NU272 Hearing and Balance
High doses of which medication can produce bilateral tinnitus? Meclizine Dimenhydrinate Promethazine Aspirin
Aspirin Explanation: 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 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? Explain that adverse effects often worsen near the end of the course of treatment. Document the fact that the client may be experiencing a relapse of malaria. Teach the client falls prevention strategies and suggest OTC antiemetics. Communicate these assessment findings to the provider promptly.
Communicate these assessment findings to the provider promptly. Explanation: 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 Mixed sensorineural and conduction disorder Infection Conduction disorder
Conduction disorder Explanation: 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 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? Sensorineural Conductive Central Mixed
Conductive Explanation: Conductive hearing loss occurs from an obstruction in the outer or middle ear such as from cerumen. Mixed hearing loss is a combination of conductive and sensorineural problems. Central hearing loss involves injury or damage to the nerves or the nuclei of the central nervous system. Sensorineural involves damage to the inner ear.
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 functional hearing loss. fluctuating hearing loss. sensorineural hearing loss. conductive hearing loss.
Conductive hearing loss Conductive hearing loss results from interference with the conduction of sound waves (sound transmission) from the tympanic membrane to the inner ear. The stapes must move freely for sound to be transmitted. Bone tissue overgrowth causes the stapes to become fixed or immobile (ankylosed) in the oval window, preventing sound transmission. In a functional hearing loss, no organic lesion is found. Fluctuating hearing loss is a form of sensorineural hearing loss that varies over time. Sensorineural hearing loss affects the inner ear and involves the cochlea and eighth cranial nerve.
The nurse is working in the triage section of a walk-in clinic. Which triad of common symptoms, when placed together, indicate Ménière's disease? Blurred vision, vertigo, nausea Disorientation, vertigo, nausea Syncope, vertigo, ear pain Hearing loss, vertigo, tinnitus
Hearing loss, vertigo, tinnitus Explanation: Hearing loss, vertigo, and tinnitus are common symptoms of many disease processes but, when placed together, indicate Ménière's disease. The other options do not include the accurate triad of symptoms.
A client is diagnosed with Meniere's disease. The nurse would most likely expect the client to report which of the following? Ear fullness Vertigo Nausea Tinnitus
Vertigo Explanation: Although tinnitus, nausea, vomiting and ear fullness may be noted, vertigo is usually the most troublesome and common complaint associated with Meniere's disease.
What does the tinnitus that is caused by vascular disorders sound like? Rings Pulses Roars Hums
Pulses Explanation: In some vascular disorders, sounds generated by turbulent blood flow (e.g., arterial bruits or venous hums) are conducted to the auditory system. Vascular disorders typically produce a pulsatile form of tinnitus.
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? "Try to ambulate independently after about 24 hours." "Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days." "Shampoo your hair every day for 10 days to help prevent ear infection." "Lie in bed with your head elevated, and refrain from blowing your nose for 24 hours."
"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days." Explanation: 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 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."
"I'll call my physician if I have ringing in the ears." Explanation: 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? "Have you asked your child's surgeon about that?" "Your child's hearing will decrease while the tubes are in place." "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." "The tubes are inserted into a section of eardrum in which the hearing is not affected."
"The tubes are inserted into a section of eardrum in which the hearing is not affected." Explanation: 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.
Distraught at the persistent ringing in his ears and his inability to alleviate it, a 50-year-old man has visited his health care provider. After diagnostic testing, no objective cause (like impacted cerumen or vascular abnormality) was found. Given these testing results, which teaching point by the care provider is most appropriate? "This is most often the result of a psychological disturbance and therapy is often useful in relieving tinnitus." "A specialist can listen with a sensitive microphone to determine whether you are actually hearing these sounds." "There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success." "There are many drugs such as blood pressure pills, relaxants, heart medications and antihistamines that can cause tinnitus."
"There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success." Explanation: Current treatment modalities for tinnitus address the symptoms of the problem rather than curing the underlying etiology. While therapy can be of some use, it is inaccurate to characterize tinnitus as a psychological disturbance. Medications, including antihistamines, anticonvulsant drugs, calcium channel blockers, benzodiazepines, and antidepressants, have been used for tinnitus alleviation; they are not implicated as a cause. While listening to differentiate between objective and subjective tinnitus is possible, the absence of objective sounds does not mean that tinnitus does not exist, rather that it is subjective. The use of tinnitus retraining therapy, which includes directive counseling and extended use of low-noise generators to facilitate auditory adaptation to the tinnitus, has met with considerable success.
The client is being seen in the clinic for the chief complaint of ringing in the ears. What questions would the nurse ask to obtain more information about the tinnitus? Select all that apply. "What is your current job and what were your previous jobs?" "What do you think you did to cause the ringing?" "How has the ringing in the ears affected you?" "Have you had to ask people to repeat what they said?" "When did you first notice the ringing in the ears?"
