Chapter 60 Drug Therapy for Disorders of the Ear

A patient has been taking oral amoxicillin to treat otitis media for the past 6 days and has told the nurse that his ear is now "back to normal." He asks the nurse if he can now stop taking his antibiotics. How should the nurse respond? A) "That's excellent that you're feeling better, but it's important to keep taking the antibiotics until they're all finished." B) "Try reducing your dose by half. If your ear infection gets worse, resume the dose you've been taking until now." C) "You should stop taking the antibiotics because if you don't, it could cause antibiotic resistance." D) "You can likely stop taking the antibiotics, but keep them on hand in case your infection returns."

A) "That's excellent that you're feeling better, but it's important to keep taking the antibiotics until they're all finished." The patient should take the full course of antibiotics and not discontinue them, even if the otitis media seems to be improving. Stopping prematurely can cause antibiotic resistance.

Which nursing action should be implemented prior to instilling eardrops? A. Evaluate the patient's pain level. B. Assess the amount of hearing loss. C. Instruct the patient to lie on the affected ear. D. Assess if cerumen is visible.

D. Assess if cerumen is visible. Prior to instilling eardrops, it is necessary to assess the patient's ear for visible cerumen. Removal of the cerumen should occur before giving the eardrops.

An adult patient has been assessed in the emergency department and diagnosed with necrotizing otitis externa. The primary care provider has prescribed ciprofloxacin. In preparation for administering this medication, what action should the nurse perform? A) Establish intravenous access B) Remove as much cerumen as possible from patient's ear canal C) Flush the affected ear with warmed sterile water D) Establish a sterile field around the perimeter of the ear

A) Establish intravenous access Ciprofloxacin (Cipro) is the drug of choice for necrotizing otitis externa. Initially, administration is intravenous, until symptoms decrease; then it is oral. Consequently, IV access is necessary for the initiation of treatment. This is a priority over rinsing the ear or removing cerumen. It is unnecessary to create a sterile field.

A pediatric nurse practitioner has diagnosed a 4-year-old girl with otitis media. The nurse should understand that infectious microorganisms likely entered the girl's middle ear by what means? A) Though an alteration in the eustachian tube B) Though the external ear C) From within the cochlea or vestibule D) From the interstitial spaces in the middle ear

A) Though an alteration in the eustachian tube The causative pathogens implicated in otitis media include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. They enter the middle ear as a result of an alteration in the eustachian tube, not from inner ear, external ear, or interstitial spaces.

A woman was diagnosed with necrotizing otitis externa and will soon begin a course of oral ciprofloxacin. When providing health education to this patient, the nurse should emphasize the need to temporarily avoid A) calcium antacids B) fatty foods C) grapefruit juice D) foods containing purines

A) calcium antacids Patients should not take oral ciprofloxacin within 2 hours of eating dairy products, calcium-fortified juices, antacids, zinc, or iron. There is no specific need to avoid fatty foods, grapefruit juice, or high-purine foods.

A 5-year-old child has been brought to the clinic with signs and symptoms that ate consistent with otits externa. What assessment question is most likely to address the etiology of this health problem? A. "Has he been swimming a lot in the last little while?" B. "Are all of his immunizations up-to-date?" C. "Has he been spending quite a bit of time around animals lately?" D. "How would you describe his overall level of hygeine?

A. "Has he been swimming a lot in the last little while?" Otitis externa in children is often attributable to moisture in the ear, often as a result of swimming. Poor hygiene, interaction with animals, and lack of immunications are not likely to be relevant factors.

An older adult with necrotizing otitis externa has been receiving IV ciprofloxacin and is now transitioning to the oral form of the drug. What health education should the nurse provide to the patient? A. "You can take this medication with food to reduce the chance that it will upset your stomach." B. "Try to avoid foods like aged cheese, red wine, and dark chocolate until you're finished with your course of antibiotics." C. "You should take this medication once per day, ideally first thing in the morning." D. "Try to increase your intake of calcium-rich foods while you're taking this drug."

A. "You can take this medication with food to reduce the chance that it will upset your stomach." Patients may take the oral preparation of Cipro with food to reduce GI upset. Concurrent use of calcium is contraindicated, and the drug is normally ever 12 hours. There is no need to avoid foods like aged cheese, red wine, and dark chocolate.

