Assessment and Care of Patients with Ear and Hearing Problems

The nurse is performing an ear assessment on an older adult. Which assessment finding does the nurse document in the client's chart as an expected age-related change? a. Coarse hair is seen in the auditory canal. b. Tympanic membrane is intact and bulging. c. Impacted cerumen is present in the auditory canal. d. Small, painless nodules are noted on the helix of the pinna.

A

The nurse is assessing several clients with hearing loss. Which client does the nurse recommend should investigate hearing aids? a. Client who has smoked two packs of cigarettes a day for 30 years b. Client who had chronic middle ear infections during childhood c. Client with constant tinnitus that becomes worse at night d. Client who worked as a security guard at rock concerts for 10 years

B

Which client is at highest risk for hearing loss? a. Client with heart failure receiving digoxin (Lanoxin), 0.125 mg orally daily b. Client with asthma receiving high-dose methylprednisolone (Solu-Medrol) therapy c. Client with osteomyelitis receiving IV gentamicin (Garamycin) d. Client with hyperkalemia being treated with intravenous glucose and insulin

C

Which is the best assessment question for the nurse to ask a client with tinnitus? a. "How exactly do you clean your ears?" b. "Have you had your hearing checked lately?" c. "Do you have ringing in both ears or in only one ear?" d. "Does the ringing make it hard for you to sleep at night?"

C

The nurse is caring for a client who is hard of hearing. Which intervention best helps the client with communication? a. Speaking loudly and adding extra inflections to the tone of voice b. Bending over the client so that he or she can see the nurse's lips more easily c. Closing the door to the room and making sure that lighting is adequate d. Asking the client's spouse to answer questions that are not heard by the client

C

A client with a ruptured tympanic membrane asks the nurse whether hearing will be affected permanently. Which is the nurse's best response? a. "Possibly. The eardrum usually heals in 1 to 2 weeks. Any persistent hearing problem should be evaluated." b. "No. Antibiotics will help resolve the infection and cure your hearing impairment." c. "Yes. It will be important for you to be fitted with a hearing aid as soon as possible." d. "Yes. Any time the eardrum is ruptured it will form a scar, which will cause some degree of permanent hearing loss."

A

Several clients come to the emergency department following an accident. Which client does the nurse assess first? a. Client with clear watery drainage from the ear canals b. Client who reports tinnitus and pain in the right ear c. Client with a deep, 1-inch laceration to the pinna d. Client who has had severe difficulty hearing since the accident

A

The nurse is caring for a client who will undergo electronystagmography testing the following day. Which instruction does the nurse provide for the client? a. "You should drink only caffeine-free beverages the day of and the day before the test." b. "Do not chew gum or clean your ears for 24 hours after the test is completed." c. "You may feel flushed as the contrast dye is injected through your IV for the test." d. "You will be sedated for the test, so you need someone to drive you home."

A

The nurse is caring for a client with Ménière's disease. The client asks the nurse how to prevent another acute episode from occurring. Which is the nurse's best response? a. "Stop or reduce cigarette smoking." b. "Use aspirin rather than acetaminophen (Tylenol) for pain." c. "Reduce the quantity of saturated fats in your diet." d. "Avoid crowds and people with upper respiratory infection."

A

A client is being discharged after a tympanoplasty. Which instruction about cephalexin (Keflex) does the nurse provide to this client? a. "Be sure to finish all the Keflex pills, even if you feel fine." b. "The Keflex may turn your urine an orange color while you are taking it." c. "Take the Keflex on an empty stomach and stay upright for 30 minutes afterward." d. "Use sunscreen and avoid exposure to sunlight while you are taking Keflex."

A

A client is scheduled for a caloric test to evaluate the vestibular portion of the inner ear. Which statement by the client leads the nurse to conclude that more teaching is necessary? a. "I can eat a hearty breakfast before the procedure." b. "I will have to stay in bed after the procedure to prevent nausea." c. "Warm water will be infused into my affected ear." d. "I may experience dizziness after the water is inserted."

