Brunner's Ch 64: Assessment and Management of Patients with Hearing and Balance Disorders Flashcards
The clinic nurse is assessing a child who has been brought to the clinic with signs and symptoms that are suggestive of otitis externa. What assessment finding is characteristic of otitis externa?
A) Tophi on the pinna and ear lobe
B) Dark yellow cerumen in the external auditory canal
C) Pain on manipulation of the auricle
D) Air bubbles visible in the middle ear
C) Pain on manipulation of the auricle
Pain when the nurse pulls gently on the auricle in preparation for an otoscopic examination of the ear canal is a characteristic finding in patients with otitis externa. Tophi are deposits of generally painless uric acid crystals; they are a common physical assessment finding in patients diagnosed with gout. Cerumen is a normal finding during assessment of the ear canal. Its presence does not necessarily indicate that inflammation is present. Air bubbles in the middle ear may be visualized with the otoscope; however, these do not indicate a problem involving the ear canal.
While reviewing the health history of an older adult experiencing hearing loss the nurse notes the patient has had no trauma or loss of balance. What aspect of this patients health history is most likely to be linked to the patients hearing deficit?
A) Recent completion of radiation therapy for treatment of thyroid cancer
B) Routine use of quinine for management of leg cramps
C) Allergy to hair coloring and hair spray
D) Previous perforation of the eardrum
B) Routine use of quinine for management of leg cramps
Long-term, regular use of quinine for management of leg cramps is associated with loss of hearing acuity. Radiation therapy for cancer should not affect hearing; however, hearing can be significantly compromised by chemotherapy. Allergy to hair products may be associated with otitis externa; however, it is not linked to hearing loss. An ear drum that perforates spontaneously due to the sudden drop in altitude associated with a high dive usually heals well and is not likely to become infected. Recurrent otitis media with perforation can affect hearing as a result of chronic inflammation of the ossicles in the middle ear.
A nurse is planning preoperative teaching for a patient with hearing loss due to otosclerosis. The patient is scheduled for a stapedectomy with insertion of a prosthesis. What information is most crucial to include in the patients preoperative teaching?
A) The procedure is an effective, time-tested treatment for sensory hearing loss.
B) The patient is likely to experience resolution of conductive hearing loss after the procedure.
C) Several months of post-procedure rehabilitation will be needed to maximize benefits.
D) The procedure is experimental, but early indications suggest great therapeutic benefits.
B) The patient is likely to experience resolution of conductive hearing loss after the procedure.
Stapedectomy is a very successful time-tested procedure, resulting in the restoration of conductive hearing loss. Lengthy rehabilitation is not normally required.
Which of the following nursing interventions would most likely facilitate effective communication with a hearing-impaired patient?
A) Ask the patient to repeat what was said in order to evaluate understanding.
B) Stand directly in front of the patient to facilitate lip reading.
C) Reduce environmental noise and distractions before communicating.
D) Raise the voice to project sound at a higher frequency.
C) Reduce environmental noise and distractions before communicating.
Communication with the hearing impaired can be facilitated by talking in a quiet space free of competing noise stimuli and other distractions. Asking the patient to repeat what was said is likely to provoke frustration in the patient. A more effective strategy would be to repeat the question or statement, choosing different words. Raising the voice to project sound at higher frequency would make understanding more difficult. The nurse cannot assume that the patient reads lips. If the patient does read lips, on average he or she will understand only 50% of words accurately.
The nurse is providing discharge education for a patient with a new diagnosis of Mnires disease. What food should the patient be instructed to limit or avoid? A) Sweet pickles B) Frozen yogurt C) Shellfish D) Red meat
A) Sweet pickles
The patient with Mnires disease should avoid foods high in salt and/or sugar; sweet pickles are high in both. Milk products are not contraindicated. Any type of meat, fish, or poultry is permitted, with the exception of canned or pickled varieties. In general, the patient with Mnires disease should avoid or limit canned and processed foods.