A patient has received a diagnosis of acute otitis externa and been prescribed a combination otic solution. The nurse should teach the patient that this medication contains which of the following components? Select all that apply. A. An antibiotic B. A steroid C. An antiseptic D. An NSAID E. A topical anesthetic

A. An antibiotic B. A steroid C. An antiseptic The otic solutions most commonly prescribed for acute otitis externa are combination solutions. These medications contain an anti-infective agent and antiseptic, glucorcticoid, and acidifying agent. They do not typically contain anesthetics or NSAIDS.

An 82-year-old resident of a long-term care facility has been diagnosed with necrotizing otitis externa. The nurse who provides care at the facility is aware of this resident's complex medical history and should recognize what risk factor that may have predisposed the resident to this disease? A. The resident has a diagnosis of type 2 diabetes B. The resident takes calcium and vitamin D supplements for the treatment of osteoperosis C. The resident was recently treated with antibiotics for an upper respiratory infection D. The resident has atrial fibrillation

A. The resident has a diagnosis of type 2 diabetes Malignant necrotizing otitis externa most commonly affects elderly patients with diabetes mellitus and patients with the human immunodeficiency virus. Osteoperosis, atrial fibrillation, and recent antibiotic use are not risk factors for necrotizing otitis externa

Which of the following nursing actions should be implemented when instilling eardrops? A. Tilt the head toward the opposite shoulder. B. Lay on the affected ear after instillation. C. Apply the medication on a cotton ball and insert in the outer auricle. D. Apply ear plugs after instilling ear drops

A. Tilt the head toward the opposite shoulder. When instilling ear drops in the affected ear, tilt the head to the opposite shoulder.term-14

Which of the following medications is administered for otitis externa & otitis media? A. ofloxacin (Floxin Otic) B. Burow's solution C. benzoyl alcohol D. Acetic acid as VoSoL Otic

A. ofloxacin (Floxin Otic) Ofloxacin (Floxin Otic) is administered for otitis externa and otitis media.

A nurse uses a diagram to show the physiologic sequence of hearing. After entering the external ear, the sound is then conducted through the (Arrange the options in sequence. Separate letters by a comma and space as follows: A, B, C, D.) A. tympanic membrane B. sensory receptors C. oval window D. acoustic nerve to the brain E. malleus, incus, and stapes

A. tympanic membrane E. malleus, incus, and stapes C. oval window B. sensory receptors D. acoustic nerve to the brain The sound impulse, after entering the external ear, is conducted through the tympanic membrane; into the malleus, incus, and stapes; through the oval window; into the sensory receptors in the inner ear; and then through the acoustic nerve to the brain.

When planning care for a patient who cannot perceive or interpret sounds, a nurse takes into consideration that the patient may have a(n) _____ hearing loss.

ANS: central The inability to perceive or interpret sounds is referred to as a central hearing loss.

A child's otitis media has resulted in pain and fever. The child's mother has asked the nurse to recommend OTC remedies to address these problems. Which of the following recommendations is most likely to be safe and affective? A) Concurrent use of ASA and ibuprofen for 3 days B) Alternating doses of acetaminophen an ibuprofen C) Monotherapy with ASA until symptoms improve D) Use of an OTC antihistamine and acetaminophen

B) Alternating doses of acetaminophen an ibuprofen Alternating acetaminophen and ibuprofen every 4 hours over a 3-day period to control fever in young children (ages 6-36 months) monotherapy with either agent. ASA is contraindicated in children, and an antihistamine is unnecessary.

A young adult has been diagnosed with otitis media. When planning his patient's care, what nursing diagnosis is the most likely priority? A) Hyperthermia related to infectious process B) Infection related to presence of microorganisms C) Distributed auditory sensory perception related to otitis media D) Chronic pain related to otitis media

B) Infection related to presence of microorganisms Infection is the essence of otitis media, and would be a priority over the diagnoses such as hyperthermia or temporary hearing loss. The pain associated with this disorder would be acute, not chronic

A 4-year-old boy was diagnosed with acute otitis media and began a course of oral amoxicillin. The boy's mother has contacted the clinic and states that there has been no significant improvement in her son's ear infection since beginning the antibiotics 3 days ago. The nurse should consider which of the following explanations for this phenomenon? A) The boy has not been receiving the medication consistently B) The boy's ear infection has a viral etiology C) The boy's ear infection is caused by an antibiotic-resistant microorganism D) The medication should have been prescribed parenterally

B) The boy's ear infection has a viral etiology Many people with acute otitis media do not benefit from antibiotics because the cause of their illness is viral, not bacterial. This possibility is more likely than incorrect administration or antibiotic resistance. Parenteral administration would be no more effective in this case.

