Exam 2: Chapter 12

Question 1

An older client reports to a nurse, “My daughter says there is something wrong with my hearing. I am not so sure. Yes, I have some problems hearing, but I am 78 years old. What does she expect? I noticed that at Christmas dinner, with all the racket around, I had some trouble. I think it is that my granddaughters mumble a lot, just like all young people. I guess it has been getting steadily worse; it seems to be both ears as well.” Based on the client’s description, the nurse suspects which of the following?

a. Presbycusis
b. Otosclerosis
c. Tinnitus
d. A perforated eardrum

Answer 1

ANS: A
Presbycusis is a type of sensorineural hearing loss. It is slow and progressive and often ignored by older adults and considered normal aging. Symptoms include difficulty filtering background noise and understanding women and children’s voices. Individuals often accuse people of mumbling. Often, it is recognized by others first, before the affected person notices it. Otosclerosis is a cause of conductive hearing loss, as is a perforated eardrum. Tinnitus is a perception of sound in one or both ears where no external sound is present.

Question 2

An older nursing home resident reports that her hearing loss is getting worse. What is the first action of the nurse?

a. Refer the resident for an evaluation for a hearing aid
b. Raise her voice when speaking to the resident
c. Examine the resident’s ears for cerumen impaction
d. Teach the resident to read lips

Answer 2

ANS: C
When hearing loss is suspected or a person with existing hearing loss experiences increasing difficulty, it is important to first check for cerumen impaction. Hearing aids are not the first intervention since the cause of the hearing loss has not been determined. Hearing aids do not help all type of hearing losses. Raising one’s voice is not effective; it often makes hearing more difficult. Lip reading may be a useful skill for an individual with hearing loss, but it is critical to first ascertain what the cause of the hearing loss is.

Question 3

An older patient asks a nurse, “My doctor referred me to a hearing specialist who thinks that surgery for a cochlear implant may be beneficial for me. Can you tell me how one of those things works?” The nurse formulates a response based on the knowledge that:

a. a cochlear implant is permanent, surgically-implanted hearing aid.
b. a cochlear implant speeds up the conduction of sound to the auditory nerve. c. a cochlear implant functions as an artificial auditory nerve.
d. a cochlear implant directly stimulates the auditory nerve.

Answer 3

ANS: D

A cochlear implant bypasses damaged portions of the ear and directly stimulates the auditory nerve.

Question 4

A 74-year-old client who has experienced a progressive loss of hearing acuity in recent years obtains a new hearing aid. Which of the following should be included in the nurse’s teaching plan?

a. “Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure.”
b. “With the right hearing aid, you can expect your hearing to be back to normal.” c. “Hearing aids are covered by Medicare Part B.”
d. “Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise.”

Answer 4

ANS: D
Hearing aids do bring challenges, such as distorted speech and amplified background noise. Although hearing aids are not indicated for all individuals with hearing loss, they are not restricted to those with hearing loss due to excessive noise exposure. Hearing aids do not restore hearing to normal cost of hearing aids.

Question 5

A nurse in an assisted living community notes that one of the residents who has hearing impairment and new bilateral hearing aids frequently does not wear the hearing aids. The nurse knows that which of the following factors contribute to low hearing aid use after purchase? (Select all that apply.)

a. Difficulty placing hearing aid properly in the ear
b. Stigma associated with wearing a hearing aid
c. Difficulty changing the batteries in the hearing aid
d. Ineffectiveness of hearing aids for individuals with age-related hearing loss e. Hearing annoying loud noises

Answer 5

ANS: A, B, C, E
Options A, B, C, and E are all factors associated with low use after purchase. Option D is incorrect; most individuals with age-related hearing loss do experience some hearing enhancement with hearing aid use.

