Chapter 66 : Management of Clients with Hearing and Balance Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 66 : Management of Clients with Hearing and Balance Disorders

MULTIPLE CHOICE

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

a.

Did you ever experience impacted cerumen?

b.

Do you swim in a pool with chlorinated water?

c.

Have you had an upper respiratory infection?

d.

Have you noted a change in the color of the ear wax?

ANS: A

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.

DIF: Application/Applying REF: pp. 1720-1721

OBJ: Assessment

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Aging Process

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

a.

amblyopia.

b.

otalgia.

c.

presbycusis.

d.

tinnitus.

ANS: C

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.

DIF: Knowledge/Remembering REF: p. 1722 OBJ: Assessment

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Aging Process

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

a.

a low-grade fever.

b.

a popping sensation in the ears.

c.

pain when the external ear is manipulated.

d.

humming or buzzing noises in the ear.

ANS: C

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.

DIF: Application/Applying REF: p. 1733 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

4. The most appropriate action that the nurse working at a camp would take to remove an insect from a campers ear is

a.

gently irrigate the ear canal with sterile water.

b.

instill a few drops of mineral oil into the ear.

c.

instruct the camper to tilt the affected ear downward.

d.

occlude the ear with a medicated cotton pledget.

ANS: B

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.

DIF: Application/Applying REF: p. 1735 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

5. 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

a.

apply ear drops directly to the wick.

b.

eliminate milk from the diet.

c.

shower frequently to remove ear secretions.

d.

sleep with the affected ear on the pillow.

ANS: A

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.

DIF: Application/Applying REF: pp. 1734-1735

OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Medication Administration

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

a.

keep the clients head in an upright position.

b.

occlude the ear canal completely with the syringe.

c.

spray the external ear with an antiseptic solution.

d.

use an irrigation solution that is at body temperature.

ANS: D

The irrigating solution (usually water) is warmed to body temperature and placed in the irrigating syringe. The clients 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.

DIF: Application/Applying REF: p. 1734 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Therapeutic Procedures

7. 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

a.

a hearing aid is usually necessary after the tympanic membrane heals.

b.

perforations often heal spontaneously with no complications.

c.

the client should remain in a quiet environment until healed.

d.

the client will most likely experience vertigo.

ANS: B

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.

DIF: Application/Applying REF: p. 1732 OBJ: Intervention

MSC: Physiological Integrity Reduction in Risk Potential-Alterations in Body Systems

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

a.

Avoid heavy lifting and do not engage in sports for 3 weeks after surgery.

b.

Leave the cotton ball dressing in the ear until your follow-up appointment.

c.

Do not sneeze, blow your nose, or cough for 1 week after surgery.

d.

Report any decreased hearing in the operative ear.

ANS: A

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.

DIF: Application/Applying REF: p. 1737 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

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

a.

conductive hearing disorder.

b.

otorrhea.

c.

sensorineural hearing loss.

d.

severe headache.

ANS: C

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.

DIF: Comprehension/Understanding REF: p. 1720 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. 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

a.

47 dB.

b.

64 dB.

c.

72 dB.

d.

80 dB.

ANS: D

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

DIF: Analysis/Analyzing REF: p. 1725 OBJ: Intervention

MSC: Health Promotion and Maintenance Health Promotion Programs

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

a.

obtain the clients attention by hand clapping.

b.

speak as loudly as possible.

c.

use an intercommunication system.

d.

use phrases to convey meaning rather than one-word answers.

ANS: D

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 clients 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.

DIF: Application/Applying REF: p. 1727 OBJ: Intervention

MSC: Physiological Integrity Reduction in Risk Potential-Alterations in Body Systems

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

a.

Deficient Knowledge.

b.

Ineffective Health Maintenance.

c.

Risk for Impaired Skin Integrity.

d.

Risk for Injury.

ANS: D

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

DIF: Analysis/Analyzing REF: p. 1738 OBJ: Diagnosis

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

13. 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

a.

clear the eustachian tube.

b.

destroy hair cells.

c.

equalize pressure.

d.

stabilize the ossicles.

ANS: B

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

DIF: Comprehension/Understanding REF: p. 1742 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Therapeutic Procedures

14. A client has Mnires disease. Which question by the nurse would elicit the most pertinent information related to client safety?

a.

