Nursing Management: Patients With Hearing and Balance Disorders
A mother brings her daughter to the clinic for an evaluation because the child is complaining of ear pain. Which of the following would lead the nurse to suspect that the child is experiencing otitis externa and not otitis media?
Aural tenderness
A client reports a sudden onset of tinnitus, hearing loss, and vertigo. The nurse carefully reviews the client's medication list to determine whether the client is taking a medication that might cause ototoxicity. Which medications would the nurse be most concerned with? Select all that apply.
aspirin lasix cisplatin
A client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?
"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."
A client comes to the emergency department reporting that an insect has flown into his ear and will not come out. Inspection confirms the presence of the insect. When assisting with removal of the insect from the client's ear, which substance would the nurse expect to be used?
mineral oil
There are several types of hearing loss. Which type of hearing loss benefits most from the use of a hearing aid?
Conductive
Hearing aids help with which of the following problems?
Makes sounds louder
Which phrase defines ossiculoplasty?
Surgical reconstruction of the middle ear bones
The clinical manifestations of motion sickness are caused by an overstimulation in what system?
Vestibular
A hospital patient is receiving IV gentamicin for the treatment of cellulitis. The nurse is cognizant of the ototoxic effects of this drug and should consequently provide what patient teaching? "You might have difficulty hearing while you're receiving this drug, but this is a temporary condition." "It's important that you tell someone promptly if you sense any change in your hearing." "If you begin having earaches with sharp, sudden pain, please let your nurse know." "It's likely that you'll get ringing in your ears with this drug, but it normally subsides a few days after the course of antibiotics is finished."
"It's important that you tell someone promptly if you sense any change in your hearing." IV medications, especially the aminoglycosides, are the most common cause of ototoxicity, and they destroy the hair cells in the organ of Corti. As such, damage is permanent and is not an expected aspect of antibiotic treatment. Ototoxicity is not normally accompanied by acute ear pain.
The nurse is supervising a family member who instilling ear drops into the client's ear. Which of the following statements, made by the family member, would require further nursing instruction?
"These drops are cold from being on the window sill."
A client undergoing mastoid surgery asks the nurse about the pain following the surgery. Which response by the nurse is appropriate? "Usually there is a constant throbbing pain for the first week. Most client report no pain with the use of the pain medications." "The incisional pain usually last 3 weeks. The doctor will make sure you have enough pain medications." "Most client report a sharp shooting pain for 1 to 2 months following the surgery from the eustachian tube opening." "Usually the incisional pain is mild and controlled by the prescribed medication for the first 24 hours."
"Usually the incisional pain is mild and controlled by the prescribed medication for the first 24 hours." The incisional pain from mastoid surgery is usually mild and controlled by prescribed pain medications. The client should be taking medications routinely the first 24 hours and as needed after 24 hours. Incisional pain usually does not last 3 weeks. The client may feel a sharp shooting pain when the eustachian tube is open for 2 to 3 weeks following surgery. A constant throbbing pain may indicate an infection and should be investigated.
When preparing a teaching plan for a client diagnosed with otitis externa, the nurse instructs the client to avoid any water sport for which duration?
7 to 10 days
You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis?
A progressive, bilateral loss of hearing
A dietary modification for a patient with Ménière's disease would be:
A decrease in sodium intake to 1500 mg daily.
The nurse is teaching a class on diseases of the ear. What would the nurse teach the class is the most characteristic symptom of otosclerosis?
A progressive, bilateral loss of hearing
The nurse caring for a client with Ménière's disease needs to assist with what when the client is experiencing an attack?
ADLs
A nurse is preparing a plan of care for a client with otitis externa. Based on the typical assessment findings, which of the following would the nurse most likely identify as the priority nursing diagnosis?
Acute pain related to inflammation
A nurse is aware of the significant potential benefits of cochlear implants for certain individuals. Which one of the following individuals is the most appropriate candidate for a cochlear implant?
An individual who has profound, bilateral, sensorineural hearing loss
A client is receiving long-term intravenous therapy with gentamicin for a chronic wound infection. Which of the following would be most important for the nurse to ensure? Obtain specimens for wound cultures daily. Arrange for audiograms twice a week. Monitor complete blood counts every other day. Assess intravenous access site daily.