Question 6

An older person reports hearing whistling in both ears when no external sounds are present and is diagnosed with tinnitus. Which of the following are causes of tinnitus? (Select all that apply.)

a. Exposure to loud noises
b. Use of a hearing aid
c. Cerumen buildup
d. Side effects of medications
e. Age-related changes in the middle and inner ear

Answer 6

ANS: A, C, D
Hearing aids are not known as a cause or a trigger to worsen tinnitus and are at times used to amplify environmental noise to mask tinnitus. Tinnitus is not an age-related change, although it occurs in about 11% of individuals who have presbycusis. Exposure to loud noise and cerumen buildup are known to exacerbate or cause tinnitus. Over 200 prescription and nonprescription medications have tinnitus as a side effect. There are also many ototoxic medications

Question 7

An older patient is diagnosed with sensorineural hearing loss. The nurse knows that causes of sensorineural hearing loss include: (Select all that apply.)

a. tumors of the middle ear.
b. cerumen impaction.
c. infections of the external and middle ear.
d. age-related hearing impairment.
e. excessive and loud noise.

Answer 7

ANS: D, E
A, B, and C are all associated with conductive hearing loss. Age-related hearing impairment, or presbycusis, is a form of sensorineural hearing loss. Excessive and loud noise can cause noise-induced hearing loss, which is also a common type of sensorineural hearing loss.

Question 8

A nurse is teaching a client about ear hygiene and health. What client statement indicates a need for further
teaching?
a. A soft cotton swab is alright to clean my ears with.
b,c,d –> idfk what happened to these

Answer 8

ANS: A

Clients should be taught not to put anything larger than their fingertip into their ears. Using a cotton swab,

Question 9

2. The student nurse is performing a Weber tuning fork test. What technique is most appropriate?
   a. Holding the vibrating tuning fork 10 to 12 inches from the clients ear
   b. Placing the vibrating fork in the middle of the clients head
   c. Starting by placing the vibrating fork on the mastoid process
   d. Tapping the vibrating tuning fork against the bridge of the nose

Answer 9

ANS: B
The Weber tuning fork test includes placing the vibrating tuning fork in the middle of the clients head and asking in which ear the client hears the vibrations louder. The other techniques are incorrect.

Question 10

The clients chart 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 dont move?

Answer 10

ANS: C
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 relate to conductive hearing loss.

Question 11

4. The nurse works with clients who have hearing problems. Which action by a client best indicates goals for an important diagnosis have been met?
   a. Babysitting the grandchildren several times a week
   b. Having an adaptive hearing device for the television
   c. Being active in community events and volunteer work
   d. Responding agreeably to suggestions for adaptive devices

Answer 11

ANS: C
Clients with hearing problems can become frustrated and withdrawn. The client who is actively engaged in the community shows the best evidence of psychosocial adjustment to hearing loss. Babysitting the grandchildren is a positive sign but does not indicate involvement outside the home. Having an adaptive device is not the same as using it, and watching TV without evidence of other activities can also indicate social isolation. Responding agreeably does not indicate the client will actually follow through.

Question 12

A client has external otitis. On what comfort measure does 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

Answer 12

ANS: C
A heating pad on low or a warm moist pack can provide comfort to the client with otitis externa. The other options are not warranted.

Question 13

An older adult in the family practice clinic reports a decrease in hearing 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.

Answer 13

ANS: A
All options are possible actions for the client with hearing loss. The first action the nurse should take is to look for cerumen buildup, which can decrease hearing in the older adult. If this is normal, medications should be assessed for ototoxicity. Further auditory testing may be needed for this client.

Question 14

A client had a myringotomy. The nurse provides which 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

Answer 14

ANS: A
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.

Question 15

A client is going on a cruise but has had motion sickness in the past. What suggestion does the nurse make to this client?

a. Avoid alcohol on the cruise ship.
b. Change positions slowly on the ship.
c. Change your travel plans.
d. Try scopolamine (Transderm Scop).

Answer 15

ANS: D
Scopolamine can successfully treat the vertigo and dizziness associated with motion sickness. Avoiding alcohol and changing positions slowly are not effective. Telling the client to change travel plans is not a caring suggestion.

