Hinkle Ch. 59: Assessment and Management of Patients with Hearing and Balance Disorders

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 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? - "Turn your head to the side so I can put these drops in." - "These drops are cold from being on the window sill." - "Let me put this cotton ball in your ear because I put the drop in." - "I squeeze the dropper to put a drop of medicine in the ear."

- "These drops are cold from being on the window sill."

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. - Stenosis of the semicircular canals. - Hardening of the tympanic membrane. - Malfunctioning of the incus and the staples.

- Damage to the hair cells inside the cochlea.

During assessment for cranial nerve functions, the client closes the eyes and begins to fall to one side. Which cranial nerve alteration causes this response? - cranial nerve VIII - optic nerve - cranial nerve VII - facial nerve

- cranial nerve VIII

Changes in pressure at high altitudes can cause discomfort in the ears. Which structure within the middle ear is instrumental in equalizing pressure? - eustachian tubes - fallopian tubes - semicircular canals - incus tubes

- eustachian tubes

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone, causing - facial nerve paralysis. - nystagmus. - motor impairment. - diplopia.

- facial nerve paralysis.

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 - conductive - tinnitus - noise exposure

- sensorineural

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 - labyrinth - tympanic membrane - incus

- stapes

A client undergoing mastoid surgery asks the nurse about the pain following the surgery. Which response by the nurse is appropriate? - "Usually the incisional pain is mild and controlled by the prescribed medication for the first 24 hours." - "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 there is a constant throbbing pain for the first week. Most client report no pain with the use of the pain medications."

- "Usually the incisional pain is mild and controlled by the prescribed medication for the first 24 hours."

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." - "It has resulted from the several recurrent episodes of acute otitis media you've had." - "You have a common infection in one of the bones of your face." - "Your eardrum has ruptured because of the extreme pressure in your middle ear from the infection."

- "You have some fluid that has collected in your middle ear but no infection."

A dietary modification for a patient with Ménière's disease would be: - A decrease in sodium intake to 1500 mg daily. - Fluid restriction to 2 L/day. - An increase in calcium to 1 g/day. - An increase in vitamin C to 1.5 g/day.

- A decrease in sodium intake to 1500 mg daily.

Which symptoms may a client with Ménière disease report before an attack? - Nystagmus - Low blood pressure - Photosensitivity - A full feeling in the ear

- A full feeling in the ear

The nurse caring for a client with Ménière's disease needs to assist with what when the client is experiencing an attack? - Sleeping - ADLs - Coughing - URIs

- 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 - Risk for infection related to drainage from the ear canal - Disturbed sensory perception: auditory related to sensorineural hearing loss. - Hyperthermia related to elevated temperature secondary to infection

- Acute pain related to inflammation

The occupational nurse is advising a client on options to enhance workplace communication because the client has progressive hearing loss. The client works as a customer service representative. In discussing the options with the client, which type would be the last option offered by the nurse? - Battery-operated hearing aid - American sign language - Headsets with amplifiers - Text-based telecommunications

- American sign language

Which of the following classification of medications is the most common cause of ototoxicity? - Aminoglycosides - Cephalosporins - Sulfonamides - Penicillins

- Aminoglycosides

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.

High doses of which medication can produce bilateral tinnitus? - Meclizine - Aspirin - Promethazine - Dimenhydrinate

- Aspirin

The nurse is instructing a client's family members on the most incapacitating symptom of Ménière disease. Which nursing instruction associated with the symptom is most helpful? - Assist the client when ambulating. - Keep a bucket beside the bed. - Ensure low lighting in the room. - Sit in front of the client when speaking.

- Assist the client when ambulating.

