Porth (2020) 5th nur 317 Flashcards
Chapter 20
Which interventions will the nurse reinforce when preparing to discharge a client being treated for Ménière’s disease?
Avoidance of foods high in saturated fats
Implementation of a physical exercise routine
Compliance with prescribed prednisone therapy
Insert cotton balls to protect ear canal
Compliance with prescribed prednisone therapy
Rationale:Prednisone, a steroid hormone, may be used to maintain satisfactory hearing and resolve dizziness. While it is generally considered healthy to limit saturate fat intake, a low-sodium diet is especially recommended for this disorder. Since vertigo is a symptom of this disorder, exercise routines should be discussed thoroughly with a health care provider before being initiated. The client should not insert anything into the ear canal.
Which condition or situation is a risk factor for the development of acute otitis media in a child?
Upper respiratory infection
Inappropriate ear hygiene techniques
Repeated exposure to loud noises
Foreign object in the ear
Upper respiratory infection
Rationale:Acute OM, which refers to an acute middle ear infection, usually follows an upper respiratory tract infection. The other options may be considered risk factors for certain types of hearing loss.
The nurse is teaching a client who has tinnitus about suggested dietary modifications. The most important information for the nurse to include would be:
“Increase intake of red wine to two glasses per day twice a week.”
“There are no dietary restrictions that you have to follow.”
“Cut down on takeout meals because of high amounts of monosodium glutamate.”
“You can drink one serving of caffeine a day and one cola.”
“Cut down on takeout meals because of high amounts of monosodium glutamate.”
Rationale:Tinnitus can be caused by some cheeses, red wine, monosodium glutamate, and caffeine. These items should be reduced in the diet to help control the symptom.
The nurse is conducting a Weber test on a client diagnosed with a conductive hearing loss. The nurse anticipates that the client will report that the sound has what qualities?
Radiates to the side without the hearing loss
Is louder on the side with the hearing loss
Can be heard equally on both sides
Cannot be heard on either side
Is louder on the side with the hearing loss
Rationale:With the Weber test, the sound would be louder on the side with the hearing loss. In a person with a sensorineural loss, the sound radiates to the side with the better hearing.
The nurse is caring for a client who has suffered hearing loss related to an ototoxic medication. The nurse understands which classes of drugs may be ototoxic? Select all that apply.
Aminoglycosides
Glucocorticosteroids
Loop diuretics
Some chemotherapeutic drugs
Antidiabetic agents
Aminoglycosides,
Loop diuretics,
Some chemotherapeutic drugs
Rationale:Several classes of drugs have been identified as having ototoxic potential, including the aminoglycosides and some antimicrobial agents, antimalarial drugs, some chemotherapeutic drugs, loop diuretics, and salicylates.
Presbycusis is degenerative hearing loss associated with aging. What is the first symptom of this disorder?
Reduction in ability to understand speech
Inability to detect sound
Inability to localize sounds
Reduction in ability to identify sounds
Reduction in ability to understand speech
Rationale:The disorder first reduces the ability to understand speech and, later, the ability to detect, identify, and localize sounds.
The nurse is describing to a new mother the health screening actions that will be performed on her infant. The client states, “I’m sure my baby’s exhausted. I’d prefer to do this in a few weeks.” What rationale for early hearing testing should the nurse describe?
“We do these tests to ensure that all fluids from birth have been cleared from your baby’s auditory canal.”
“We prioritize these tests in order to determine if any hearing damage occurred during the birth process.”
“It’s actually a very easy test, so it’s best to just get it out of the way now.”
“If there is a hearing problem, it can be addressed right away before your baby starts to adapt to it.”
“If there is a hearing problem, it can be addressed right away before your baby starts to adapt to it.”
Rationale:Early hearing testing occurs so that if there is a hearing problem, it can be addressed before the child begins to acclimate to its life. Stating that the testing is easy does not address the woman’s concerns. Hearing deficits in newborns are not typically the result of fluid or of trauma during birth.
A 26-year-old client who has recently traveled by airplane complains of pain in his right ear. The nurse suspects which condition?
Cerumen accumulation
Barotrauma
Otitis media
Otitis externa
Barotrauma
Rationale:Considering the client’s age and recent air travel, a likely diagnosis would be barotrauma. The other options are not affected by age and changes in pressure experienced during air travel.
The nurse is admitting a client to the acute medicine unit and is reviewing the results of the medication reconciliation. The nurse should recognize which drugs as having the potential for ototoxicity? Select all that apply.
Aspirin
A beta adrenergic blocker
An opioid analgesic
A loop diuretic
Vitamin D supplements
Aspirin, A loop diuretic
Rationale:Loop diuretics and aspirin are among the drugs known to cause ototoxicity. Beta blockers, vitamin D, and opioids do not have this effect.
The nurse is developing a plan of care for a 65-year-old client who has significant hearing loss. Which treatment option is most appropriate to include in this client’s plan of care? Select all that apply.
Closed captioning on televised programs
Use of sign language
Vascular decompression
Hearing aids
Speech reading class
Closed captioning on televised programs, Hearing aids, Speech reading class
Rationale:The interventions for hearing loss include hearing aids, speech reading class, and closed captioning on televised programs. Vascular decompression surgery will not correct the problem and sign language class is not appropriate at this time.
To diagnose a vestibular disorder, which test would be used that assesses the eye movements in response to vestibular, visual, and positional stimulation?
Audiogram
Electronystagmography
Romberg test
Caloric stimulation
Electronystagmography
Rationale:Of the options provided, the only test which records the eye movements in response to vestibular, visual, cervical, rotational and positional stimulation is the electronystagmography.
