Deck 63: Assessment and Management of Patients With Hearing and Balance Disorders

Question 1

The clinic nurse is assessing a child who has been brought to the clinic with signs and symptoms that are suggestive of otitis externa. What assessment finding is characteristic of otitis externa?

A) Tophi on the pinna and ear lobe
B) Dark yellow cerumen in the external auditory canal
C) Pain on manipulation of the auricle
D) Air bubbles visible in the middle ear

Answer 1

Pain on manipulation of the auricle

Question 2

While reviewing the health history of an older adult experiencing hearing loss the nurse notes the patient has had no trauma or loss of balance. What aspect of this patients health history is most likely to be linked to the patients hearing deficit?

A) Recent completion of radiation therapy for treatment of thyroid cancer
B) Routine use of quinine for management of leg cramps
C) Allergy to hair coloring and hair spray
D) Previous perforation of the eardrum

Answer 2

Routine use of quinine for management of leg cramps

Question 3

A nurse is planning preoperative teaching for a patient with hearing loss due to otosclerosis. The patient is scheduled for a stapedectomy with insertion of a prosthesis. What information is most crucial to include in the patients preoperative teaching?

A) The procedure is an effective, time-tested treatment for sensory hearing loss.
B) The patient is likely to experience resolution of conductive hearing loss after the procedure.
C) Several months of post-procedure rehabilitation will be needed to maximize benefits.
D) The procedure is experimental, but early indications suggest great therapeutic benefits.

Answer 3

The patient is likely to experience resolution of conductive hearing loss after the procedure.

Question 4

Which of the following nursing interventions would most likely facilitate effective communication with a hearing-impaired patient?

A) Ask the patient to repeat what was said in order to evaluate understanding.
B) Stand directly in front of the patient to facilitate lip reading.
C) Reduce environmental noise and distractions before communicating.
D) Raise the voice to project sound at a higher frequency.

Question 5

The nurse is providing discharge education for a patient with a new diagnosis of Mnires disease. What food should the patient be instructed to limit or avoid?

A) Sweet pickles
B) Frozen yogurt
C) Shellfish
D) Red meat

Question 6

Following a motorcycle accident, a 17-year-old man is brought to the ED. What physical assessment findings related to the ear should be reported by the nurse immediately?

A) The malleus can be visualized during otoscopic examination.
B) The tympanic membrane is pearly gray.
C) Tenderness is reported by the patient when the mastoid area is palpated.
D) Clear, watery fluid is draining from the patients ear.

Question 7

A patient has been diagnosed with hearing loss related to damage of the end organ for hearing or cranial nerve VIII. What term is used to describe this condition?

A) Exostoses
B) Otalgia
C) Sensorineural hearing loss
D) Presbycusis

Question 8

A group of high school students is attending a concert, which will be at a volume of 80 to $90 \mathrm{~dB}$ . What is a health consequence of this sound level?

A) Hearing will not be affected by a decibel level in this range.
B) Hearing loss may occur with a decibel level in this range.
C) Sounds in this decibel level are not perceived to be harsh to the ear.
D) Ear plugs will have no effect on these decibel levels.

Question 9

A patient has undergone diagnostic testing and has been diagnosed with otosclerosis? What ear structure is primarily affected by this diagnosis?

A) Malleus
B) Stapes
C) Incus
D) Tympanic membrane

Question 10

A patient with otosclerosis has significant hearing loss. What should the nurse do to best facilitate communication with the patient?

A) Sit or stand in front of the patient when speaking.
B) Use exaggerated lip and mouth movements when talking.
C) Stand in front of a light or window when speaking.
D) Say the patients name loudly before starting to talk.

Question 11

The nurse in the ED is caring for a 4 year-old brought in by his parents who state that the child will not stop crying and pulling at his ear. Based on information collected by the nurse, which of the following statements applies to a diagnosis of external otitis?

A) External otitis is characterized by aural tenderness.
B) External otitis is usually accompanied by a high fever.
C) External otitis is usually related to an upper respiratory infection.
D) External otitis can be prevented by using cotton-tipped applicators to clean the ear.

Question 12

A patient diagnosed with arthritis has been taking aspirin and now reports experiencing tinnitus and hearing loss. What should the nurse teach this patient?

