MED SURG 2 CH. 54 EAQ

The nurse observes an adult patient in self-administration of ear drops. Which action by the patient indicates the need for more teaching? 1. The patient pulls the auricle down and back during administration. 2. The patient lies down with the affected ear up after administering drops. 3. The patient warms the drops to body temperature before administration. 4. The patient holds the dropper near the opening of the canal during administration.

1. The patient pulls the auricle down and back during administration. In the adult ear, the auricle is pulled up and back to straighten the external canal. The auricle of a child is pulled down and back. The patient should lie down for several minutes with the affected ear up to keep the medication from dripping out of the canal. Ear drops should be warmed to body temperature prior to administration. The dropper is held near the opening of the canal but not touching the skin to prevent contamination.

The nurse should assist with evaluating the patient with Ménière disease for the desired outcome for which medications? Select all that apply. 1. Antiemetic 2. Antianxiety 3. Antipyretics 4. Antispasmodic 5. Antihistamines

1. Antiemetic 2. Antianxiety 5. Antihistamines Ménière disease symptoms are associated with change of fluid volume of the inner ear. Medications used to control the signs and symptoms are antiemetics, antianxiety medications, and antihistamines. Antipyretics are used to reduce fever. Antispasmodics suppress muscle spasms.

Which typical change in the ear may lead to hearing loss in the older adult? 1. Atrophy of the cochlea 2. Thickening of the eardrum 3. Long and coarse canal hair 4. Dryness and itching of the ear canal

1. Atrophy of the cochlea Changes in the external, middle, and inner ear with aging are common and may lead to serious problems in hearing and balance. Changes in the inner ear like atrophy of the cochlea, degeneration of the cochlear nerve cells and organ of Corti may lead to hearing impairment in the elderly. Thickening of the eardrum does not affect hearing in the elderly. Long and coarse hair along with dry earwax may block the canal. Dryness and itching of the ear canal is due to a decrease in production of cerumen.

What physiologic changes might the ear go through during the aging process that may affect hearing? Select all that apply. 1. Atrophy of the cochlea 2. Dryness and wrinkling of auricle skin 3. Hairs in auditory canal may become coarser 4. Decrease in the number of cochlear nerve cells 5. Decrease in size and flexibility of organ of Corti

1. Atrophy of the cochlea 4. Decrease in the number of cochlear nerve cells 5. Decrease in size and flexibility of organ of Corti Degenerative changes associated with hearing difficulty include atrophy of the cochlea, decrease in the number of cochlear nerve cells, and decrease in the size and flexibility of the organ of Corti. Dryness and wrinkling of the auricle skin does not affect hearing. Coarseness of the hairs in the auditory canal does not directly affect hearing.

What are the components of all hearing aids? Select all that apply. 1. Battery 2. Receiver 3. Amplifier 4. Microphone 5. Headphones

1. Battery 2. Receiver 3. Amplifier 4. Microphone All hearing aids have four components: (1) a microphone to receive sound waves and convert them to electrical signals, (2) an amplifier to strengthen the signals, (3) a receiver to convert signals to sound waves, and (4) a battery to power the device. Various aids are designed to be worn in the ear, behind the ear, or in the middle of the chest. Headphones may assist the hearing-impaired person with using electronic devices, such as a radio or television, but are not a functional part of a hearing aid.

A student nurse is preparing a presentation on the structures involved in hearing and correctly labels the organ of Corti, which is the receptor end-organ for hearing, in which structure? 1. Cochlea 2. Eustachian tube 3. Mastoid process 4. Tympanic membrane

1. Cochlea The cochlea is a coiled tube in the inner ear that looks like a snail. It contains the organ of Corti, which is the receptor end-organ of hearing. An important structure in the middle ear is the Eustachian tube; it creates an air passage to the middle ear so that air pressure remains the same on both sides of the tympanic membrane. The mastoid process is the bony structure behind the auricle. The tympanic membrane is commonly called the eardrum. Sound waves entering the external auditory canal cause the membrane to vibrate.

Which conditions constitute a risk factor for ear or hearing disorders? Select all that apply. 1. Diabetes 2. Sinus infection 3. Dental problems 4. Recent head injury 5. Urinary tract infection 6. Upper respiratory infection

1. Diabetes 2. Sinus infection 3. Dental problems 4. Recent head injury 6. Upper respiratory infection Diabetes, sinus infections, dental issues, head injuries, and upper respiratory infections can possibly lead to ear or hearing disorders. Urinary tract infections are generally not associated with ear issues.

