PrepU Hearing Impairment

Question 1

The nurse is caring for a client experiencing hearing loss. The nurse uses the otoscope to assess the ear canal and tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be most accurate?
A. Central
B. Mixed
C. Conductive
D. Sensorineural

Answer 1

C. Conductive: occurs from obstruction in the outer or middle ear, such as from cerumen. Mixed includes conductive and sensorineural problems. Central involves injury or damage to the nerves/nuclei of CNS. Sensorineural involves damage to the inner ear.

Question 2

A client is newly diagnosed with otitis externa. Which information should the nurse teach the client before the client leaves the clinic?
A. Proper instillation of prescribed ear drops
B. Side effects of oral antibiotics
C. Cleaning ear canal with cotton-tipped applicator after showering
D. Strategies to cope with temporary sensorineural hearing loss

Answer 2

A: Otitis externa is usually treated with antimicrobial otic drops. Antibiotics would not be prescribed because it is not a systemic issue. May cause temporary conductive, not sensorineural, hearing loss.

Question 3

The results of a client’s Rinne test are as follows: bone conduction > air conduction. How should the nurse explain these findings to the client?
A. “You have conductive hearing loss.”
B. “You have nerve damage in your ears.”
C. “You have a unilateral hearing loss.”
D. “You have a high frequency hearing loss.”

Answer 3

A. The Rinne test is for conductive hearing loss. Air conduction should be twice as long as bone conduction.
-The whisper test evaluates loss of high frequency sounds.
-An audiogram can reveal a nerve related or unilateral hearing loss

Question 4

A nurse in a primary care provider’s office is performing a focused assessment on a 71-year-old male client who is reporting hearing loss in their right ear.
-The Weber test reveals lateralization of sound to the right ear.
-The results of the Rinne test reveal bone conduction that is greater than air conduction. The client reports
-frequent ear infections and
-increased ear wax.
Denote whether each of these individual reports are sensorineural hearing loss or conductive hearing loss.

Answer 4

Lateralization of sound to the affected ear; bone conduction greater than air conduction; increased ear way = conductive hearing loss.
Frequent ear infections = sensorineural hearing loss
- In conductive hearing loss, the environmental noise cannot reach the tiny bones of the ear (such as the cochlea), due to cerebrum, or thickened tympanic membranes from scarring caused by frequent ear infections. Weber and Rinne test = conductive tests.

Question 5

What aspects should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?
A. Impaired facial movement
B. Reduced urinary output
C. Signs of hypotension
D. Tinnitus and sensorineural hearing loss

Answer 5

Signs and symptoms of ototoxicity include tinnitus and sensorineural hearing loss. The other answers are not signs of ototoxicity.

Question 6

A 15-year-old client is brought to the emergency department by his friends. He reports visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition?
A. Caffeine abuse
B. Ibuprofen overdose
C. Acute acetaminophen poisoning
D. Salicylate intoxication

Answer 6

D: Symptoms of salicylate intoxication includes nausea/V, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, and hyperventilation.

Question 7

A 38-year-old client who has begun to develop hearing loss is being evaluated by the nurse practitioner. The client says that hearing improves when on the telephone and that chewing sounds very loud. What does the nurse practitioner expect?
A. Tinnitus
B. Senile anacusis
C. Otosclerosis
D. Otitis media

Answer 7

C: Involves the reabsorption of bone and replacement with new, sclerotic bone around the stapes and oval window, which slowly impedes hearing. 20-40 y.o. Increased bone conduction of sound = hearing on tele better and chewing is loud.

Question 8

Which manifestation is the MOST problematic for the client diagnosed with Meniere disease?
A. Vertigo
B. Hearing loss
C. Diaphoresis
D. Tinnitus

Answer 8

Vertigo is most troublesome complaint, followed by tinnitus, diaphoresis, and hearing loss.

Question 9

What would a class be taught is the most characteristic symptom of otosclerosis?
A. The client describing a history of having had a recent upper respiratory infection.
B. A red and swollen ear drum
C. The client being distressed in the mornings
D. A progressive, bilateral loss of hearing.

