Chapter 43: Caring for Clients with Ear Disorders

Acoustic neuromas are benign tumors of which of the following cranial nerves?

VIII Acoustic neuromas are slow-growing, benign tumors of cranial nerve VIII, usually arising from the Schwann cells of the vestibular portion of the nerve.

Which is a correct rationale for encouraging a client with otitis externa to eat soft foods

Chewing may cause discomfort. The nurse encourages a client with otitis externa to eat soft foods or consume nourishing liquids because chewing may cause discomfort. Chewing will not react with the prescribed medications or cause complications such as otitis media and excessive drainage.

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 Sensorineural hearing loss usually is irreversible.

Instructing a class of sixth graders on the importance of protecting their hearing by avoiding excessive noise, the nurse lists the activities that can destroy hearing. On the list are loud concerts, loud mP3 player volume, loud headphones, etc. The nurse also indicates the signs of hearing impairment so the students can help protect their friends. What are signs of diminished hearing? Select all that apply.

turning the head asking for words to be repeated The nurse observes for signs of hearing impairment such as frequently asking that words be repeated.

A client is diagnosed as having serous otitis media. When describing this condition to the client, which of the following would be most accurate?

"You have some fluid that has collected in your middle ear but no infection." Serous otitis media involves fluid, without evidence of active infection, in the middle ear. Recurrent episodes of acute otitis media leads to chronic otitis media. An infection of the temporal bone (temporal bone osteomyelitis) is a serious but rare external ear infection called malignant external otitis. Rupturing of the eardrum refers to tympanic membrane perforation.

High doses of which medication can produce bilateral tinnitus?

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.

After mastoid surgery, an 81-year-old client has been identified as needing assistance in her home. What would be a primary focus of this client's home care?

Assisting the client with ambulation as needed to avoid falling The caregiver and client are cautioned that the client may experience some vertigo and will therefore require help with ambulation to avoid falling. The client should not be expected to experience hearing loss and no foods are contraindicated. Adequate rest is needed, but this is not a primary focus of home care.

Which instruction regarding swimming should the nurse give to the client who is recovering from otitis externa?

Avoid swimming for 7-10 days The nurse should advise the client to avoid swimming for 7 to 10 days to allow the canal to heal completely. Wearing a scarf or inserting cotton does not help prevent recurrence of the disorder. Avoiding cold water does not help to improve the client's condition.

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. The client reports that the hearing aid is not helping, such that the sounds are not loud enough. This statement is consistent with inadequate amplification. Cerumen in the ears is a possible cause. A loose ear mold would cause a whistling noise. An improperly fitted mold or middle ear infection would lead to pain from the mold.

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 Scopolamine and Phenergan are popular anticholinergics; ephedrine is a popular sympathomimetic. Dramamine and Antivert are over-the-counter antihistamines that act by blocking the conduction of the vestibular pathway of the inner ear.

Which action by the nurse has the highest priority when caring for a client diagnosed with vertigo?

Educate the client on using the call light for assistance with ambulation. The client should restrict movement and change positions slowly to prevent an injury related to the vertigo. The prevention of injury related to the vertigo should be the highest priority nursing intervention; therefore, the nurse needs to teach the client about using the call light for assistance with ambulation. All other interventions are appropriate but do not address safety. The client should keep his or her eyes open and focus on one spot to reduce vertigo.

A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear?

Inner ear A client with vertigo experiences problems with the inner ear, which is responsible for maintaining equilibrium. The external ear collects sound; the middle ear conducts sound. The tympanic membrane (eardrum) vibrates in response to sound stimulation.

A nurse practitioner in an emergency room receives a telephone call from a mother whose 4-year-old child has a mosquito stuck in his external ear canal. Which of the following is the best information the nurse could give the mother?

Instill a few drops of warmed mineral oil to cover the insect. Removing a foreign body from the external auditory canal can be quite challenging. The three standard methods for removing foreign bodies are the same as those for removing cerumen: irrigation, suction, and instrumentation. Foreign vegetable bodies and insects tend to swell; thus, irrigation is contraindicated. Usually, an insect can be dislodged by instilling mineral oil, which will kill the insect and allow it to be removed.

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. Sodium and fluid retention disrupts the delicate balance between the endolymph and perilymph in the inner ear. Therefore, many clients can control their symptoms by adhering to a low-sodium diet. Caffeinated fluids are to be avoided because of their diuretic effect. Diuretics, not antihistamines, would be prescribed to lower the pressure in the endolymphatic system. Foods high in potassium would be encouraged if the client is prescribed a diuretic that causes potassium loss.

Hearing aids help with which of the following problems?

Makes sounds louder A hearing aid makes sounds louder, but it does not improve a patient's ability to discriminate words or understand speech. Hearing aids amplify all sounds, including background noise, which may be disturbing to the wearer. It does not improve communication skills.