The nurse is performing the Rinne test for a patient as a part of a routine health assessment and finds that the patient hears the vibrations longer than the patient feels them. Which is the nurse's priority action? 1. Document the findings of the Rinne test as normal. 2. Alert the health care provider to the patient's conductive hearing loss. 3. Alert the health care provider to the patient's sensorineural hearing loss. 4. Document the precise measures of hearing acuity that were determined.

1. Document the findings of the Rinne test as normal. For the Rinne test, the tuning fork is tapped on the hand to activate it and then it is placed at the base of the patient's mastoid bone. Normally, air conduction is greater than it is with bone conduction. There is no reason to suggest sensorineural hearing loss. Audiometry provides a precise measurement of hearing acuity. If bone conduction is greater than air conduction, then the patient has a conductive hearing loss.

Which terms can the nurse use to assist a patient in describing ear pain during data collection? Select all that apply. 1. Dull 2. Itching 3. Sharp 4. Dizziness 5. Throbbing

1. Dull 3. Sharp 5. Throbbing Data collection for the ear begins with a full description of any symptoms that may reflect problems with the ear. Ask the patient to describe the nature of the pain, such as dull, sharp, or throbbing, and when it occurs. Itching and dizziness can be troubling symptoms, but are not pain descriptors.

A patient has dried and impacted cerumen. Which is likely to be included for treatment in the plan of care? 1. Ear drops 2. Distilled water 3. Heated olive oil 4. Vitamin supplements

1. Ear drops One of the most common causes of obstruction of the external ear canal is impacted cerumen. When a large amount of hardened cerumen is present, the health care prescriber may prescribe ear drops to soften the cerumen before irrigation. Distilled water is sometimes used in ear procedures, but it is not effective for hardened cerumen. Heated olive oil is an old-fashioned ear treatment that has fallen out of use and may cause harm to the ear. Vitamin supplements are oral medications that would have no effect on the physical aspects of impacted cerumen.

A patient tells the nurse, "My ears are ringing." The nurse reviews the patient's medication list and determines which drug may be causing this? 1. Furosemide (Lasix) 2. Warfarin (Coumadin) 3. Meperidine (Demerol) 4. Acetaminophen with codeine (Tylenol with codeine)

1. Furosemide (Lasix) Ototoxicity is associated with furosemide use and can lead to tinnitus and deafness. Meperidine, warfarin, and acetaminophen with codeine are not associated with ototoxicity.

A patient complains of nausea, vertigo, and headache following an acute upper respiratory infection. The nurse knows that these symptoms may indicate which conditions? 1. Labyrinthitis 2. Acute otitis media 3. Meniere's disease 4. External otitis

1. Labyrinthitis Labyrinthitis usually follows a respiratory infection, pneumonia, or influenza. Symptoms include headache, nausea, vomiting, vertigo and nystagmus. Presbycusis is hearing loss related to aging. Acute otitis media is associated with upper respiratory infection and signified by pain and fever. Ménière disease has symptoms of vertigo, nausea, and vomiting but no substance or stimuli trigger episodes. External otitis signs and symptoms include pain, dizziness, fever, and drainage.

A patient is complaining of malaise, headache, and soreness behind one ear. The nurse notes redness and swelling upon assessment. What condition does the nurse suspect based on this information? 1. Mastoiditis 2. Otitis media 3. Labyrinthitis 4. Foreign body

1. Mastoiditis Symptoms of mastoiditis include swelling behind the ear, soreness, headache, and malaise. Otitis media does not result in swelling behind the ear. Labyrinthitis results in dizziness. Foreign bodies do not result in swelling behind the ear.

The nurse is caring for a patient with Ménière disease. Which symptoms would the nurse expect to observe in this patient? Select all that apply. 1. Pallor 2. Ptosis 3. Vertigo 4. Nausea 5. Tinnitus 6. Epistaxis

1. Pallor 3. Vertigo 4. Nausea 5. Tinnitus Pallor, vertigo, nausea, vomiting, tinnitus, and sweating are symptoms of Ménière disease. Ptosis is drooping of the upper or lower eyelid. Epistaxis is associated with nasal lesions or blood disorders.