A

The nurse is caring for a newly deaf client who is learning to read lips. Which client statement indicates that additional teaching is needed? a. "After I practice lip reading for a while, I won't need to worry about using sign language anymore." b. "I will have a harder time lip reading when I am not familiar with the topic of the conversation." c. "Focusing so much on lip reading will make me tired, so I will try to keep conversations short." d. "I may not be able to lip read very well when the other person has a beard or when light in the room is inadequate."

A

The nurse is caring for an older client whose ear canals are impacted with hard cerumen. Which action by the nurse is best to remove the cerumen? a. Instruct the client to put a few drops of mineral oil into each ear every evening and to schedule the irrigation for 3 days later. b. Aim the irrigation fluid directly at the center of the cerumen to facilitate dissolving the impaction. c. Administer 10 mg of prochlorperazine (Compazine) to prevent nausea during irrigation of the ears. d. Irrigate the ears with 35 to 40 mL of sterile normal saline and repeat as needed until the cerumen is cleared.

A

The nurse notes reddened areas behind both ears. What does the nurse ask the client? a. "Do you wear eyeglasses?" b. "Do you have any allergies?" c. "Do you use dandruff shampoo?" d. "Have you been around anyone with lice?

A

Which recommendation does the nurse provide for the client with Ménière's disease who has periodic spells of vertigo? a. "Avoid wearing high-heeled shoes." b. "Put brightly colored rugs on the floor for visibility." c. "Step on a sturdy chair to get items from high shelves." d. "Wait to drive a car until after you have taken your Benadryl."

A

Which client statement indicates that the client understands teaching about stapedectomy surgery? (Select all that apply.) a. "My hearing will get worse before it gets better." b. "I will have to miss 6 weeks of swim team practice." c. "I will see the doctor 1 week after surgery to have my stitches removed." d. "Foods may taste funny for a short time after surgery." e. "I may get dizzy and feel like the room is spinning after surgery." f. "I can blow my nose to relieve the feeling of fullness in my ear after surgery."

A, B, D, E

Which of the nurse's assessment findings will require collaboration with the client's primary health care provider? (Select all that apply.) a. Purulent drainage from the ear canal b. Hearing loss with nausea and vertigo c. Ringing in the ears after attending a loud rock concert d. Presence of cerumen blocking 50% of the ear canal e. Increasing hearing loss since starting furosemide (Lasix) f. Temperature of 101.7° F following a stapedectomy 3 days ago

A, B, E, F

A client is being taught how to safely irrigate ears to remove cerumen. What is the correct order of self-ear irrigation? (Separate letters by a comma and space as follows: a, b, c, d.) a. Fill the syringe with lukewarm water. b. Hold the head at a 30-degree angle. c. Insert the tip of the syringe carefully into the ear canal and aim toward the canal roof. d. Tilt the head at a 90-degree angle to remove excess fluid. e. Use one hand to hold the syringe and the other to push the plunger. f. Repeat the procedure on the opposite ear. g. Continue the procedure until at least a cup of fluid has flowed into and out of the ear. h. The ear should fill with fluid and the water will flow out with cerumen.

A, C, B, E, G, H, D, F

Which statements by a client alert the nurse that the client may have some psychosocial issues with impaired hearing? (Select all that apply.) a. "I get so angry when I cannot hear what my daughter says." b. "When I use my hearing aids, I hear the choir so clearly." c. "I don't mind sitting in my chair all day long and not playing bingo." d. "My family never seems to visit anymore because their voices all seem so distant." e. "No one asks my opinion because I cannot hear their question." f. "My grandchildren do not think that I am funny anymore because I cannot hear their jokes."

A, C, D, E, F

The nurse is caring for an older client who presents with dizziness and difficulty hearing. Which of the nurse's assessment findings will require collaboration with the client's primary health care provider? (Select all that apply.) a. Tympanic membrane is retracted, with multiple air bubbles. b. The client reports inability to hear high-frequency voices and sounds. c. Clear watery drainage is present in the ear canal and is positive for glucose. d. Tympanic membrane is shiny and translucent, with light reflex noted. e. Hearing test indicates positive Rinne test, with AC > BC noted bilaterally. f. The client reports dizziness after taking naproxen (Aleve) for arthritis pain.

