Deck 51: Care of Patients With Ear and Hearing Problems

Question 1

The nurse is caring for a client with otitis media and notes purulent drainage in the ear canal during the physical assessment.Which is the nurse's priority intervention?

A) Obtain a specimen of the drainage for culture.
B) Irrigate the ear canal with sterile normal saline.
C)Gently examine the client's ear with an otoscope.
D) Place a cotton ball in the ear canal to absorb the drainage.

Answer 1

Gently examine the client's ear with an otoscope.

Question 2

The nurse is assessing several clients with hearing loss.Which client does the nurse recommend should investigate hearing aids?

A) Client who has smoked two packs of cigarettes a day for 30 years
B) Client who had chronic middle ear infections during childhood
C) Client with constant tinnitus that becomes worse at night
D) Client who worked as a security guard at rock concerts for 10 years

Answer 2

Client who had chronic middle ear infections during childhood

Question 3

The nurse is caring for a client with Ménière's disease.The client asks the nurse how to prevent another acute episode from occurring.Which is the nurse's best response?

A) "Stop or reduce cigarette smoking."
B) "Use aspirin rather than acetaminophen (Tylenol) for pain."
C) "Reduce the quantity of saturated fats in your diet."
D) "Avoid crowds and people with upper respiratory infection."

Answer 3

"Stop or reduce cigarette smoking."

Question 4

The nurse is caring for a client with otitis media.The client reports that the pain was severe during the night but was gone upon awakening in the morning.Which finding does the nurse expect to observe during the client's physical assessment?

A) The tympanic membrane is bluish-gray.
B) Purulent fluid is present in the ear canal.
C) The pinna and the tragus are reddened and swollen.
D) Sounds are lateralized toward the affected ear.

Question 5

A client with a ruptured tympanic membrane asks the nurse whether hearing will be affected permanently.Which is the nurse's best response?

A) "Possibly. The eardrum usually heals in 1 to 2 weeks. Any persistent hearing problem should be evaluated."
B) "No. Antibiotics will help resolve the infection and cure your hearing impairment."
C) "Yes. It will be important for you to be fitted with a hearing aid as soon as possible."
D) "Yes. Any time the eardrum is ruptured it will form a scar, which will cause some degree of permanent hearing loss."

Question 6

The nurse is caring for a newly deaf client who is learning to read lips.Which client statement indicates that additional teaching is needed?

A) "After I practice lip reading for a while, I won't need to worry about using sign language anymore."
B) "I will have a harder time lip reading when I am not familiar with the topic of the conversation."
C) "Focusing so much on lip reading will make me tired, so I will try to keep conversations short."
D) "I may not be able to lip read very well when the other person has a beard or when light in the room is inadequate."

Question 7

A client is being discharged after a tympanoplasty.Which instruction about cephalexin (Keflex)does the nurse provide to this client?

A) "Be sure to finish all the Keflex pills, even if you feel fine."
B) "The Keflex may turn your urine an orange color while you are taking it."
C) "Take the Keflex on an empty stomach and stay upright for 30 minutes afterward."
D) "Use sunscreen and avoid exposure to sunlight while you are taking Keflex."

Question 8

When performing a client's physical assessment,the nurse notes that the client has conductive hearing loss.Which finding does the nurse expect to see in the client's medical history?

A) History of diabetes with peripheral neuropathy
B) Frequent episodes of otitis media during childhood
C) History of frequent impactions of cerumen in the ear canals
D) History of osteomyelitis treated with IV gentamicin (Garamycin)

Question 9

Which is the best approach for the nurse to use to obtain a history from a client with sudden hearing loss?

A) Question the client's family.
B) Write out the questions for the client to answer.
C) Obtain the information from the client's old chart.
D) Check with the client's primary health care provider.

Question 10

The client requires a hearing aid but tells the nurse that he cannot afford to pay for it right now.What is the nurse's best response?

A) "Your insurance company should pay some of the cost."
B) "The hospital can set up a payment plan for the new hearing aid."
C) "I'll ask the social worker about organizations that help pay for hearing aids."
D) "You can check around to see who has the lowest price."

Question 11

The nurse is caring for a client with Ménière's disease.What does the nurse recommend to the client to reduce the symptoms of vertigo?

A) "Take salt and potassium supplements daily."
B) "Drink at least eight glasses of water every day."
C) "Blow your nose hard when dizziness first begins."
D) "When dizziness begins, lie down and keep your head still."

Question 12

The nurse is caring for a client who has just been diagnosed with profound hearing loss.The client tells the nurse,"The doctors must have made a mistake.There's no way I can be deaf!" Which is the nurse's best response?

A) "Why do you think that the doctors made a mistake?"
B) "I can tell that you are anxious and scared about your hearing."
C) "Lots of people lead productive lives after losing their hearing."
D) "The doctors did extensive tests to make sure that the diagnosis was correct."

Question 13

The nurse is providing discharge instructions for a client who will be going home following tympanoplasty surgery.Which statement by the client indicates that additional teaching is needed?

A) "I will wear earplugs whenever I am in noisy areas."
B) "I will occlude only one nostril when I blow my nose."
C) "I will wait 3 weeks before I resume my aerobics workouts."
D) "I will use a cotton swab to clean drainage from inside my ear."