The nurse and a colleague are performing the Epley maneuver with a client who has a diagnosis of benign paroxysmal positional vertigo. The nurses should begin this maneuver by performing what action? - Placing the client in a prone position - Assisting the client into a sitting position - Instilling 15 mL of warm normal saline into one of the client's ears - Assessing the client's baseline hearing by performing the whisper test

- Assisting the client into a sitting position

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? - Fever - Aural tenderness - Bulging eardrum - Ear drainage

- Aural tenderness

A client is diagnosed with otitis externa. Which instruction is most appropriate for the nurse to give? - Keep the ear covered with a scarf. - Avoid using cold water when shampooing hair. - Avoid swimming for 7 to 10 days. - Keep a dry cotton ball in the ear canal.

- Avoid swimming for 7 to 10 days.

Which of the following brain structures is responsible for equilibrium? - Cerebellum - Brainstem - Thalamus - Hypothalamus

- Cerebellum

Which is a correct rationale for encouraging a client with otitis externa to eat soft foods? - Chewy foods, such as red meat, may react with prescribed analgesics and antibiotics. - Chewing may cause discomfort. - Chewing may lead to further complications, such as otitis media. - Chewing may cause excessive drainage.

- Chewing may cause discomfort.

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? - Ear mold is loose. - Client has cerumen in the ear. - The mold is not properly fitted. - The client has an ear infection.

- Client has cerumen in the ear.

The nurse is caring for a client experiencing hearing loss. The nurse uses the otoscope to assess the ear canal and tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be most accurate? - Conductive - Mixed - Central - Sensorineural

- Conductive

Which statement is consistent with acute otitis media? - The infection usually lasts more than 6 weeks. - It is a relatively uncommon childhood infection. - It is usually caused by a fungal infection. - Conductive hearing loss may occur.

- Conductive hearing loss may occur.

Nursing assessment of hearing loss in an older adult client includes evaluation of age-related changes, as well as a history of current illnesses and medications. Which of the following factors are associated with ototoxic effects? Select all that apply. - Coronary artery disease - Diabetes mellitus - Loop diuretics (e.g., Lasix) - Asthma - Bacterial meningitis - Gentamicin

- Diabetes mellitus - Loop diuretics (e.g., Lasix) - Bacterial meningitis - Gentamicin

Which action by the nurse has the highest priority when caring for a client diagnosed with vertigo? - Encourage the client to keep his or her eyes open. - Administer antivertiginous medication as ordered. - Encourage the client to stare straight ahead, focusing on one object. - Educate the client on using the call light for assistance with ambulation.

- Educate the client on using the call light for assistance with ambulation.

The client is consulting with a physician regarding a potential diagnosis of Ménière's disease. The nurse is assisting in positional testing and documentation. Which diagnostic test would the nurse anticipate to obtain a more precise evaluation of vestibular function? - Audiometry - Electronystagmography - Caloric stimulation test - Romberg test

- Electronystagmography

The nurse is caring for a client who just returned from a trip requiring an airline flight. The client reported ear pain upon descent. The nurse is correct in stating which site as being the pressure equalizer in the ear? - Eustachian tube - Auricle - Tympanic membrane - Labyrinth

- Eustachian tube

A nurse is performing an otoscopic examination on a client. Which finding would the nurse document as abnormal? - Umbo in the center of the tympanic membrane - External auditory canal erythema - Tympanic membrane pearly gray - Manubrium superior to the umbo

- External auditory canal erythema

The nurse is caring for a client in the triage section of a walk-in clinic. Which triad of common symptoms suggests a diagnosis of Ménière disease? - Blurred vision, vertigo, nausea - Syncope, vertigo, ear pain - Disorientation, vertigo, nausea - Hearing loss, vertigo, tinnitus

- Hearing loss, vertigo, tinnitus

The client is having a Weber test. During a Weber test, where should the tuning fork be placed? - On the mastoid process behind the ear - In the midline of the client's skull or in the center of the forehead - Near the external meatus of each ear - Under the bridge of the nose

- In the midline of the client's skull or in the center of the forehead

Loud, persistent noise has what effect on the body? - Dilation of peripheral blood vessels - Increased blood pressure - Decreased heart rate - Decreased gastrointestinal activity

- Increased blood pressure

A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear? - External ear - Middle ear - Inner ear - Tympanic membrane

- Inner ear

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? - Irrigate the ear canal with warm water to flush out the insect. - Use an aural suction cup to pull out the insect. - Insert a cotton-tipped applicator (e.g., Q-tip) to trap the insect and slowly pull the applicator backward. - Instill a few drops of warmed mineral oil to cover the insect.