Are your attacks at certain times of the day?

b.

Do your attacks come on without warning?

c.

How long does each attack last?

d.

What seems to bring on your attacks?

ANS: B

Mnires 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.

DIF: Analysis/Analyzing REF: pp. 1738, 1740

OBJ: Assessment

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

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

a.

directing the voice toward the left ear.

b.

speaking in a normal tone.

c.

smiling while talking to seem friendly.

d.

standing in front of the client.

ANS: C

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.

DIF: Comprehension/Understanding REF: p. 1727 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

16. 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

a.

cleanse the ear mold if needed with mild soap and water.

b.

evaluate how well the client understood the nurses earlier instructions.

c.

help the client insert the ear mold into the ear.

d.

turn the hearing aid off before removing it at bedtime.

ANS: B

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.

DIF: Comprehension/Understanding REF: p. 1729 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

17. A clients 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

a.

It seems like its hard to listen to your family when you dont agree with them.

b.

My father has a hearing aid and is really glad he got it.

c.

Theres nothing to be ashamed about having poor hearing.

d.

Why dont you believe what your family is saying?

ANS: A

This response opens up an avenue for communication in which the clients 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 clients feelings, as does option c. Option d is argumentative.

DIF: Application REF: p. 1727 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Grief and Loss

18. 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

a.

any physical activity.

b.

blowing the nose.

c.

flying in an aircraft.

d.

getting the ear wet.

ANS: D

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.

DIF: Application/Applying REF: p. 1737 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

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

a.

cola.

b.

ginger ale.

c.

lemonade.

d.

mineral water.

ANS: A

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

DIF: Analysis/Analyzing REF: p. 1740 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

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

a.

allow the client to adjust volume before speaking.

b.

cup hand over the clients ear to check for feedback.

c.

explain that the whistling noise will subside in a few minutes.

d.

stand in front of the client and speak loudly.

ANS: A

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

DIF: Application/Applying REF: p. 1729 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

21. The nurse caring for a client with a conductive hearing loss would enhance communication by facing the client and

a.

lowering the pitch of the voice.

b.

speaking loudly.

c.

speaking slowly.

d.

using lip movement to shape words.

ANS: A

Conduction hearing loss occurs in the higher frequencies. Loud, slow, or exaggerated movements may confuse the client.

DIF: Application/Applying REF: pp. 1723, 1727

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

MULTIPLE RESPONSE

1. A client with severe hearing loss has the nursing diagnosis: Ineffective Coping related to recent hearing loss. The nurse would assess that goals for this diagnosis have been met when the client (Select all that apply)

a.

engages in more activities within the community.

b.

is willing to role-play informing others about the hearing loss.

c.

self-refers to a university hospital audiology clinic.

d.

stores the new hearing aid properly when not in use.

ANS: B, C

Goals for the diagnosis Ineffective Coping include taking the initiative to inform others of the hearing problem and enlisting their help in communication; not feeling embarrassed, frustrated, or wanting to withdraw socially because of feelings of worthlessness; not blaming others for failure to communicate; and not avoiding situations that impair hearing. Finding and using resources to help deal with the hearing loss also demonstrate that goals have been met. Engaging more in social events relates to the nursing diagnosis Impaired Social Interaction. Proper handling of equipment relates to Deficient Knowledge.

DIF: Evaluation/Evaluating REF: p. 1728 OBJ: Evaluation

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

2. The nurse is conducting a wellness seminar on healthy hearing through the life span and would suggest which of the following activities as primary prevention measures for hearing loss? (Select all that apply)

a.

Avoid inserting hard objects into the ear.

b.

Care for your hearing aids according to the manufacturers directions.

c.

Dont use medications that can cause hearing loss.

d.

See your doctor right away for symptoms of ear infection.

e.

Wear protective head gear when participating in sports.

ANS: A, C, E

Primary prevention aims to prevent diseases before they occur, and these three options would help prevent hearing loss. Caring for hearing aids is part of tertiary prevention, which provides rehabilitation. Obtaining prompt diagnosis and treatment for an ear infection would, along with screening, be part of secondary prevention.

DIF: Analysis/Analyzing REF: p. 1725 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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