Chapter 48 Care of Patient with Ear and Hearing Problems

The home health nurse is caring for an older patient with a mild hearing loss. What action should the nurse take to reduce communication problems?

Emphasize the sounds at the beginning of each word.

What statement about self-irrigating the ears to remove earwax is correct?

A hair dryer can be used to dry the ear afterward.

Which test best determines hearing acuity?

Audioscopy

What preoperative measure must the patient take before undergoing a tympanoplasty?

Avoid people with upper respiratory infections

What safety measure must a patient take who recently underwent a myringotomy?

Avoid showering for several days

In what ways can trauma to the eardrum be prevented? Select all that apply.

Avoid slapping over the ear. Avoid excessive nose blowing.

During an assessment, the nurse infuses warm water into a patient's ear. The response is the onset of vertigo and nystagmus within 20 to 30 seconds. The nurse performed which diagnostic test?

Caloric testing

What education does the nurse provide to a patient and family about proper hearing aid care?

Clean debris from the hole in the middle part with a toothpick

What are common causes of pain in the ear? Select all that apply.

Swimming without ear plugs Impaction of a foreign object in the ear canal Presence of a furuncle (or boil) inside the ear canal

What is an audiometry test used to assess?

Extent and type of hearing loss

What is the most accurate statement regarding the different causes of hearing loss?

Fusion of the bony ossicles may cause conductive hearing loss.

A patient is experiencing impaired hearing 6 weeks after a stapedectomy. How should the nurse communicate with this patient?

Get the patient's attention before speaking.

The nurse is using an otoscope to assess the ear canal. How should the nurse perform this assessment?

Hold the otoscope upside down in the dominant hand.

A patient reports pain in the ear. When examining the patient's external ear using an otoscope, what should the nurse do?

Hold the otoscope upside down like a large pen.

The nurse is assessing a patient with recent changes in hearing. After taking a medication history, which drugs does the nurse identify as possible causes of the patient's hearing change? Select all that apply.

Ibuprofen Furosemide Erythromycin

The nurse documents the presence of hyperacusis in a patient. What does this condition indicate?

Intolerance of sound levels that do not bother others

What measure should the nurse take when irrigating the ear of a patient?

Irrigate only if the eardrum is intact.

What comfort measures may the patient with external otitis find helpful?

Minimizing head movements

What instruction does the nurse provide to reduce a patient's manifestations of vertigo?

Move head slowly

A patient reports an inability to sleep because of a loud ringing noise in the ears. What does the nurse suggest to alleviate the symptoms?

Music

When caring for a hearing aid, which patient action indicates a need for the nurse to intervene?

Never washing the hearing aid with soap and water

A patient is scheduled for tympanometry. What condition can be diagnosed with this test?

Otitis media

Which factor is a common cause of tinnitus?

Otosclerosis

What statement about genetic factors affecting hearing loss is accurate?

People with a gene mutation on chromosome 1 develop hearing loss.

A patient reports purulent drainage from the ear and a decrease in pain. What does the nurse expect to find during an otoscopic examination?

Perforated eardrum

Which technique is the correct way to instill eardrops?

Place the medication bottle in a bowl of warm water before instillation.

What is a typical cause of sensorineural hearing loss?

Prolonged exposure to noise

What is the proper technique for assessing an adult patient's ear with an otoscope?

Pull the pinna up and back with the nondominant hand

What otoscopic examination finding helps the nurse to identify mastoiditis in a patient with ear pain?

Red, dull, thick, and immobile eardrum with perforations

The nurse instructs an older adult patient to irrigate the ear canal weekly or whenever a change in hearing is experienced. Which age-related change observed in older adults requires this action?

Reduced hearing function due to dry cerumen

A patient recently diagnosed with Ménière's disease is struggling with tinnitus. How should the nurse provide support to this patient?

Refer the patient to the American Tinnitus Association.