A patient has responded appreciably to first-line treatments for necrotizing otitis externa, and the care team is concerned about the possible progression of the disease. The nurse should be aware that this infection has the potential to progress to A) meningitis B) osteomyelitis C) necrotizing fasciitis D) epiglottitis

B) osteomyelitis The advancement of necrotizing otitis externa results in osteomyelitis of the skull and temporomandibular joint. It does not cause meningitis, necrotizing fasciitis, or epiglottitis.

The nurse in an extended care facility has instilled medicated eardrops into a resident's left ear as ordered. What instruction should the nurse provide after administering this medication? A. "Let's put your hearing aid back in place." B. "Keep lying on your right side for the next 20 minutes or so." C. "Gently massage your ear until you can hear normally." D. "Try to avoid touching your left ear for the next hour."

B. "Keep lying on your right side for the next 20 minutes or so." After instillation of eardrops, the patient should lie on the side opposite the side of administration for 20 minutes. It would be inappropriate to reinsert a hearing aid immediately. It is unnecessary to massage the ear or, conversely, to avoid touching the ear.

A 40-year-old man sought care because of several days of worsening otalgia that was accompanied by purulent discharge. He was subsequently prescribed Cortisporin Otic. The nurse should teach the patient that he should not exceed the maximum duration of treatment, which is how many days? A. 7 days B. 10 days C. 4 D. 14

B. 10 days Adults should instill 4 drops of Cortisporin Otic three to four times daily for no more than 10 days.

A woman is taking oral ciprofloxacin for necrotizing otitis externa. When she takes the ciprofloxacin, which of the following foods should be eliminated from her diet? A. Cranberry juice B. Calcium-enriched orange juice C. Bread D. Turkey

B. Calcium-enriched orange juice A patient who is taking ciprofloxacin should not eat calcium-fortified juices, dairy products, iron, zinc, and cal- cium products along with antacids.

A 70-year-old man has been diagnosed with necrotizing otitis media. What is the patient at risk for developing while being treated with ciprofloxacin? A. Edema B. Tendon rupture C. Decreased QT interval D. Chest pain

B. Tendon rupture Older patients who receive ciprofloxacin are at risk for tendon rupture.

The client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder involving this part of the ear? A. Pruritis B. Tinnitus C. Hearing loss D. Burning in the ear

B. Tinnitus

A 76-year-old woman is receiving amoxicillin (Amoxil) for acute otitis media. She also has gout. Which of the following antigout medications increases the effect of amoxicillin? A. Allopurinol B. probenecid C. aspirin D. Acetaminophen

B. probenecid Amoxicillin combined with probenecid results in increased effects of the amoxicillin.

The nurse is providing health education for the parents of a child whose otitis media has warranted treatment with Cortisporin Otic. The nurse should explain that this medication contains which of the following components? Select all that apply. A) An analgesic B) A topical anesthetic C) An antibiotic D) A steroid E) An immunomodulator

C) An antibiotic D) A steroid Health care providers use the combination drug Cortisporin Otic (neomycin-polymyxin B-hydrocortisone) for the treatment of acute external otitis media. Neomycin and polymyxin B are antibiotics, which combat bacterial infections. Hydrocortisone is a steroid, which reduces the actions of chemicals in the body that cause inflammation, redness, and swelling. This medication does not contain analgesics, anesthetics, or immunomodulators.

A young boy has just returned home from his family's tropical vacation and is now complaining of worsening tenderness in his right ear. He is subsequently diagnosed with otitis externa. What causative factor of this infection should the nurse suspect? A) Immunocompromised state resulting from sleep deprivation while on vacation B) The potential for foodborne pathogens ingested while on vacation C) Frequent swimming and water sports while the boy was on vacation D) Ear trauma related to pressurization and depressurization while flying

C) Frequent swimming and water sports while the boy was on vacation People whose ears are frequently exposed to moisture are more prone to the development of otitis externa. Swimming is a more likely cause of infection than pressure changes, foodborne pathogens, or impaired immunity.

A nurse is demonstrating the correct technique for instilling antibiotic ear drops into a child's ear canal. The nurse should teach the child's caregivers to do which of the following? A) Have the child lie supine during instillation of the ear drops B) Have the child lie still for 30 to 45 minutes after instilling the ear drops C) Place a cotton ball in the ear canal after instilling the ear drops D) Rinse the child's ear canal with normal saline prior to instilling the ear drops.

