Lewis Ch 21: Assessment and Management of Auditory Problems Flashcards
To decrease the risk for future hearing loss, which action should the nurse implement with college students at the on-campus health clinic?
a. Perform tympanometry.
b. Schedule otoscopic examinations.
c. Administer influenza immunizations.
d. Discuss exposure to amplified music.
d. Discuss exposure to amplified music.
The nurse should discuss the impact of amplified music on hearing with young adults and discourage listening to highly amplified music, especially for prolonged periods. Tympanometry measures the ability of the eardrum to vibrate and would not help prevent future hearing loss. Although students are at risk for the influenza virus, being vaccinated does not help prevent future hearing loss. Otoscopic examinations are not necessary for all patients
A patient diagnosed with external otitis is being discharged from the emergency department with an ear wick in place. Which statement by the patient indicates a need for further teaching?
a. “I will apply the eardrops to the cotton wick in the ear canal.”
b. “I can use aspirin or acetaminophen (Tylenol) for pain relief.”
c. “I will clean the ear canal daily with a cotton-tipped applicator.”
d. “I can use warm compresses to the outside of the ear for comfort.”
c. “I will clean the ear canal daily with a cotton-tipped applicator.”
Insertion of instruments such as cotton-tipped applicators into the ear should be avoided. The other patient statements indicate that the teaching has been successful.
What should the nurse include when teaching a patient who has undergone a left tympanoplasty?
a. “Remain on bed rest.”
b. “Keep your head elevated.”
c. “Avoid blowing your nose.”
d. “Irrigate your left ear canal.”
c. “Avoid blowing your nose.”
Coughing or blowing the nose increases pressure in the eustachian tube and middle ear cavity and disrupts postoperative healing. There is no postoperative need for prolonged bed rest, elevation of the head, or continuous antibiotic irrigation.
The nurse is assessing a patient who was recently treated with amoxicillin for acute otitis media of the right ear. Which finding is a priority to report to the health care provider?
a. The patient has a temperature of 100.6° F.
b. The patient report frequent “popping” in the ear.
c. Clear fluid is visible through the tympanic membrane.
d. The patient frequently asks the nurse to repeat information.
a. The patient has a temperature of 100.6° F.
The fever indicates that the infection may not be resolved, and the patient might need further antibiotic therapy. A feeling of fullness, “popping” of the ear, decreased hearing, and fluid in the middle ear are indications of otitis media with effusion. These symptoms are normal for weeks to months after an episode of acute otitis media and usually resolve without treatment.
A patient who has Ménière’s disease is admitted with vertigo, nausea, and vomiting. Which nursing intervention will be included in the care plan?
a. Dim the lights in the patient’s room.
b. Encourage increased oral fluid intake.
c. Change the patient’s position every 2 hours.
d. Keep the head of the bed elevated 45 degrees.
a. Dim the lights in the patient’s room.
A darkened, quiet room will decrease the symptoms of the acute attack of Ménière’s disease. Because the patient will be nauseated during an acute attack, fluids are administered IV. Position changes will cause vertigo and nausea. The head of the bed can be positioned for patient comfort.
Which statement by the patient to the home health nurse indicates a need for further teaching about self-administering eardrops?
a. “I will leave the ear wick in place while administering the drops.”
b. “I will hold the tip of the dropper above the ear to administer the drops.”
c. “I will refrigerate the medication until I am ready to administer the drops.”
d. “I should lie down before and for 5 minutes after administering the drops.”
c. “I will refrigerate the medication until I am ready to administer the drops.”
Administration of cold eardrops can cause dizziness because of stimulation of the semicircular canals. The other patient actions are appropriate.
An older patient who is being admitted to the hospital repeatedly asks the nurse to “speak up so that I can hear you.” Which action should the nurse take?
a. Increase the speaking volume.
b. Overenunciate while speaking.
c. Speak normally but more slowly.
d. Use more facial expressions when talking.
c. Speak normally but more slowly.
Patient understanding of the nurse’s speech will be enhanced by speaking at a normal tone, but more slowly. Increasing the volume, overenunciating, and exaggerating facial expressions will not improve the patient’s ability to comprehend.