A 23-year-old patient is diagnosed with otosclerosis. Which one coexisting condition would cause otosclerosis to progress at a faster rate? 1. Pregnancy 2. Hypertension 3. Diabetes mellitus 4. Polycystic ovarian syndrome

1. Pregnancy Otosclerosis is most common in young Caucasian women. The onset is usually in the late teens or early twenties. During pregnancy, it progresses at a faster rate. Hypertension, diabetes mellitus, and polycystic ovarian syndrome do not increase the rate of progression of otosclerosis.

A patient with normal hearing presents with an "earache" of 5 days duration. Which should be included in the data collection to present a full picture of the problem? Select all that apply. 1. Review of systems 2. Physical ear exam 3. Mental health status 4. Functional assessment 5. Psychosocial assessment

1. Review of systems 2. Physical ear exam 4. Functional assessment Data collection of patients with disorders of the ear should include review of systems, physical ear exam, functional assessment, past history, family history, and systems review. Psychosocial history or mental health status may be appropriate for patients with hearing loss, but are not helpful in assisting with data collection.

The nurse is educating the patient on diagnostic tests that will evaluate for sensorineural hearing loss. Which tests should the nurse include in the teaching? Select all that apply. 1. Rinne test 2. Caloric test 3. Weber test 4. Audiometry 5. Electronystagmography

1. Rinne test 2. Caloric test 3. Weber test 4. Audiometry Audiometry tests the ability of the ear to assess sound waves. The Rinne and Weber tests are used to differentiate conductive from sensory hearing loss. The caloric test is used to diagnose disorders in the vestibular system or in the central nervous system (CNS) connections. Electronystagmography assesses for lesions in the vestibule.

The nurse is to irrigate the right ear of a patient. The nurse uses which technique to perform the technique correctly? 1. Select a syringe tip that is smaller than the canal. 2. Use a syringe of cool solution to irrigate the canal. 3. Direct the solution into the center of the ear canal. 4. Have the patient lie on the left side during the procedure.

1. Select a syringe tip that is smaller than the canal. The nurse would use a syringe or bulb with a tip that is smaller than the canal. Cool solution will cause the patient discomfort. The solution should be directed along the top wall of the canal. The patient should sit up during the procedure to allow solution to drain.

The nurse is assisting with determining a patient's hearing ability using the Weber test. The nurse documents the patient's result as normal if the patient reports which result after the vibrating tuning fork is placed on the midline of the skull? 1. Sound is equal in both ears. 2. Sound is absent in both ears. 3. Sound is louder in the left ear. 4. Sound is louder in the right ear.

1. Sound is equal in both ears. In a normal finding for a Weber test, sound will be heard equally in both ears. If the sound is absent, it is not a normal finding. The sound is louder in an ear with conductive hearing loss.

During a teaching session, a patient frequently asks the nurse to repeat questions. What is the best action by the nurse? 1. Speak slowly in lower tones. 2. Place a bright light behind you. 3. Shout loudly into the patient's ear. 4. Use exaggerated facial expressions.

1. Speak slowly in lower tones. Speaking slowly and in lower tones makes it easier to be heard. A bright light behind you will create glare, making it more difficult for the patient to see. Shouting into the ear distorts the voice. Exaggerated facial expressions distort the mouth, making it harder to understand the message.

The licensed practical nurse (LPN) is assisting with the conduction of a Rinne test to assess the patient's hearing. Which is the first step in the testing process? 1. Tap the tuning fork on the examiner's hand. 2. Ask the patient if he or she can hear the sound. 3. Place the base of tuning fork on the patient's mastoid process. 4. Move the fork near the ear canal when the sound is not heard.

1. Tap the tuning fork on the examiner's hand. Tapping the tuning fork on the examiner's hand is the first step in the examination process. Then, the nurse places the base of the tuning fork on the patient's mastoid process. The patient is asked to report when he or she can no longer hear the sound. Then, the fork is moved near the ear canal when the sound is not heard any longer. The patient is once again asked to report when the sound can longer be heard.

The patient is diagnosed with an inner ear disorder. Which is a complaint associated with inner ear disorders? Select all that apply. 1. Vertigo 2. Tinnitus 3. Headache 4. Hearing loss 5. Ear drainage

1. Vertigo 2. Tinnitus 3. Headache 4. Hearing loss Vertigo, tinnitus, headache, and hearing loss are associated with inner ear disorders. Ear drainage is associated with external ear disorders.