Question 14

A client is being started on scopolamine (Transderm Scop)for vertigo.What does the nurse tell the client regarding this medication?

A) "You may drive your car while taking this medication."
B) "Concentration on your college courses will not be affected."
C) "It is recommended that you limit activities requiring a detailed focus."
D) "You should be able to continue your job as a crane operator."

Question 15

The nurse is caring for an older client whose ear canals are impacted with hard cerumen.Which action by the nurse is best to remove the cerumen?

A) Instruct the client to put a few drops of mineral oil into each ear every evening and to schedule the irrigation for 3 days later.
B) Aim the irrigation fluid directly at the center of the cerumen to facilitate dissolving the impaction.
C) Administer 10 mg of prochlorperazine (Compazine) to prevent nausea during irrigation of the ears.
D) Irrigate the ears with 35 to 40 mL of sterile normal saline and repeat as needed until the cerumen is cleared.

Question 16

The nurse is caring for a client with external otitis.Which assessment finding indicates to the nurse that the client's infection has worsened?

A) The client now reports tinnitus and vertigo at night.
B) The client now has a positive Rinne test, with AC > BC.
C) The tympanic membrane is pearly gray with white patches.
D) The auricular lymph nodes have increased in size over the last 24 hours.

Question 17

The nurse is caring for a client with a furuncle on the pinna at the opening of the ear canal.The nurse is reviewing home care instructions with the client.Which statement by the client indicates that additional teaching is needed?

A) "I will put the bacitracin ointment on the sore three times a day."
B) "I will gently squeeze the sore to drain the liquid out once a day."
C) "I will take Tylenol (acetaminophen) if my ear starts to hurt a lot."
D) "I will put a warm compress on the sore for 15 minutes three times a day."

Question 18

Which recommendation does the nurse provide for the client with Ménière's disease who has periodic spells of vertigo?

A) "Avoid wearing high-heeled shoes."
B) "Put brightly colored rugs on the floor for visibility."
C) "Step on a sturdy chair to get items from high shelves."
D) "Wait to drive a car until after you have taken your Benadryl."

Question 19

The nurse teaches a client's wife how to administer eardrops to the client.Which statement by the client's wife indicates that additional teaching is needed?

A) "I will make sure that the eardrops are at room temperature before using them."
B) "I will wash my hands before and after giving my husband the eardrops."
C) "After I put the drops in, I will gently tug on the outer ear to make sure that they go into the ear canal."
D) "I will have my husband lay on his back with his chin up when I give him the eardrops."

Question 20

A client tells the nurse,"Bumps have developed in my ear canals from my hearing aid." Which is the nurse's best recommendation for the client?

A) "Clean your hearing aid with rubbing alcohol every evening and let it dry overnight."
B) "Apply a small amount of benzoyl peroxide cream to the inside of your ear canals before you insert your hearing aid."
C) "Clean your hearing aid with mild soap and water and make sure that it is completely dry before inserting it in your ears."
D) "Clean your ears with half-strength hydrogen peroxide twice a day before you put in your hearing aid and after you take it out."

Question 21

The nurse is instilling eardrops into a client's ear.Place the following in order according to best practice.(Separate letters by a comma and space as follows: a,b,c,d.)

A) Ask the client to move the head gently back and forth five times.
B) Wash your hands.
C) Wear gloves to remove any packing from the ear.
D) Perform an otoscopic examination to see if the eardrum is intact.
E) Irrigate the ear if needed to remove cerumen.
F) Tilt the client's head in the opposite direction of the affected ear and place the drops in the affected ear.
G) Warm the bottle of eardrops in a bowl of warm water for 5 minutes.
H) Wash your hands again.
I) Insert a ball of cotton in the ear as packing.

Question 22

Which client statement indicates that the client understands teaching about stapedectomy surgery?

A) "My hearing will get worse before it gets better."
B) "I will have to miss 6 weeks of swim team practice."
C) "I will see the doctor 1 week after surgery to have my stitches removed."
D) "Foods may taste funny for a short time after surgery."
E) "I may get dizzy and feel like the room is spinning after surgery."
F) "I can blow my nose to relieve the feeling of fullness in my ear after surgery."

Question 23

Which of the nurse's assessment findings will require collaboration with the client's primary health care provider?

A) Purulent drainage from the ear canal
B) Hearing loss with nausea and vertigo
C) Ringing in the ears after attending a loud rock concert
D) Presence of cerumen blocking 50% of the ear canal
E) Increasing hearing loss since starting furosemide (Lasix)
F) Temperature of 101.7° F following a stapedectomy 3 days ago

Question 24

The nurse is caring for a 132-lb client with an ear infection who is to receive amoxicillin,40 mg/kg/day in divided doses every 8 hours.The nurse will administer ____ mg/dose of amoxicillin to the client.

Question 25

A client has mastoiditis.The nurse assesses most carefully for which manifestations?

A) Red and bulging eardrum
B) A crackling sound upon yawning
C) Enlarged lymph nodes behind the ear
D) Low-grade fever and malaise
E) Diminished hearing
F) Loss of appetite