C) Place a cotton ball in the ear canal after instilling the ear drops The proper administration of ear drops requires tilting the head toward the opposite shoulder, pulling the superior aspect of the auricle upward, and instilling the ear drops into the ear canal. The patient should then lie on the side opposite the side of administration for 20 minutes. To maximize medication absorption, the patient should have a cotton ball placed in the ear canal. Supine positioning is not used, and the ear canal does not need to be rinsed prior to drug administration.

A pediatric nurse is providing inpatient care for a child who was diagnosed with necrotizing otitis externa. The child is currently being treated with ciprofloxacin. What microorganism is the most likely cause of this child's infection? A) Aspergillus B) Candida albicans C) Pseudomonas aeruginosa D) Escherichia coli

C) Pseudomonas aeruginosa Health care providers use ciprofloxacin for the treatment of Pseudomonas aeruginosa in patients with necrotizing otitis externa. If the causative agent is Aspergillus, amphotericin B is the drug of choice. E. coli and Candida are not typically implicated in cases of necrotizing otitis externa.

Which of the following patients are at risk for the development of otitis externa? A. A patient who wears ear plugs while swimming B. A patient who has hearing loss C. A patient who wears a hearing aid D. A patient with labyrinthitis

C. A patient who wears a hearing aid A patient who wears hearing aids is prone to the development of otitis externa.

A child has been diagnosed with acute otitis media. Before the child begins antibiotic treatment, what assessment should the nurse perform? A. Assess whether the child has ever has tuberculosis skin test B. Assess the child for allergies to salicylates C. Assess the child for allergies to penicillin's D. Assess the child's immunization status

C. Assess the child for allergies to penicillin's Amoxicillin (Amoxil) is the preferred antibacterial agent for the treatment of acute otitis media. Because this medication is a penicillin, it is necessary to assess for allergies to these antibiotics. The child's immunization status, history of TB skin tests, and allergies to salicylates are not central to the child's care.

A 2-year-old boy has been diagnosed with an ear infection and the prescriber has chosen to treat the child's infection with Cipro HC, a combination medication that contains ciprofloxacin and hydrocortisone. What is a potential advantage of this medication over Cortisporin Otic? A. It does not require follow-up blood work in a laboratory. B. It is available over the counter but is equally effective as Cortisporin Otic. C. It does not have to be administered as frequently as Cortisporin Otic. D. It can be administered as an oral suspension that has a pleasant flavor.

C. It does not have to be administered as frequently as Cortisporin Otic. The combination drug Cipro HC contains ciprofloxacin and hydrocortisone. Its twice-daily administration makes it more convenient for parents with young children. Neither Cortisporin Otic nor Cipro HC is available OTC, is available as an oral suspension, or requires blood work.

A patient has a diagnosis of otitis media and has just begun antibiotic treatment. The patient complains of otalgia and has asked for medication. The nurse should anticipate the administration of A. Morphine sulfate B. Ketoralac C. Hydromorphone (Dilaudid) D. Acetaminphen (Tylenol)

D. Acetaminphen (Tylenol) Tylenol is the first-line analgesic for most cases of otalgia accompanying otitis. Opioids and ketorolac are not normally indicated.

A patient has been prescribed combination eardrops to treat otitis externa. What nursing action should be performed prior to drug administration? A. Assessing the patient's vestibular function by testing balance B. Irrigating the ear with a 1% chlorhexidine solution C. Removing any excess cerumen from the patient's ear D. Having the patient lie on the side of the infected ear for 15 to 20 minutes

C. Removing any excess cerumen from the patient's ear If cerumen is present, cleaning of the ear canal with a cotton swab prior to ear drop instillation is important. Irrigation is unnecessary and assessment of balance is not required. The patient should not lie on the affected side prior to administration of eardrops.

The nurse is caring for a hearing-impaired client. Which of the following approaches will facilitate communication? A. Speak loudly B. Speak frequently C. Speak at a normal volume D. Speak directly into the impaired ear.

C. Speak at a normal volume

A patient has presented with signs and symptoms characteristics of otitis externa and is requesting prescription eardrops. The nurse would recognize that the safe and effective use of Cortisporin Otic would be contraindicated by what variable? A. The patient uses a wide variety of herbal supplements on a daily basis. B. The patient is allergic to penicillin's. C. The patient's infection is thought to have a viral etiology. D. The patient takes oral corticosteroids to treat joint inflammation.