The nurse is educating the patient on age-related changes to the middle ear. Which information should the nurse include in the teaching plan? 1. Cerumen production increases. 2. The eardrum thickens. 3. The cochlea begins to hypertrophy. 4. There is increased sensitivity to sound.

2. The eardrum thickens. The eardrum thickens, and the bony joints of the middle ear degenerate. Cerumen production decreases. The inner ear cochlea begins to atrophy, not hypertrophy. The sensitivity to sound declines.

The patient with a hearing aid asks the nurse to repeat questions multiple times. Which is the nurse's priority intervention? 1. Change the hearing aid battery. 2. Check the hearing aid's placement. 3. Irrigate the canal with normal saline. 4. Soak the hearing aid in normal saline.

2. Check the hearing aid's placement. Amplification may not be optimal when a hearing aid is not placed properly. The battery may need changing, but the placement should be checked first. The ear mold is the only part of the hearing aid that is to be cleaned with soap and water. Soaking the aid will damage the component. Irrigation can remove material from the canal; however, this may require an order from the health care provider and is not the priority action.

Which patient action most closely demonstrates difficulty in coping with hearing loss? 1. Enrolling in a speech-reading class 2. Denying the problem for as long as possible 3. Learning everything possible about hearing aids 4. Being open to teaching about hearing assistance

2. Denying the problem for as long as possible The way patients cope with hearing loss varies with the individual. The patient who is not coping well may deny the problem for as long as possible and often is resistant to teaching, so he or she may not take advantage of opportunities to deal with the problem effectively. People who are coping well with hearing loss will learn all they can about available help. Enrolling in a speech-reading class demonstrates adequate coping.

There is an anatomical progression for normal hearing. Prioritize the list in structural order, beginning with the outer structures and working through the inner structures. 1. Acoustic nerve 2. External canal 3. Tympanic membrane 4. Sensory receptors in inner ear

2. External canal 3. Tympanic membrane 4. Sensory receptors in inner ear 1. Acoustic nerve The normal progression is: external ear canal to the tympanic membrane, to the malleus, incus, and stapes, to the oval window, to the sensory receptors in the inner ear, to the acoustic window, and ultimately to the brain.

The seventh cranial nerve, which lies alongside the auditory canal, is also called by which name? 1. Optic nerve 2. Facial nerve 3. Auditory nerve 4. Maxillary nerve

2. Facial nerve Many nerves innervate the ear. This is the reason pain in the ear can sometimes be traced to disorders of the nose, mouth, or neck. Of special importance is the facial nerve (the seventh cranial nerve), which lies alongside the auditory canal. The facial nerve is protected in the canal by a thin bony covering. It exits from the skull just in front of the ear and branches across the face to control muscle movement. The optic nerve is the second cranial nerve, the auditory nerve is the eighth cranial nerve, and the maxillary nerve is the fifth cranial nerve.

The nurse is caring for a patient with a middle ear infection. The nurse knows that which is the first sign of a complication? 1. Nuchal rigidity 2. Mastoid swelling 3. Changes in mental status 4. Paralysis of facial muscles

2. Mastoid swelling Because the middle ear is directly connected to the air cells in the mastoid bone, infection in the middle ear can extend first into the mastoid bone, causing severe mastoid swelling and pain. In addition, because the brain lies next to the mastoid bone, the infection can spread to the brain as well. Mastoiditis is a very serious condition because it can lead to a brain abscess, meningitis, or paralysis of the facial muscles. Reports of jaw pain should be passed to the health care provider immediately.

The LPN is administering ear drops to an adult patient. Which is the first step in the administration process? 1. Straighten the external auditory canal by pulling the auricle up and back. 2. Roll the bottle between the nurse's palms to warm the drops to body temperature. 3. Have the patient tilt the head so that the ear to be treated is positioned toward the examiner. 4. Hold the dropper at the opening of the canal, and avoid contaminating the tip by not touching skin.

2. Roll the bottle between the nurse's palms to warm the drops to body temperature. The nurse would first warm the ear drops by rolling the bottle between his or her palms; cold ear drops can cause dizziness for the patient. Then, the patient would tilt the head so the ear to be treated is positioned toward the nurse. The nurse would straighten the auditory canal by pulling the auricle up and back, then hold the dropper at the opening of the canal, and avoid contaminating the tip by not touching the skin.

