Ch 40: Assessment and Concepts of Care for Patients With Ear and Hearing Conditions (Evolve Questions)

Which statement by a client with progressive hearing loss would the nurse further assess as the priority?

A. "I think I may need a phone amplifier."

B. "It's getting harder for me to hear people in restaurants."

C. "It's easier for me to stay home than to go out and socialize."

D. "I would like to talk to the audiologist about getting better hearing aids."

C

The nurse will further explore the client's statement about staying home versus going out to socialize as the priority. This statement could indicate that the client is discouraged or is becoming more socially isolated (Choice C). The other statements can be further explored later because in those statements the client is demonstrating self-advocacy by reporting personal concerns and/or considering interventions. Considering the purchase of an amplifier for the phone is proactive (Choice A). Stating that it is getting harder to hear people in restaurants indicates that the client is still socially active but notices a problem to address (Choice B). Wanting to talk to the audiologist about better hearing aids indicates a proactive approach toward enhancing hearing (Choice D).

The nurse is caring for a client with progressive hearing loss. Which action would the nurse teach assistive personnel (AP) when delegating hearing aid care?

A. Clean the ear mold with alcohol to remove debris.

B. Store the cleaned devices in a dry, sealed container.

C. Immerse the hearing aid in warm water after cleaning it.

D. Take the hearing aid apart to assure that the inside is cleaned

B

Hearing aids provide an important service to the client and can be very costly. The nurse will instruct the AP to protect the devices by storing them in a dry, sealed container (Choice B). This minimizes exposure to environmental moisture and protects the devices if dropped. The ear mold should be cleaned with mild soap and water (Choice A). Alcohol is too harsh. The hearing aids should never be immersed in water, as this could also damage them (Choice C). Hearing aids should never be taken apart by AP or the nurse (Choice D); any action like this must be performed by a hearing aid specialist.

Which of the following client statements regarding Ménière disease demonstrates to the nurse an understanding of this condition? Select all that apply.

A. "I am not going to drive when I have an attack."

B. "Surgery is going to be required to fix this problem."

C. "If I begin to feel dizzy, I will sit or lie down immediately."

D. "When I drink a lot of caffeine, the vertigo seems to be worse."

E. "This problem may come and go over the course of my lifetime."

A, C, D, E

Tinnitus is a condition that ranges from mild ringing to severe roaring in the ear. Clients who state that they should not drive during an attack—which usually involves dizziness or vertigo—and that they should lie down as soon as they feel symptoms have demonstrated an understanding of this condition. Identifying triggers, such as high salt intake, caffeine, monosodium glutamate (MSG), alcohol, nicotine, stress, and allergens, demonstrates understanding. Recognizing that this condition may persist over a lifetime demonstrates understanding. Surgery is a last resort treatment method; lifestyle modifications and nonsurgical interventions are always used first

The nurse is caring for a client who is deaf. Which communication method would the nurse use when beginning to perform care?

A. Ask the client to read lips.

B. Talk to the family member.

C. Enunciate words when speaking.

D. Use a board for pictures and writing

D

The nurse will use a board with pictures and writing to communicate with a client who is deaf (Choice D). This facilitates communication, as the client and the nurse can point to pictures or write messages. Not all clients who are deaf can read lips (Choice A). Dialoguing specifically with the client's caregivers excludes the client from participation in their own care (Choice B). It is inappropriate to enunciate words, as the client cannot hear (Choice C)

The nurse is teaching older adults at a community health fair. Which of the following hearing changes associated with aging would the nurse discuss? Select all that apply.

A. Hair in the ear thickens and accumulates.

B. Hearing acuity changes in all older adults.

C. Cerumen dries and becomes more easily impacted.

D. The ability to hear high-frequency pitches diminishes first.

E. Sounds such as f, s, sh, and pa become more difficult to discern.

A, C, D, E

The nurse will teach the group of older adults that as part of the aging process, hair in the ear thickens and accumulates (Choice A), cerumen dries and becomes more easily impacted (Choice C), the ability to hear high-frequency pitches diminishes first (Choice D), and sounds such as f, s, sh, and pa become more difficult to discern (Choice E). Hearing acuity changes in some—but not all—older adults (Choice B)

When preparing to examine a client's ear with drainage, which action will the nurse take?