C. The patient's infection is thought to have a viral etiology. Prescribers should not order Cortisporin Otic for viral, fungal, or mycobacterial infections. Herbal supplements are not noted to interact with this medication, and an allergy to penicillin's is not problematic. Concurrent use of corticosteroids is acceptable.

______ are often formed when excess cells accumulate in a cyst or sac formed near the tympanic membrane.

Cholesteatomas Cholesteatomas are often formed when excess cells accumulate in a cyst or sac formed near the tympanic membrane.

The nurse is providing care for a teenager with otitis media. When assessing the patient for potentially adverse effects of Cortisporin Otic, what question should the nurse ask? A) "Have you developed a fever since you started to use the ear drops?" B) "Have you been getting any headaches since you started talking the drops?" C) "Has there been any blood that you've noticed in your outer ear?" D) "Have you noticed any loss of hearing since you started taking the drops?"

D) "Have you noticed any loss of hearing since you started taking the drops?" It is also necessary to assess the patient taking Cortisporin Otic for signs of hearing loss dues to ototoxicity. Fever, bleeding, and headaches are not typical adverse effects.

A child's primary health care provider has prescribed Cortisporin Otic for a child who has otitis media in her right ear. What administration instructions should the nurse provide to the parents of the child? A) "Put one drop into her right ear each morning." B) "Place two drops in her right ear each morning and then again before bedtime." C) "Put one to two drops in her right ear whenever you notice discharge or she complains of pain." D) "Place three drops into her ear four times a day."

D) "Place three drops into her ear four times a day." For children 6 months and older, 3 drops of Cortisoprin Otic are installed into the effected ear three to four times daily. Dosage is not matched to acute symptoms.

A 12-year-old boy has been diagnosed with acute otitis externa. The patient's mother has asked if oral medications might be more effective than ear drops. The nurse should respond in the knowledge that systemic medications for the treatment of otitis externa are only indicated in what circumstances? A) The infection is accompanied by ear discharge B) The patient is allergic to penicillins C) The patient is unable to self-administer ear drops D) A deep tissue infection develops

D) A deep tissue infection develops For acute otitis externa, use of topical agents, as opposed to systemic agents, is more common. Systemic medications are indicated only if a deep tissue infection develops outsode the external canal or if immunocompromised status is an issue. Allergy status, ability to self-administer, and the presence or discharge are not indications for systemic antibiotics.

The nurse is performing an otoscopic examination on a client with mastoiditis on examination of the tympanic membrane, which of the following would the nurse expect to observe? A. A pink-colored tympanic membrane B. A pearly colored tympanic membrane C. A transparent and clear tympanic membrane D. A red, dull, thick, and immobile tympanic membrane

D. A red, dull, thick, and immobile tympanic membrane

The nurse notes the physician has documented a diagnosis of presbycusis on the client's chart. The nurse plans care knowing that the condition is: A. Tinnitus that occurs with aging B. Nystagmus that occurs with aging C. A conductive hearing loss that occurs with aging D. A sensoruneural hearing loss that occurs with aging

D. A sensoruneural hearing loss that occurs with aging

A child receives a diagnosis of acute otitis media. His physician orders amoxicillin (Amoxil). Which of the following adverse effects warrants the discontinuation of the medication? A. Onset of diarrhea B. Onset of abdominal pain C. Onset of diminished appetite D. Onset of wheezing

D. Onset of wheezing A child who develops wheezing with the administration of amoxicillin (Amoxil) is having an allergic reaction. It is essential that the drug be discontinued and the child taken to the emergency department for an evaluation.

The nurse has administered a patient's first scheduled dose of amoxicillin after the patient was diagnosed with acute otitis media. What subsequent assessment finding should prompt the nurse to discontinue the use of this drug? A. The patient states that she has a frontal lobe headache. B. The patient complains of acid reflux. C. The patient states that she feels nauseous. D. The patient complains of shortness of breath.

D. The patient complains of shortness of breath. Shortness of breath is suggestive of a hypersensitivity reaction and would likely warrant discontinuation of the drug. Nausea, reflux, and headache should each be addressed, but none likely necessitates discontinuation of drug therapy.