A patient who swims regularly has been diagnosed with external otitis. Which instructions should the nurse include when educating the patient? 1. Use ear buds while jogging. 2. Use ear plugs while swimming. 3. Irrigate the ears with warm water. 4. Avoid placing eardrops on the ear wick.

2. Use ear plugs while swimming. Using ear plugs while swimming will help prevent water washing out protective cerumen. Ear buds can be painful if the canal is irritated; if infection is present, they can become contaminated and reinfect the ear when reinserted. Irrigating the ears will irritate the condition by washing away protective cerumen. The purpose of the ear wick is to provide a route for medication to be distributed in the canal.

Which is a common event after stapedectomy surgery? 1. Rash 2. Vertigo 3. Hunger 4. Itchiness

2. Vertigo Nausea, vomiting, and vertigo are common after stapedectomy due to the effect the surgery may have on the structures of the ear involved with balance and equilibrium. Rash and itchiness are not usually associated with stapedectomy, due to the location of the surgery. Many patients have a lack of appetite after a stapedectomy, so hunger generally is not an issue.

Otic drops need to be administered in the proper order. For the best possible adult patient outcome, in which order should the nurse administer the otic drops? Select all that apply. 1. Hold the dropper at the opening of the canal, without touching any ear structure. 2. Warm the drops to body temperature. 3. instruct the patient to keep the treated ear up for several minutes. 4. Straighten the external auditory canal by pulling the auricle up and back.

2. Warm the drops to body temperature. 4. Straighten the external auditory canal by pulling the auricle up and back. 1. Hold the dropper at the opening of the canal, without touching any ear structure. 3. instruct the patient to keep the treated ear up for several minutes. When administering ear drops, this is the procedural order: 1. Be sure to use an otic solution. 2. Warm the drops to body temperature by rolling the bottle between the palms. 3. Have the patient tilt the head so that the ear to be treated is positioned toward you. 4. Straighten the external auditory canal of an adult by pulling the auricle up and back. For a child, pull the auricle down and back. 5. Hold the dropper at the opening of the canal, but do not contaminate the tip by touching the skin. 6. Instruct the patient to keep the treated ear up for several minutes to keep the medication from leaking from the ear. Sometimes the health care provider prescribes a cotton ball to be placed loosely in the canal to keep the medicine in place. Text Reference: pp. 1256-1257

The LPN is preparing to irrigate the patient's ear. Which is the first step in this procedure? 1. Drape the shoulder under the basin. 2. Warm the solution to body temperature. 3. Have the patient sit up and hold an emesis basin under the ear to be irrigated. 4. Select an irrigating syringe or bulb syringe with a tip that is smaller than the canal.

2. Warm the solution to body temperature. The initial step in irrigating the patient's ear is to warm the solution to body temperature. Cold irrigating solution may cause dizziness and discomfort to the patient. The nurse would also drape the shoulder under the basin, have the patient sit up and hold an emesis basin under ear to be irrigated, and select an irrigating syringe or bulb syringe with a tip that is smaller than the ear canal.

From the diagram, select the structure that would be most directly involved with a cochlear implant.2431288248 1. 1 2. 2 3. 3 4. 4

3. 3 A cochlear implant would be placed within or on the cochlea.

A patient has been diagnosed with hearing loss as a result of interference with the transmission of sound waves from the middle ear to the inner ear. This type of hearing loss is referred to by which term? 1. Mixed 2. Central 3. Conductive 4. Sensorineural

3. Conductive Conductive hearing loss is the result of an interference with the transmission of sound waves from the external or middle ear to the inner ear. Sensorineural hearing loss is sometimes referred to as nerve deafness; it is a disturbance of the neural structures in the inner ear or the nerve pathways to the brain. Mixed hearing loss is a combination of conductive and sensorineural losses. Central hearing loss is caused by some problem in the central nervous system; the patient cannot either perceive or interpret sounds that are heard

A patient complains that speech sounds are muffled. The patient asks about the benefits of a hearing aid. The nurse would include which information in response to this patient? 1. The hearing aid will make sounds clearer. 2. The hearing aid will distort sound further. 3. The hearing aid will amplify sound for the patient. 4. The hearing aid will have no benefit to the patient.

3. The hearing aid will amplify sound for the patient. Sensorineural hearing loss results in speech sounding muffled. The hearing aid will amplify sound for the patient, but speech will continue to sound muffled. The hearing aid will not distort sound further. The patient will have some benefit from amplification.

