Chap 20 Disorders of Hearing and Vestibular Function

The nurse is performing a health history for a 72-year-old client. When reviewing the client's medications, the client states, "I take a baby aspirin every day, but I'm worried. I heard that aspirin can cause hearing problems!" What is an appropriate response by the nurse?

"A baby aspirin is a low dose that is considered to be safe." Explanation: A frequently overlooked ototoxic agent is aspirin. Little is known about what level of dosage causes ototoxicity, but it is generally believed that 81 mg of aspirin on a daily basis is safe.

The nurse is teaching a client who has tinnitus about suggested dietary modifications. The most important information for the nurse to include would be:

"Cut down on takeout meals because of high amounts of monosodium glutamate." Explanation: Tinnitus can be caused by some cheeses, red wine, monosodium glutamate, and caffeine. These items should be reduced in the diet to help control the symptom.

The nurse is teaching a teenaged client strategies to avoid recurrent ear infections. The nurse understands that further teaching is required when the client states:

"I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming." Explanation: Otitis externa treatment usually includes the use of eardrops containing an appropriate antimicrobial or antifungal agent. Use of ear plugs is recommended to prevent moisture. Cotton-tipped applicators and other devices should be avoided.

The nurse is describing to a new mother the health screening actions that will be performed on her infant. The client states, "I'm sure my baby's exhausted. I'd prefer to do this in a few weeks." What rationale for early hearing testing should the nurse describe?

"If there is a hearing problem, it can be addressed right away before your baby starts to adapt to it." Explanation: Early hearing testing occurs so that if there is a hearing problem, it can be addressed before the child begins to acclimate to its life. Stating that the testing is easy does not address the woman's concerns. Hearing deficits in newborns are not typically the result of fluid or of trauma during birth.

A client reports occasional ringing in the ears that worsens toward the end of the day. The most important question for the nurse to ask would be:

"What prescription medication and over-the-counter medication do you take?" Explanation: Medications and stimulants, such as aspirin, caffeine, and nicotine, can cause tinnitus. The client should be questioned to determine if this is a potential cause. Impacted cerumen is a benign cause of tinnitus, which resolves after the earwax is removed. Respiratory infections may cause fluid in the ears and decreased hearing.

The nurse is caring for a pediatric client whose parent reports that the child has been pulling at her ears, has a fever, and has been crying more than usual. The nurse suspects the client may be experiencing which of the following?

Acute otitis media Explanation: Acute otitis media is characterized by the following key criteria: acute onset of otalgia (or pulling of the ears in an infant), fever, hearing loss, evidence of middle ear inflammation, and middle ear effusion.

The nurse understands that an antimicrobial drug is most likely to be prescribed for which condition?

Acute otitis media Explanation: Otitis media with effusion does not usually require treatment with antimicrobial agents; however, acute otitis media is treated with antimicrobials. Barotrauma and otosclerosis are not treated with antimicrobials.

A 26-year-old client who has recently traveled by airplane complains of pain in his right ear. The nurse suspects which condition?

Barotrauma Explanation: Considering the client's age and recent air travel, a likely diagnosis would be barotrauma. The other options are not affected by age and changes in pressure experienced during air travel.

The nurse is working at a first aid station in an amusement park. A 45-year-old client arrives reporting severe dizziness after a ride on the roller coaster. The nurse understands that a common cause of this sensation is:

Benign paroxysmal positional vertigo Explanation: Benign paroxysmal positional vertigo is the most common cause of pathologic vertigo and usually develops after the fourth decade of life. It commonly occurs when the person is getting in and out of bed, bending over and straightening up, or extending the head to look up. It also can be triggered by amusement rides that feature turns and twists. The other conditions are not manifested by severe sudden vertigo.

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:

Conduction disorder Explanation: Impacted earwax is one cause for conductive hearing loss. It is not a cause of the other answer choices.

For which type of hearing loss should the nurse assess in a child who has had recurrent otitis media since birth?

Conductive loss Explanation: Hearing loss that is associated with recurrent otitis media is conductive loss.

Which cranial nerve is designated as the vestibulocochlear nerve?

Cranial nerve VIII Explanation: The vestibulocochlear nerve is cranial nerve VIII.