A) The hearing loss will likely resolve with time after the drug is discontinued.
B) The patients hearing loss and tinnitus are irreversible at this point.
C) The patients tinnitus is likely multifactorial, and not directly related to aspirin use.
D) The patients tinnitus will abate as tolerance to aspirin develops.

Question 13

A patient is postoperative day 6 following tympanoplasty and mastoidectomy. The patient has phoned the surgical unit and states that she is experiencing occasional sharp, shooting pains in her affected ear. How should the nurse best interpret this patients complaint?

A) These pains are an expected finding during the first few weeks of recovery.
B) The patients complaints are suggestive of a postoperative infection.
C) The patient may have experienced a spontaneous rupture of the tympanic membrane.
D) The patients surgery may have been unsuccessful.

Question 14

The nurse is discussing the results of a patients diagnostic testing with the nurse practitioner. What Weber test result would indicate the presence of a sensorineural loss?

A) The sound is heard better in the ear in which hearing is better.
B) The sound is heard equally in both ears.
C) The sound is heard better in the ear in which hearing is poorer.
D) The sound is heard longer in the ear in which hearing is better.

Question 15

The advanced practice nurse is attempting to examine the patients ear with an otoscope. Because of impacted cerumen, the tympanic membrane cannot be visualized. The nurse irrigates the patients ear with a solution of hydrogen peroxide and water to remove the impacted cerumen. What nursing intervention is most important to minimize nausea and vertigo during the procedure?

A) Maintain the irrigation fluid at a warm temperature.
B) Instill short, sharp bursts of fluid into the ear canal.
C) Follow the procedure with insertion of a cerumen curette to extract missed ear wax.
D) Have the patient stand during the procedure.

Question 16

A patient is scheduled to have an electronystagmography as part of a diagnostic workup for Mnires disease. What question is it most important for the nurse to ask the patient in preparation for this test?

A) Have you ever experienced claustrophobia or feelings of anxiety while in enclosed spaces?
B) Do you currently take any tranquilizers or stimulants on a regular basis?
C) Do you have a history of falls or problems with loss of balance?
D) Do you have a history of either high or low blood pressure?

Question 17

The nurse is planning the care of a patient who is adapting to the use of a hearing aid for the first time. What is the most significant challenge experienced by a patient with hearing loss who is adapting to using a hearing aid for the first time?

A) Regulating the tone and volume
B) Learning to cope with amplification of background noise
C) Constant irritation of the external auditory canal
D) Challenges in keeping the hearing aid clean while minimizing exposure to moisture

Question 18

A patient with mastoiditis is admitted to the post-surgical unit after undergoing a radical mastoidectomy. The nurse should identify what priority of postoperative care?

A) Assessing for mouth droop and decreased lateral eye gaze
B) Assessing for increased middle ear pressure and perforated ear drum
C) Assessing for gradual onset of conductive hearing loss and nystagmus
D) Assessing for scar tissue and cerumen obstructing the auditory canal

Question 19

The nurse is assessing a patient with multiple sclerosis who is demonstrating involuntary, rhythmic eye movements. What term will the nurse use when documenting these eye movements?

A) Vertigo
B) Tinnitus
C) Nystagmus
D) Astigmatism

Question 20

A patient has been diagnosed with serous otitis media for the third time in the past year. How should the nurse best interpret this patients health status?

A) For some patients, these recurrent infections constitute an age-related physiologic change.
B) The patient would benefit from a temporary mobility restriction to facilitate healing.
C) The patient needs to be assessed for nasopharyngeal cancer.
D) Blood cultures should be drawn to rule out a systemic infection.

Question 21

A patient with a sudden onset of hearing loss tells the nurse that he would like to begin using hearing aids. The nurse understands that the health professional dispensing hearing aids would have what responsibility?

A) Test the patients hearing promptly.
B) Perform an otoscopy.
C) Measure the width of the patients ear canal.
D) Refer the patient to his primary care physician.

Question 22

The nurse is providing care for a patient who has benefited from a cochlear implant. The nurse should understand that this patients health history likely includes which of the following? Select all that apply.

A) The patient was diagnosed with sensorineural hearing loss.
B) The patients hearing did not improve appreciably with the use of hearing aids.
C) The patient has deficits in peripheral nervous function.
D) The patients hearing deficit is likely accompanied by a cognitive deficit.
E) The patient is unable to lip-read.