"When did you first notice the ringing in the ears?" "What is your current job and what were your previous jobs?" "Have you had to ask people to repeat what they said?" "How has the ringing in the ears affected you?" Explanation: When obtaining a targeted assessment, the nurse asks questions relating to signs and symptoms, onset/duration, predisposing factors, and effect on the client. Appropriate questions include queries on when the client first noticed the ringing, current and past jobs, whether the client asks others to repeat statements, and how the ringing has affected the client. The question, "What do you think you did to cause the ringing?" places blame on the client and is nontherapeutic. It may cause the client to become defensive.
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 red and swollen ear drum A progressive, bilateral loss of hearing The client describing a recent upper respiratory infection The client being distressed in the mornings
A progressive, bilateral loss of hearing Explanation: 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.
You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis? The client being distressed in the mornings A red and swollen ear drum A progressive, bilateral loss of hearing The client describing a history of having had a recent upper respiratory infection
A progressive, bilateral loss of hearing Explanation: 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.
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? Provide paper and pencil for written communication Contact a person skilled in sign language Assess how the client would like to communicate Use facial and hand gestures
Assess how the client would like to communicate Explanation: 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 caring for an 88-year-old male admitted 2 days ago for dehydration. The nurse brings the client his breakfast tray and notes that the client appears to be having difficulty understanding what she is saying to him today. Which nursing action is most appropriate? Check the client's ear canals for cerumen. Speak to the older adult client in a high-frequency tone of voice. Use facial expressions and sign language to communicate. Ask the client if he left his earplugs in his ears.
Check the client's ear canals for cerumen. Explanation: Ear wax (cerumen) becomes drier in older adults and can block the ear canal and cause decreased hearing. Asking the client if he has earplugs in his ears is not appropriate. Using facial expressions and sign language is appropriate in communicating with the hard of hearing, but this client's hearing loss was acute and requires further assessment. When speaking to older adults who are hearing-impaired, one needs to use low tones to facilitate communication; high-frequency tones are problematic for older adults.
The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? It is generally severe and unresponsive to medical treatment. It is caused by chronic otitis media or another infection. It is often undetected until the child goes to school. It is caused by maternal rubella.
It is caused by chronic otitis media or another infection. Explanation: 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 caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? 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. It is caused by maternal rubella.
It is caused by chronic otitis media or another infection. Explanation: 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.
Select the statement that best describes Meniere disease. Meniere disease is a disorder of the middle ear due to constriction of the endolymphatic compartment of the inner ear, causing hearing loss. Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear; the client will be asymptomatic. Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing hearing loss, vertigo, and tinnitus. Meniere disease is a bacterial infection of the outer inner ear due to distention of the endolymphatic compartment.
Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing hearing loss, vertigo, and tinnitus. Explanation: Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing a triad of hearing loss, vertigo, and tinnitus.
A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiologic process has characterized her diagnosis? Her tympanic cavity is becoming filled with bone due to inappropriate osteogenesis. New spongy bone has been formed around her stapes and oval window. Her temporal bone is experiencing unusually rapid resorption. Her incus, malleus, and stapes have become disconnected from her normal neural pathways.
New spongy bone has been formed around her stapes and oval window. Explanation: Otosclerosis begins with resorption of bone in one or more foci. During active bone resorption, the bone structure appears spongy and softer than normal (i.e., otospongiosis). The resorbed bone is replaced by an overgrowth of new, hard, sclerotic bone. Distortion of neural pathways, resorption of the temporal bone, and filling of the tympanic cavity do not occur with otosclerosis.
The nurse is assessing the hearing of a 25-year-old client who reports chronic painless tinnitus and difficulty hearing. The nurse suspects the client may have which diagnosis? Mastoiditis Otitis media effusion Otosclerosis Acute otitis media
Otosclerosis Explanation: Otosclerosis may begin at any time in life but usually does not appear until after puberty, most frequently between the ages of 20 and 30 years. The symptoms of otosclerosis involve an insidious hearing loss, tinnitus, and vertigo. Acute otitis media is characterized by otalgia, fever, hearing loss, and inflammation. Otitis media effusion is an accumulation of fluid in the middle ear without signs of infection. It may cause hearing loss. Mastoiditis can occur when tympanic membranes perforate.
Which terms refers to the progressive hearing loss associated with aging? Sensorineural hearing loss Exostoses Presbycusis Otalgia
Presbycusis Explanation: Age-related changes of both the middle and inner ear result in hearing loss. Exostoses refer to small, hard, bony protrusions in the lower posterior bony portion of the ear canal. Otalgia refers to a sensation of fullness or pain in the ear. Sensorineural hearing loss is loss of hearing related to damage of the end organ for hearing and/or cranial nerve VIII.
