Chapter 43 Practice Questions - Assessment and Concepts of Care for Patients With Ear and Hearing Problems Flashcards
A nurse is teaching a client about ear hygiene and health. Which statement by the client indicates a need for further teaching?
a. “A soft cotton swab is alright to clean my ears with.”
b. “I make sure my ears are dry after I go swimming.”
c. “I use good earplugs when I practice with the band.”
d. “Keeping my diabetes under control helps my hearing.”
a. “A soft cotton swab is alright to clean my ears with.”
Clients should be taught not to put anything larger than their fingertip into their ears. Using a cotton swab, although soft, can cause damage to the ears and cerumen buildup. The other statements are accurate.
The nurse is teaching new assistive personnel (AP) about caring for older adults. Which statement would the nurse include about hearing ability of this client group?
a. “You need to talk very loudly when communicating with these clients.”
b. “You always need to check each client’s ears for excess ear wax.”
c. “Remember to face the client when talking with him or her.”
d. “Assess each client’s hearing ability using the voice or whisper test.”
c. “Remember to face the client when talking with him or her.”
Losing one’s hearing is not a normal change of aging although high frequency sounds may be more difficult to hear. AP does not perform assessments and it is not necessary to talk loudly or shout unless a hearing impairment exists. Therefore, facing the client is the best strategy when communicating with most older adults.
The client’s electronic health record indicates a sensorineural hearing loss. What assessment question does the nurse ask to determine the possible cause?
a. “Do you feel like something is in your ear?”
b. “Do you have frequent ear infections?”
c. “Have you been exposed to loud noises?”
d. “Have you been told your ear bones don’t move?”
c. “Have you been exposed to loud noises?”
Sensorineural hearing loss can occur from damage to the cochlea, the eighth cranial nerve, or the brain. Exposure to loud music is one etiology. The other questions are related to conductive hearing loss.
A client has external otitis. About what comfort measure would the nurse instruct the client?
a. Applying ice four times a day
b. Instilling vinegar-and-water drops
c. Use of a heating pad to the ear
d. Using a home humidifier
c. Use of a heating pad to the ear
A heating pad on low or a warm moist pack can provide comfort to the client with otitis externa. The other options are not appropriate.
An older adult in the family practice clinic reports a decrease in hearing in one ear for over a week. What action by the nurse is most appropriate?
a. Assess for cerumen buildup.
b. Facilitate audiological testing.
c. Perform tuning fork tests.
d. Review the medication list.
a. Assess for cerumen buildup.
All options are possible actions for the client with hearing loss. The first action the nurse would take is to look for cerumen buildup, which can decrease hearing in the older adult. If this is normal, medications would be assessed for ototoxicity. Further auditory testing may be
needed for this patient.
A client had a myringotomy. What would the nurse include as part of discharge teaching?
a. Buy dry shampoo to use for a week.
b. Drink liquids through a straw.
c. Flying is not allowed for 1 month.
d. Hot water showers will help the pain.
a. Buy dry shampoo to use for a week.
The client cannot shower or get the head wet for 1 week after surgery, so using dry shampoo is a good suggestion. The other instructions are incorrect: straws are not allowed for 2 to 3 weeks, flying is not allowed for 2 to 3 weeks, and the client should not shower.
A nurse is teaching a community group about noise-induced hearing loss. Which client who does not use ear protection would the nurse refer to an audiologist as the priority?
a. Client with an hour car commutes on the freeway each day.
b. Client who rides a motorcycle to work 20 minutes each way.
c. Client who sat in the back row at a rock concert recently.
d. Client who is a tree-trimmer and uses a chainsaw 6 to 7 hours a day.
d. Client who is a tree-trimmer and uses a chainsaw 6 to 7 hours a day.
A chainsaw becomes dangerous to hearing after several hours of exposure without hearing protection. This client needs to be referred as the priority. Normal car traffic and motorcycle noise is safe unless for a very long time. Although a client was at a rock concert, he or she
was in the back row and had less exposure. In addition, a one-time exposure is less damaging than chronic exposure.