Which of the following assessment Findings reveals that the amoxicillin (Amoxil) is decreasing the symptoms of acute otitis media? A. Retracted tympanic membrane B. Otalgia C. Otorrhea D. Visible cone of light

D. Visible cone of light A visible cone of light on the tympanic membrane reveals a decrease in fluid in the tympanic membrane and a resolving infection.

______ is the creation of a small opening in the tympanic membrane to reduce pressure and allow fluid to drain.

Myringotomy is the creation of a small opening in the tympanic membrane to reduce pressure and allow fluid to drain.

A patient complains that his hearing aid is not working. What actions should a nurse implement to assess the device? (Select all that apply.) a. Check to see if the device is turned on. b. Clean the earpiece and remove cerumen clogged in the vent. c. Open the earpiece to see if the microphone wire is connected. d. Examine the interior of the earpiece for water. e. Validate that the battery is correctly placed.

a. Check to see if the device is turned on. b. Clean the earpiece and remove cerumen clogged in the vent. e. Validate that the battery is correctly placed. Cleaning the earpiece to remove clogged cerumen and checking the device to see if it is turned on and if the battery is placed correctly are all good options. The earpiece should not be opened. If the hearing aid is still not working, it should be evaluated by the dealer.

A nurse assessing the results of a Rinne test sees the notation of BC > AC. How should the nurse translate this result? a. Conductive hearing loss b. Sensorineural hearing loss c. Normal hearing d. Cochlear defect

a. Conductive hearing loss When the bone conduction (BC) is greater than the air conduction (AC), the results of the Rinne test will read, BC > AC, which means the patient has a conductive hearing loss. The normal finding for the Rinne test is that AC is greater than BC (AC > BC).

Which common characteristics might a patient with conductive hearing loss display? (Select all that apply.) a. Hears adequately in noisy settings b. Hears sounds but has difficulty understanding speech c. Has improved hearing with hearing aids d. Has a history of diabetes mellitus e. Speaks in a normal volume

a. Hears adequately in noisy settings c. Has improved hearing with hearing aids e. Speaks in a normal volume Persons with conductive hearing loss can hear in a noisy setting and can have improved hearing with the use of hearing aids. Persons with conductive hearing loss speak at a normal or soft volume because they can hear themselves. Muffled sounds and a history of diabetes would be associated with sensorineural hearing loss.

A young woman being admitted to the clinic service states that all the members of her family have been hard of hearing. She says her hearing loss became more pronounced when she was pregnant. What term explains this type of hearing loss? a. Otosclerosis b. Ototoxicity c. Otalgia d. Otitis media

a. Otosclerosis Otosclerosis is hereditary, develops in young women, and worsens with pregnancy.

When making an initial assessment on a patient with a hearing deficit, the patient reports that he often feels off balance and is dizzy when he stands up. Which diagnosis might explain these symptoms? a. Sinus infection b. Rubella c. Otalgia d. Presbycusis

a. Sinus infection A sinus infection can be an acute cause of hearing deficits and can create problems with balance.

Which instruction should a nurse include when providing patient teaching information for a patient who will be self-administering ear drops for an ear infection? a. Tip the affected ear up and keep it in that position for several minutes after instilling the medication. b. Keep the medication in the refrigerator to preserve it. Instill the medication with the affected ear tilted upward. c. Touch the dropper to the opening of the ear canal to ensure that the drops are correctly instilled. d. Warm the ear drops and then tilt the head downward.

a. Tip the affected ear up and keep it in that position for several minutes after instilling the medication. The head is kept in an upward position to ensure that the drops penetrate deep into the external ear.

Which patient behaviors should alert a nurse to a possible hearing deficit? (Select all that apply.) a. Watches the speaker's mouth b. Gives inappropriate answers to questions c. Pulls at the ears d. Fails to respond when spoken to e. Turns the good ear to the speaker

a. Watches the speaker's mouth b. Gives inappropriate answers to questions d. Fails to respond when spoken to e. Turns the good ear to the speaker Pulling at the ear is not a signal for hearing loss; all of the other options are.

What should a nurse include when educating a patient with Ménière disease? a. "When you feel dizzy, just stay in bed and take your medications." b. "Decrease your sodium intake and take your diuretic medication between attacks." c. "Vestibular rehabilitation might help, and you can still drink your morning coffee." d. "Your vertigo will get better if you take your medications. You won't need any relaxation techniques."

b. "Decrease your sodium intake and take your diuretic medication between attacks." A low-sodium diet and diuretic medications between attacks will prevent edema, which could cause an attack.

