PrepU Chapter 59: Assessment and Management of Patients with Hearing and Balance Disorders

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?

7-10 days A client with otitis externa should refrain from any water sport for approximately 7 to 10 days to allow the canal to heal completely. Otherwise, recurrence is highly likely.

The nurse is assisting the client in planning care during exacerbations of Ménière's disease. Which diet would the nurse identify as appropriate at this time?

A low-sodium diet Treatment for Ménière's disease is related to reducing fluid production in the inner ear, facilitating its drainage, and treating the symptoms that accompany the attack. A low-sodium and sodium-free diet lessens edema.

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.

The client has been diagnosed with objective vertigo. Which symptom would the nurse relate to the tentative diagnosis?

A sensation of things moving Objective vertigo includes the sensation that the environment is moving or a sense that things are moving around oneself. The symptoms do not include a headache, pain in the outer ear, and difficulty hearing.

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.

A patient has been diagnosed with a fungal infection causing external otitis. What is the most common fungal infection in the ear?

Aspergillus The most common bacterial pathogens associated with external otitis are Staphylococcus aureus and Pseudomonas species. The most common fungus isolated in both normal and infected ears is

High doses of which medication can produce bilateral tinnitus?

Aspirin At high doses, aspirin toxicity can produce bilateral tinnitus. Meclizine and dimenhydrinate are used for nausea and vomiting related to motion sickness. Antiemetics, such as promethazine suppositories, help control nausea and vomiting and vertigo through an antihistamine effect.

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 client who has been fitted with a hearing aid comes for a follow-up evaluation. During the visit, the client states, "I've noticed that I still don't seem to hear well enough. The hearing aid doesn't seem to make the sounds louder." Which of the following might the nurse determine as the possible cause?

Client has cerumen in the ear.

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 Scopolamine and Phenergan are popular anticholinergics; ephedrine is a popular sympathomimetic. Dramamine and Antivert are over-the-counter antihistamines that act by blocking the conduction of the vestibular pathway of the inner ear.

The nurse is caring for a client who just returned from a trip requiring an airline flight. The client reported ear pain 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 client with progressive hearing loss is diagnosed with a malignant tumor of the right external ear. For which additional alteration in physical status will the nurse assess the client?

Facial nerve paralysis Malignant tumors may occur in the external ear. Most common are basal cell carcinomas on the pinna and squamous cell carcinomas in the ear canal. If untreated, squamous cell carcinoma may spread through the temporal bone, causing facial nerve paralysis and hearing loss. Since the client is already experiencing a change in hearing, the facial nerve needs to be assessed. The client does not need to be assessed for a frontal headache, cervical node edema, or parotid gland hypertrophy.

Which precautions should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance?

Grasp the siderails when rising to a standing position. The nurse should have the client use firm supports, such as siderails, whenever arising. There is no need to limit the client's gaze or head movements. Keeping the eyes closed can exacerbate disorientation.

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

In the Rinne test, the examiner shifts the stem of a vibrating tuning fork between two positions to test air and bone conduction of sound.

The nurse is performing a Weber test on a client. During this test, where should the nurse place the tuning fork?

In the midline of the client's skull or in the center of the forehead

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 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.

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.

The nurse is instructing a patient with Ménière's disease on dietary management to include as an adjunct to other more traditional therapies. The nurse would include which of the following? Select all that apply.

Limit foods high in salt and sugar. Avoid aspirin and aspirin products. Avoid coffee, tea, and soft drinks. Treatment aims at reducing fluid. A low-sodium or sodium-free diet lessens edema and is effective in controlling the symptoms. Aspirin and aspirin products can increase tinnitus and vertigo. Caffeine has a diuretic effect and as such is not recommended. Eat fresh fruits, vegetables, and whole grains and avoid or limit intake of processed foods, especially those with high sodium content.

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. Sodium and fluid retention disrupts the delicate balance between the endolymph and perilymph in the inner ear. Therefore, many clients can control their symptoms by adhering to a low-sodium diet. Caffeinated fluids are to be avoided because of their diuretic effect. Diuretics, not antihistamines, would be prescribed to lower the pressure in the endolymphatic system. Foods high in potassium would be encouraged if the client is prescribed a diuretic that causes potassium loss.

Which nursing suggestion would be most helpful to the client with recurrent otitis externa?

Place ear plugs into the ears before swimming

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 refers 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.

The nurse is assessing a client's hearing using the Rinne test. When providing instruction to elicit client feedback, which instruction is essential?

Raise your hand when you no longer hear sound. It is essential to provide clear directions on when the client is to notify the nurse of client response. The information gleaned from the response is what the nurse uses to interpret the test. The correct time to induce feedback is when the vibration is held.

A client is diagnosed with benign paroxysmal positional vertigo. Which information will the nurse provide about a step in canalith repositioning?

Rapidly changing positions from sitting to supine

Which nursing diagnosis takes highest priority for a client admitted for evaluation for Ménière's disease

Risk for injury related to vertigo Vertigo, the chief finding in Ménière's disease, is a severe, rotational whirling sensation that typically causes the client to fall when attempting to stand or walk. Because client safety is paramount, the nursing diagnosis of Risk for injury related to vertigo takes priority. Vertigo doesn't cause pain. Although nausea and vomiting may lead to inadequate nutrition and fluid loss, these problems are secondary to client safety.

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

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 he 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.

Which statement describes benign paroxysmal positional vertigo (BPPV)?

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

Which statement describes benign paroxysmal positional vertigo (BPPV)?

The vertigo is usually accompanied by nausea and vomiting. BPPV is a brief period of incapacitating vertigo that occurs when the position of the client'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 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.

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 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.

When caring for a client after ear surgery, what is an important aspect of nursing care?

Validate client's feelings of discomfort.

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

Nursing management of the client with acute symptoms of benign paroxysmal positional vertigo includes

bed rest Bed rest is recommended for clients with acute symptoms. Canalith repositioning procedures may be used to resolve attacks of vertigo, and clients with acute vertigo may be medicated with meclizine for 1 to 2 weeks. The Epley procedure is not recommended for clients with acute vertigo. The Dix-Hallpike test is an assessment test used to evaluate for benign paroxysmal positional vertigo.

During assessment for cranial nerve functions, the client closes the eyes and begins to fall to one side. Which cranial nerve alteration causes this response?

cranial nerve VIII

Acoustic neuromas are benign tumors of which of the following cranial nerves?

eighth cranial nerve = VIII

Which portion of the middle ear equalizes pressure?

eustachian tube It drains secretions of the middle ear and equalizes pressure in the middle ear with that of the atmosphere.

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

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

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.

What is located in the cochlea of the inner ear?

organ of corti The fluid motion created by the vibrating stapes excites the nerve endings in the sensitive sound receptors of the organ of Corti located in the cochlea. The labyrinth is the name for the inner ear, and the semicircular canals and vestibulocochlear nerves are other components of the inner ear.

Which condition is characterized by the formation of abnormal spongy bone 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.

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. The other options 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.

Which symptom is related to vertigo?

spinning sensation Vertigo is defined as the misperception or illusion of motion of the person or the surroundings. Most people with vertigo describe a spinning sensation or say they feel as though objects are moving around them.

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.

Which manifestation is the most problematic for the client diagnosed with Ménière disease?

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

The clinical manifestations of motion sickness are caused by an overstimulation in what system?

vestibular Motion sickness is a disturbance of equilibrium caused by constant motion. The syndrome manifests itself in sweating, pallor, nausea, and vomiting caused by vestibular overstimulation. Motion sickness is not caused by cardiovascular, cochlear, or gastrointestinal overstimulation.