A. Whisper in the client's ear.

B. Provide reassurance that ear drainage is normal.

C. Give the client a gown to wear during the examination.

D. Don clean gloves.

D

The nurse needs to don clean gloves to prevent infection, as Contact Precautions need to be used when assessing drainage from a client's ear canal. Whispering in the client's ear is not used when examining an ear for drainage. Ear drainage is not normal and must be investigated. The client does not need to wear a gown during an ear examination.

The nurse is talking to a client about cerumen removal from the ear canal. Which statement by the client indicates a need for further teaching?

A. "I dry my ears using my fingertip and a towel."

B. "I use Swim-Ear after I go swimming."

C. "I should not use an ear candle to soften the wax."

D. "I use a cotton swab to remove earwax."

D

Further teaching is needed when the client states, "I use a cotton swab to remove earwax." Nothing smaller than the client's own fingertip should be inserted into the ear canal. Use of a cotton swab or other device like a key can scrape the skin of the canal, push cerumen up against the eardrum, and even puncture the eardrum. All other statements are appropriate and do not require further teaching.

During an assessment, an older adult client appears frustrated and says, "Speak up and quit mumbling!" What is the appropriate nursing response?

A. Apologize and speak louder and clearer.

B. Ask if the client has hearing loss.

C. Raise the voice higher to be heard.

D. Suggests moving to a soundproof examination room.

A

The nurse will apologize, repeat and speak more clearly first and then determine whether further assessment is needed. It would not be assumed that the client has a hearing loss; this suggestion may frustrate the client, especially if they are denial. Raising the voice higher is not recommended because it can make understanding more difficult; this is also considered rude and nontherapeutic. Soundproof rooms are used for hearing tests, not for routine assessments.

The nurse is teaching a client with dizziness associated with tinnitus about safety precautions for fall prevention. Which statement by the client indicates a need for further instruction?

A. "I may need to use a cane to keep my balance."

B. "My grandchildren need to keep their toys out of the hallway."

C. "Moving more slowly may help the vertigo subside."

D. "Medication alleviates dizziness, so I can drive."

D

The client's statement about taking medication and driving a car indicates further teaching is needed. Medications for dizziness associated with tinnitus can cause drowsiness, so the client must not drive or operate machinery while taking these drugs. All other statements are appropriate and do not require further teaching.

An older adult client reports ear pain. Which assessment finding will the nurse report as the priority to the health care provider?

A. Dry, flaky cerumen

B. Pain on movement of the tragus

C. Ringing in the ears

D. Intermittent dizziness

D

Dizziness could be the indication of numerous clinical findings; also, the client's risk for falling (or other safety concerns) is raised when dizziness is present. The nurse will report this symptom as the priority to the health care provider. The other concerns can be reported secondary to dizziness.

An older adult client reports nausea during irrigation of the ear canal to remove impacted cerumen. Which action will the nurse take?

A. Administer an antiemetic.

B. Call the health care provider.

C. Stop irrigation immediately.

D. Use less water to irrigate.

C

If nausea, vomiting, or dizziness develops in the client, the nurse needs to stop the irrigation immediately. Nausea may be a sign of impending vertigo. Antiemetics would not be administered immediately in this case, as further assessment is required first. The health care provider would not be notified before further assessment of the client is done by the nurse. Using less water will not alleviate the client's nausea.

Which drug does the nurse anticipate will be prescribed for a client with Ménière disease to decrease endolymph volume?

A. Ibuprofen

B. Atorvastatin

C. Furosemide

D. Doxazosin

C

Mild diuretics like furosemide are often prescribed to decrease endolymph volume. Ménière disease causes an excess of endolymphatic fluid that distorts the entire inner-canal system. This distortion decreases hearing by dilating the cochlear duct, causes vertigo because of damage to the vestibular system, and stimulates tinnitus. Ibuprofen, atorvastatin, and doxazosin are not indicated for Ménière disease. Ibuprofen should be avoided, as it can increase water retention.

