Ignatavicius Ch 48: Assessment and Care of Patients with Ear and Hearing Problems Flashcards
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. 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 ears.
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 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
b. Placing the vibrating fork in the middle of the clients head
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.
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?
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 relate to conductive hearing loss.
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
c. Being active in community events and volunteer work
Clients with hearing problems can become frustrated and withdrawn.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.
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
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 warranted.
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.
a. Assess for cerumen buildup.
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.
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.
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 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).
d. Try scopolamine (Transderm Scop).
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.
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
d. Client who is a tree-trimmer and uses a chainsaw 6 to 7 hours a day
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.
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
d. Washing the hands and removing the packing
The student should wash his or her hands, don gloves, and then remove the packing. The other actions are correct.
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.
d. Stop the irrigation immediately.
During ear irrigation, if the client becomes nauseated, stop the procedure. The other options are not helpful.
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.
a. Assess the ordered antibiotics for ototoxicity.
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.
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.
a. Always wear a bicycle helmet.
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.
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).
c. Refer the client to online or local support groups.
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.
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.
a. Immediately report headache or stiff neck.
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.
