed near the external meatus of each ear or under the bridge of the nose.

A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear?

Inner ear A client with vertigo experiences problems with the inner ear, which is responsible for maintaining equilibrium. The external ear collects sound; the middle ear conducts sound. The tympanic membrane (eardrum) vibrates in response to sound stimulation.

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?

Instillation of mineral oil Mineral oil is instilled into the ear to smother an insect. Carbamide peroxide is used to soften dried cerumen, and small forceps are used to remove solid objects. Hot liquids cause dizziness and should not be instilled in the ear.

You are doing discharge teaching with a client after a stapedectomy. Why would it be important for you to advise the client to refrain from blowing the nose?

It may dislodge the prosthesis. The nurse should advise a client who has undergone a stapedectomy to refrain from blowing the nose because it may dislodge the prosthesis. It does not lead to sudden headaches, vertigo, or excessive drainage.

A patient is participating in aural rehabilitation. The nurse understands that this type of training emphasizes which of the following?

Listening skills Auditory training emphasizes listening skills, so the person who is hearing-impaired concentrates on the speaker.

Hearing aids help with which of the following problems?

Makes sounds louder A hearing aid makes sounds louder, but it does not improve a patient's ability to discriminate words or understand speech. Hearing aids amplify all sounds, including background noise, which may be disturbing to the wearer. It does not improve communication skills.

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) Pharmacologic therapy for Ménière's disease consists of antihistamines, such as meclizine, which shortens the attack (NIDCD, 2010).

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 An insect in the ear canal can be dislodged by instilling mineral oil, which kills the insect and allows removal. Irrigation is contraindicated because the insect would swell. Hair pin or tweezers should not be used due to the risk for trauma.

Which of the following describes a condition characterized by abnormal spongy bone formation around the stapes?

Otosclerosis Otosclerosis is more common in females than males and is frequently hereditary. A middle ear effusion is denoted by fluid in the middle ear without evidence of infection. Chronic otitis media is defined as repeated episodes of acute otitis media causing irreversible tissue damage and persistent tympanic membrane perforation. Otitis externa refers to inflammation of the external auditory canal.

Which terms refers to the progressive hearing loss associated with aging?

Presbycusis Both middle and inner ear age-related changes result in hearing loss. Exostoses refer to small, hard, bony protrusions in the lower posterior bony portion of the ear canal. Otalgia refers to a sensation of fullness or pain in the ear. Sensorineural hearing loss is loss of hearing related to damage of the end organ for hearing and/or cranial nerve VIII.

Which of the following is hearing loss associated with degenerative changes?

Presbycusis The term presbycusis refers to hearing loss associated with degenerative changes.

A patient is newly diagnosed with otitis externa. Which of the following should the nurse teach the patient before the patient leaves the clinic?

Proper instillation of prescribed ear drops Otitis externa is usually treated with antimicrobial otic drops. The nurse should anticipate teaching the patient how to instill the ear drops properly. Otitis externa is usually not treated with oral antibiotics because it is not a systemic issue. A cotton-tip applicator should not be used in the ear canal because it can cause trauma, which may lead to otitis externa. Otitis externa may have temporary conductive hearing loss, not a sensorineural one.

The nurse is caring for an 8-year-old and anticipates that the client has otitis externa from symptoms stated on the history. Which symptoms, from the history and physical examination, would confirm the diagnosis?

Pus noted in the ear canal The diagnosis of otitis externa (inflammation of the tissue of the outer ear) is confirmed by the presence of pus in the ear canal. The inflammation is usually caused by an overgrowth of pathogens. The other symptoms are also common in otitis media.

Which of the following tests uses a tuning fork between two positions to assess hearing?

Rinne's In the Rinne's test, the examiner shifts the stem of a vibrating tuning fork between two positions to test air conduction of sound and bone conduction of sound. The whisper test involves covering the untested ear and, whispering from a distance of 1 or 2 feet from the unoccluded ear, and the ability of the patient to repeat what was whispered. The watch tick test relies on the ability of the patient to perceive the high-pitched sound made by a watch held at the patient's auricle. The Weber's test uses bone conduction to test lateralization of sound.

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 A flaky scaliness on or behind the auricle usually indicates seborrheic dermatitis and can be present on the scalp and facial structures as well.

What kind of otitis media is a pathogen-free fluid behind the tympanic membrane, resulting from irritation associated with respiratory allergies and enlarged adenoids?

Serous otitis media Serous otitis media, a collection of pathogen-free fluid behind the tympanic membrane, results from irritation associated with respiratory allergies and enlarged adenoids. Options B and D are distractors for this question. Purulent otitis media usually results from the spread of microorganisms from the eustachian tube to the middle ear during upper respiratory infections.