The nurse is educating a client diagnosed with Meniere disease on lifestyle modifications to reduce the frequency and/or intensity of exacerbations. Which should the nurse include?

Decrease dietary intake of sodium Explanation: A lifestyle change that would be recommended for a client with Meniere disease is to consume a low sodium diet, related to the medication treatment (diuretics). The other modifications are not relevant to Meniere disease.

The nurse is conducting a community education class on acute otitis media. Which statement by the participants indicates to the nurse that they understand the education?

It can be caused by a bacterial infection. Explanation: The nurse determines that the participants understand the information when they state that acute otitis media can be caused by a bacterial infection. Breast-fed babies have a lower incidence of acute otitis media. The tympanic membrane appears cloudy in otitis media with effusions. Acute otitis media is not another name for swimmer's ear.

A client suffering from chronic sinusitis arrives at the urgent care center complaining of a sudden onset of dizziness and difficulty walking straight. What diagnosis does the admitting nurse suspects this client has?

Labyrinthitis Explanation: Chronic infection in the sinuses can cause infection of the inner ear (labyrinthitis), producing symptoms such as vertigo, dizziness, loss of balance, nausea, and vomiting.

A 5-month-old infant is being treated for acute otitis media (AOM) for the second time in the past 10 weeks. Which action should the nurse recommend to prevent future recurrences?

Limiting the infant's exposure to large group settings Explanation: Ways to reduce the risk of developing AOM include minimal exposure to group settings. MMR and hepatitis vaccines are irrelevant to the etiology of AOM. Ear rinsing is not recommended.

The nurse is caring for a client undergoing hyperbaric oxygen therapy to promote wound healing. The nurse understands that the client may experience which condition related to this treatment?

Middle ear barotrauma Explanation: One cause of middle ear barotrauma is hyperbaric oxygen therapy (increased atmospheric pressure and partial oxygen pressure in tissues) used for many people with multiple disorders.

A client reports feeling like the room is spinning around him when standing still. Which diagnosis is this client likely experiencing?

Objective vertigo Explanation: Objective vertigo is the sensation of the person being stationary and the environment in motion. Subjective vertigo is a sensation of a person who may be in motion and the environment stationary. Nystagmus refers to the involuntary rhythmic and oscillatory eye movements that preserve eye fixation on stable objects in the visual field during angular and rotational movements of the head. Syncope is "fainting."

The nurse is providing education to a client with otosclerosis. Which statement by the client would cause the nurse to decide that the client needs further education?

Otosclerosis usually appears prior to puberty. Explanation: Initially the client with otosclerosis is unable to hear a whisper and this results in progressive deafness. It is a familial disease that typically presents after puberty.

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?

Paget disease Explanation: 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.

The nurse is conducting the Rinne test. What is included in this test?

Placing a vibrating tuning fork on the client's mastoid bone and in front of the ear in an alternating fashion Explanation: The Rinne test compares air and bone conduction. The test is done by alternately placing the tuning fork on the mastoid bone and in front of the ear canal. In conductive losses, bone conduction exceeds air conduction. In sensorineural losses, the opposite occurs.

The nurse is treating a client with a history of chronic alcohol abuse. The client's spouse tells the nurse that the client has no difficulty speaking and responds when spoken to but is having difficulty understanding what is being said. The spouse asks if the nurse believes the client needs a hearing aid. The nurse explains to the spouse that the client probably does not require a hearing aid but may be suffering from:

Receptive aphasia Explanation: Chronic alcohol abuse causes damage to the Wernicke's area in the brain, which controls a person's ability to understand spoken language, and which is termed receptive aphasia. Clients who have receptive aphasia can speak without difficulty and hear words spoken, but cannot understand what is being said.

What are the clinical manifestations of Ménière disease? Select all that apply.

Severe ringing in the ear(s) Feeling of fullness in the ear(s) Episodes of disabling vertigo Dizziness triggered by turning the head Explanation: Ménière's disease is characterized by severe, disabling episodes of tinnitus; feelings of ear fullness; and violent rotary vertigo. Benign paroxysmal positional vertigo (BPPV) is a condition believed to be caused by free-floating particles in the posterior semicircular canal. It presents as a sudden onset of dizziness or vertigo that is provoked by certain changes in head position.