Arrange for audiograms twice a week. Although obtaining wound cultures and intravenous site assessment would be important, the most important action would be to ensure that the client has arrangements for audiograms twice a week while receiving intravenous gentamicin because of the increased risk for toxicity from long-term use. Wound cultures would not be needed daily. Blood levels of gentamicin would need to be monitored. Complete blood counts may be ordered but they would not be as important as monitoring the client for possible ototoxicity.
A client you are caring for has a hearing loss. The client tells you he is self-conscious about his hearing loss. What advice should the nurse give a self-conscious client with hearing loss to protect his self-esteem?
Be forthright and inform others about the hearing deficit.
The physician suggests that a client use meclizine as treatment for his motion sickness. The nurse explains the rationale for this drug based on an understanding of which of the following as the drug's action? Lowers endolymphatic system pressure Antagonizes the response of histamine Depresses the central nervous system Blocks conduction of the vestibular pathways
Blocks conduction of the vestibular pathways Meclizine blocks the conduction of the vestibular pathway in the inner ear to provide some relief of nausea and vomiting. Anticholinergic agents, such as scopolamine, antagonize the histamine response. Meclizine does not depress the central nervous system. Diuretics help to lower the pressure of the endolymphatic system in Meniere's disease.
Which of the following teaching points would a nurse include as postoperative instructions for patients who have had middle ear surgery? Select all that apply.
Blow the nose gently, one side at a time, for 7 days after surgery. Report excessive ear drainage to the health care provider. Avoid getting water in the ear for 14 days after surgery. Avoid lifting more than 10 pounds for a few weeks after surgery.
A client who has been fitted with a hearing aid comes for a follow-up evaluation. During the visit, the client states, "I've noticed that I still don't seem to hear well enough. The hearing aid doesn't seem to make the sounds louder." Which of the following might the nurse determine as the possible cause?
Client has cerumen in the ear.
During assessment of a patient with a hearing loss, the nurse notes a defect in the tympanic membrane. The nurse documents this disturbance as a loss known as:
Conductive.
Loud, persistent noise has been found to have which of the following effects on the body? Select all that apply.
Constriction of peripheral blood vessels Increased blood pressure Increased heart rate
A nurse practitioner explains to a patient recently diagnosed with noise-induced hearing loss that the basic altered physiology in the ear is the result of:
Damage to the hair cells inside the cochlea.
Health teaching for a patient who suffers from motion sickness would include recommending the use of which one of the following over-the-counter drugs?
Dramamine
If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone causing which of the following?
Facial nerve paralysis
Which precaution should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance?
Have the client wait for help before moving
A client comes to the walk-in clinic complaining of a "bug in my ear." What action should be taken when there is an insect in the ear?
Instillation of mineral oil
Which of the following are methods of removing foreign bodies from the ear? Select all that apply. Suction Stapedotomy Instrumentation Irrigation Stapedectomy
Irrigation Suction Instrumentation The three standard methods for removing foreign bodies are the same as those for removing cerumen: irrigation, suction, and instrumentation. A stapedectomy involves removing the stapes superstructure and part of the footplate and inserting a tissue graft and a suitable prosthesis for treatment of otosclerosis.
A female patient's severe ear infection has resulted in tympanic membrane perforation. The patient's care provider has concluded that surgical repair is unnecessary because the membrane is healing spontaneously. What health education should the nurse emphasize to this patient?
It is important to keep the ear canal dry until the membrane has healed.
You are doing discharge teaching with a client after a stapedectomy. Why would it be important for you to advise the client to refrain from blowing the nose?
It may dislodge the prosthesis.
The nurse is developing a plan of care for a client with Meniere's disease and identifies a nursing diagnosis of excess fluid volume related to fluid retention in the inner ear. Which intervention would be most appropriate to include in the plan of care?
Limit foods that are high in sodium.
The nurse recognizes which methods are not correct for removing a foreign body from the ear? Instrumentation Manual pressure Suction Irrigation
Manual pressure The three standard methods for removing foreign bodies are the same as those for removing cerumen: irrigation, suction, and instrumentation. Manual pressure is not a correct method for removing a foreign body from the ear.
The nurse is caring for a patient with Ménière's disease who is hospitalized with severe vertigo. What medication does the nurse anticipate administering to shorten the attack?
Meclizine (Antivert)
The nurse is caring for a client with recurrent ear infections. The nurse assesses the client for further infectious processes traveling deeper into the tissue and becoming more lethal. Which infection, originated in the ear, is of most concern? Meningitis Mastoiditis Labyrinthitis Sinusitis
Meningitis The infection stemming for the ear may extend to the meninges, causing meningitis, or a brain abscess could occur. This could be life threatening. The other options are also potential complications of an ear infection.