Question 23

A patient presents to the ED complaining of a sudden onset of incapacitating vertigo, with nausea and vomiting and tinnitus. The patient mentions to the nurse that she suddenly cannot hear very well. What would the nurse suspect the patients diagnosis will be?

A) Ossiculitis
B) Mnires disease
C) Ototoxicity
D) Labyrinthitis

Question 24

Which of the following nurses actions carries the greatest potential to prevent hearing loss due to ototoxicity?

A) Ensure that patients understand the differences between sensory hearing loss and conductive
Hearing loss.
B) Educate patients about expected age-related changes in hearing perception.
C) Educate patients about the risks associated with prolonged exposure to environmental noise.
D) Be aware of patients medication regimens and collaborate with other professionals accordingly.

Question 25

A child goes to the school nurse and complains of not being able to hear the teacher. What test could the school nurse perform that would preliminarily indicate hearing loss?

A) Audiometry
B) Rinne test
C) Whisper test
D) Weber test

Question 26

A nurse is teaching preventative measures for otitis externa to a group of older adults. What action should the nurse encourage?

A) Rinsing the ears with normal saline after swimming
B) Avoiding loud environmental noises
C) Instilling antibiotic ointments on a regular basis
D) Avoiding the use of cotton swabs

Question 27

The nurse is reviewing the health history of a newly admitted patient and reads that the patient has been previously diagnosed with exostoses. How should the nurse accommodate this fact into the patients plan of care?

A) The nurse should perform the Rinne and Weber tests.
B) The nurse should arrange for audiometry testing as soon as possible.
C) The nurse should collaborate with the pharmacist to assess for potential ototoxic medications.
D) No specific assessments or interventions are necessary to addressing exostoses.

Question 28

The nurse is caring for a patient who has undergone a mastoidectomy. In an effort to prevent postoperative infection, what intervention should the nurse implement?

A) Teach the patient about the risks of ototoxic medications.
B) Instruct the patient to protect the ear from water for several weeks.
C) Teach the patient to remove cerumen safely at least once per week.
D) Instruct the patient to protect the ear from temperature extremes until healing is complete.

Question 29

A patient is being discharged home after mastoid surgery. What topic should the nurse address in the patients 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 OTC ear drops

Question 30

After mastoid surgery, an 81-year-old patient has been identified as needing assistance in her home. What would be a primary focus of this patients home care?

A) Preparation of nutritious meals and avoidance of contraindicated foods
B) Ensuring the patient receives adequate rest each day
C) Helping the patient adapt to temporary hearing loss
D) Assisting the patient with ambulation as needed to avoid falling

Question 31

A hearing-impaired patient is scheduled to have an MRI. What would be important for the nurse to
Remember when caring for this patient?

A) Patient 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 patient like any other patient.

Question 32

The nurse and a colleague are performing the Epley maneuver with a patient who has a diagnosis of benign paroxysmal positional vertigo. The nurses should begin this maneuver by performing what action?

A) Placing the patient in a prone position
B) Assisting the patient into a sitting position
C) Instilling $15 \mathrm{~mL}$ of warm normal saline into one of the patients ears
D) Assessing the patients baseline hearing by performing the whisper test

Question 33

A 6-month-old infant is brought to the ED by his parents for inconsolable crying and pulling at his 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

Question 34

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

Question 35

An older adult with a recent history of mixed hearing loss has been diagnosed with a cholesteatoma. What should this patient 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.

Question 36

The nurse is admitting a patient to the unit who is scheduled to have an ossiculoplasty. What postoperative assessment will best determine whether the procedure has been successful?

A) Otoscopy
B) Audiometry
C) Balance testing
D) Culture and sensitivity testing of ear discharge

Question 37

On 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

Question 38

The nurse is discharging a patient 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) Dont blow your nose for 2 to 3 weeks.

Question 39

An advanced practice nurse has performed a Rinne test on a new patient. During the test, the patient reports that air-conducted sound is louder than bone-conducted sound. How should the nurse best interpret this assessment finding?

A) The patients hearing is likely normal.
B) The patient is at risk for tinnitus.
C) The patient likely has otosclerosis.
D) The patient likely has sensorineural hearing loss.