TEST 3: Chapter 16- Hearing

6. A 76-year-old adult expresses frustration to the nurse regarding hearing loss despite a lifetime of being conscientious about avoiding known causes of hearing damage. Which of the following age-related changes may result in hearing loss? A) Degeneration of the inner ear structures B) Decreased viscosity and quantity of cerumen C) Plaque formation and occlusion of the Eustachian tubes D) Hypertrophy of the external ear structures

Ans: A Age-related changes of the inner ear include loss of hair cells, reduction of blood supply, diminution of endolymph production, decreased basilar membrane flexibility, degeneration of spiral ganglion cells, and loss of neurons in the cochlear nuclei. These inner ear changes result in the degenerative hearing impairment termed presbycusis. Cerumen often becomes more viscous with age, and occlusion of the Eustachian tubes is not a normal, age-related change. Changes to the external ear structures are not implicated in age-related hearing loss

13. A nurse teaches an older adult about risks related to ototoxic medications. Which of the following medications should the adult minimize or avoid? A) Nonsteroidal anti-inflammatory agents B) Osmotic stool softeners C) Over-the-counter sleep aids D) Penicillin-type antibiotics

Ans: A Ototoxic medications include (but are not limited to) aminoglycosides, macrolides, quinolones, and some antifungals (not penicillins), aspirin and other salicylates, as well as nonsteroidal anti-inflammatory drugs. Neither sleep aids nor stool softeners have been implicated in ototoxicity

7. A nurse who regularly visits an adult daycare center has noted evidence of a hearing deficit in a man who has no documented history of hearing loss. Which of the following factors should the nurse consider when attempting to ascertain the etiology of the man's hearing loss? (Select all that apply.) A) Genetic factors B) Environmental conditions C) Fluid and electrolyte imbalances D) Ototoxic medications E) Atherosclerosis or thrombotic events

Ans: A, B, D Medications, genetic factors, and environmental factors are all among the many potential contributors to hearing loss in older adults. Fluid and electrolyte imbalances, atherosclerosis, and thrombosis are not commonly implicated in hearing loss among older adults

14. After an older adult has had irrigation for removing impacted cerumen, which of the following interventions would be helpful for preventing a recurrence? (Select all that apply.) A) Ceruminolytic drops as indicated B) Cotton-tipped swabs daily C) Ear candling monthly D) Home oral jet irrigator bimonthly E) Examination by the health care provider every 6 to 12 months

Ans: A, E Prophylactic use of ceruminolytic agents can reduce the risk of impacted cerumen. Those at high risk for impaction should get an examination by qualified health care provider every 6 to 12 months. Teach all older adults to avoid putting anything smaller than their elbow in their ear: this includes candles, oral jets, and swabs. All of these are potentially harmful to the ear

9. As part of a comprehensive physical assessment of an older adult client, a nurse is performing an otoscopic examination. Which of the following assessment findings most clearly warrants further assessment and possible intervention? A) There is a small amount of cerumen visible in the ear canal. B) The epithelial lining is bright red. C) The tympanic membrane is intact. D) The tympanic membrane is a pearl-gray color

Ans: B Bright red epithelial lining in the ear is an abnormal finding; the lining should be pinkish white. A small amount of cerumen and an intact, pearl-gray tympanic membrane are expected findings

4. A nurse notes that a client who has heart failure could hear well during the last home visit, and is having difficulty hearing today. Which of the following laboratory findings is most likely associated with impaired hearing? A) Albumin of 4.1 B) Creatinine of 4.2 C) Potassium of 4.3 D) Sodium of 144

Ans: B Older adults with heart failure are at increased risk for hearing loss caused by medications (e.g., diuretics) and decreased renal and cardiac perfusion. Normal levels of albumin, potassium, and sodium are not associated with hearing loss

11. A gerontological nurse presents at a local conference regarding recent findings in age-related hearing loss. Which age-related changes indicated in hearing loss and speech perception should the nurse include? A) Changes to the external auditory canal and pinna B) Degenerative changes to the auditory brainstem C) Growth of longer and thicker hair in the ear canal D) Thickening of the tympanic membrane

Ans: B Studies suggest that central auditory structures (e.g., primary auditory cortex and auditory brainstem) account for a significant component of hearing loss in older adults, particularly with regard to speech perception. The external ear changes that occur with normal aging are not directly related to hearing loss (including hair growth in men). The tympanic membrane thins and stiffens with age

5. An 85-year-old woman who lives alone says to the nurse, "There is nothing I can do about my hearing. I am 85 years old, and I am not really interested in listening to television programs anymore." Which of the following would be the nurse's best response? A)"You are lucky you still live alone at 85, and I understand why you don't care about the programs on television." B)"Have you talked with your health care provider about a hearing evaluation? This would determine the problem and possible solutions to it." C)"I know a hearing aid dealer who offers free testing. Have you thought about trying a hearing aid?" D)"Did you know that there are closedcaption television sets that would allow you to enjoy some shows?"

