A
A client is being discharged home after mastoid surgery. What topic should the nurse address in the client's discharge education?
A. Expected changes in facial nerve function
B. The need for audiometry testing every 6 months following recovery
C. Safe use of analgesics and antivertiginous agents
D. Appropriate use of over-the-counter (OTC) ear drops
ANS: C
Rationale: Clients require instruction about medication therapy, such as analgesics and antivertiginous agents (e.g., antihistamines) prescribed for balance disturbance. Over-the-counter (OTC) ear drops are not recommended and changes in facial nerve function are signs of a complication that needs to be addressed promptly. There is no need for serial audiometry testing.
After mastoid surgery, an 81-year-old client has been identified as needing assistance in her home. What would be a primary focus of this client's home care?
A. Preparation of nutritious meals and avoidance of contraindicated foods
B. Ensuring the client receives adequate rest each day
C. Helping the client adapt to temporary hearing loss
D. Assisting the client with ambulation as needed to avoid falling
D
Rationale: The caregiver and client are cautioned that the client may experience some vertigo and will therefore require help with ambulation to avoid falling. The client should not be expected to experience hearing loss and no foods are contraindicated. Adequate rest is needed, but this is not a primary focus of home care.
A hearing-impaired client is scheduled to have an MRI. What would be important for the nurse to remember when caring for this client?
A. Client is likely unable to hear the nurse during test.
B. A person adept in sign language must be present during test.
C. Lip reading will be the method of communication that is necessary.
D. The nurse should interact with the client like any other client.
ANS: A
Rationale: During health care and screening procedures, the practitioner (e.g., dentist, health care provider, nurse) must be aware that clients who are deaf or hearing impaired are unable to read lips, see a signer, or read written materials in the dark rooms required during some diagnostic tests. The same situation exists if the practitioner is wearing a mask or not in sight (e.g., x-ray studies, MRI, colonoscopy).
A 6-month-old infant is brought to the ED by the parents for inconsolable crying and pulling at the right ear. When assessing this infant, the advanced practice nurse is aware that the tympanic membrane should be what color in a healthy ear?
A. Yellowish-white
B. Pink
C. Gray
D. Bluish-white
ANS: C
Rationale: The healthy tympanic membrane appears pearly gray and is positioned obliquely at the base of the ear canal. Any other color is suggestive of a pathologic process.
A child has been experiencing recurrent episodes of acute otitis media (AOM). The nurse should anticipate that what intervention is likely to be ordered?
A. Ossiculoplasty
B. Insertion of a cochlear implant
C. Stapedectomy
D. Insertion of a ventilation tube
ANS: D
Rationale: If AOM recurs and there is no contraindication, a ventilating, or pressure-equalizing, tube may be inserted. The ventilating tube, which temporarily takes the place of the eustachian tube in equalizing pressure, is retained for 6 to 18 months. Ossiculoplasty is not used to treat AOM and stapedectomy is performed to treat otosclerosis. Cochlear implants are used to treat sensorineural hearing loss.
An older adult with a recent history of mixed hearing loss has been diagnosed with a cholesteatoma. What should this client be taught about this diagnosis? Select all that apply.
A. Cholesteatomas are benign and self-limiting, and hearing loss will resolve spontaneously.
B. Cholesteatomas are usually the result of metastasis from a distant tumor site.
C. Cholesteatomas are often the result of chronic otitis media.
D. Cholesteatomas, if left untreated, result in intractable neuropathic pain.
E. Cholesteatomas usually must be removed surgically.
ANS: C, E
Rationale: Cholesteatoma is a tumor of the external layer of the eardrum into the middle ear, often resulting from chronic otitis media. They usually do not cause pain; however, if treatment or surgery is delayed, they may burst or destroy the mastoid bone. They are not normally the result of metastasis and are not self-limiting.
Upon examination via otoscopy, a red blemish behind the tympanic membrane is suggestive of what diagnosis?
A. Acoustic tumor
B. Cholesteatoma
C. Facial nerve neuroma
D. Glomus tympanicum
ANS: D
Rationale: In the case of glomus tympanicum, a red blemish on or behind the tympanic membrane is seen on otoscopy. This assessment finding is not associated with an acoustic tumor, facial nerve neuroma, or cholesteatoma.
The nurse is discharging a client home after mastoid surgery. What should the nurse include in discharge teaching?
A. "Try to induce a sneeze every 4 hours to equalize pressure."
B. "Be sure to exercise to reduce fatigue."
C. "Avoid sleeping in a side-lying position."
D. "Don't blow your nose for 2 to 3 weeks."
ANS: D
Rationale: The client is instructed to avoid heavy lifting, straining, exertion, and nose blowing for 2 to 3 weeks after surgery to prevent dislodging the tympanic membrane graft or ossicular prosthesis. Side-lying is not contraindicated; sneezing could cause trauma.