A patient with Ménière disease is experiencing severe vertigo. Which instruction should the nurse give to the patient to assist in controlling the vertigo? Select all that apply. 1. Have frequent visitors 2. Increase daily fluid intake 3. Decease sodium in the diet 4. Lie still and watch television 5. Avoid sudden head movement

3. Decease sodium in the diet 5. Avoid sudden head movement Slow head movements will prevent worsening of vertigo. Patients often have a decrease in symptoms with a low-sodium diet and fluid restriction. Increasing fluids and watching television will cause the vertigo to worsen. Patients with vertigo should lie still in a cool, quiet, darkened room.

Which device may be installed in the home or living area to alert the person with a hearing impairment to doorbells, telephones, or alarm clocks? 1. Electronic devices 2. Loud speakers 3. Flashing lights 4. Earphones

3. Flashing lights In the home, flashing lights can be used to alert the person to doorbells, telephones, and alarm clocks. Electronic devices allow communication electronically. Loud speakers amplify sounds. Earphones allow a person with a hearing impairment to adjust the volume and reduce environmental noise.

Which type of data collection technique will best verify the presence of external otitis? 1. Removal of visualized cerumen 2. Irrigation of the external auditory canal 3. Inspection of the external auditory canal 4. Inspection of the third and fourth cranial nerve

3. Inspection of the external auditory canal Assessment includes inspection of the external canal and evaluation of pain. Removal of cerumen or irrigation of the external auditory canal are medical procedures rather than assessments. It is not possible to visualize the cranial nerves.

The nurse is instructing a patient on removing cerumen from the ear canals. Which is the best method? 1. Using ear drops while lying down 2. Using a suction bulb in the external canal 3. Irrigating the ear canal with warm solution 4. Inserting a cotton swab into the external canal

3. Irrigating the ear canal with warm solution Irrigating the canal with warm solution will rinse dried cerumen or foreign bodies out of the canal. Ear drops may soften the wax to help make it easier to remove, but irrigation is still needed. Suction is not recommended. A cotton swab may push the dried wax further into the canal.

The patient with Ménière disease is encouraged to modify his diet. The nurse knows that which modification is the most common for this condition? 1. Low fat 2. High fiber 3. Low sodium 4. High protein

3. Low sodium A low-sodium diet is recommended to reduce attacks in patients with Ménière disease. Fat, fiber, and protein do not affect Ménière disease.

The nurse is preparing the patient for an electronystagmography. Which instruction would the nurse include in preprocedure teaching? 1. Expect no ill effects after the test. 2. Take nothing by mouth for 8 hours before the test. 3. Medications may be withheld on the health care provider's directions. 4. Do not consume caffeine or alcoholic beverages for 12 hours before the test.

3. Medications may be withheld on the health care provider's directions. Before electronystagmography, medications may be withheld on the health care provider's directions. The patient may experience nausea and vomiting after the test. Rather than taking nothing by mouth for 8 hours prior to the test, the patient need only be NPO for 3 hours before the test. The patient is not to consume caffeine or alcohol for 24 to 48 hours before the test, not 12 hours.

Sensorineural hearing loss is often referred to by which term? 1. Bone deafness 2. Old-age deafness 3. Nerve deafness 4. Swimmers' ear

3. Nerve deafness Sensorineural hearing loss is sometimes called nerve deafness. It is a disturbance of the neural structures in the inner ear or the nerve pathways to the brain. Conductive hearing loss may be referred to as bone deafness. Old age deafness is another term for presbycusis. The accumulation of fluid in the external auditory canal is also called swimmers' ear.

The nurse is caring for a patient after an ear procedure that includes a graft on the tympanic membrane. The nurse would assist the patient into which position? 1. On the affected side 2. In the supine position 3. On the unaffected side 4. In the semi-Fowler position

3. On the unaffected side If the procedure includes a graft on the tympanic membrane, the patient is usually positioned on the unaffected side to encourage adherence of the graft. After a procedure is performed on the ear, the patient is positioned on the affected side if drainage is being encouraged. The supine position and semi-Fowler positions do not promote adherence of the graft.

A patient has vertigo. Which goals would be appropriate to prevent injury for this patient? Select all that apply. 1. The patient maintains adequate nutrition. 2. The patient maintains adequate hydration. 3. The patient keeps the head still when dizzy. 4. The patient experiences no falls when walking. 5. The patient assumes a safe position when dizzy.