Ans: B The first step would be to determine what the problem is. Free testing is not comprehensive in its evaluative scope. Telling the client she is lucky to be living alone at 85 years of age is nontherapeutic communication and suggesting that the woman use closedcaption television does not address the hearing issue.

10. A nurse has been caring for an 83-yearold resident of a nursing home for 2 years and has developed a high level of trust with the resident. Which of the following recent changes in the resident's behavior may signal the possibility of hearing loss? A) The resident's statements occasionally suggest that he is not oriented to time. B)The resident had a recent episode where he became visibly angry at a nursing assistant. C) The resident's attention span is short and he is easily distracted. D) The resident has become increasingly disagreeable and terse in his demeanor

Ans: C Short attention span and easy distractibility are indicators of hearing loss. Aggression and agitation more often suggest alternative etiologies, such as neurologic health problems

1. A 62-year-old who has worked on an assembly line since he was 24 years old began taking aspirin for arthritis 6 months ago. The client presents to the nurse with hearing problems and ringing in the ears. Which of the following problems should the nurse suspect? A) Tinnitus B) Vertigo C) Ototoxicity D) Impacted cerumen

Ans: C The older adult has symptoms of ototoxicity. Aspirin is a known ototoxic drug. Tinnitus is the persistent sensation of ringing in the ears, which is one of this client's symptoms. Vertigo is a sensation of motion, which is not a reported symptom for this client. Although common, impacted cerumen would not lead to ringing in the ears.

2. A new nursing assistant asks the nurse how best to approach a hearingimpaired older adult. Which of the following approaches should the nurse recommend? A) Raise the volume of your voice. B) Leave the radio on to calm the older adult. C) Lower the tone of your voice. D) Use exaggerated lip movements.

Ans: C Communication interventions for the hearing impaired should aim at clarity of words. This is accomplished by slowing the rate of speech and eliminating environmental noise and distractions. When communicating, lower the tone while speaking in a moderately loud voice

12. The Functional Consequences Theory approach to hearing loss identifies health promotion interventions for promoting hearing wellness. Which of the following interventions will most directly affect auditory health of the older adult? A) Avoidance of medications B) Regular colonics C) Smoking cessation D) Ear muff use in winter

Ans: C Reviews of studies identified the following risk factors for hearing impairment: male gender, increased age, genetic predisposition, exposure to noise, impacted cerumen, smoking, exposure to secondhand smoke, use of ototoxic medications, education level less than or equal to high school diploma, and certain medical conditions. Colonic use and ear coverage for warmth have not been identified as risk factors to hearing loss

3. A nurse is teaching a group of hearingimpaired nursing home residents about hearing aids. Which of the following points should the nurse emphasize? A) It is not necessary to use the hearing aid for one-on-one conversations. B) The hearing aid should be used only in the dining room or social area. C) While inserting the hearing aid, make sure the volume is turned off. D) If whistling is heard, the volume of the hearing aid may need to be increased

Ans: C The hearing aid should be inserted with the volume off with the canal portion pointing into the ear. A hearing aid should be used for one-on-one conversation and should not be used in a dining room where there is background noise. If whistling is heard, the volume should be decreased

15. A home care nurse teaches a caregiver about the care of hearing aids. Which of the following statements, if made by the caregiver, indicates that further teaching is required? A) "I lay a towel over the table while working on them." B) "I turn off the aid before I change the battery." C) "I wash the earmold with warm soapy water each week." D) "I have purchased enough batteries to last a year."

Ans: D Care of hearing aids includes to keep a fresh battery available but to not purchase batteries more than 1 month in advance. Turn off the hearing aid before changing the battery. Clean the aid weekly, using warm, soapy water for the earmold. And avoid dropping the aid on a hard surface; when handling it, keep it over a soft or padded surface

8. The incidence of hearing loss in a longterm care facility is high, especially among white men. What strategy should care providers adopt when communicating with older adults who have hearing loss? A)Use less complex concepts when communicating with hearing-impaired older adults. B) Use a high, consistent tone and pitch when speaking to adults with hearing loss. C)Speak at a high volume directly into the less affected ear when talking to an older adult with a hearing deficit. D)Make eye contact before and during a conversation with hearing-impaired adults.

Ans: D Eye contact helps facilitate communication with individuals who have hearing loss. It is unnecessary, and likely inappropriate, to simplify the content of conversations, and a low tone is more beneficial than a high tone. It is not normally necessary to speak directly into the ear of the older adult