A, C, F

The nurse is caring for a client who has just been diagnosed with profound hearing loss. The client tells the nurse, "The doctors must have made a mistake. There's no way I can be deaf!" Which is the nurse's best response? a. "Why do you think that the doctors made a mistake?" b. "I can tell that you are anxious and scared about your hearing." c. "Lots of people lead productive lives after losing their hearing." d. "The doctors did extensive tests to make sure that the diagnosis was correct."

B

The nurse is caring for a client who may have an ear infection. Which intervention is used to prevent spread of the infection to other clients? a. A new sterile otoscope speculum is used to examine each of the client's ears. b. The nurse washes his hands after removing hearing aids from the client's ears. c. Hearing aids are cleaned with alcohol before they are re-inserted into the client's ears. d. The tuning fork is cleaned with hydrogen peroxide before and after use with the client.

B

The nurse is caring for a client with otitis media and notes purulent drainage in the ear canal during the physical assessment. Which is the nurse's priority intervention? a. Obtain a specimen of the drainage for culture. b. Irrigate the ear canal with sterile normal saline. c. Gently examine the client's ear with an otoscope. d. Place a cotton ball in the ear canal to absorb the drainage.

C

The nurse is caring for a client with a furuncle on the pinna at the opening of the ear canal. The nurse is reviewing home care instructions with the client. Which statement by the client indicates that additional teaching is needed? a. "I will put the bacitracin ointment on the sore three times a day." b. "I will gently squeeze the sore to drain the liquid out once a day." c. "I will take Tylenol (acetaminophen) if my ear starts to hurt a lot." d. "I will put a warm compress on the sore for 15 minutes three times a day."

B

The nurse is caring for a client with otitis media. The client reports that the pain was severe during the night but was gone upon awakening in the morning. Which finding does the nurse expect to observe during the client's physical assessment? a. The tympanic membrane is bluish-gray. b. Purulent fluid is present in the ear canal. c. The pinna and the tragus are reddened and swollen. d. Sounds are lateralized toward the affected ear.

B

The nurse notes that a client's tympanic membrane moves in response to air injected into the external canal. What is the nurse's best action? a. Notify the health care provider. b. Document the finding. c. Prepare to wash the external ear canal. d. Immediately remove the otoscope.

B

When performing a client's physical assessment, the nurse notes that the client has conductive hearing loss. Which finding does the nurse expect to see in the client's medical history? a. History of diabetes with peripheral neuropathy b. Frequent episodes of otitis media during childhood c. History of frequent impactions of cerumen in the ear canals d. History of osteomyelitis treated with IV gentamicin (Garamycin)

B

Which is the best approach for the nurse to use to obtain a history from a client with sudden hearing loss? a. Question the client's family. b. Write out the questions for the client to answer. c. Obtain the information from the client's old chart. d. Check with the client's primary health care provider.

B

A client asks the nurse why there is "waxy yellow stuff" on the cotton swab when he cleans his ears. Which is the nurse's best response? a. "The yellow ear wax helps transmit sound to your middle ear." b. "The yellow ear wax indicates that you have an infection in your ears." c. "The yellow ear wax helps protect and lubricate the inside of your ear canal." d. "The yellow ear wax builds up when you don't clean your ears often enough."

C

A client is being started on scopolamine (Transderm Scop) for vertigo. What does the nurse tell the client regarding this medication? a. "You may drive your car while taking this medication." b. "Concentration on your college courses will not be affected." c. "It is recommended that you limit activities requiring a detailed focus." d. "You should be able to continue your job as a crane operator."

C

A client tells the nurse, "Bumps have developed in my ear canals from my hearing aid." Which is the nurse's best recommendation for the client? a. "Clean your hearing aid with rubbing alcohol every evening and let it dry overnight." b. "Apply a small amount of benzoyl peroxide cream to the inside of your ear canals before you insert your hearing aid." c. "Clean your hearing aid with mild soap and water and make sure that it is completely dry before inserting it in your ears." d. "Clean your ears with half-strength hydrogen peroxide twice a day before you put in your hearing aid and after you take it out."