A patient with presbycusis is fitted with binaural hearing aids. Which information will the nurse include when teaching the patient how to use the hearing aids?
a. Keep the volume low on the hearing aids for the first week.
b. Experiment with volume and hearing in a quiet environment.
c. Add the second hearing aid after making adjustments to the first hearing aid.
d. Begin wearing the hearing aids for an hour a day, gradually increasing the use.
b. Experiment with volume and hearing in a quiet environment.
Initially the patient should use the hearing aids in a quiet environment such as the home, experimenting with increasing and decreasing the volume as needed. There is no need to gradually increase the time of wear. The patient should experiment with the level of volume to find what works well in various situations. Both hearing aids should be used.
Which information will the nurse include for a patient considering a cochlear implant? Cochlear implants:
a. are not useful for patients with congenital deafness.
b. are most helpful as an early intervention for presbycusis.
c. improve hearing in patients with conductive hearing loss.
d. require extensive training in order to reach the full benefit.
d. require extensive training in order to reach the full benefit.
Extensive rehabilitation is required after cochlear implants for patients to receive the maximum benefit. Hearing aids, rather than cochlear implants, are used initially for presbycusis. Cochlear implants are used for sensorineural hearing loss and would not be helpful for conductive loss. They are appropriate for some patients with congenital deafness.
Unlicensed assistive personnel (UAP) perform the following actions when caring for a patient with Ménière’s disease who is experiencing an acute attack. Which action by UAP indicates that the nurse should intervene?
a. UAP raises the side rails on the bed.
b. UAP turns on the patient’s television.
c. UAP places an emesis basin at the bedside.
d. UAP helps the patient turn to the right side.
b. UAP turns on the patient’s television.
Watching television may exacerbate the symptoms of an acute attack of Ménière’s disease. The other actions are appropriate because the patient will be at high fall risk and may suffer from nausea during the acute attack.
What is the priority problem for a patient experiencing an acute attack with Meniere’s disease?
a. Being at risk for falls
b. Imbalanced nutritional intake
c. Difficulty performing self-care
d. Impaired verbal communication
a. Being at risk for falls
All the problems are appropriate, but because sudden attacks of vertigo can lead to “drop attacks,” the major focus of nursing care is to prevent injuries associated with dizziness.
Which information about a patient who had a stapedotomy yesterday is most important for the
nurse to communicate to the health care provider?
a. The patient reports ear “fullness.”
b. Oral temperature is 100.8° F (38.1° C).
c. Small amount of dried drainage on dressing.
d. The patient reports that hearing has gotten worse.
b. Oral temperature is 100.8° F (38.1° C).
An elevated temperature may indicate a postoperative infection. Although the nurse would report all the data, a temporary decrease in hearing, bloody drainage on the dressing, and a feeling of congestion (because of the accumulation of blood and drainage in the ear) are common after this surgery.
Which action will the nurse take when performing ear irrigation for a patient with cerumen impaction?
a. Assist the patient to a supine position for the irrigation.
b. Fill the irrigation syringe with body-temperature solution.
c. Use a sterile applicator to clean the ear canal before irrigating.
d. Occlude the ear canal completely with the syringe while irrigating.
b. Fill the irrigation syringe with body-temperature solution.
Solution at body temperature is used for ear irrigation. The patient should be sitting for the procedure. Use of cotton-tipped applicators to clear the ear may result in forcing the cerumen deeper into the ear canal. The ear should not be completely occluded with the syringe.
The nurse is observing a student who is preparing to perform an ear examination for a 30-year-old patient. Which action by the student indicates that the nurse should intervene?
a. Pulls the auricle of the ear up and posterior.
b. Chooses a speculum larger than the ear canal.
c. Stabilizes the hand holding the otoscope on the patient’s head.
d. Stops inserting the otoscope after observing impacted cerumen.
b. Chooses a speculum larger than the ear canal.
The speculum should be smaller than the ear canal, so it can be inserted without damage to the external ear canal. The other actions are appropriate when performing an ear examination.
A patient reports dizziness when bending over and of nausea and dizziness associated with physical activities. What exam should the nurse expect to prepare the patient to undergo?
a. Tympanometry
b. Rotary chair testing
c. Pure-tone audiometry
d. Bone-conduction testing
b. Rotary chair testing
The patient’s clinical manifestations of dizziness and nausea suggest a disorder of the labyrinth, which controls balance and contains three semicircular canals and the vestibule. Rotary chair testing is used to test vestibular function. The other tests are used to test for problems with hearing.
