Unit 5 Chapter 20 Path

Question 1

A 26-year-old client who has recently traveled by airplane complains of pain in his right ear. The nurse suspects which condition?

A) Barotrauma

B) Otitis externa

C) Cerumen accumulation

D) Otitis media

Answer 1

A) 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.

Question 2

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

C) Cerumen impaction loss

D) Sensorineural loss

Answer 2

B) Conductive loss

Rationale:Hearing loss that is associated with recurrent otitis media is conductive loss.

Question 3

Which condition or situation is a risk factor for the development of acute otitis media in a child?

A) Upper respiratory infection

B) Repeated exposure to loud noises

C) Inappropriate ear hygiene techniques

D) Foreign object in the ear

Answer 3

A) 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.

Question 4

A client, who travels frequently for work, reports intense ear pain during ascent from and descent into airports. The health care provider will recommend which category of medications to help alleviate this symptom?

A) oral corticosteroid, such as prednisone

B) antihistamine nasal spray such as olopatadine

C) decongestant nasal spary such as phenylephrine

D) intranasal steroid such as fluticasone propionate

Answer 4

C) decongestant nasal spary such as phenylephrin

Rationale:Barotrauma most often occurs in people who travel while suffering from an upper respiratory tract infection. Decongestants, such as nose drops or nasal sprays, may be used 30 to 60 minutes prior to ascent or descent to reduce congestion and open the eustachian tubes. Steroids are not recommended for barotrauma. They are helpful for inflammation and nasal polyps. Antihistamines are helpful for tinnitus and vertigo.

Question 5

Which interventions will the nurse reinforce when preparing to discharge a client being treated for Ménière’s disease?

A) Insert cotton balls to protect ear canal

B) Compliance with prescribed prednisone therapy

C) Avoidance of foods high in saturated fats

D) Implementation of a physical exercise routine

Answer 5

B) 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.

Question 6

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.

A) Vitamin D supplements

B) A beta adrenergic blocker

C) A loop diuretic

D) An opioid analgesic

E) Aspirin

Answer 6

C) A loop diuretic
E) Aspirin

Rationale:Loop diuretics and aspirin are among the drugs known to cause ototoxicity. Beta blockers, vitamin D, and opioids do not have this effect.

Question 7

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?

A) Administration of the measles–mumps–rubella (MMR) vaccine

B) Gently rinsing the infant’s outer ears with saline twice weekly

C) Administration of the hepatitis B vaccine

D) Limiting the infant’s exposure to large group settings

Answer 7

D) 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

Question 8

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?

A) Radiates to the side without the hearing loss

B) Cannot be heard on either side

C) Can be heard equally on both sides

D) Is louder on the side with the hearing loss

Answer 8

D) 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.

Question 9

Presbycusis is degenerative hearing loss associated with aging. What is the first symptom of this disorder?

A) Reduction in ability to understand speech

B) Inability to detect sound

C) Inability to localize sounds

D) Reduction in ability to identify sounds

Answer 9

A) 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.

Question 10

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.

A) “Yes, he has been pulling at his ear.”

B) “He jabbers all the time usually.”

C) “He’s been very irritable and fussy the past couple of days.”

D) “When I dropped a pan on the floor, he jumped.”

E) “We like to throw him up in the air hoping any water in his ear will drain.”

Answer 10

A) “Yes, he has been pulling at his ear.”
C) “He’s been very irritable and fussy the past couple of days.”

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.

Question 11

To diagnose a vestibular disorder, which test would be used that assesses the eye movements in response to vestibular, visual, and positional stimulation?

A) Romberg test

B) Caloric stimulation

C) Electronystagmography

D) Audiogram

Answer 11

C) 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.

Question 12

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:

A) Sensorineural disorder

B) Mixed sensorineural and conduction disorder

C) Conduction disorder

D) Infection

Answer 12

C) Conduction disorder

Rationale:Impacted earwax is one cause for conductive hearing loss. It is not a cause of the other answer choices

Question 13

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?

A) Avoid crowds to reduce infection

B) Avoid acetaminophen

C) Decrease dietary intake of fats

D) Decrease dietary intake of sodium

Answer 13

D) 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

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.

A) Glucocorticosteroids

B) Loop diuretics

C) Some chemotherapeutic drugs

D) Aminoglycosides

E) Antidiabetic agents

Answer 14

B) Loop diuretics
C) Some chemotherapeutic drugs
D) Aminoglycosides

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.

Question 15

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.

A) Vascular decompression

B) Use of sign language

C) Speech reading class

D) Hearing aids

E) Closed captioning on televised programs

Answer 15

C) Speech reading class
D) Hearing aids
E) Closed captioning on televised programs

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

Question 16

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.

A) Asking your health care professional to prescribe an anti-motion sickness drug

B) Reading a book while traveling

C) Chewing gum while traveling

D) Looking out of the car window and focusing on the scenery

Answer 16

A) Asking your health care professional to prescribe an anti-motion sickness drug
D) 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.

Question 17

A client reports feeling like the room is spinning around him when standing still. Which diagnosis is this client likely experiencing?

A) Syncopal episodes

B) Objective vertigo

C) Nystagmus

D) Subjective vertigo

Answer 17

B) 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.”

Question 18

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:

A) “How often do you clean your ears?”

B) “What prescription medication and over-the-counter medication do you take?”

C) “Have you had any recent respiratory infections?”

D) “Do you use Q-tips in your ears?

Answer 18

B) “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.

Question 19

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?

A) “If there is a hearing problem, it can be addressed right away before your baby starts to adapt to it.”

B) “We do these tests to ensure that all fluids from birth have been cleared from your baby’s auditory canal.”

C) “It’s actually a very easy test, so it’s best to just get it out of the way now.”

D) “We prioritize these tests in order to determine if any hearing damage occurred during the birth process.”

Answer 19

A) “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.

Question 20

The nurse is teaching a client who has tinnitus about suggested dietary modifications. The most important information for the nurse to include would be:

A) “You can drink one serving of caffeine a day and one cola.”

B) “There are no dietary restrictions that you have to follow.”

C) “Cut down on takeout meals because of high amounts of monosodium glutamate.”

D) “Increase intake of red wine to two glasses per day twice a week.”

Answer 20

C) “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.

Question 21

What are the clinical manifestations of Ménière disease? Select all that apply.

A) Acute pain in ear(s)

B) Episodes of disabling vertigo

C) Dizziness triggered by turning the head

D) Feeling of fullness in the ear(s)

E) Severe ringing in the ear(s)

Answer 21

B) Episodes of disabling vertigo
C) Dizziness triggered by turning the head
D) Feeling of fullness in the ear(s)
E) Severe ringing in the ear(s)

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.