NU272 Week 1 PrepU: Hearing Impairment
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? "Lie in bed with your head elevated, and refrain from blowing your nose for 24 hours." "Try to ambulate independently after about 24 hours." "Shampoo your hair every day for 10 days to help prevent ear infection." "Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."
"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days." The nurse should instruct the client to avoid air travel, sudden movements that may cause trauma, and exposure to loud sounds and pressure changes (such as from high altitudes) for 30 days after a stapedectomy. Immediately after surgery, the client should lie flat with the surgical ear facing upward; nose blowing is permitted but should be done gently and on one side at a time. The client's first attempt at postoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness. The client must avoid shampooing and swimming to keep the dressing and the ear dry.
A client with rheumatoid arthritis is being discharged with a prescription for aspirin, 600 mg P.O. every 6 hours. Which statement by the client indicates understanding of the adverse effects of the medication? "I know this medication may cause constipation so I will take a daily stool softener." "I'll call my physician if I have ringing in the ears." "I know this mediation may cause bleeding so I will take it on an empty stomach." "I'll call my physician if I have difficulty voiding."
"I'll call my physician if I have ringing in the ears." The client with rheumatoid arthritis typically takes a relatively high dosage of aspirin for its anti-inflammatory effect. The nurse should instruct the client to report signs and symptoms of aspirin toxicity, such as tinnitus (ringing in the ears). Dysuria and constipation are not associated with aspirin use or toxicity. Bleeding is, so the client is instructed to take with food.
The parent of a child having myringotomy tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer? "The tubes are inserted into a section of eardrum in which the hearing is not affected." "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." "Your child's hearing will decrease while the tubes are in place." "Have you asked your child's surgeon about that?"
"The tubes are inserted into a section of eardrum in which the hearing is not affected." Myringotomy tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing. There is no risk of permanent deafness and hearing will be increased while the tubes are in place, not decreased. The nurse should answer the parent's question honestly without dismissing it or referring to another health care provider. This indicates to the parent that something may be wrong or serious. The nurse can refer the parent to the surgeon if the parent's questions have not been adequately addressed.
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? The client being distressed in the mornings A progressive, bilateral loss of hearing A red and swollen ear drum The client describing a recent upper respiratory infection
A progressive, bilateral loss of hearing A progressive, bilateral loss of hearing is the characteristic symptom of otosclerosis. Tinnitus appears as the loss of hearing progresses; it is especially noticeable at night, when surroundings are quiet, and may be quite distressing to the client. The eardrum appears pinkish-orange from structural changes in the middle ear. The client often describes a history of having had a recent upper respiratory infection in case of otitis media, not otosclerosis.
High doses of which medication can produce bilateral tinnitus? Meclizine Aspirin Promethazine Dimenhydrinate
Aspirin At high doses, aspirin toxicity can produce bilateral tinnitus. Meclizine and dimenhydrinate are used for nausea and vomiting related to motion sickness. Antiemetics, such as promethazine suppositories, help control nausea and vomiting and vertigo through an antihistamine effect.
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication? Assess how the client would like to communicate Use facial and hand gestures Contact a person skilled in sign language Provide paper and pencil for written communication
Assess how the client would like to communicate Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important. For example, if a deaf client can read and write, writing can facilitate communication. If the client knows sign language, the nurse could use a person trained in sign language. Using hand gestures and exaggerated facial movements does not allow for adequate acquisition of knowledge.
The nurse is assessing a client's risk for sensorineural hearing loss. Which condition or situation places the client at greatest risk? Impacted earwax Otitis media Nystagmus Chronic noise exposure
Chronic noise exposure Chronic exposure to noise is a risk factor for sensorineural hearing loss. Impacted earwax and otitis media are risk factors for conductive hearing loss.
A client has been prescribed primaquine to prevent a relapse of malaria and is nearing the end of the prescribed course of treatment. During the nurse's most recent assessment, the client reports "I'm feeling dizzy and nauseous a lot, with ringing in my ears." What is the nurse's best action? Communicate these assessment findings to the provider promptly. Explain that adverse effects often worsen near the end of the course of treatment. Teach the client falls prevention strategies and suggest OTC antiemetics. Document the fact that the client may be experiencing a relapse of malaria.
Communicate these assessment findings to the provider promptly. The combination of dizziness, tinnitus and nausea during primaquine treatment suggests cinchonism, which should be reported to the provider. The presence of tinnitus suggests adverse effects rather than a relapse. Adverse effects are not necessary worst near the end of treatment.
The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to: Sensorineural disorder Conduction disorder Mixed sensorineural and conduction disorder Infection
Conduction disorder Impacted earwax is one cause for conductive hearing loss. It is not a cause of the other answer choices.