Question 16

A nurse is teaching a community group about noise-induced hearing loss. Which client who does not use ear protection should the nurse refer to an audiologist as the priority?

a. Client with an hour car commute 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

Answer 16

ANS: D
A chainsaw becomes dangerous to hearing after 2 hours of exposure without hearing protection. This client needs to be referred as the priority. Normal car traffic is safe for more than 8 hours. Motorcycle noise is safe for about 8 hours. The safe exposure time for a front-row rock concert seat is 3 minutes, but this client was in the back, and so had less exposure. In addition, a one-time exposure is less damaging than chronic exposure.

Question 17

A nursing student is instructed to remove a clients ear packing and instill eardrops. What action by the student requires intervention by the registered nurse?

a. Assessing the eardrum with an otoscope
b. Inserting a cotton ball in the ear after the drops
c. Warming the eardrops in water for 5 minutes
d. Washing the hands and removing the packing

Answer 17

ANS: D

The student should wash his or her hands, don gloves, and then remove the packing. The other actions are correct.

Question 18

A nurse is irrigating a clients ear when the client becomes nauseated. What action by the nurse is most appropriate for client comfort?

a. Have the client tilt the head back.
b. Re-position the client on the other side.
c. Slow the rate of the irrigation.
d. Stop the irrigation immediately.

Answer 18

ANS: D

During ear irrigation, if the client becomes nauseated, stop the procedure. The other options are not helpful.

Question 19

A client hospitalized for a wound infection has a blood urea nitrogen of 45 mg/dL and creatinine of 4.2 mg/dL. What action by the nurse is best?

a. Assess the ordered antibiotics for ototoxicity.
b. Explain how kidney damage causes hearing loss.
c. Use ibuprofen (Motrin) for pain control.
d. Teach that hearing loss is temporary.

Answer 19

ANS: A
Some medications are known to be ototoxic. Diminished kidney function slows the excretion of drugs from the body, worsening the ototoxic effects. The nurse should assess the antibiotics the client is receiving for ototoxicity. The other options are not warranted.

Question 20

A nurse is teaching a community group about preventing hearing loss. What instruction is best?

a. Always wear a bicycle helmet.
b. Avoid swimming in ponds or lakes.
c. Dont go to fireworks displays.
d. Use a soft cotton swab to clean ears.

Answer 20

ANS: A
Avoiding head trauma is a practical way to help prevent hearing loss. Swimming can lead to hearing loss if the client has repeated infections. Fireworks displays are loud, but usually brief and only occasional. Nothing smaller than the clients fingertip should be placed in the ear canal.

Question 21

A client has severe tinnitus that cannot be treated adequately. What action by the nurse is best?

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. Teach the client side effects of furosemide (Lasix).

Answer 21

ANS: C
If the clients tinnitus cannot be treated, he or she will have to learn to cope with it. Referring the client to tinnitus support groups can be helpful. The other options are not warranted.

Question 22

A client has labyrinthitis and is prescribed antibiotics. What instruction 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.

Answer 22

ANS: A
Meningitis is a complication of labyrinthitis. 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.

Question 23

A client with Mnires disease is in the hospital when the client has an attack of this disorder. What action by the nurse takes priority?

a. Assess vital signs every 15 minutes.
b. Dim or turn off lights in the clients room.
c. Place the client in bed with the upper siderails up.
d. Provide a cool, wet cloth for the clients face.

Answer 23

ANS: C
Clients with Meniere’s disease can have vertigo so severe that they can fall. The nurse should assist the client into bed and put the siderails 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 Meniere’s disease.

Question 24

A client is scheduled to have a tumor of the middle ear removed. What teaching topic is most important for the nurse to cover?

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

Answer 24

ANS: A
Removal of an inner ear tumor will likely destroy hearing in the affected ear. The other teaching topics are appropriate for any surgical client.