During an intake physical examination, a patient reports that he has been taking 10 aspirin tablets a day for his arthritis. What question should the nurse ask based on this information? a. "Can you hear high-pitched sounds?" b. "Have you noticed deafness in just one ear?" c. "Do you have ringing in your ears?" d. "Do you experience dizziness when you stand?"

c. "Do you have ringing in your ears?" A ringing in the ears (tinnitus) is an indication of aspirin toxicity. The patient should be advised to stop taking aspirin.

A nursing report on a newly admitted patient who is profoundly deaf says that the patient is confused and difficult to assess because she does not appropriately respond to questions or sometimes fails to respond at all. What should be the first action of the oncoming nurse? a. Consider asking the physician to assess the patient for dementia. b. Assess the patient to determine whether her hearing aids are in. c. Report to the physician that the patient is exhibiting signs of the sundown syndrome. d. Assess the patient's medications to check for an overdose.

b. Assess the patient to determine whether her hearing aids are in. Profoundly deaf persons can be mistakenly assessed as being confused or disoriented when not wearing their hearing aids.

What information should a nurse stress when teaching a patient with Ménière disease about managing the disorder? a. Limiting fluid intake b. Avoiding the use of alcohol and tobacco c. Using antiemetic medications sparingly d. Staying active during the day

b. Avoiding the use of alcohol and tobacco The use of alcohol and tobacco products affects the amount of fluid in the middle ear, worsening the symptoms of Ménière disease. The patient with Ménière disease should drink adequate fluid, use antiemetic medications as needed, and conserve energy during the day.

A 75-year-old patient has normal age-related changes in his ear. What change should not be considered a normal change in the aging patient? a. Dry and wrinkled skin on the auricle b. Otitis externa c. Dry cerumen d. Hair in the ear canal

b. Otitis externa Otitis externa is an outer ear infection and therefore an exception. The other three options are normal age-related changes.

Which patient problem should take priority in planning care for a patient with Ménière disease? a. Decreased socialization b. Potential injury c. Fluid volume deficit d. Inadequate nutrition

b. Potential injury The patient problem that should take priority is that of preventing injury to the patient. A patient with Ménière disease is prone to falls because of dizziness.

A 75-year-old patient reports having difficulty hearing in crowds but can hear just fine at home with his wife. What hearing disorder should the nurse suspect? a. Otitis media b. Presbycusis c. Ototoxicity d. Central deafness

b. Presbycusis Presbycusis is a conductive hearing loss associated with normal aging and is caused by changes in the cochlea.

An 85-year-old patient has had age-related changes in the cochlea. What is the most appropriate nursing action for the nurse to implement? a. Speak slowly. b. Provide assistance with ambulation. c. Speak in a lower tone. d. Communicate with the patient in writing.

b. Provide assistance with ambulation. Assisting the patient when ambulating will diminish the risk of a fall. Changes in the cochlea will cause dizziness and ataxia.

Which nursing diagnosis is most appropriate for a patient having ear surgery? a. Disturbed body image b. Risk for injury c. Acute confusion d. Ineffective protection

b. Risk for injury Patients who have had ear surgery are at risk for vertigo, fluid accumulation, or pressure in the operative ear. Because of the surgery and potential postoperative conditions, the patient may be at risk for a fall.

Which nursing diagnosis should take priority in a nursing care plan for a patient with Ménière disease? a. Social isolation, related to anxiety b. Risk for injury, related to falls c. Risk for deficient fluid intake, related to weakness d. Nutrition: Less than body requirements, related to fatigue

b. Risk for injury, related to falls The nursing diagnosis that should take priority is that of preventing injury to the patient. A patient with Ménière disease is prone to falls because of dizziness.

Which nursing diagnosis is most appropriate when considering the impact of a hearing deficit when planning care for a child who has been diagnosed with a hearing impairment? a. Risk for injury, related to hearing impairment b. Risk for social isolation, related to hearing impairment c. Knowledge deficit, related to hearing impairment d. Anxiety, related to hearing impairment

b. Risk for social isolation, related to hearing impairment The loss of hearing and the mild stigma associated with hearing impairment place the newly diagnosed child at risk for social isolation.

A patient comes to the primary care clinic complaining of a head cold and ear pain with drainage. What should the nurse suspect this patient is experiencing? a. Otitis externa b. Hearing loss c. Acute otitis media d. Mastoiditis

c. Acute otitis media Acute otitis media is connected with colds and drainage from the ear. A hearing loss may be experienced as well, but the pain and drainage place the need to intervene for the infection first.

