Question 1

Which action is most appropriate when performing ear irrigation to remove excess wax? The nurse should

Accepted Answer

The irrigating solution (usually water) is warmed to body temperature and placed in the irrigating syringe. The client's head should be positioned with the ear to be tipped downward so the irrigation solution runs out easily. If you obstruct the ear canal, the fluid cannot flow out of the ear. Spraying the external ear with antiseptic is not part of the procedure.

Question 2

A client's family reports that the client does not hear well. The client becomes angry and defensive and denies having a hearing problem. The best response by the nurse would be

Accepted Answer

This response opens up an avenue for communication in which the client's feelings are acknowledged. The client must go through the steps of grieving before accepting the hearing loss and beginning any type of program to help with hearing. Option b might be a helpful thing to say when a client is considering a hearing aid, but at this point would diminish the client's feelings, as does option c. Option d is argumentative.

Question 3

The occupational health nurse evaluating a factory where the noise level is high would recommend noise abatement or use of earplugs when the noise level exceeds

Accepted Answer

Exposure to noise levels in excess of 80 decibels (dB) over a period of 8 hours is considered excessive.

Question 4

The nurse would explain that a nonsurgical approach to reduce the clinical manifestations of labyrinthitis is injection of an ototoxic drug into the middle ear to

Accepted Answer

The ototoxic drug destroys hair cells in the middle ear, which will reduce the manifestations of vertigo.

Question 5

The school nurse teaches the young swimmer that the earliest manifestation of external otitis is

Accepted Answer

A clue to early external otitis is tenderness when the pinna is gently pulled on, in contrast to otitis media, in which touching the ear does not cause pain.

Question 6

The nurse caring for a frail 72-year-old client recently diagnosed with Ménière's disease would know that the nursing diagnosis frequently associated with this problem that is the priority for the client is

Accepted Answer

Ménière's disease causes vertigo and balance problems; thus the client is at risk for injury, particularly because the client is frail.

Question 7

The nurse assessing a client with an inner ear disorder would be aware that the presenting clinical manifestation will be

Accepted Answer

Sensorineural hearing loss results from disease or trauma to the organ of Corti or auditory nerve pathways of the inner ear leading to the brain stem.

Question 8

To provide appropriate instructions to a client who has an ear wick inserted to facilitate medication administration for external otitis, the nurse would advise the client to

Accepted Answer

Ear drops are placed directly on the wick. Milk has no effect on ear infections and wick-administered medications. Clients are advised to keep water out of their ears during any infectious process. They should lie on the unaffected side for 3-5 minutes after instillation of the medicine.

Question 9

The nurse is assigning an unlicensed assistive personnel (UAP) to work with a client who has a hearing aid. Which action by the UAP is inconsistent with appropriate delegation? The nurse asks the UAP to

Accepted Answer

Nurses are able to delegate many simple tasks to the UAP who is working with a client who has a hearing aid. However, teaching and evaluation of teaching must be done by the professional nurse.

Question 10

When a client who underwent vestibular surgery complains of thirst, the nurse would avoid offering this client

Accepted Answer

The client should avoid caffeine, which is a vestibular stimulant.

Question 11

A young client has a perforation of the tympanic membrane that occurred while cleaning the ear with a pointed object. The nurse would advise that

Accepted Answer

A perforation may be either acute, as seen in trauma and acute infection, or chronic, as seen in repeated infection. An acute perforation has a better chance of healing spontaneously than does a chronic perforation.

Question 12

After assisting a client with insertion of a hearing aid, the nurse would

Accepted Answer

After a client has the hearing aid in place, the nurse should allow the client to adjust the volume before speaking.

Question 13

An 82-year-old man tells the nurse he is having difficulty hearing and that he has "too much ear wax." Because of the client's age, the nurse would ask

Accepted Answer

Obstruction of the ear is most often caused by impacted cerumen. Older adults are more susceptible to cerumen impaction because hair in the ear becomes coarser with age and traps the wax. Impacted cerumen can cause hearing loss in clients of all ages.

Question 14

The problem with the ear that the nurse would consider to be associated with the aging process is

Accepted Answer

Many physiologic changes lead to changes in hearing in older adults. Presbycusis is a progressive hearing loss seen predominantly in older clients. Amblyopia is a vision condition with diminished vision in one eye. Otalgia is ear pain. Tinnitis is noise, often ringing, in the ears.

Question 15

The nurse is aware that when speaking with a client who has impaired hearing in the right ear, the behavior that would make it more difficult for the client to understand the communication is

Accepted Answer

The nurse should not smile, chew gum, or cover the mouth while talking to a hearing- impaired client because such activities distort the lip movement and make it difficult to speech read.

Question 16

The nurse preparing written discharge instructions for the day-surgery unit where ear surgery is performed would plan to include which instruction?

Accepted Answer

Client discharge teaching after ear surgery should include instructions to avoid heavy lifting and need to refrain from sports and exercising for 3 weeks. The cotton ball in the ear should be changed daily as prescribed. When sneezing or coughing, keep the mouth open to avoid increased pressure. Blowing only one side of the nose at a time will also avoid increasing pressure.

Question 17

The nurse providing instructions to a client after ear surgery would tell the client that for the next 4 to 6 weeks, he/she should avoid

Accepted Answer

Keep the ear dry for 4 to 6 weeks after ear surgery. Avoid physical activity for 1 week and exercises or sports for 3 weeks. Blow the nose gently one side at a time and sneeze or cough with the mouth open for 1 week after surgery. Avoid airplane flights for the first week after surgery.

Question 18

A client has Ménière's disease. Which question by the nurse would elicit the most pertinent information related to client safety?

Accepted Answer

Ménière's disease triggers attacks of vertigo that present safety concerns for the client. While all the questions elicit useful information, knowing that a client has no warning before becoming dizzy would lead the nurse to advise that the client not drive, swim, climb ladders or scaffolds, or do other activities where a sudden onset of dizziness would present an increased risk of injury.

Question 19

When communicating with a client who has a significant hearing loss, the nurse would

Accepted Answer

Phrases should be used to convey meaning rather than one-word answers. The nurse should state the major topic of the discussion first and then give details. To get the client's attention, raise your arm or hand. Intercommunication systems may distort sounds and may confuse clients or lead to worse communication. Speak in a normal tone and do not shout.

Question 20

The most appropriate action that the nurse working at a camp would take to remove an insect from a camper's ear is

Accepted Answer

For removal of a live insect, the ear canal is filled with mineral oil, lidocaine, or an ether-soaked cotton ball, not water, to kill or stupefy the insect. Water will cause the insect to swell, making it harder to remove.

Quiz 66: Management of Clients with Hearing and Balance Disorders