An advanced practice nurse has performed a Rinne test on a new client. During the test, the client reports that air-conducted sound is louder than bone-conducted sound. How should the nurse best interpret this assessment finding?
A. The client's hearing is likely normal.
B. The client is at risk for tinnitus.
C. The client likely has otosclerosis.
D. The client likely has sensorineural hearing loss.
ANS: A
Rationale: The Rinne test is useful for distinguishing between conductive and sensorineural hearing loss. A person with normal hearing reports that air-conducted sound is louder than bone-conducted sound.
A nurse is preparing a presentation for a group of elementary school parents about ways to promote the health of the ears and hearing in their children. When describing the structure and function of the ears, which structure would the nurse most likely include as part of the middle ear? Select all that apply.
A. pinna
B. tympanic membrane
C. oval window
D. cochlea
E. organ of Corti
ANS: B, C
Rationale: The middle ear contains the tympanic membrane and oval window. The pinna is part of the external ear. The cochlea and organ of Corti are part of the inner ear.
A older adult client comes to the clinic for an evaluation. The client says, "It just doesn't seem like I hear as well as I used to hear." As part of the assessment, the nurse evaluates the client's gross auditory acuity. Which test would the nurse most likely conduct?
A. whisper test
B. Weber test
C. Rinne test
D. audiometry
ANS: A
Rationale: A general estimate of hearing can be made by assessing the client's ability to hear a whispered phrase or a ticking watch, testing one ear at a time. The Weber and Rinne tests may be used to distinguish conductive loss from sensorineural loss when hearing is impaired. Audiometry is an important diagnostic test to evaluate hearing and provides specific information about a person's hearing status.
A client is scheduled for audiometry to evaluate hearing. When teaching the client about this test, which characteristic would the nurse include as being evaluated? Select all that apply.
A. pitch
B. frequency
C. intensity
D. compliance
E. postural control capabilities
ANS: A, B, C
Rationale: When evaluating hearing, three characteristics are important: frequency, pitch, and intensity. Frequency refers to the number of sound waves emanating from a source per second, measured as cycles per second, or Hertz (Hz). Pitch is the term used to describe frequency; a tone with 100 Hz is considered of low pitch, and a tone of 10,000 Hz is considered of high pitch. The unit for measuring loudness (intensity of sound) is the decibel (dB), the pressure exerted by sound. Compliance refers to the tympanic membrane function and is measured by a tympanogram. A platform post-urography is used to measure postural control capabilities.
A nurse suspects that an older adult client may be experiencing hearing loss. Which finding would support the nurse's suspicion? Select all that apply.
A. Dropping of word endings
B. Disinterest in conversations
C. Social withdrawal
D. Domination of conversations
E. Quick decision making
ANS: A, B, C, D
Rationale: The person who slurs words or drops word endings, or produces flat-sounding speech, may not be hearing correctly. The ears guide the voice, both in loudness and in pronunciation. It is easy for the person who cannot hear what others say to become depressed and disinterested in life in general. Not being able to hear causes a person who is hearing-impaired to withdraw from situations that might prove embarrassing. Lack of self-confidence and fear of mistakes create a feeling of insecurity in many people who are hearing-impaired. No one likes to say the wrong thing or do anything that might appear foolish. Loss of self-confidence makes it increasingly difficult for a person who is hearing-impaired to make decisions. Many people who are hearing-impaired tend to dominate the conversation, knowing that as long as it is centered on them and they can control it, they are not so likely to be embarrassed by some mistake.
A client with hearing loss is scheduled to undergo aural rehabilitation. When describing this therapy, the nurse would include which information as the primary purpose?
A. Increase hearing ability.
B. Maximize ability to communicate.
C. Facilitate use of a hearing aid.
D. Limit extraneous noise.
ANS: B
Rationale: If hearing loss is permanent or cannot be treated by medical or surgical means, or if the client elects not to undergo surgery, aural rehabilitation may be beneficial. The purpose of aural rehabilitation is to maximize the communication skills of the person with hearing impairment. Aural rehabilitation includes auditory training, speech reading, speech training, and the use of hearing aids and hearing guide dogs.
A client develops a perforated eardrum. When teaching the client about this condition, the nurse would identify which condition as a most likely cause?
A. infection
B. otosclerosis
C. Meniere disease
D. cholesteatoma
ANS: A
Rationale: Perforation of the tympanic membrane is usually caused by infection or trauma. Sources of trauma include skull fracture, explosive injury, or a severe blow to the ear. Less frequently, perforation is caused by foreign objects (e.g., cotton-tipped applicators, bobby pins, keys) that have been pushed too far into the external auditory canal. A perforated eardrum is not associated with Meniere's disease, otosclerosis, or cholesteatoma.