Question 25

A nursing student studying the auditory system learns about the structures of the inner ear. What structures does this include? (Select all that apply.)

a. Cochlea
b. Epitympanum
c. Organ of Corti
d. Semicircular canals
e. Vestibule

Answer 25

ANS: A, C, D, E
The cochlea, organ of Corti, semicircular canals, and vestibule are all part of the inner ear. The epitympanum is in the middle ear.

Question 26

A client has Mnires disease with frequent attacks. About what drugs does the nurse plan to teach the client? (Select all that apply.)

a. Broad-spectrum antibiotics
b. Chlorpromazine hydrochloride (Thorazine)
c. Diphenhydramine (Benadryl)
d. Meclizine (Antivert)
e. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer 26

ANS: B, C, D
Drugs such as chlorpromazine, diphenhydramine, and meclizine can all be used to treat Mnires disease. Antibiotics and NSAIDs are not used.

Question 27

A client is scheduled for a tympanoplasty. What actions by the nurse are most appropriate? (Select all that apply.)

a. Administer preoperative antibiotics.
b. Assess for allergies to local anesthetics.
c. Ensure that informed consent is on the chart.
d. Give ordered antivertigo medications.
e. Teach that hearing improves immediately.

Answer 27

ANS: A, C
Preoperatively, the nurse administers antibiotics and ensures that informed consent is on the chart. Local anesthetics can be used, but general anesthesia is used more often. Antivertigo medications are not used. Hearing will be decreased immediately after the operation until the ear packing is removed.

Question 28

A client has a hearing aid. What care instructions does the nurse provide the unlicensed assistive personnel (UAP) in the care of this client? (Select all that apply.)

a. Be careful not to drop the hearing aid when handling.
b. Soak the hearing aid in hot water for 20 minutes.
c. Turn the hearing aid off when the client goes to bed.
d. Use a toothpick to clean debris from the device.
e. Wash the device with soap and a small amount of warm water.

Answer 28

ANS: A, C, D, E
All these actions except soaking the hearing aid are proper instructions for the nurse to give to the UAP. While some water is used to clean the hearing aid, excessive wetting should be avoided.

Question 29

A hospitalized client has Menires disease. What menu selections demonstrate good knowledge of the recommended diet for this disorder? (Select all that apply.)

a. Chinese stir fry with vegetables
b. Broiled chicken breast
c. Chocolate espresso cookies
d. Deli turkey sandwich and chips
e. Green herbal tea with meals

Answer 29

ANS: B, E
The diet recommendations for Mnires disease include low-sodium, caffeine-free foods and fluids distributed evenly throughout the day. Plenty of water is also needed. The broiled chicken breast and herbal tea are the best selections. The stir fry is high in sodium and possibly monosodium glutamate (MSG, also not recommended). The cookies have caffeine, and the sandwich and chips are high in sodium.

Question 30

A client is scheduled for a stapedectomy in 2 weeks. What teaching instructions are most appropriate? (Select all that apply.)

a. Avoid alcohol use before surgery.
b. Blow the nose gently if needed.
c. Clean the telephone often.
d. Sneeze with the mouth open.
e. Wash the external ear daily.

Answer 30

ANS: B, C, D, E
It is imperative that the client having a stapedectomy is free from ear infection. Teaching includes ways to prevent such infections, such as blowing the nose gently, cleaning objects that come into contact with the ear, sneezing with the mouth open, and washing the external ear daily. Avoiding alcohol will not help prevent ear infections

Question 31

A client is admitted to the nursing unit after having a tympanoplasty. What activities does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

a. Administer prescribed antibiotics.
b. Keep the head of the clients bed flat.
c. Remind the client to lie on the operative side.
d. Remove the iodoform gauze in 8 hours.
e. Take and record postoperative vital signs.

Answer 31

ANS: B, E
The UAP can keep the head of the clients bed flat and take/record vital signs. The nurse administers medications. The client should lie flat with the head turned so the operative side is up. The nurse or surgeon removes the gauze packing.