3. The patient keeps the head still when dizzy. 4. The patient experiences no falls when walking. 5. The patient assumes a safe position when dizzy. The patient is high risk for injury due to falls when experiencing vertigo. The patient should be instructed to sit or lie down when dizzy to avoid an injury from falling. Movement of the head can increase dizziness. Patients with vertigo need to maintain nutrition and hydration to prevent nausea and vomiting, but this is not related to preventing injury.

When obtaining a health history on a patient, the nurse documents that the patient reports a "continuous ringing in both ears." This ringing can be noted by which term? 1. Otalgia 2. Vertigo 3. Tinnitus 4. Ototoxicity

3. Tinnitus Tinnitus is defined as a ringing or buzzing in the ears. Otalgia is defined as pain in the ears. Vertigo is the sensation that one's body or the room is spinning. Ototoxicity means that drug damage has occurred to the eighth cranial nerve or to the organs of hearing and balance.

An adolescent patient is scheduled to undergo a cochlear implant surgery. Which statement by the family indicates that preoperative teaching has been successful? 1. "If the implant does not work, we will try a different hearing aid." 2. "Grandma will be excited to talk to him on the telephone after surgery." 3. "The device is completely hidden, so our child will not be embarrassed." 4. "Several months of training are needed to learn to tell sounds apart."

4. "Several months of training are needed to learn to tell sounds apart." Months of training sessions are needed after cochlear implant surgery to learn to distinguish sounds. Not all patients with a cochlear implant can distinguish sound well enough to hear on a telephone, even after training. Cochlear implants are for patients who cannot benefit from regular hearing aids.

Patients who have which type of hearing loss hear better in noisy settings? 1. Mixed 2. Neural 3. Central 4. Conductive

4. Conductive Conductive hearing loss results from interference with the transmission of sound waves from the external or middle ear to the inner ear. Patients who have conductive hearing loss hear better in noisy settings than in quiet settings. They do not speak loudly because bone conduction allows them to hear their own voices. Neural hearing loss is a result of disease or physical conditions that damage the nerves that communicate effectively with the brain, resulting in sound distortion. Quiet settings are more conducive for people with hearing loss due to nerve damage.

A patient has had a caloric test performed to diagnose a disorder in the vestibular system or its central nervous system connections. The results confirm that the patient has vestibular disease. The nurse expects the patient to experience which response to the test? 1. Vertigo 2. Nystagmus 3. Nausea and vomiting 4. Decreased or absent response

4. Decreased or absent response A patient with vestibular disease has a decreased or absent response to the caloric test. A person with a labyrinth disorder responds to the test with vertigo, specific abnormal eye movements (nystagmus), and nausea and vomiting.

A patient is scheduled to undergo electronystagmography. Which is the LPN's first step in initiating this test? 1. Place electrodes around the patient's eyes. 2. Ask the patient to focus on specific targets. 3. Turn the patient in various positions in a special chair. 4. Ensure that the patient has withheld alcohol and caffeine for 24 to 48 hours.

4. Ensure that the patient has withheld alcohol and caffeine for 24 to 48 hours. Ensuring that the patient has withheld alcohol and caffeine for 24 to 48 hours is the first step in implementing this test. After determining that the patient has abstained from alcohol and caffeine for the last 24 to 48 hours, the nurse would place electrodes around the patient's eyes, ask the patient to focus on specific targets, and turn the patient in various positions in a special chair.

When a hearing-impaired patient is hospitalized, the nurse should remind the staff that the patient may be unable to use which item due to hearing or verbalizing issues associated with hearing impairment? 1. Bed controls 2. TV remote control 3. Daily menu sheets 4. Intercom or telephone

4. Intercom or telephone When a hearing-impaired patient is hospitalized, be sure a call bell is provided, but remind staff that the patient may not be able to use the intercom or telephone. Depending on the patient, he or she may not be able to verbalize, or to hear a response. Bed controls, the TV remote, and daily menu sheets are all visual tools and would not be affected by the level of hearing.