What nonsurgical management method does the nurse expect the health care provider to prescribe for a patient with acute otitis media?

Systemic antibiotic therapy

Which statement about the intensity of sound in normal hearing is correct?

Soft whispers have an intensity of around 20 decibels.

On assessment, the nurse finds that an older adult patient's ability to hear high-frequency sounds is lost. The patient also has problems hearing the f, s, sh, and pa sounds. Which nursing interventions would be helpful to this patient? Select all that apply.

Speak slowly in a deeper voice. Provide a quiet environment and face the patient while speaking.

Which factors are common causes of external otitis? Select all that apply.

Use of earrings Use of earphones Use of hair sprays

Malignant otitis can cause the destruction of which cranial nerve (CN)?

VII

An older adult patient reports ear pain. To differentiate the cause, which clinical manifestation is more indicative of otitis media?

Vertigo

Which pigment-related disorder results in hearing loss caused by the loss of melanin-containing cells?

Vitiligo

When preparing to examine an ear with drainage, what does the nurse do first?

Wears clean gloves

During a yearly check-up, a 75-year-old patient claims to have perfect vision and hearing. The nurse performs a voice test to assess hearing. What should the nurse do to administer this test accurately?

Whisper something to the patient and ask the patient to repeat it back

An older adult patient reports ear pain. Otoscopic examination by the nurse practitioner (NP) reveals a dull and retracted membrane. What does the NP do next?

Continues further assessment

A patient is scheduled for a tympanoplasty. What information does the nurse provide the patient about this procedure?

Coughing after surgery should be avoided.

How can a patient best adjust to a new hearing aid?

Listen to the radio to get used to new sounds.

Which part of the ear develops in the embryo along with the kidneys and urinary tract? Select all that apply.

The pinna The mastoid process

The nurse is teaching a patient who will soon be fitted for a hearing aid about proper care and use. Which statement by the patient indicates that teaching was effective?

"Listening to the radio and television will help me get used to new sounds."

The nurse is caring for a patient with recurrent external otitis. What does the nurse teach the patient about keeping the external ear canal dry?

"Use earplugs when engaging in water sports."

The nurse is teaching a patient how to remove earwax at home. What information is most important for the nurse to include?

"You can put mineral oil into the ear about an hour before you remove the wax."

A patient with external otitis media is prescribed ear drops. Arrange the actions of medication administration in the order in which the nurse performs them.

1.Wear gloves to remove and discard any ear packing. 2.Wash hands and perform a gentle otoscopic examination. 3.Irrigate the ear if the eardrum is intact. 4.Place the bottle of eardrops in warm water for 5 minutes. 5.Tilt the patient's head and place warmed drops in the ear. 6. Move the head in a tilted position back and forth five times. 7.Insert a cotton ball into the opening of the ear canal and wash the hands.

A patient who attended a rock concert the previous day was likely exposed to what intensity of sound?

120 decibels

What is the normal decibel level of conversational speech?

60

What is the intensity of sound generated by car traffic?

70 decibels

The nurse instructs a patient to block one external ear canal while the nurse stands 1 to 2 feet away. The nurse quietly whispers a statement and asks the patient to repeat it. Which diagnostic test is the nurse performing?

the voice test

During a routine check-up, the nurse assesses a deep-sea diver for current ear-related problems. What questions does the nurse ask to assess whether the patient has vertigo?

"Do you sense a spinning movement at times?"

A patient reports difficulty in hearing voices over the telephone. The patient's brother also has a similar problem. What other questions does the nurse ask to determine whether the patient has a genetic risk for hearing loss? Select all that apply.

"Does anybody else in your family have similar hearing problems?" "At what age did your relatives experience reduction in hearing for the first time?"

The nurse is assessing a patient who reports hearing loss. What question does the nurse ask to determine if there is age-related loss of hearing?

"Have you been diagnosed with folate deficiency?'

The nurse is preparing a patient for electronystagmography. Which statement by the patient indicates that teaching was effective?