Otosclerosis is a condition where spongy, pathologic bone grows around the stapes and oval window.Which surgical treatment may be performed for otosclerosis?

Stapedectomy Explanation: Because much of the conductive hearing loss associated with otosclerosis is caused by stapedial fixation, surgical treatment involves stapedectomy with stapedial reconstruction using the client's own stapes or stapedial prosthesis.

When a client reports that he feels like he is spinning but the room is stable, the nurse should document the finding as:

Subjective vertigo Explanation: The description of feeling like one is spinning but the room is stable is a common description of subjective vertigo. The description of the person remaining fixed and the environment spinning around is a common description of objective vertigo. The other options are characterized by losing consciousness.

The nurse observes nystagmus in a client sitting quietly without head movement. The nurse interprets this finding in which way?

This is a pathological finding. Explanation: Spontaneous nystagmus that occurs without head movement or visual stimuli is always pathologic and requires investigation, but is not an emergency situation.

Which condition or situation is a risk factor for the development of acute otitis media in a child?

Upper respiratory infection Explanation: Acute OM, which refers to an acute middle ear infection, usually follows an upper respiratory tract infection. The other options may be considered risk factors for certain types of hearing loss.

The nurse is preparing a client for a surgical procedure to create an endolymphatic shunt. The nurse understands that this procedure aims to relieve which symptom?

Vertigo Explanation: A surgical method to treat Meniere disease includes the creation of an endolymphatic shunt in which excess endolymph from the inner ear is diverted into the subarachnoid space or the mastoid area. This relieves symptoms associated with Meniere disease, such as vertigo. The other symptoms are not manifestations of Meniere disease.

Although both vertigo and dizziness can result from peripheral or central vestibular disorders, vertigo is distinctly different because it causes:

an illusion of motion. Explanation: Vertigo or dizziness can result from peripheral or central vestibular disorders (proprioception) unrelated to hearing loss. Vertigo is a vestibular disorder in which a unique illusion of motion occurs. Persons with vertigo frequently describe it as a sensation of spinning or tumbling, a "to-and-fro" motion, or falling forward or backward. Light-headedness, faintness, and unsteadiness are different in that the person perceives weakness yet still has a sense of balance. Syncope (loss of consciousness) is not directly associated with the sensation of vertigo.

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) Explanation: Tinnitus ("ringing in the ears") may be caused by aspirin.

Otitis externa is an inflammation of the outer ear. What fungi cause otitis externa?

Aspergillus Explanation: The most common bacterial pathogens are gram-negative rods (Pseudomonas aeruginosa, Proteus spp.) and fungi (Aspergillus) that grow in the presence of excess moisture. The other answers are not fungi.

A client with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond?

"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." Explanation: Nondrug therapies for BPPV using habituation exercises and canalith repositioning are successful in many people. Canalith repositioning involves a series of maneuvers in which the head is moved to different positions in an effort to reposition the free-floating debris in the endolymph of the semicircular canals. Surgery is not a noted treatment option and even in the absence of hearing loss, treatment is warranted.

What is the major cause of sensorineural hearing loss in children?

Genetic causes Explanation: Causes of sensorineural hearing impairment include genetic, infectious (most common infectious cause is cytomegalovirus (CMV), traumatic, and ototoxic factors). Genetic causes are probably responsible for as much as 50% of sensorineural hearing loss in children. Foreign bodies, including pieces of cotton and insects, may impair hearing and result in conductive hearing loss.

The nurse is discussing measures that a client may take to prevent barotrauma related to airplane travel. Which measure will the nurse recommend during changes in air pressure?

Swallowing Explanation: Swallowing, yawning, and chewing gum are measures that open the Eustachian tube, which equalizes air pressure in the middle ear.

A 2-year-old child has been diagnosed with uncomplicated acute otitis media by a nurse practitioner. When explaining the plan of care, which description is most appropriate?

"Let's keep a close eye on his condition for a couple of days before starting antibiotics." Explanation: Observation without antimicrobial agents is an option in a child over 6 months of age with uncomplicated AOM. These approaches involve waiting for 24 hours to 72 hours (greater than 6 months of age) to see if symptoms improve before institution of antibiotic therapy. Antiviral medications and decongestants are ineffective and rinsing of the ears is not curative.