Following a motorcycle accident, a 17-year-old man is brought to the ED. What physical assessment findings related to the ear should be reported by the nurse immediately?
A) The malleus can be visualized during otoscopic examination.
B) The tympanic membrane is pearly gray.
C) Tenderness is reported by the patient when the mastoid area is palpated.
D) Clear, watery fluid is draining from the patients ear.
D) Clear, watery fluid is draining from the patients ear.
For the patient experiencing acute head trauma, immediately report the presence of clear, watery drainage from the ear. The fluid is likely to be cerebrospinal fluid associated with skull fracture. The ability to visualize the malleus is a normal physical assessment finding. The tympanic membrane is normally pearly gray in color. Tenderness of the mastoid area usually indicates inflammation. This should be reported, but is not a finding indicating urgent intervention.
A patient has been diagnosed with hearing loss related to damage of the end organ for hearing or cranial nerve VIII. What term is used to describe this condition? A) Exostoses B) Otalgia C) Sensorineural hearing loss D) Presbycusis
C) Sensorineural hearing loss
Sensorineural hearing loss is loss of hearing related to damage of the end organ for hearing or cranial nerve VIII. 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. Presbycusis is the term used to refer to the progressive hearing loss associated with aging. Both middle and inner ear age-related changes result in hearing loss.
A group of high school students is attending a concert, which will be at a volume of 80 to 90 dB. What is a health consequence of this sound level?
A) Hearing will not be affected by a decibel level in this range.
B) Hearing loss may occur with a decibel level in this range.
C) Sounds in this decibel level are not perceived to be harsh to the ear.
D) Ear plugs will have no effect on these decibel levels.
B) Hearing loss may occur with a decibel level in this range.
Sound louder than 80 dB is perceived by the human ear to be harsh and can be damaging to the inner ear. Ear protection or plugs do help to minimize the effects of high decibel levels.
A patient has undergone diagnostic testing and has been diagnosed with otosclerosis? What ear structure is primarily affected by this diagnosis? A) Malleus B) Stapes C) Incus D) Tympanic membrane
B) Stapes
Otosclerosis involves the stapes and is thought to result from the formation of new, abnormal bone, especially around the oval window, with resulting fixation of the stapes.
A patient with otosclerosis has significant hearing loss. What should the nurse do to best facilitate communication with the patient?
A) Sit or stand in front of the patient when speaking.
B) Use exaggerated lip and mouth movements when talking.
C) Stand in front of a light or window when speaking.
D) Say the patients name loudly before starting to talk.
A) Sit or stand in front of the patient when speaking.
Standing directly in front of a hearing-impaired patient allows him or her to lip-read and see facial expressions that offer clues to what is being said. Using exaggerated lip and mouth movements can make lip-reading more difficult by distorting words. Backlighting can create glare, making it difficult for the patient to lip-read. To get the attention of a hearing-impaired patient, gently touch the patients shoulder or stand in front of the patient.
The nurse in the ED is caring for a 4 year-old brought in by his parents who state that the child will not stop crying and pulling at his ear. Based on information collected by the nurse, which of the following statements applies to a diagnosis of external otitis?
A) External otitis is characterized by aural tenderness.
B) External otitis is usually accompanied by a high fever.
C) External otitis is usually related to an upper respiratory infection.
D) External otitis can be prevented by using cotton-tipped applicators to clean the ear.
A) External otitis is characterized by aural tenderness.
Patients with otitis externa usually exhibit pain, discharge from the external auditory canal, and aural tenderness. Fever and accompanying upper respiratory infection occur more commonly in conjunction with otitis media (infection of the middle ear). Cotton-tipped applicators can actually cause external otitis so their use should be avoided.
A patient diagnosed with arthritis has been taking aspirin and now reports experiencing tinnitus and hearing loss. What should the nurse teach this patient?
A) The hearing loss will likely resolve with time after the drug is discontinued.
B) The patients hearing loss and tinnitus are irreversible at this point.