The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? It is caused by chronic otitis media or another infection. It is caused by maternal rubella. It is generally severe and unresponsive to medical treatment. It is often undetected until the child goes to school.
It is caused by chronic otitis media or another infection. In conductive hearing loss, the transmission of sound through the middle ear is disrupted. Structures fail to carry sound waves to the inner ear. Fluid fills the ear so the tympanic membrane is unable to move properly. This type of impairment most often results from chronic serious otitis media or other infection. Infants have hearing tests before being discharged from the hospital to determine hearing loss, especially premature infants. Hearing loss can be detected early because language development will be impaired. This type of hearing loss is treatable with the use of hearing aids, cochlear implants and communication devices. Rubella causes sensorineural hearing loss.
he nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? It is caused by chronic otitis media or another infection. It is caused by maternal rubella. It is generally severe and unresponsive to medical treatment. It is often undetected until the child goes to school.
It is caused by chronic otitis media or another infection. In conductive hearing loss, the transmission of sound through the middle ear is disrupted. Structures fail to carry sound waves to the inner ear. Fluid fills the ear so the tympanic membrane is unable to move properly. This type of impairment most often results from chronic serious otitis media or other infection. Infants have hearing tests before being discharged from the hospital to determine hearing loss, especially premature infants. Hearing loss can be detected early because language development will be impaired. This type of hearing loss is treatable with the use of hearing aids, cochlear implants and communication devices. Rubella causes sensorineural hearing loss.
The nurse is instructing a patient with Ménière's disease on dietary management to include as an adjunct to other more traditional therapies. The nurse would include which of the following? Select all that apply: Limit foods high in salt and sugar. Avoid aspirin and aspirin products. Avoid coffee, tea, and soft drinks. Avoid high-fiber foods.
Limit foods high in salt and sugar. Avoid aspirin and aspirin products. Avoid coffee, tea, and soft drinks. Treatment aims at reducing fluid. A low-sodium or sodium-free diet lessens edema and is effective in controlling the symptoms. Aspirin and aspirin products can increase tinnitus and vertigo. Caffeine has a diuretic effect and as such is not recommended. Eat fresh fruits, vegetables, and whole grains and avoid or limit intake of processed foods, especially those with high sodium content.
Conductive hearing loss can occur for a variety of reasons, including foreign bodies in the ear canal, damage to the ear drum, or disease. What disease is associated with conductive hearing loss? Huntington disease Paget disease Alzheimer disease Parkinson disease
Paget disease More permanent causes of hearing loss are thickening or damage of the tympanic membrane or involvement of the bony structures (ossicles and oval window) of the middle ear due to otosclerosis or Paget disease. Huntington, Alzheimer, and Parkinson diseases are not associated with conductive hearing loss.
A client is newly diagnosed with otitis externa. Which information should the nurse teach the client before the client leaves the clinic? Proper instillation of prescribed ear drops Side effects of oral antibiotics Cleaning ear canal with cotton-tipped applicator after showering Strategies to cope with temporary sensorineural hearing loss
Proper instillation of prescribed ear drops Otitis externa is usually treated with antimicrobial otic drops. The nurse should anticipate teaching the client how to instill the ear drops properly. Otitis externa is usually not treated with oral antibiotics because it is not a systemic issue. A cotton-tipped applicator should not be used in the ear canal because it can cause trauma, which may lead to otitis externa. Otitis externa may cause temporary conductive, not sensorineural, hearing loss.
Which intervention best demonstrates the L & D nurse is respectful of a client who is deaf and in early labor? Write down information on a piece of paper that the client can keep. Seek assistance from another health care professional who can converse in sign language. Utilize the labor coach so he or she can interpret and relay information to the client. Utilize hand signals like in charades to try to communicate important pieces of information.
Seek assistance from another health care professional who can converse in sign language. Cultural differences occur across not only different ethnic backgrounds but also different sociodemographic groups. A parent who has been deaf since birth, for example, expects her deaf culture to be respected by having health care professionals locate a sign language interpreter for her while she is in labor. If an interpreter cannot be located, writing down questions and answers is an alternative, assuming the parent has the ability to read and comprehend while dealing with labor contractions. Use of friends and family members is not considered to be the best option since many family/friends find it difficult to interpret medical terms. Hand signals can help in an emergency; however, it not the best way to interpret questions/comments from a laboring woman who is deaf.
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? Signs of hypotension Reduced urinary output Tinnitus and sensorineural hearing loss Impaired facial movement
Tinnitus and sensorineural hearing loss It is important that nurses are knowledgeable about the ototoxic effects of certain medications such as salicylates, loop diuretics, quinidine, quinine, and aminoglycosides. Signs and symptoms of ototoxicity include tinnitus and sensorineural hearing loss. Hypotension, reduced urinary output, and impaired facial movement are not signs of ototoxicity.