- Instill a few drops of warmed mineral oil to cover the insect.

A client comes to the walk-in clinic reporting feeling a "bug in my ear." What action should be taken when there is an insect in the ear? - Instillation of mineral oil - Instillation of carbamide peroxide - Instillation of hot water - Use of a small forceps

- Instillation of mineral oil

Which of the following are methods of removing foreign bodies from the ear? Select all that apply. - Irrigation - Suction - Instrumentation - Stapedectomy - Stapedotomy

- Irrigation - Suction - Instrumentation

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 cause sudden headaches. - It may cause vertigo. - It may dislodge the prosthesis. - It may cause excessive drainage.

- It may dislodge the prosthesis.

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) - Furosemide (Lasix) - Cortisporin otic solution - Gentamicin (Garamycin) intravenously

- Meclizine (Antivert)

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 - Irrigation - Hair pin - Tweezers

- Mineral oil

Which of the following describes vertigo? Select all that apply. - Misperception of motion - Spinning sensation - Objects are moving around him or her - Syncope - Fainting

- Misperception of motion - Spinning sensation - Objects are moving around him or her

Tinnitus is associated with which of the following hearing disorders? Select all that apply. - Ménière's disease - Acoustic neuroma - Otosclerosis - Thyroid disease - Migraine headaches

- Ménière's disease - Acoustic neuroma - Otosclerosis - Thyroid disease - Migraine headaches

The nurse on a cruise ship is assessing clients for motion sickness. Which of the following is a common misconception? - Repeated motion is the cause. - Once symptoms occur, they will always be present. - Medications help the symptoms. - Pallor and diaphoresis is a first symptom.

- Once symptoms occur, they will always be present.

What is located in the cochlea of the inner ear? - Semicircular canals - Labyrinth - Vestibulocochlear nerve - Organ of Corti

- Organ of Corti

The nurse is performing an assessment of a patient's ears. When looking at the tympanic membrane, the nurse observes a healthy membrane. What should the appearance be? - Pearly gray and translucent - White and cloudy - Pink with white exudate - Dark yellow with cerumen

- Pearly gray and translucent

Which condition refers to hearing loss associated with degenerative changes? - Presbycusis - Myopia - Strabismus - Presbyopia

- Presbyopia

The nurse is assessing a client's hearing using the Rinne test. When providing instruction to elicit client feedback, which instruction is essential? - Raise your hand when you hear the vibration. - Raise your hand when you no longer hear sound. - Raise your hand when the vibration exceeds the sound. - Raise your hand when the sound exceeds the vibration.

- Raise your hand when you no longer hear sound.

A client is diagnosed with benign paroxysmal positional vertigo. Which information will the nurse provide about a step in canalith repositioning? - Shaking the head to the left and right - Rapidly changing positions from sitting to supine - Rotating the head to the left, right, up, and down - Moving the head left to right in the prone position

- Rapidly changing positions from sitting to supine

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? - Instilling 1 to 2 drops of half-strength peroxide in the ear - Using warm glycerin or mineral oil to soften the cerumen - Removing the cerumen by means of a cotton tip applicator - Irrigating the ear with warm water and a rubber-bulb syringe

- Removing the cerumen by means of a cotton tip applicator

Which test uses a tuning fork shifted between two positions to assess hearing? - Whisper - Watch tick - Rinne - Weber

- Rinne

Which nursing diagnosis takes highest priority for a client admitted for evaluation for Ménière's disease? - Acute pain related to vertigo - Imbalanced nutrition: Less than body requirements related to nausea and vomiting - Risk for deficient fluid volume related to vomiting - Risk for injury related to vertigo

- Risk for injury related to vertigo

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: - Conduction problem. - Sensorineural loss. - Mixed cause. - Psychogenic issue.