C

The client requires a hearing aid but tells the nurse that he cannot afford to pay for it right now. What is the nurse's best response? a. "Your insurance company should pay some of the cost." b. "The hospital can set up a payment plan for the new hearing aid." c. "I'll ask the social worker about organizations that help pay for hearing aids." d. "You can check around to see who has the lowest price."

C

The nurse is caring for an older adult client with sensorineural hearing loss. Which assessment finding does the nurse correlate with the client's health history? a. History of frequent ear infections b. Swims frequently c. Worked in a sawmill for the last 20 years d. Had a tumor removed from his left eardrum last year

C

Which statement indicates that a client needs additional teaching about ear hygiene? a. "I will wash my hands before I put in my earplugs at work." b. "I will clean my ears with plain warm water and a washcloth every day." c. "I will use a cotton swab to get the extra water out of my ears after I swim." d. "I can rinse my ears with half-strength hydrogen peroxide if ear wax builds up."

C

The nurse is instilling eardrops into a client's ear. Place the following in order according to best practice. (Separate letters by a comma and space as follows: a, b, c, d.) a. Ask the client to move the head gently back and forth five times. b. Wash your hands. c. Wear gloves to remove any packing from the ear. d. Perform an otoscopic examination to see if the eardrum is intact. e. Irrigate the ear if needed to remove cerumen. f. Tilt the client's head in the opposite direction of the affected ear and place the drops in the affected ear. g. Warm the bottle of eardrops in a bowl of warm water for 5 minutes. h. Wash your hands again. i. Insert a ball of cotton in the ear as packing.

C, B, D, E, G, F, A, I, H

A client has mastoiditis. The nurse assesses most carefully for which manifestations? (Select all that apply.) a. Red and bulging eardrum b. A crackling sound upon yawning c. Enlarged lymph nodes behind the ear d. Low-grade fever and malaise e. Diminished hearing f. Loss of appetite

C, D, E, F

The nurse is caring for a client with Ménière's disease. What does the nurse recommend to the client to reduce the symptoms of vertigo? a. "Take salt and potassium supplements daily." b. "Drink at least eight glasses of water every day." c. "Blow your nose hard when dizziness first begins." d. "When dizziness begins, lie down and keep your head still."

D

The nurse is caring for a client with external otitis. Which assessment finding indicates to the nurse that the client's infection has worsened? a. The client now reports tinnitus and vertigo at night. b. The client now has a positive Rinne test, with AC > BC. c. The tympanic membrane is pearly gray with white patches. d. The auricular lymph nodes have increased in size over the last 24 hours.

D

The nurse is providing discharge instructions for a client who will be going home following tympanoplasty surgery. Which statement by the client indicates that additional teaching is needed? a. "I will wear earplugs whenever I am in noisy areas." b. "I will occlude only one nostril when I blow my nose." c. "I will wait 3 weeks before I resume my aerobics workouts." d. "I will use a cotton swab to clean drainage from inside my ear."

D

The nurse teaches a client's wife how to administer eardrops to the client. Which statement by the client's wife indicates that additional teaching is needed? a. "I will make sure that the eardrops are at room temperature before using them." b. "I will wash my hands before and after giving my husband the eardrops." c. "After I put the drops in, I will gently tug on the outer ear to make sure that they go into the ear canal." d. "I will have my husband lay on his back with his chin up when I give him the eardrops."

D

Which statement indicates that a client needs additional teaching about protecting the ears and preventing hearing loss? a. "I will start a smoking cessation program and will take a multivitamin every day." b. "I will wear earplugs whenever I cut the grass or use my snow blower." c. "I will blow my nose gently, one nostril at a time, whenever I get a cold or the flu." d. "I will take Motrin (ibuprofen) instead of Tylenol (acetaminophen) for pain."

D