C) The patients tinnitus is likely multifactorial, and not directly related to aspirin use.
D) The patients tinnitus will abate as tolerance to aspirin develops.
A) The hearing loss will likely resolve with time after the drug is discontinued.
Tinnitus and hearing loss are signs of ototoxicity, which is associated with aspirin use. In most cases, this will resolve upon discontinuing the aspirin. Many other drugs cause irreversible ototoxicity.
A patient is postoperative day 6 following tympanoplasty and mastoidectomy. The patient has phoned the surgical unit and states that she is experiencing occasional sharp, shooting pains in her affected ear. How should the nurse best interpret this patients complaint?
A) These pains are an expected finding during the first few weeks of recovery.
B) The patients complaints are suggestive of a postoperative infection.
C) The patient may have experienced a spontaneous rupture of the tympanic membrane.
D) The patients surgery may have been unsuccessful.
A) These pains are an expected finding during the first few weeks of recovery.
For 2 to 3 weeks after surgery, the patient may experience sharp, shooting pains intermittently as the eustachian tube opens and allows air to enter the middle ear. Constant, throbbing pain accompanied by fever may indicate infection and should be reported to the primary care provider. The patients pain does not suggest tympanic perforation or unsuccessful surgery.
The nurse is discussing the results of a patients diagnostic testing with the nurse practitioner. What Weber test result would indicate the presence of a sensorineural loss?
A) The sound is heard better in the ear in which hearing is better.
B) The sound is heard equally in both ears.
C) The sound is heard better in the ear in which hearing is poorer.
D) The sound is heard longer in the ear in which hearing is better.
A) The sound is heard better in the ear in which hearing is better.
A patient with sensorineural hearing loss hears the sound better in the ear in which hearing is better. The Weber test assesses bone conduction of sound and is used for assessing unilateral hearing loss. A tuning fork is used. A patient with normal hearing hears the sound equally in both ears or describes the sound as centered in the middle of the head. A patient whose hearing loss is conductive hears the sound better in the affected ear.
The advanced practice nurse is attempting to examine the patients ear with an otoscope. Because of impacted cerumen, the tympanic membrane cannot be visualized. The nurse irrigates the patients ear with a solution of hydrogen peroxide and water to remove the impacted cerumen. What nursing intervention is most important to minimize nausea and vertigo during the procedure?
A) Maintain the irrigation fluid at a warm temperature.
B) Instill short, sharp bursts of fluid into the ear canal.
C) Follow the procedure with insertion of a cerumen curette to extract missed ear wax.
D) Have the patient stand during the procedure.
A) Maintain the irrigation fluid at a warm temperature.
Warm water (never cold or hot) and gentle, not forceful, irrigation should be used to remove cerumen. Too forceful irrigation can cause perforation of the tympanic membrane, and ice water causes vomiting. Cerumen curettes should not be routinely used by the nurse. Special training is required to use a curette safely. It is unnecessary to have the patient stand during the procedure.
A patient is scheduled to have an electronystagmography as part of a diagnostic workup for Mnires disease. What question is it most important for the nurse to ask the patient in preparation for this test?
A) Have you ever experienced claustrophobia or feelings of anxiety while in enclosed spaces?
B) Do you currently take any tranquilizers or stimulants on a regular basis?
C) Do you have a history of falls or problems with loss of balance?
D) Do you have a history of either high or low blood pressure?
B) Do you currently take any tranquilizers or stimulants on a regular basis?
Electronystagmography measures changes in electrical potentials created by eye movements during induced nystagmus. Medications such as tranquilizers, stimulants, or antivertigo agents are withheld for 5 days before the test. Claustrophobia is not a significant concern associated with this test; rather, it is most often a concern for patients undergoing magnetic resonance imaging (MRI). Balance is impaired by Mnires disease; therefore, a patient history of balance problems is important, but is not relevant to test preparation. Hypertension or hypotension, while important health problems, should not be affected by this test.