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) Pharmacologic therapy for Ménière's disease consists of antihistamines, such as meclizine, which shortens the attack (NIDCD, 2010).

Which condition is characterized by the formation of abnormal spongy bone around the stapes?

Otosclerosis Otosclerosis is more common in females than males and is frequently hereditary. A middle ear effusion is denoted by fluid in the middle ear without evidence of infection. Chronic otitis media is defined as repeated episodes of acute otitis media, causing irreversible tissue damage and persistent tympanic membrane perforation. Otitis externa refers to inflammation of the external auditory canal.

The nurse is developing a plan of care for a patient with severe vertigo. What expected outcome statement would be a priority for this patient?

Patient will experience no falls due to balance disorder. Although all of these are expected outcomes for a patient with vertigo, the priority expected outcome is that the patient will experience no falls due to the balance disturbance, as falls poses the greatest risk to the patient's health.

A client is experiencing vertigo. Which nursing interventions would be included in the client's plan of care? Select all that apply.

Place pillows on each side of the head to restrict movement. Instruct the client to lie down; apply side rails to bed. Encourage the client to express feelings associated with condition. Movement aggravates vertigo. Lying down in a bed with side rails eliminates the possibility of falling and injury. The client will require a great deal of emotional support because of the unpredictability of the attacks and the resulting impairments. Clients should close their eyes during an attack of vertigo. Not seeing the room spin has a tendency to decelerate the dizzy sensation.

Which of the following nursing interventions would most likely facilitate effective communication with a hearing-impaired client?

Reduce environmental noise and distractions before communicating. Communication with the hearing impaired can be facilitated by talking in a quiet space free of competing noise stimuli and other distractions. Asking the client to repeat what was said is likely to provoke frustration in the client. A more effective strategy would be to repeat the question or statement, choosing different words. Raising the voice to project sound at higher frequency would make understanding more difficult. The nurse cannot assume that the client reads lips. If the client does read lips, on average he or she will understand only 50% of words accurately.

During his annual physical examination, a retired airplane mechanic reports noticeable hearing loss. The nurse practitioner prescribes a series of hearing tests to confirm or rule out noise-induced hearing loss, which is classified as a:

Sensorineural loss. Noise-induced hearing loss refers to hearing loss that follows a long period of exposure to loud noise. It is inherent in jobs that involve heavy machinery, noisy engines, and artillery.

Which of the following is the treatment of choice for acoustic neuromas?

Surgery Surgical removal of acoustic tumors is the treatment of choice because these tumors do not respond well to radiation or chemotherapy. There would be no need for palliation.

A client diagnosed with arthritis has been taking aspirin and now reports experiencing tinnitus and hearing loss. What should the nurse teach this client?

The hearing loss will likely resolve with time after the drug is discontinued. Tinnitus and hearing loss are signs of ototoxicity, which is associated with aspirin use. In most cases, this will resolve upon discontinuing the aspirin. Many other drugs cause irreversible ototoxicity.

Which statement describes benign paroxysmal positional vertigo (BPPV)?

The vertigo is usually accompanied by nausea and vomiting. BPPV is a brief period of incapacitating vertigo that occurs when the position of the client's head is changed with respect to gravity. The vertigo is usually accompanied by nausea and vomiting; however, hearing impairment does not generally occur. The onset of BPPV is sudden and followed by a predisposition for positional vertigo, usually for hours to weeks but occasionally months or years. BPPV is thought to be caused by the disruption of debris within the semicircular canal. This debris is formed from small crystals of calcium carbonate from the inner ear structure, the utricle. BPPV is frequently stimulated by head trauma, infection, or other events.

A client is diagnosed with Meniere's disease. The nurse would most likely expect the client to report which of the following?

Vertigo Although tinnitus, nausea, vomiting and ear fullness may be noted, vertigo is usually the most troublesome and common complaint associated with Meniere's disease.

Which instructions regarding swimming should the nurse give to a client who is recovering from otitis externa?

Wear soft plastic earplugs. The nurse should advise the client to wear soft plastic earplugs to prevent trapping water in the ear while swimming. Wear soft plastic earplugs to prevent trapping water in the ear while swimming. Cotton can be used, but if so it needs to be covered in petroleum jelly to prevent water from entering the external canal. Wearing a scarf does not help prevent or treat otitis externa. Swimming in cold water is not related to otitis externa.

A nurse needs to change a dressing on an abdominal wound for a patient who is hearing-impaired and whose speech is difficult to understand. Which of the following is the best approach for the nurse?

Write down the steps of the procedure for the patient to read before beginning the treatment. Written communication is an excellent resource and means of mutual understanding. Distraction is not appropriate because a hearing-impaired person needs the care provider's full attention. Do not pretend to understand or complete the person's sentences for them.

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 Salicylates, loop diuretics, and certain chemotherapeutic agents are drugs associated with ototoxicity. Cephalosporins are not known to cause ototoxicity.