A client who has had cold symptoms for a week visits the local urgent care center with report of left ear discomfort, dizziness, and decreased hearing. What additional assessment findings would the nurse expect?
a. High fever
b. Nausea and vomiting
c. Elevated blood pressure
d. Purulent ear drainage
d. Purulent ear drainage
The client presents with symptoms that indicate possible serous otitis or otitis media. In either case, the client would not have a high fever or blood pressure. Nausea and vomiting are not common with either diagnosis, but purulent ear drainage is likely to occur if the tympanic
eardrum perforates. The client’s decreased hearing could indicate that perforation already occurred.
The nurse is teaching a client about factors that can cause external otitis. Which of these factors would the nurse emphasize as the highest risk?
a. Excess cerumen
b. Swimming
c. Sinus congestion
d. Meniere disease
b. Swimming
External otitis is often called “swimmer’s ear” because it is most often caused by swimming in lakes, ponds, and untreated pools.
A nurse is teaching a community group about preventing hearing loss. What instruction is appropriate?
a. “Always wear a bicycle helmet.”
b. “Avoid swimming in ponds or lakes.”
c. “Don’t attend fireworks shows.”
d. “Use a cerumen spoon to clean ears.”
a. “Always wear a bicycle helmet.”
Avoiding head trauma is a practical way to help prevent hearing loss. Swimming can lead to hearing loss only if the client has repeated infections. Fireworks displays/shows are loud, but usually brief and only occasional. A cerumen spoon is only used by primary health care providers to remove ear wax from in the ear canal.
A client has severe tinnitus that has not responded to treatment. What action by the nurse is appropriate?
a. Advise the client to take antianxiety medication.
b. Educate the client on nerve-cutting procedures.
c. Refer the client to online or local support groups.
d. Refer the client to a mental health professional.
c. Refer the client to online or local support groups.
If the client’s tinnitus cannot be treated, he or she will need to learn how to cope with it. Referring the client to tinnitus support groups can be helpful. The other options are not warranted.
A client has mastoiditis and is prescribed antibiotics. What health teaching by the nurse is most important for this client?
a. “Immediately report headache or stiff neck.”
b. “Keep all follow-up appointments.”
c. “Take the antibiotics with a full glass of water.”
d. “Take the antibiotic on an empty stomach.”
a. “Immediately report headache or stiff neck.”
Meningitis is a complication of mastoiditis. The client should be taught to take all antibiotics as prescribed and to report manifestations of meningitis such as fever, headache, or stiff neck. Keeping follow-up appointments is important for all clients. Without knowing what antibiotic was prescribed, the nurse cannot instruct the client on how to take it
A client with Ménière disease is in the hospital when the client has an episode of this disorder. What action by the nurse is appropriate?
a. Assess vital signs every 15 minutes.
b. Dim or turn off lights in the client’s room.
c. Place the client in bed with the upper side rails up.
d. Provide a cool, wet cloth for the client’s face.
c. Place the client in bed with the upper side rails up.
Clients with Ménière disease can have vertigo so severe that they can fall. The nurse would assist the client into bed and put the side rails up to keep the client from falling out of bed due to the intense whirling feeling. The other actions are not warranted for clients with Ménière
disease.
A client is scheduled to have a tumor of the middle ear removed. Which perioperative health teaching is most important for the nurse to include?
a. Expecting hearing loss in the affected ear
b. Managing postoperative pain
c. Maintaining NPO status prior to surgery
d. Understanding which medications are allowed the day of surgery
a. Expecting hearing loss in the affected ear
Removal of an inner ear tumor will likely destroy hearing in the affected ear. The other teaching topics are appropriate for any surgical client.
The nurse is teaching an older adult how to prevent buildup of ear wax. Which statement by the nurse is most appropriate?
a. “Visit your primary health care provider each month for wax removal.”
b. “Drink plenty of water and other liquids to prevent hardening of the ear wax.”
c. “Irrigate each ear once a month to remove wax and prevent was buildup.”
d. “Put one drop of mineral oil in each ear once a week at bedtime.”
d. “Put one drop of mineral oil in each ear once a week at bedtime.
”Mineral oil provides lubrication to soften cerumen so that it flows out of the ears to prevent buildup. It is a safer method than irrigating the ears. If needed, the client would need to go to a primary health care provider for removal of impaction. Drinking water helps prevent
hardening of wax but does not necessarily prevent wax buildup.