A 5-month-old infant is being treated for acute otitis media (AOM) for the second time in the past 10 weeks. Which action should the nurse recommend to prevent future recurrences?
Administration of the hepatitis B vaccine
Limiting the infant’s exposure to large group settings
Administration of the measles–mumps–rubella (MMR) vaccine
Gently rinsing the infant’s outer ears with saline twice weekly
Limiting the infant’s exposure to large group settings
Rationale:Ways to reduce the risk of developing AOM include minimal exposure to group settings. MMR and hepatitis vaccines are irrelevant to the etiology of AOM. Ear rinsing is not recommended.
The nurse is educating a client diagnosed with Meniere disease on lifestyle modifications to reduce the frequency and/or intensity of exacerbations. Which should the nurse include?
Decrease dietary intake of fats
Decrease dietary intake of sodium
Avoid crowds to reduce infection
Avoid acetaminophen
Decrease dietary intake of sodium
Rationale:A lifestyle change that would be recommended for a client with Meniere disease is to consume a low sodium diet, related to the medication treatment (diuretics). The other modifications are not relevant to Meniere disease.
Question
14 of 21
A client reports feeling like the room is spinning around him when standing still. Which diagnosis is this client likely experiencing?
Subjective vertigo
Objective vertigo
Syncopal episodes
Nystagmus
Objective vertigo
Rationale:Objective vertigo is the sensation of the person being stationary and the environment in motion. Subjective vertigo is a sensation of a person who may be in motion and the environment stationary. Nystagmus refers to the involuntary rhythmic and oscillatory eye movements that preserve eye fixation on stable objects in the visual field during angular and rotational movements of the head. Syncope is “fainting.”
A new mother brings her infant to the clinic reporting that the child is not sleeping or eating much. Upon assessment, the health care provider notes that the infant’s ear canal is reddened with a bulging tympanic membrane. Which other data collected would lead to the diagnosis of acute otitis media (AOM)? Select all that apply.
“He jabbers all the time usually.”
“He’s been very irritable and fussy the past couple of days.”
“Yes, he has been pulling at his ear.”
“We like to throw him up in the air hoping any water in his ear will drain.”
“When I dropped a pan on the floor, he jumped.”
“He’s been very irritable and fussy the past couple of days.”, “Yes, he has been pulling at his ear.”
Rationale:AOM is characterized by an acute onset of otalgia (ear pain), fever, and hearing loss. Younger children often have nonspecific signs and symptoms that manifest as ear tugging, irritability, nighttime awakening, and poor feeding. Key diagnostic criteria include ear pain that interferes with activity or sleep, tympanic membrane erythema (redness), and middle ear effusion. A child with otitis media with effusion (OME) may develop delayed speech and language skills.
A client reports occasional ringing in the ears that worsens toward the end of the day. The most important question for the nurse to ask would be:
“What prescription medication and over-the-counter medication do you take?”
“Do you use Q-tips in your ears?’
“Have you had any recent respiratory infections?”
“How often do you clean your ears?”
“What prescription medication and over-the-counter medication do you take?”
Rationale:Medications and stimulants, such as aspirin, caffeine, and nicotine, can cause tinnitus. The client should be questioned to determine if this is a potential cause. Impacted cerumen is a benign cause of tinnitus, which resolves after the earwax is removed. Respiratory infections may cause fluid in the ears and decreased hearing.
For which type of hearing loss should the nurse assess in a child who has had recurrent otitis media since birth?
Sensorineural loss
Conductive loss
Cochlear nerve loss
Cerumen impaction loss
Conductive loss
Rationale:Hearing loss that is associated with recurrent otitis media is conductive loss.
The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to:
Sensorineural disorder
Mixed sensorineural and conduction disorder
Conduction disorder
Infection
Conduction disorder
Rationale:Impacted earwax is one cause for conductive hearing loss. It is not a cause of the other answer choices.
The nurse is discussing strategies to decrease the likelihood of motion sickness with a client who is concerned about a planned car trip. Which interventions might the nurse suggest? Select all that apply.
Asking your health care professional to prescribe an anti-motion sickness drug
Looking out of the car window and focusing on the scenery
Chewing gum while traveling
Reading a book while traveling
:Asking your health care professional to prescribe an anti-motion sickness drug, Looking out of the car window and focusing on the scenery
Rationale:Motion sickness can usually be suppressed by supplying visual signals that more closely match the motion signals being supplied to the vestibular system. For example, looking out the window and watching the environment move when experiencing motion sickness associated with car travel provides the vestibular system with the visual sensation of motion, but reading a book provides the vestibular system with the miscue that the environment is stable. Motion sickness usually decreases in severity with repeated exposure. Anti-motion sickness drugs also may be used to reduce or ameliorate the symptoms.
What are the clinical manifestations of Ménière disease? Select all that apply.
Feeling of fullness in the ear(s)
Severe ringing in the ear(s)
Episodes of disabling vertigo
Acute pain in ear(s)
Dizziness triggered by turning the head
Feeling of fullness in the ear(s), Severe ringing in the ear(s), Episodes of disabling vertigo, Dizziness triggered by turning the head
Rationale:Ménière’s disease is characterized by severe, disabling episodes of tinnitus; feelings of ear fullness; and violent rotary vertigo. Benign paroxysmal positional vertigo (BPPV) is a condition believed to be caused by free-floating particles in the posterior semicircular canal. It presents as a sudden onset of dizziness or vertigo that is provoked by certain changes in head position.