A client is returned to the medical-surgical unit immediately after tympanoplasty. How will the nurse position the client?

A. On the affected side

B. Supine, with eyes toward the ceiling

C. With the head elevated 60 degrees

D. Flat with the affected ear facing up

D

The nurse keeps the client flat, with the head turned to the side and the operative ear facing up, for at least 12 hours after surgery. All other choices are incorrect and do not facilitate healing.

The nurse is reviewing postoperative instructions with a client undergoing stapedectomy. Which client statement indicates a need for further teaching?

A. "I may have problems with vertigo after the surgery."

B. "I should not drink from a straw for several weeks."

C. "I will have to take antibiotics after the surgery."

D. "I will be able to hear better as soon as my dressing is removed."

D

Further teaching is necessary if the client states that hearing will be better as soon as the dressing is removed. Hearing is initially worse after a stapedectomy. The client would be informed that improvement in hearing may not occur until 6 weeks after surgery. At first, the ear packing interferes with hearing, and swelling in the ear after surgery reduces hearing, but these conditions are temporary. All other statements are appropriate and do not require further teaching.

The nurse is caring for a client who is admitted with mastoiditis. Which nursing action is appropriate?

A. Prepare to administer IV antibiotics.

B. Teach about using an ear drying agent.

C. Don gloves to examine the pinna.

D. Perform a baseline hearing assessment.

C

The appropriate nursing action when a client is admitted for mastoiditis is to prepare to administer IV medication. Mastoiditis can progress to a brain abscess, meningitis, or death if not appropriately managed. Teaching about using an ear drying agent, donning gloves to examine the pinna, and performing a baseline hearing assessment are not parts of care associated with mastoiditis. Interventions are focused on halting the infection before it spreads to other structures.

The nurse has just received change-of-shift report about these clients. Which client will the oncoming nurse assess first?

A. Client with Ménière’s disease who is reporting severe nausea and is requesting an antiemetic

B. Client who has had removal of an acoustic neuroma and has complete hearing loss on the surgical side

C. Client with labyrinthitis who has a temperature of 103.1°F (39.5°C) and a severe headache

D. Client who has acute otitis media and is reporting drainage from the affected ear

C

The client with an elevated temperature and headache with labyrinthitis must be assessed first. These findings may indicate that the client has developed meningitis requiring immediate intervention. Severe nausea is an expected finding with Ménière’s disease. Complete hearing loss on the surgical side is an expected postoperative finding after an acoustic neuroma. Drainage from the affected ear can be an expected finding with otitis media. These clients can be seen after the client with potential meningitis.

Which client does the nurse identify that is at high risk for developing hearing problems? (Select all that apply.)

A. Airline mechanic

B. Client with Down syndrome

C. Drummer in a rock band

D. Young adult regularly listening to music with ear buds

E. Telephone operator

A, B, C, D

Clients who are at high risk for hearing problems include an airline mechanic who is exposed to excessive noise, a client with Down syndrome, (a genetic condition associated with frequent hearing problems), a drummer in a rock band due to exposure to loud noise, and a young adult listening to music using ear buds. Ear buds are known risk factors for increasing potential hearing loss among people who use them on a regular basis with elevated noise levels. The telephone operator is not at risk for hearing problems, as they are not frequently exposed to loud noises.

The nurse is assessing a client with recent changes in hearing. After taking a medication history, which drug does the nurse identify as a possible cause of the client’s hearing change? (Select all that apply.)

A. Acetaminophen

B. Atenolol

C. Erythromycin

D. Ibuprofen

E. Furosemide

C, D, E

The nurse identifies erythromycin, ibuprofen, and furosemide as medications known to increase the risk for ototoxicity and hearing problems. Acetaminophen and beta blockers are not known ototoxic drugs.