Answer 9

D: Progressive, bilateral loss of hearing is characteristic symptom. Tinnitus appears as the loss of hearing progresses- especially at night, when sounds are quiet, which may be quite distressing; eardrum appears pinkish-orange from structural changes in middle ear.
Otitis media relates to an upper respiratory infection

Question 10

Audiometry consists of mechanical sound transmission, neural sound transmission, and speech discrimination ability. What are the locations of function for each of those tests?

Answer 10

Mechanical sound transmission (middle ear function)
Neural sound transmission (cochlear function)
Speech discrimination (central integration)

Question 11

Abbreviation for within normal limits

Answer 11

(WNL)

Question 12

Abbreviation for head, eyes, nose, and throat assessment

Answer 12

HEENT

Question 13

Most common cause for conductive hearing loss in children?

Answer 13

Frequent episodes of acute otitis media. Requires early invention. Monitor for pain, temperature, swelling behind the tympanic membrane. Would require a dose of antibiotics, as well as a referral to a audiologist for a hearing eval.
Pain and fever should resolve after antibiotic treatment. Hearing issues should not be monitored in a clinic, so referral to an ENT is priority for early intervention.

Question 14

Cytomegalovirus infection during parent’s pregnancy is linked to what?

Answer 14

Hearing loss in children> not if the child is infected themselves.

Question 15

T or False. Trisomy 21 (down syndrome) is associated with hearing loss

Answer 15

T. increases risk of hearing loss in children.

Question 16

When are topical steroids administered for children with an ear complaint?

Answer 16

If there is a perforation of the tympanic membrane.

Question 17

The parent of a child having tympanoplasty tubes placed asks, “Will my child lose hearing while the tubes are in place?” What is the best answer?

Answer 17

The tubes are inserted into a section of eardrum in which the hearing is not affected.

Question 18

What do tympanostomy tubes do?

Answer 18

helps to ventilate the cavities of the middle ear and balance the pressure on each side of the tympanic membrane. No risk of permanent deafness and hearing will be increased while the tubes are in place.

Question 19

A client has been diagnosed with hearing loss related to damage of the cochlea. What term is used to describe this condition?
A. Sensorineural hearing loss
B. Presbycusis
C. Exostoses
D. Otalgia

Answer 19

A. Sensorineural hearing loss is hearing related to damage of the end organ for hearing (cochlea) or cranial nerve VIII.
Exostoses refers to small, hard, bony protrusions in the lower posterior bony portion of the ear canal.
Otalgia refers to a sensation of fullness or pain in the ear.
Presbycusis refers to progressive hearing loss associated with aging. Middle and inner ear age-related changes result in hearing loss.

Question 20

The nurse is caring for a client who reports, “My ears are constantly ringing!” The nurse will evaluate the client further for the use of which medication?
A. acetylsalicylic acid (aspirin)
B. acetaminophen
C. vitamin C
D. potassium chloride

Answer 20

A

Question 21

A nursing instructor is speaking to a group of nursing students about proper care of the ears to promote hearing as well as techniques to follow when working with clients with hearing impairment. Which nursing intervention is appropriate?
A. cleaning the clients ears daily
B. demonstrating or pantomiming ideas
C. speaking loudly and directly
D. encouraging the use of earphones adjusted to a loud volume for hearing.

Answer 21

B

Question 22

A client diagnosed with otosclerosis is able to hear bone conduction longer than air conduction when the Rinne test is performed. How should the nurse classify this client’s hearing?
A. Bilateral conductive hearing loss
B. Unilateral conductive hearing loss

Answer 22

B.
Otosclerosis is usually a cause of unilateral conductive hearing loss.

Question 23

A client with hypertension comes to the outpatient department for a routine checkup. Because hypertension is a risk factor for cerebral hemorrhage, the nurse questions the client closely about warning signs and symptoms of hemorrhage. Which complaints are a possible indicator of cerebral hemorrhage in this client? (SATA)
A. Visual aura
B. Seizures
C. Nausea
D. Tinnitus

Answer 23

B,C,D
Warning signs of cerebral hemorrhage include severe headache, nausea, vomiting, tinnitus,, a change in level of consciousness, and seizures. Loss of vision or diplopia may be experienced but a visual aura is not a common indicator.