Which terms refers to the progressive hearing loss associated with aging? Sensorineural hearing loss Otalgia Exostoses Presbycusis
Presbycusis is hearing loss associated with aging. Exotoses are small, bony, hard protrusions in the bony portion of the ear canal. Otalgia is the sensation of fullness or pain in the ear. Sensorineural hear loss is related to damage to the end organ for hearing and/or cranial nerve VIII.
A nurse is assessing a client who is reporting hearing loss. Which test will the nurse use to assess for sensorineural and conductive deafness? Rinne test Ishihara test Acetylcysteine test Snellen test
Rinne test Explanation: The nurse will assess for hearing loss by using a tuning fork and the Rinne test. The Ishihara test assesses for color vision, the Snellen test for sight and the acetylcysteine tests for anosmia.
A 15-year-old client is brought to the emergency department by his friends. He reports visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition? Acute acetaminophen poisoning Salicylate intoxication Caffeine abuse Ibuprofen overdose
Salicylate intoxication Explanation: Symptoms of salicylate intoxication include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, and hyperventilation. The scenario described does not suggest acetaminophen poisoning, ibuprofen overdose, or caffeine abuse.
Which intervention best demonstrates the L & D nurse is respectful of a client who is deaf and in early labor? 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. Write down information on a piece of paper that the client can keep. 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. Explanation: 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? Reduced urinary output Impaired facial movement Tinnitus and sensorineural hearing loss Signs of hypotension
Tinnitus and sensorineural hearing loss Explanation: 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.
The nurse is triaging victims after an explosion at an oil refinery. One victim reports tinnitus, dizziness, and otorrhea. For what probable condition should the nurse prepare care? Tympanic rupture Abdominal injury Head injury Blast lung
Tympanic rupture Explanation: The nurse should prepare to care for a client with probable tympanic rupture. Signs and symptoms of tympanic rupture include hearing loss, tinnitus, pain, dizziness, and otorrhea. Symptoms of blast lung include dyspnea, hypoxia, tachypnea or apnea, cough, chest pain, and hemodynamic instability. Symptoms of head injury include postconcussive syndrome. Symptoms of abdominal injury include pain, guarding, rebound tenderness, rectal bleeding, nausea, and vomiting.
Which manifestation is the most problematic for the client diagnosed with Ménière disease? Hearing loss Tinnitus Diaphoresis Vertigo
Vertigo Explanation: Vertigo is usually the most troublesome complaint related to Ménière disease. Other clinical manifestations 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? potassium chloride acetaminophen vitamin C acetylsalicylic acid (aspirin)
acetylsalicylic acid (aspirin) Explanation: 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 lack of knowledge about the child's illness and treatment communication barriers between the mother and staff the mother's feelings of loss of control over her child
communication barriers between the mother and staff Explanation: 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.
Screening for this most common birth defect is required by law in most states. Each nurse should know the law for his or her state and the requirements for screening. The nurse would expect a newborn to be screened for which defect as the most common? skeletal malformations hearing genetic-linked vision
hearing Explanation: Hearing loss is the most common birth defect in the United States: one in 1,000 newborns are profoundly deaf, and 3 in 1,000 have some degree of hearing impairment. Newborn hearing screening is required by law in most states. Vision, genetic-linked, and skeletal malformations are other forms of birth defects that can occur.
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? cardiac arrhythmias aplastic anemia seizures ototoxicity
ototoxicity Explanation: 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.
The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion? tendency to act silly in the classroom prevention and treatment of otitis media suddenly doing poorly in school playing the radio loudly
prevention and treatment of otitis media Explanation: 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: salicylate intoxication. caffeine overdose. acute acetaminophen toxicity. ibuprofen overdose.
salicylate intoxication. Explanation: 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.
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? conductive tinnitus noise exposure sensorineural
sensorineural Explanation: Sensorineural hearing loss usually is irreversible.
A client who is receiving hydroxychloroquine comes to the clinic with nausea, vomiting, and vertigo. Which would the nurse also expect to assess if the client was experiencing cinchonism? tinnitus fever dyspepsia rash
tinnitus Explanation: Cinchonism, due to high levels of hydroxychloroquine or primaquine, is manifested by nausea, vomiting, vertigo, and tinnitus. Fever is an adverse effect associated with antimalarial therapy; it is not associated with cinchonism. Dyspepsia is an adverse effect associated with antimalarial therapy; it is not associated with cinchonism. Rash is an adverse effect associated with antimalarial therapy; it is not associated with cinchonism.