A client comes to the emergency department, reporting that a bee has flown into his ear and is stuck. The client reports a significant amount of pain. Which of the following would be most appropriate to use to remove the bee?
Mineral oil
Which of the following describes vertigo? Select all that apply.
Misperception of motion Spinning sensation Objects are moving around him or her
A patient has serous otitis media with significant hearing loss in the right ear. The patient states, "I have not been able to hear for 2 months." What procedure does the nurse anticipate preparing the patient for?
Myringotomy
The nurse on a cruise ship is assessing clients for motion sickness. Which of the following is a common misconception?
Once symptoms occur, they will always be present.
The nurse on a cruise ship is assessing clients for motion sickness. Which of the following is a common misconception? Medications help the symptoms. Repeated motion is the cause. Pallor and diaphoresis is a first symptom. Once symptoms occur, they will always be present.
Once symptoms occur, they will always be present. When the client experiences motion sickness, the client will use that data to avoid further symptoms in the future. The client can use medication, change location or position, and recognize symptoms earlier for symptom management. The other options are correct and teachable statements.
Which condition is characterized by the formation of abnormal spongy bone around the stapes?
Otosclerosis
You are teaching the daughter how to instill ear drops into her father's ear to remove impacted cerumen. What is a priority action to teach this woman?
Place the container in warm water before instillation.
Which terms refers to the progressive hearing loss associated with aging?
Presbycusis
Some clients with acoustic neuromas have vertigo. What is a priority nursing action for clients with vertigo?
Protect the client from injury.
Tap water irrigation of an older adult's ear canal has failed to dislodge the impacted cerumen that has been causing the patient to experience otalgia. In preparation for another attempt at relieving the patient's problem, what action should the nurse take? Instill a hypertonic saline solution for 30 minutes prior to irrigating the patient's ear. Use a flexible suction catheter and 100 to 120 mm Hg of wall suction to remove the cerumen. Attempt irrigation using a 10 mL syringe and higher pressure. Put a small amount of mineral oil in the patient's ear before attempting removal.
Put a small amount of mineral oil in the patient's ear before attempting removal. Instilling a few drops of warmed glycerin, mineral oil, or half-strength hydrogen peroxide into the ear canal for 30 minutes can soften cerumen before its removal. High-pressure irrigation and high-pressure suction can cause damage. Hypertonic solutions are not instilled into the ear canal.
Which of the following nursing interventions would be most likely to facilitate effective communication with a hearing impaired patient? Stand directly in front of the patient to facilitate lip reading. Raise the voice to project sound at a higher frequency. Reduce environmental noise and distractions before communicating. Ask the patient to repeat what was said in order to evaluate understanding.
Reduce environmental noise and distractions before communicating.
The nurse is instructing the client with dried cerumen blocking the ear canal on potential methods to reduce symptoms. Which at-home methods of cerumen removal are discouraged?
Removing the cerumen by means of a cotton tip applicator
While reviewing the health history of a 72-year-old patient experiencing hearing loss, the nurse notes the patient has had no trauma or loss of balance. What factor is likely to be linked to the patient's hearing deficit? Recent completion of radiation therapy for treatment of thyroid cancer Allergy to hair coloring and hair spray Routine use of quinine for management of leg cramps Recent psychological stressors
Routine use of quinine for management of leg cramps Long-term, regular use of quinine for management of leg cramps is associated with loss of hearing acuity. Radiation therapy for cancer should not affect hearing; however, hearing can be significantly compromised by chemotherapy. Allergy to hair products may be associated with otitis externa; however, it is not linked to hearing loss. Hearing loss is not a common manifestation of stress.
A patient has been diagnosed with a loss of hearing related to damage of the end organ for hearing. What term is used to describe this condition?
Sensorineural hearing loss
Postoperative nursing assessment for a patient who has had a mastoidectomy should include observing for facial paralysis, which might indicate damage to which cranial nerve?