- Sensorineural loss.

What kind of otitis media is a pathogen-free fluid behind the tympanic membrane, resulting from irritation associated with respiratory allergies and enlarged adenoids? - Purulent otitis media - Infectious otitis media - Serous otitis media - Sterile otitis media

- Serous otitis media

A nurse is preparing to perform the whisper test to assess a client's gross auditory acuity. Which of the following would be most appropriate for the nurse to do? - Stand at a position diagonal to the client. - Have the client use a finger to occlude the ear to be tested. - Stand about 1 to 2 feet away from the ear to be tested. - Speak a phrase in a low normal tone of voice.

- Stand about 1 to 2 feet away from the ear to be tested.

A client has undergone diagnostic testing and has been diagnosed with otosclerosis. What ear structure is primarily affected by this diagnosis? - Malleus - Stapes - Incus - Tympanic membrane

- Stapes

Which of the following is the treatment of choice for acoustic neuromas? - Surgery - Radiation - Chemotherapy - Palliation

- Surgery

Which phrase defines ossiculoplasty? - Surgical reconstruction of the middle ear bones - Surgical repair of the eardrums - Incision into the tympanic membrane - Incision into the eardrum

- Surgical reconstruction of the middle ear bones

A client comes to the walk-in clinic complaining of an earache. The cause is found to be impacted cerumen. The client asks the nurse what he can do at home to soften hardened cerumen. What should the nurse recommend to a client to soften hardened cerumen? - Avoid harsh sunlight. - Increase intake of red meat. - Increase intake of beta-carotene. - Take nonprescription preparations.

- Take nonprescription preparations.

The nurse is assessing a client for objective signs of hearing difficulties. Which symptom leads the nurse to take alternate measures to ensure client understanding of teaching? - The client interrupts by asking the nurse to repeat instruction. - The client is quiet and responds appropriately. - The client leans forward and turns the head. - The client quietly reads the instructional literature.

- The client leans forward and turns the head.

The nurse is working in the emergency department when a physician asks for help as the client is performing a Romberg test. In which position would the nurse stand to be most helpful? - The nurse would stand directly in front of the client. - The nurse would stand between the client and physician. - The nurse would stand across the room but in direct alignment from the client. - The nurse would stand laterally to the client, opposite side to where the physician is standing.

- The nurse would stand laterally to the client, opposite side to where the physician is standing.

When discussing diseases of the middle ear, the nursing instructor distinguishes the different types of otitis media. What generally causes purulent otitis media? - Irritation associated with respiratory allergies and enlarged adenoids - Bronchial tree - Outer ear - Upper respiratory infections

- Upper respiratory infections

Acoustic neuromas are benign tumors of which of the following cranial nerves? - VIII - VII - VI - V

- VIII

When caring for a client after ear surgery, what is an important aspect of nursing care? - Assess social support. - Feed small frequent meals to minimize nausea. - Fit for a hearing aid. - Validate client's feelings of discomfort.

- Validate client's feelings of discomfort.

A client is diagnosed with Meniere's disease. The nurse would most likely expect the client to report which of the following? - Tinnitus - Vertigo - Nausea - Ear fullness

- Vertigo

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

Which manifestation is the most problematic for the client diagnosed with Ménière disease? - Tinnitus - Diaphoresis - Vertigo - Hearing loss

- Vertigo

The clinical manifestations of motion sickness are caused by an overstimulation in what system? - Vestibular - Cardiovascular - Cochlear - Gastrointestinal

- Vestibular