Question 24

A patient on anti-arrhythmic drug therapy reports nausea, vomiting, abdominal pain, diarrhea, and a ringing sensation in the ears. Which drug should the nurse consider as the cause for these adverse effects?
A. Flecainide
B. Lidocaine
C. Quinidine
E. Procainamide

Answer 24

C. Quinidine toxicity is called cinchonism. Symptoms may present ringing in the ears (tinnitus), hearing loss, headache, nausea, vomiting, abdominal pain, dizziness, vertigo, and light-headedness.
*Lidocaine, flecainide, and procainamide do not cause tinnitus or hearing loss

Question 25

Which type of intoxication may include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, hyperventilation, and others.

Answer 25

Salicylate (overdose on aspirin)
-Acetaminophen toxicity results in fatal hepatoxicity.
-Ibuprofen overdose causes gastric mucosal damage.
Caffeine overdose = tachycardia

Question 26

What disease is associated with conductive hearing loss?
A. Alzheimer disease
B. Huntington disease
C. Paget disease
D. Parkinson disease

Answer 26

C. Permanent causes of hearing loss are thickening or damage of the tympanic membrane or involvement of the bony structures (ossicles and oval window) of the middle ear due to otosclerosis or Paget disease.
-Huntington, Alzheimer, and Parkinson diseases are not associated with conductive hearing loss

Question 27

The nurse is caring for a client in the triage section of a walk-in clinic. Which triad of common symptoms suggests a diagnosis of Meniere disease?
A. hearing loss, vertigo, tinnitus
B. syncope, vertigo, ear pain
C. blurred vision, vertigo, nausea
D. disorientation, vertigo, nausea

Answer 27

A. This triad is characteristic of Meniere disease

Question 28

When assessing a client’s risk for hearing loss, what related client teaching would be important? (SATA)
A. types of noises to avoid
B. types of protective equipment used
C. instruction for the use of protective ear equipment
D. length of time to limit protective equipment
E. Effectiveness of protective equipment

Answer 28

B,C,E.

Question 29

The nurse is assessing a client’s risk for sensorineural hearing loss. Which condition or situation places the client at risk?
A. otitis media
B. impacted cerebrum
C. Chronic noise exposure
D. otosclerosis

Answer 29

C. otitis media and impacted earwax are factors related to conductive hearing loss

Question 30

The parents are questioning why their newborn was born deaf when there are no other deaf family members. The nurse could explore possible exposure to teratogenic agent at which stage of the pregnancy?
A. 6 weeks
B. at fertilization
C. 18 weeks
D. 12 weeks

Answer 30

A. Teratogenic agents ingested during embryonic stage (2-8 weeks) can affect the neurologic system of the fetus.
*weeks 6-8 the fetus is most vulnerable to teratogenic agents.
-through week 2, there is a decreased risk due to no implantation or transfer of substances from the mother to the developing blastocyte.
-From weeks 9-birth, risk from teratogenics are decreased as focus is on the formation of fetal growth.

Question 31

The parent of a young client with severe hearing loss is quite concerned about the child’s future independence and asks about the effectiveness of hearing aids. What information should the nurse include when responding?
A. Hearing aids may help, but other methods such as reading lips will likely be required
B. Hearing aids are not required at this time.
C. Hearing aids will restore the client’s ability to hear normal sounds and conversations

Answer 31

A. A client with severe hearing loss will not be able to hear many sounds and will miss most conversational content. Powerful hearing aids may help, but the client and parent will also want to pursue other methods to manage the hearing impairment and facilitate independence, such as learning to read lips and possible use of sign language.
Hearing aids would be able to restore the ability to understand conversations for someone with moderate, not severe, hearing impairment.
-Hearing aids would not be necessary for someone with mild hearing impairment, and they would not work for someone who is completely deaf.

Question 32

For which type of hearing loss should the nurse assess in a child who has had recurrent otitis media since birth?
A. cochlear nerve loss
B. conductive loss

Answer 32

Any hearing loss associated with recurring otitis media is conductive hearing loss.