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 Injury to the seventh cranial nerve, also known as the facial nerve, is a complication of a mastoidectomy, although rare. Hearing loss of less than 30 dB is a more common complication.

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. When performing the whisper test, the nurse covers the untested ear wtih the palm of the hand and then whispers softly form a distance of 1 to 2 feet from the unoccluded ear and out of the client's sight. The client with normal hearing can correctly repeat what was whispered

Which of the following is the treatment of choice for acoustic neuromas?

Surgery Surgical removal of acoustic tumors is the treatment of choice because these tumors do not respond well to radiation or chemotherapy. There would be no need for palliation.

A client comes to the walk-in clinic complaining of an earache. The cause is found to be impacted cerumen. The client asks the nurse what they can do at home to soften hardened cerumen. What should the nurse recommend to a client to soften hardened cerumen?

Take nonprescription preparations. The nurse should recommend nonprescription preparations that are available for softening hardened cerumen. Increasing the intake of red meat or beta-carotene or avoiding harsh sunlight will not soften the cerumen

You are admitting a client with an acoustic neuroma to your unit. What would you include during the assessment of this client?

Test for facial sensation. The assessment of a client with an acoustic neuroma includes evaluating hearing function, observing the client's facial movements, and testing for facial sensation. The client's urine output, height and weight, and ability to sustain balance, though important, are not as essential as testing for facial sensation.

Which of the following statements describes benign paroxysmal positional vertigo (BPPV)?

The vertigo is usually accompanied by nausea and vomiting; however, hearing impairment does not generally occur. BPPV is a brief period of incapacitating vertigo that occurs when the position of the patient's head is changed with respect to gravity. The vertigo is usually accompanied by nausea and vomiting; however, hearing impairment does not generally occur. The onset of BPPV is sudden and followed by a predisposition for positional vertigo, usually for hours to weeks but occasionally for months or years. BPPV is thought to be caused by the disruption of debris within the semicircular canal. This debris is formed from small crystals of calcium carbonate from the inner ear structure, the utricle. BPPV is frequently stimulated by head trauma, infection, or other events.

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 It is important that nurses are knowledgeable about the ototoxic effects of certain medications such as salicylates, loop diuretics, quinidine, quinine, and aminoglycosides. Signs and symptoms of ototoxicity include tinnitus and sensorineural hearing loss. Hypotension, reduced urinary output, and impaired facial movement are not signs of ototoxicity.

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 A low-sodium diet lessens edema. This measure does not help minimize the adverse effects of drug therapy, reduce the magnitude of the hearing deficit, or minimize the risk of a tumor that involves the vestibulocochlear nerve.

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?

Use a hair dryer set on high to dry the ear canal after swimming. To prevent swimmer's ear (otitis externa), the nurse would instruct the client to wear ear plugs when swimming, showering, or washing the hair, use a hair dryer on low to dry the ear canal after swimming, instill alcohol drops into the ear after swimming to dry the canal, and avoid scratching or exposing the ear to trauma.

A client is diagnosed with Meniere's disease. The nurse would most likely expect the client to report which of the following?

Vertigo Although tinnitus, nausea, vomiting and ear fullness may be noted, vertigo is usually the most troublesome and common complaint associated with Meniere's disease.

Which of the following manifestations is most problematic for the patient diagnosed with Ménière's disease?

Vertigo Vertigo is usually the most troublesome complaint related to Ménière's disease. Other clinical manifestations may include tinnitus, diaphoresis, and hearing loss.

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. Written communication is an excellent resource and means of mutual understanding. Distraction is not appropriate because a hearing-impaired person needs the care provider's full attention. Do not pretend to understand or complete the person's sentences for them.

A client has a history of hearing loss and is returning for an annual hearing examination. During client education, the nurse explains that hearing involves which areas of the ear?

all sections Sound is perceived because of a chain reaction involving all three areas of the ear.

Changes in pressure at high altitudes can cause discomfort in the ears. Which structure within the middle ear is instrumental in equalizing pressure?

eustachian tubes The eustachian tube extends from the floor of the middle ear to the pharynx and is lined with mucous membrane. It equalizes air pressure in the middle ear.

An older adult client reports pain in the ears and an unusual sense of fullness. The client also indicates not hearing as well as in the past. On inspection, the nurse notes that there is an accumulation of earwax in the client's ears. The client is suffering from:

otalgia. Otalgia is ear pain or an earache. Otalgia has several causes, one of which is accumulated earwax.

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 Otosclerosis is the result of a bony overgrowth of the stapes and a common cause of hearing impairment among adults.

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?

the one the client will use Although there are several communication strategies for clients with significant hearing loss, the only effective method is the one the client will consistently use