"I can't drink caffeine 24 to 48 hours before the test."

The nurse is teaching a patient how to self-irrigate the ear to remove earwax. What statement by the patient indicates a need for further teaching?

"I should irrigate the ear to remove pus before instilling eardrops."

The nurse is teaching the caregiver of a 6-year-old patient who is prone to ear infections how to prevent them. Which caregiver responses require the nurse to intervene? Select all that apply.

"I should make my child sneeze gently with the mouth is closed." "I should use a cotton swab to clean the ears as gently as I can."

The nurse is talking to a patient about ear hygiene safety. Which statement by the patient indicates a need for further teaching?

"I use a bobby pin to remove earwax."

The nurse is reviewing postoperative instructions with a patient undergoing stapedectomy. Which statement by the patient indicates a need for further teaching?

"I will be able to hear as soon as my dressing is removed."

The nursing instructor is teaching nursing students about the structure and function of the inner ear. What statement made by a student indicates a correct understanding of the information?

"The scala tympani is filled with perilymph."

What instructions does the nurse provide when preparing a patient for an auditory brainstem-evoked response test? Select all that apply.

"The test will diagnose conductive hearing loss." "The test will diagnose sensorineural hearing loss."

The nurse is instructing a patient about ear hygiene. What does the nurse tell the patient about cleaning the ear?

"Use a soapy, wet washcloth to clean the external ear daily."

A patient who works as a lumberjack is exposed to the sounds of chainsaws at his job. What is the duration of noise exposure that is safe for this patient?

2 hours

The nurse is preparing a patient for a routine audiometry test. What does the nurse explain to the patient about the test?

It measures the hearing acuity of the patient.

A patient with a hearing problem is scheduled to undergo electronystagmography (ENG). What statement about ENG is correct?

It requires the patient to do simple math problems.

A patient is in the immediate postoperative period after tympanoplasty. How does the nurse position the patient?

With the affected ear facing up

A patient is having a stapedectomy. Which form of postoperative communication is most effective for the nurse to use?

Writing

A patient reporting dizziness and nausea is scheduled for caloric testing to assess balance. What does the nurse tell the patient while explaining the procedure? Select all that apply.

"After the test, you will be on bedrest for a period of time." "Warm water or warm air will be infused into your ear during the test." "This test will evaluate the nerve that carries hearing information to your brain."

What nonsurgical management measures does the nurse tell a patient with Ménière's disease to perform?

"Avoid foods and fluids containing salt."

What are causes of conductive hearing loss? Select all that apply.

Impaction of cerumen Presence of a foreign body Ruptured tympanic membrane

The nurse is performing an otoscopic examination of a patient's ear and sees a greenish-white drainage. What does the nurse do next?

Disposes of the otoscope tip and washes the hands before examining the other ear

A patient is scheduled for electronystagmography (ENG). What does this procedure entail?

ENG determines abnormalities in the brainstem

The nurse is examining the ear of an Asian patient during a routine health assessment. What is the most accurate statement about the patient's earwax?

Earwax may be light brown to gray in color.

What is the purpose of tympanometry testing?

Assesses the patency of the eustachian tube

An older adult patient reports nausea during removal of impacted cerumen from the ear canal. What should the nurse do next?

Stop irrigation immediately.

The nurse is teaching a patient with impaired hearing about audiometric testing. Which statement by the nurse effectively communicates information about the procedure to the patient?

"I will sit right in front of you in the soundproof booth and give you instructions on what types of sounds you will hear and how you'll need to respond."

The nurse is educating a patient on the prevention of ear infections. Which patient statement requires further nursing teaching?

"I'll block one nostril while blowing my nose."

The nurse is teaching a patient about hearing aid care and ear irrigation. Which patient statement requires further teaching?

"I'll clean the ear wax away with a lot of soap and water."

The nurse is educating a patient regarding ear irrigation for cerumen removal. Which patient statements reflect understanding? Select all that apply.