A new mother brings her infant to the clinic reporting that the child is not sleeping or eating much. Upon assessment, the health care provider notes that the infant's ear canal is reddened with a bulging tympanic membrane. Which other data collected would lead to the diagnosis of acute otitis media (AOM)? Select all that apply.

"Yes, he has been pulling at his ear." "He's been very irritable and fussy the past couple of days." Explanation: AOM is characterized by an acute onset of otalgia (ear pain), fever, and hearing loss. Younger children often have nonspecific signs and symptoms that manifest as ear tugging, irritability, nighttime awakening, and poor feeding. Key diagnostic criteria include ear pain that interferes with activity or sleep, tympanic membrane erythema (redness), and middle ear effusion. A child with otitis media with effusion (OME) may develop delayed speech and language skills.

The nurse is caring for a pediatric client whose parent reports that the child has been pulling at her ears, has a fever, and has been crying more than usual. The nurse suspects the client may be experiencing which of the following?

Acute otitis media Explanation: Acute otitis media is characterized by the following key criteria: acute onset of otalgia (or pulling of the ears in an infant), fever, hearing loss, evidence of middle ear inflammation, and middle ear effusion.

An adult client has presented to the emergency department reporting symptoms of vertigo. Further assessment reveals that the client is ataxic and has facial weakness. The care team should consider which possible cause of this client's health problem?

Brain stem ischemia Explanation: Central causes of vertigo include brain stem ischemia. When brain stem ischemia is the cause of vertigo, it usually is associated with other brain stem signs such as diplopia, ataxia, dysarthria, or facial weakness. Cerumen impaction and auditory tumors can affect hearing, but not balance. Otitis media does not cause ataxia or facial weakness.

The nurse suggests which action to a mother who is taking her 2-month-old infant on an airplane ride?

Breast-feed or bottle feed the infant during the airplane's ascent or descent. Explanation: Barotrauma can occur when the airplane changes altitudes and pressure in the middle ear is unequal with ambient air pressure. Attempts to equalize air pressure in the middle ear may include swallowing.

The nurse is assessing a client's risk for sensorineural hearing loss. Which condition or situation places the client at greatest risk?

Chronic noise exposure Explanation: Chronic exposure to noise is a risk factor for sensorineural hearing losss. Impacted earwax and otitis media are risk factors for conductive hearing loss.

The nurse is evaluating the hearing of a newborn with the understanding that an infant may be born with hearing deficits related to which family history? Select all that apply.

Developmental malformation of the inner ear Maternal rubella Genetic causes Explanation: Hearing loss in infants may be caused by developmental malformation of the inner ear, genetic causes, and intrauterine exposure to maternal rubella. Maternal immunization for influenza is not associated with hearing deficits in the infant.

The nurse is caring for a client who has been diagnosed with presbycusis. The nurse understands that with this disorder, the client experiences which of the following?

Difficulty hearing high-pitched frequencies Explanation: Presbycusis is used to describe degenerative hearing loss that occurs with advancing age. It is characterized by high-frequency hearing loss.

To diagnose a vestibular disorder, which test would be used that assesses the eye movements in response to vestibular, visual, and positional stimulation?

Electronystagmography Explanation: Of the options provided, the only test which records the eye movements in response to vestibular, visual, cervical, rotational and positional stimulation is the electronystagmography.

Which nursing intervention is the highest priority intervention for a nurse caring for a 26-year-old client diagnosed with benign paroxysmal positional vertigo?

Fall precautions Explanation: The client with benign paroxysmal positional vertigo (BPPV) experiences brief periods of vertigo when getting in and out of bed, bending over and straightening up, and extending head to look up. This places the client at increased risk for falls and necessitates implementation of fall precautions. The Weber test and administration of an antibiotic are not indicated when caring for a client with BPPV. Skin assessment, while always a part of the nursing assessment, has a lower priority than implementation of safety measures for this client.

A nurse caring for a client in the hospital with new onset of Ménière disease reviews the treatment options with the client. Which medication will the nurse teach the client about to decrease the volume of endolymph?

Furosemide Explanation: The use of diuretics, such as furosemide, stimulates the kidneys to excrete more fluid into the urine, thereby decreasing the fluid volume in the body, including the endolymph. Decreasing the endolymphatic compartment and in particular the endolymphatic sac within the inner ear helps to alleviate hearing loss, vertigo, and tinnitus.