Which action might accommodate effective communication with a patient who is hearing-impaired and who is able to lip read? 1. Chewing gum while speaking to the patient 2. Taking sips of water while speaking to the patient 3. Raising your voice tone while speaking to the patient 4. Providing adequate lighting directed toward your face while speaking

4. Providing adequate lighting directed toward your face while speaking When communicating with a hearing-impaired patient who can lip read, do not eat, drink, smoke, or chew gum while speaking with the patient, as this can create conflicting speech patterns for the lip reader. Keep your voice tone low, as shouting can distort lip movements. Provide adequate lighting directed toward your face. A strong light behind the nurse creates a glare and makes it hard to see the nurse's facial features.

Irrigation may be ordered to help cleanse the ear. To properly irrigate a child's ear, place the steps for proper irrigation of a child's ear in priority order. 1. Describe any substances rinsed from the ear. 2. Straighten the external canal by pulling the auricle down and back. 3. Have the patient hold an emesis basin under the ear to be irrigated. 4. Select the solution, as ordered by the physician and warm to body temperature. 5. Direct the solution towards the top of the canal, rather than towards the eardrum.

4. Select the solution, as ordered by the physician and warm to body temperature. 3. Have the patient hold an emesis basin under the ear to be irrigated. 2. Straighten the external canal by pulling the auricle down and back. 5. Direct the solution towards the top of the canal, rather than towards the eardrum. 1. Describe any substances rinsed from the ear. 1. Select the correct solution as ordered by the physician. 2. Warm the solution to body temperature (95° F to 105° F). 3. Have the patient sit up and hold an emesis basin under the ear to be irrigated. 4. Drape the shoulder under the basin. 5. Straighten the external canal of an adult by pulling the auricle up and back. For a child, pull the auricle down and back. 6. Select an irrigating syringe or bulb syringe with a tip that is smaller than the canal. 7. Direct the solution toward the top of the canal in a steady stream, not toward the eardrum. The procedure can be repeated several times if needed. 8. Sometimes ear drops are ordered to soften impacted cerumen before irrigating. 9. Describe any substances rinsed out of the ear. If the impacted cerumen or foreign body does not wash out, then inform the physician. 10. If the tympanic membrane (i.e., eardrum) is ruptured, then the canal should not be irrigated because fluid could be forced into the middle ear.

A diagnosis of presbycusis is made by the health care provider. Which information would the nurse use in planning care for this patient? 1. Tinnitus occurs with aging. 2. Nystagmus occurs with aging. 3. Conductive hearing loss occurs with aging. 4. Sensorineural hearing loss occurs with aging.

4. Sensorineural hearing loss occurs with aging. Presbycusis is a sensorineural hearing loss that occurs with aging. Tinnitus is associated with various conditions and age groups. Conductive hearing loss is associated with obstruction of the canal or Eustachian tubes, and otosclerosis can occur in a variety of age groups. Topics

A cochlear implant may help a patient to recover some level of hearing. Place the steps for hearing with a cochlear implant in the correct order. 1. Processor selects code. 2. Electric codes are sent back to processor. 3. Sound is sent from the microphone to the processor. 4. Sound enters the system through a small microphone.

4. Sound enters the system through a small microphone. 3. Sound is sent from the microphone to the processor. 1. Processor selects code. 2. Electric codes are sent back to processor. When a cochlear implant is functioning correctly, the sound enters the system through a small microphone. The sound is sent from the microphone to the processor. The processor then selects the proper code for the sound, so that electric codes can be sent back to the processor. In this way, the codes eventually reach the brain, which can translate the code into sound.

A patient with conductive hearing loss asks the nurse how this occurred. The nurse's response should include which statement about conductive hearing loss? 1. Conductive hearing loss is not easily treated. 2. The cause of conductive hearing loss is not known. 3. Conductive hearing loss is caused by repeated exposure to loud noise. 4. The cause of conductive hearing loss is due to damage of the middle ear.

4. The cause of conductive hearing loss is due to damage of the middle ear. Conductive hearing loss results from changes in the external or middle ear. Hearing aids and reconstructive surgery can improve hearing loss. Repeated exposure to loud noise results in sensorineural hearing loss.

In serous otitis media, where does sterile fluid accumulate? 1. Stapes 2. Facial nerve 3. Auditory canal 4. Tympanic membrane

4. Tympanic membrane Otitis media is an infection of the middle ear. Several types of otitis media exist. In serous otitis media, sterile fluid accumulates behind the tympanic membrane. It can precede or follow acute otitis media. Otitis media does not occur in the stapes, facial nerve, or auditory canal.