"I'll fill the syringe with lukewarm water." "I'll tilt my head forward 30 degrees to perform irrigation." "I won't try to irrigate my ear if I find any drainage from it."

The nurse is preparing a patient for electronystagmography (ENG) testing. What does the nurse teach the patient?

"If you have a pacemaker, you should not undergo the test."

A patient has undergone a myringotomy for otitis media. What postoperative teaching does the nurse provide to the patient?

"Keep a cotton ball coated with Vaseline in the ear for 6 weeks."

The nurse is preparing a patient with a possible hearing problem for a speech discrimination test. What does the nurse instruct the patient about the test?

"One-syllable words will be presented to you at about 30 dB above the speech reception threshold."

During a routine examination, the nurse notices impacted earwax in the patient's ear. After removing the wax, the nurse teaches the patient how to self-irrigate the ear for earwax removal at home. What does the nurse tell the patient?

"Self-irrigate anytime, weekly or monthly."

The nurse is working with the family of an older adult patient who presents with moderate hearing impairment. What does the nurse teach the family about improving communication? Select all that apply.

"Speak at a slow pace, with a deeper voice." "Face the patient while talking to him or her." "Avoid chewing gum or eating during a conversation."

The nursing instructor is teaching nursing students about the anatomy and physiology of the external ear. What statement by a student indicates a need for further teaching?

"The distance from the opening of the ear to the eardrum in adults is 5 cm."

An older patient is concerned that the coarse, long hair in the ear canal is causing loss of hearing. What does the nurse tell the patient?

"The ear must be irrigated frequently."

A patient reports pain, itching, and a feeling of fullness in the ear. On further assessment, the nurse observes the presence of wax in the ear. Which intervention would be beneficial for this patient?

Applying a ceruminolytic product

What is the spiral-shaped organ present in the ear?

Cochlea

Patients with sensorineural hearing loss may use which methods to improve hearing?

Cochlear implantation

What pathophysiologic process is a typical cause of sensorineural hearing loss?

Damage to cochlear hair cells

Which diagnostic test is appropriate if both central and peripheral disease of the vestibular system in a patient's ear is suspected?

Electronystagmography (ENG)

When assessing a patient, the nurse notices small, crusted, and ulcerated lesions on the pinna. What possible condition does the nurse suspect?

Squamous Cell Carcinoma

The nurse is conducting a voice test for a patient. What action should the nurse take for this assessment?

Stand 2 feet away from the patient and whisper.

What is the best way to communicate with a patient who has a hearing impairment?

Stand in front of the patient.

What common manifestations are present in a patient with mastoiditis? Select all that apply.

Swelling behind the ear Cellulitis on the external scalp Tender, enlarged lymph nodes Pain with movement of the head

The nurse assesses a patient's ears using an otoscope. What findings does the nurse document as normal when examining the right ear? Select all that apply.

The eardrum appears opaque. The eardrum appears transparent. The ear canal contains soft cerumen.

Which statement about the bones of the middle ear is correct?

The incus transmits vibrations from the malleus.

Which observation helps to identify hearing loss in an older adult patient?

The patient lip reads when the nurse asks questions.

The nurse is assessing a 73-year-old patient for changes in the ear and hearing. Which change is normal and needs no intervention?

The pinna has become longer.

Which statement about the inner ear is correct?

The vestibule contains the utricle and the saccule, which are essential for balance.

Which rationale explains the use of mild diuretics in the treatment of Ménière's disease?

They decrease endolymph volume.

What is the purpose of an otoscopic examination for older adult patients?

To assess the patency of the external ear canal

What is the function of the fluid and hair cells that are present in the semicircular canals?

To assist in maintaining the sense of balance

The development of an acoustic neuroma affects cranial nerve VIII. In which order do these effects occur?

tinnitus sensorineural hearing loss mild to moderate vertigo Damage to nearby cranial nerves