What significant instruction should a nurse include to a patient being discharged after ear surgery? a. Use stool softeners with caution. b. Assume your usual activities. c. Avoid blowing your nose. d. Shampoo your hair with baby shampoo.

c. Avoid blowing your nose. The patient should avoid blowing the nose to prevent back pressure in the eustachian tube. The patient should take stool softeners, limit activity until balance returns, and delay shampooing.

A 75-year-old patient reports to a nurse that although she has cleaned her ears with cotton-tipped applicators for weeks, she still cannot hear her television unless the volume is loud, and she misses a great deal of conversations. What should the nurse anticipate when examining her ears? a. Otitis externa b. Purulent drainage c. Dry cerumen across the canal d. Pearly tympanic membrane

c. Dry cerumen across the canal Obstruction of the external canal with cerumen will result in a hearing loss. Cleaning the ears with something such as an applicator will pack the cerumen in the canal.

1. A nurse reads in a patient's history that the patient has experienced otalgia. How should the nurse interpret this term? a. Difficulty hearing b. Buildup of cerumen c. Ear pain d. Ringing in the ears

c. Ear pain Otic is the root word for ear, and -algia is the root term for pain of any type.

A 94-year-old patient is receiving gentamicin sulfate (Garamycin) in a continuous intravenous (IV) infusion. The nurse adds to the nursing care plan the patient problem "Potential injury." What nursing action should be implemented? a. Pull side rails in place. b. Assist with ambulation. c. Measure intake and output. d. Provide for a possible seizure.

c. Measure intake and output. Reduced urine output would cause the drug to stay in the system rather than being excreted, which could result in a drug saturation. Gentamicin is ototoxic and can cause hearing impairment.

What nursing action should be implemented when irrigating a patient's ear? a. Straighten the ear canal and irrigate with a large-tipped bulb syringe. b. Direct the solution to the middle of the canal to avoid damaging the ear. c. Use a body temperature solution and have the patient hold a basin under the ear while directing the solution toward the top of the canal. d. Repeat the irrigation with hotter water.

c. Use a body temperature solution and have the patient hold a basin under the ear while directing the solution toward the top of the canal. The irrigation is done with warm water using a small-tipped syringe. The flow is directed upward. If the cerumen does not wash out, the procedure can be repeated but with the same water temperature.

A patient reports that her hearing loss has become more severe over the past 3 months. The clinic nurse makes arrangements for an evaluation for a hearing aid. What health care provider should provide this service? a. Otologist b. Otolaryngologist c. Audiometrist d. Audiologist

d. Audiologist Audiologists assess patients for hearing aids. The other specialists treat ear, nose, and throat (ENT) disorders.

A patient undergoing a Weber test says that the sound is louder in her left ear. What should this result indicate? a. Normal hearing b. Nerve damage from listening to loud music c. Blocked ear canal in the right ear d. Conductive hearing loss in the left ear

d. Conductive hearing loss in the left ear With the Weber test, a conductive hearing loss is determined by the sound being heard loudest in the affected ear.

A nurse is assisting with a caloric test and notes that the specific patient response that indicates a hearing disorder is a problem in the labyrinth. Which response did the nurse witness? a. Blinking b. Grimacing c. Headache d. Nystagmus

d. Nystagmus When warm or cold water is introduced into the ear, the appearance of nystagmus is a positive indication that the hearing problem has its cause in the labyrinth.

A patient with diabetes says that he needs a hearing aid because he cannot hear well, and everything sounds garbled and distant. What type of hearing loss should the nurse suspect? a. Mixed hearing loss b. Conductive hearing loss c. Central hearing loss d. Sensorineural hearing loss

d. Sensorineural hearing loss A patient with long-term diabetes may have a sensorineural hearing loss that is not helped by hearing aids.

When a patient has a suspected vestibular disorder, the physician orders an electronystagmography test. Which instruction should the nurse include when educating the patient about this test? a. Use tea or coffee on the morning of test. b. Electrodes will be placed on the scalp. c. Air will be blown into the external ear. d. The patient should have nothing to eat or drink (NPO) 3 hours before the test.

d. The patient should have nothing to eat or drink (NPO) 3 hours before the test. Electronystagmography is used to detect vestibular lesions and requires a 3-hour period of NPO before the test. Coffee and tea should also be avoided before the test.