It is important to differentiate between the kinds of hearing loss so they can be appropriately treated. What is used to test between conductive and sensorineural hearing loss? Audioscope Audiometer Tone analysis Tuning fork
Tuning fork Tuning forks are used to differentiate conductive and sensorineural hearing loss. Audioscope, audiometer, and tone analysis do not differentiate between conductive and sensorineural hearing loss.
The nurse is talking with a patient diagnosed with Ménière's disease about the patient's symptoms. What symptom does the patient inform the nurse is the most troublesome? Nausea Diarrhea Tinnitus Vertigo
Vertigo Vertigo is the misperception or illusion of motion of the person or the surroundings. Most people with vertigo describe a spinning sensation or say they feel as though objects are moving around them. Vertigo is usually the most troublesome complaint related to Ménière's disease.
Which manifestation is most problematic for the client diagnosed with Ménière disease? Tinnitus Diaphoresis Vertigo Hearing loss
Vertigo Vertigo is usually the most troublesome complaint related to Ménière disease. Other clinical manifestations may include tinnitus, diaphoresis, and hearing loss.
The nurse is caring for a client who reports, "My ears are constantly ringing!" The nurse will evaluate the client further for the use of which medication? acetylsalicylic acid (aspirin) acetaminophen vitamin C potassium chloride
acetylsalicylic acid (aspirin) Several classes of drugs have been identified as having ototoxic potential, including aminoglycosides, antimalarials, some chemotherapeutic drugs, loop diuretics (e.g., furosemide), and salicylates (e.g., aspirin). This hearing loss is considered sensorineural and my be temporary or permanent. Acetaminophen, potassium, and vitamin C are not associated with ototoxicity.
The nurse is caring for a child whose mother is deaf and untrusting of staff. She frequently cries at the bedside, but refuses intervention from the social worker or the chaplain. Which issue is most important for the nurse to address with the mother to promote a trusting relationship? the mother's fear that the staff do not respect her the mother's feelings of loss of control over her child communication barriers between the mother and staff lack of knowledge about the child's illness and treatment
communication barriers between the mother and staff The communication barrier is the most significant and would require immediate attention. Strategies need to be implemented that include taking the time to share information via the written word with all new members of the healthcare team and the mother. Fear, loss of control, and lack of knowledge about the illness of the child may contribute to the overall stress of the situation.
A client with a severe staphylococcal infection is receiving the aminoglycoside gentamicin sulfate by the I.V. route. The nurse should assess the client for which adverse reaction? aplastic anemia ototoxicity cardiac arrhythmias seizures
ototoxicity The most significant adverse reactions to gentamicin and other aminoglycosides are ototoxicity (indicated by vertigo, tinnitus, and hearing loss) and nephrotoxicity (indicated by urinary cells or casts, oliguria, proteinuria, and reduced creatinine clearance). These adverse reactions are most common in elderly and dehydrated clients, those with renal impairment, and those receiving concomitant therapy with another potentially ototoxic or nephrotoxic drug. Gentamicin isn't associated with aplastic anemia, cardiac arrhythmias, or seizures.
A client comes to the clinic reporting of a ringing sound in the ears and dizziness. When the nurse takes the client's history, the nurse discovers that the client has been taking several ibuprofen every day for various discomforts. What does the nurse understand has occurred with this client? ototoxicity from the ibuprofen immunotoxicity from the ibuprofen allergic reaction to the ibuprofen anaphylactic reaction to the ibuprofen
ototoxicity from the ibuprofen Ototoxicity is damage to the eighth cranial nerve. It may or may not be reversible. Signs and symptoms of ototoxicity include tinnitus, which is a buzzing or ringing sound in the ear, and sensorineural hearing loss. Other signs and symptoms, particularly of vestibular toxicity, include light-headedness, vertigo, a spinning sensation from a seated position, and nausea and vomiting.
The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion? suddenly doing poorly in school tendency to act silly in the classroom playing the radio loudly prevention and treatment of otitis media
prevention and treatment of otitis media The most common cause of conductive hearing impairment is otitis media. Hearing loss can be associated with intermittent bouts of acute otitis media and can hinder language development. Suddenly doing poorly in school, acting silly in the classroom, and playing the radio loudly are symptoms of hearing loss in children but they are symptoms after loss has occurred. The preventive education would include helping the child not develop otitis media.
A patient enters the emergency room with reports of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to: acute acetaminophen toxicity. salicylate intoxication. ibuprofen overdose. caffeine overdose.
salicylate intoxication. Salicylate intoxication may occur with an acute overdose of aspirin. Manifestations of salicylism include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, hyperventilation, and others. Acute acetaminophen toxicity results in potentially fatal hepatotoxicity. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.