The nurse is assisting with a client who is undergoing caloric testing. The nurse expects which action will be needed to complete the test?

Have ice water available. Explanation: Caloric testing involves elevating the head 30 degrees and irrigating each external auditory canal separately with 30 to 50 mL of ice water. The client does not stand for the test. No electrodes are use for this test.

The nurse is caring for a client who has been diagnosed with Meniere disease. The nurse expects which medication will be prescribed to manage the symptoms?

Promethazine Explanation: Pharmacologic management includes suppressant drugs such as promethazine. The other medications are not used to treat Meniere disease.

A 38-year-old client who has begun to develop hearing loss is being evaluated by the nurse practitioner. The client tells the nurse that hearing improves when she is on the telephone and that chewing sounds very loud. What does the nurse practitioner suspect?

Otosclerosis Explanation: Otosclerosis involves the reabsorption of bone and replacement with new, sclerotic bone around the stapes and oval window, which slowly impedes hearing. The typical presentation is around 20 to 40 years of age. People with otosclerosis often experience an increase in the sound of chewing and can often hear on the telephone better than in person, due to the bone conduction of sound.

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?

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 typanic membranes perforate.

What is the nursing focus when the nurse performs a hearing test on a newborn infant?

Preventing developmental delays Explanation: Early detection of hearing loss can prevent developmental delay by allowing early intervention. The hearing test on a newborn evaluates the physical ability to respond, not the ability to perform language or communication skills. The test records the infant's ability to perceive sound but does not improve it. Older adults, not infants, are at risk for depression as a result of hearing loss.

What does the tinnitus that is caused by vascular disorders sound like?

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.

Which diagnostic test results indicate a client has a vestibular disturbance?

Romberg test response shows increased swaying with arm drift to one side. Explanation: During a Romberg test the client closes the eyes while standing with feet together and arms extended. A vestibular disorder will produce increased swaying, and arm drift toward the affected side. A caloric stimulation test instills ice water into the ear to trigger the vestibular system. The eyes should have a slow nystagmus toward the irrigated side for 2 to 3 minutes followed by rapid movement away from the irrigated side. A client should not have nystagmus when focusing on a steady object. The Dix-Hallpike maneuver is commonly used to stimulate benign positional vertigo. The test is considered normal if the client does not experience nystagmus or vertigo.

A nurse working in a clinic performs screening tests for hearing loss. Which result indicates the client has hearing loss?

The client heard bone conduction longer than air conduction in the Rinne test. Explanation: A client is said to have normal hearing if they can detect sounds softer than 26 decibels. In addition to volume of sound, there is the ability to detect frequency. The human ear is most sensitive in detecting a range between 1000-3000 Hz. A Weber test compares ears. The sound of the tuning fork will lateralize to the weaker ear if there is conductive loss, and to the stronger ear if there is sensorineural loss. The Rinne test compares bone and air conduction. In conductive hearing loss, the bone conduction lasts longer than air conduction.

A client with otosclerosis had a stapedectomy with reconstruction using a prosthesis. What is an expected outcome?

The client is able to hear quiet sounds from a distance. Explanation: Clients with otosclerosis tend to speak softly as the conduction of sound through bone remains intact while nerve conduction of sound decreases. Otosclerosis can place pressure on the vestibulocochlear nerve, creating tinnitus, vertigo, and sensorineural hearing loss. A positive outcome of the surgery would be improved hearing as a result of conduction of sound transmitted via the restored stapes to the tympanic membrane.

A client has been diagnosed with sensorineural hearing loss. What should the care team assess to determine a plausible cause?

The client's recent medication use Explanation: Ototoxic responses to medications can result in sensorineural hearing loss. Cerumen accumulation can cause conductive hearing loss. The client's immunization status and the patency of Eustachian tubes are not related to the most common causes of sensorineural hearing loss.

The nurse is preparing a pediatric client for insertion of a tympanostomy tube. The nurse will give which instruction to the parents postprocedure?

The ears must be kept out of water. Explanation: Tympanostomy tube insertion is a surgical procedure used to treat otitis media (OM). The ears of children with tubes must be kept out of water.

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?

Tuning fork Explanation: 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.