Seventh
A client has undergone a mastoidectomy. The nurse teaches the client about possible complications, instructing the client to notify the physician immediately if which of the following occur? Slurred speech Aural fullness Intermittent sharp, shooting pain Serosanguinous drainage
Slurred speech After a mastoidectomy, the client needs to notify the physician immediately of any evidence of facial nerve weakness, such as drooping of the mouth on the operative side, slurred speech, decreased sensation, and difficulty swallowing. Aural fullness is to be expected. For 2 to 3 weeks after surgery, the client may experience sharp, shooting pains intermittently as the eustachian tube opens and allows air to enter the middle ear. A constant, throbbing pain with fever should be reported. Some serosanguinous drainage from the external auditory canal is normal after surgery.
What inner ear structure is affected when a patient is diagnosed with otosclerosis?
Stapes
The nurse knows which statements are consistent with acute otitis media? Select all that apply. Conductive hearing loss may occur. It is a relatively uncommon childhood infection. A purulent exudate is usually present in the middle ear. Permanent hearing loss is a likely outcome. The infection usually lasts less than 6 weeks.
The infection usually lasts less than 6 weeks. A purulent exudate is usually present in the middle ear. Conductive hearing loss may occur. Acute otitis media affects people of all ages but is common in children. Approximately 3 in 4 children experience an ear infection by the time they are 3 years of age. The infection usually lasts less than 6 weeks. Conductive hearing loss may occur. A purulent exudate is usually present in the middle ear. Acute otitis media rarely results in permanent hearing loss
Which statement describes benign paroxysmal positional vertigo (BPPV)?
The vertigo is usually accompanied by nausea and vomiting; generally, however, hearing is not impaired.
During a pharmacology class, the students are told that some drugs need to be closely monitored. What aspect should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?
Tinnitus and sensorineural hearing loss
The nurse is doing discharge teaching with a client newly diagnosed with Ménière's disease. Why would the nurse advise a low-sodium diet to this client?
To reduce the production of fluid in the inner ear
When discussing diseases of the middle ear, the nursing instructor distinguishes the different types of otitis media. What generally causes purulent otitis media?
Upper respiratory infections
When caring for a client after ear surgery, what is an important aspect of nursing care?
Validate client's feelings of discomfort.
Which manifestation is the most problematic for the client diagnosed with Ménière disease? Tinnitus Diaphoresis Hearing loss Vertigo
Vertigo Vertigo is usually the most troublesome complaint related to Ménière disease. Other clinical manifestations include tinnitus, diaphoresis, and hearing loss.
A nurse is preparing a presentation for a local community about hearing loss and prevention. Which of the following would the nurse integrate into the presentation as the most effective preventive measure? Wearing ear protection when exposed to noise Maintaining daily hygiene for the ears Obtaining prompt treatment for ear infections Having yearly audiometric testing
Wearing ear protection when exposed to noise
A client with otosclerosis comes to the clinic for a follow-up. When assessing this client's hearing, which type of hearing loss would the nurse expect to find? loss of high frequency sounds conductive sensorineural no hearing loss
conductive Otosclerosis may involve one or both ears and manifests as a progressive conductive or mixed hearing loss.
Audiometry confirms a client's chronic progressive hearing loss. Further investigation reveals ankylosis of the stapes in the oval window, a condition that prevents sound transmission. This type of hearing loss is called: sensorineural hearing loss. fluctuating hearing loss. conductive hearing loss. functional hearing loss.
conductive hearing loss.
The parent of a young client with severe hearing loss is quite concerned about the child's future independence because of impaired hearing. Which type of hearing loss is usually irreversible?
sensorineural
Which is not a surgical procedure used in the treatment of Ménière's disease? stapedectomy middle and inner ear perfusion labyrinthectomy endolymphatic sac decompression
stapedectomy Stapedectomy is performed on clients with otosclerosis. In endolymphatic sac decompression, a small portion of bone is removed from over the top of the endolymphatic sac. In middle and inner ear perfusion, antibiotics, such as gentamicin or streptomycin (considered to be ototoxic), are infused into the middle and inner ear. This procedure decreases vestibular function and vertigo but holds a high risk for significant hearing loss. Labyrinthectomy is excision of the labyrinth through the transcanal or transmastoid route to assist in eliminating vertigo.
A client has been diagnosed with otosclerosis. The nurse explains to the client that this is a common cause of hearing impairment among adults and is the result of a bony overgrowth of the:
stapes
A client who has a lengthy history of progressive hearing loss is very forthright about the condition, and the nurse wants to develop a communication strategy for this client's hospital stay. Which communication strategy has proven to be the most effective?
the one the client will use