A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be:

Tympanostomy tube insertion Explanation: Tympanostomy tubes should be the next course of action with the child having hearing loss and OM persisting for 4 months or longer. The parents should be taught to continue to monitor for signs of OM.

A client is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is:

Vestibular apparatus Explanation: The vestibular system maintains and assists recovery of stable body and head position and balance through control of postural reflexes. The vestibular system includes the three semicircular canals.

The nurse is explaining to the parent of a 5-year-old that the child has otitis media with effusion (OME), noted by otoscopic exam, following an upper respiratory infection. Unlike acute otitis media (AOM), OME does not require treatment with antibiotics because it is usually:

asymptomatic and often self-limiting. Explanation: It is very important to distinguish appropriately AOM from OME to ensure the proper treatment and to avoid the unnecessary use of antimicrobials. AOM often presents with sudden onset of ear pain, fever, hearing loss, and middle ear infection, whereas OME often presents as an asymptomatic effusion of the middle ear.

A client's chart documents the finding of cholesteatoma. The nurse interprets this to mean that the client has:

cystlike mass in the middle ear. Explanation: Cholesteatoma is a cystlike mass of the middle ear that often extends to involve the temporal bone.

A client, who travels frequently for work, reports intense ear pain during ascent from and descent into airports. The health care provider will recommend which category of medications to help alleviate this symptom?

decongestant nasal spary such as phenylephrine Explanation: Barotrauma most often occurs in people who travel while suffering from an upper respiratory tract infection. Decongestants, such as nose drops or nasal sprays, may be used 30 to 60 minutes prior to ascent or descent to reduce congestion and open the eustachian tubes. Steroids are not recommended for barotrauma. They are helpful for inflammation and nasal polyps. Antihistamines are helpful for tinnitus and vertigo.

The nurse understands that vestibular rehabilitation includes:

exercises in balance retraining. Explanation: Vestibular rehabilitation has been shown to be helpful as a treatment for peripheral vestibular disorders. Physical therapists are usually involved in developing a program including habituation exercises, balance retraining exercises, and a general conditioning program for people to use at home.

The nurse is caring for a client who is hearing impaired. The nurse understands that effective communication with the client includes:

facing the client so that the client can visualize the lips. Explanation: It is important that nurses speaking to people with hearing impairment face the person and articulate so that lip-reading cues can be used. The other options are not recommended.

The nurse is examining a pediatric client who reports ear pain. As the nurse inserts the otoscope, the child begins to cough and gag. The nurse understands that this behavior is most likely related to:

stimulation of the vagus nerve. Explanation: Because of vagal innervation, the insertion of a speculum or an otoscope into the external ear canal can stimulate coughing or vomiting reflexes, particularly in young children.

The nurse is caring for a client diagnosed with labrynthitis. The nurse explains that manifestations of this disorder are generally expected:

to resolve in 10 to 14 days. Explanation: Labrynthitis (also called acute vestibular neuronitis) generally resolves in about 10 to 14 days.

The nurse understands that movement of otoliths may result in:

vertigo and nystagmus. Explanation: Movement of the otoliths or free-floating debris causes the vestibular system to become more sensitive, such that any movement of the head in the plane parallel to the posterior duct may cause vertigo and nystagmus.

On the first obstetric clinic visit, which client is at risk for delivering a child with sensorineural hearing loss? Select all that apply.

woman working in an industrial factory where exposed to toluene, a solvent in paints, and styrene in manufacturing plastics woman with a history of renal disease who regularly takes furosemide, a loop diuretic to control blood pressure woman who is an athlete and regularly receives traumatic kicks to the torso and abdomen during soccer matches Explanation: Early in pregnancy, the embryo is particularly sensitive to toxic substances, including ototoxic drugs such as the aminoglycosides and loop diuretics. Trauma, particularly head trauma, may also cause sensorineural hearing loss. Toluene and styrene are the most widely and extensively used aromatic solvents in industry and can cause ototoxicity. Toluene is a major component of adhesives, paints, lacquers, varnishes, printing inks, degreasers, fuel additives, glues and thinners, whereas styrene is present when manufacturing plastics, rubber articles, and glass fibers. The businesswoman working long hours is at no greater risk than any pregnant female. Nurses are exposed to numerous infections, but standard precautions recommended by the CDC provides good protection.