. The nurse is providing instructions to a nursing assistant regarding care of an older client with hearing loss. The nurse tells the assistant that clients with a hearing loss:a) are often distractedb) have middle ear changesc) respond to low-pitched tonesd) develop moist cerumen production

2. The nurse is performing an otoscopic examination on a client with mastoiditis. On examination of the tympanic membrane, which of the following would the nurse expect to observe?

a) a pink-colored tympanic membraneb) a pearly colored tympanic membranec) a transparent and clear tympanic membraned) a red, dull, thick and immobile tympanic membrane

3. The client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder involving this part of the ear?

a) pruritusb) tinnitusc) hearing lossd) burning in the ear

4. The nurse is performing a voice test to assess hearing. Which of the following describes the accurate procedure for performing this test?

a) whisper a statement while the client blocks both earsb) whisper a statement with the examiner's back facing the clientc) whisper a statement and ask the client to repeat it while blocking one eard) stand 4 feet away from the client to ensure that the client can hear at this distance

5. During a hearing assessment, the nurse notes that the sound lateralizes to the client's left ear with the Weber test. The nurse analyzes these results as:

a) a normal findingb) the presence of nystagmusc) a sensorineural or conductive lossd) a conductive loss in the right ear

1) C- Presbycusis refers to the age-related irreversible degenerative changes of the inner ear that lead to decreased hearing ability. As a result of these changes, the older client has a decreased response to high-frequency sounds. Low-pitched voice tones are heard more easily and can be interpreted by the older client. Options A, B, and D are not accurate.

2) D- Otoscopic examination in a client with mastoiditis reveals a red, dull, thick, and immobile tympanic membrane, with or without perforation. Postauricular lymph nodes are tender and enlarged. Clients also have a low-grade fever, malaise, anorexia, swelling behind the ear, and pain with minimal movement of the head.

3) B- Tinnitus is the most common complaint of clients with otological disorders, especially disorders involving the inner ear. Symptoms of tinnitus range from mild ringing in the ear, which can go unnoticed during the day, to a loud roaring in the ear, which can interfere with the client’s thinking process and attention span. Options A, C, and D are not associated specifically with disorders of the inner ear.

4) C- In the voice test, the examiner stands 1 to 2 feet away from the client and asks the client to block one external ear canal. The nurse whispers a statement and asks the client to repeat it. Each ear is tested separately.

5) C- In the Weber tuning fork test, the nurse places the vibrating tuning fork in the middle of the client’s head, at the midline of the forehead, or above the upper lip over the teeth. Normally, the sound is heard equally in both ears by bone conduction. If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear. If the client has a conductive hearing loss in one ear, the sound is heard in that ear.

6. The nurse is caring for a hearing-impaired client. Which of the following approaches will facilitate communication?

a) speak loudlyb) speak frequentlyc) speak at a normal volumed) speak directly into the impaired ear

7. A client arrives at the emergency room with a foreign body in the left ear that has been determined to be an insect. Which intervention would the nurse anticipate to be prescribed initially?

a) irrigation of the earb) instillation of diluted alcoholc) instillation of antibiotic ear dropsd) instillation of corticosteroid ointment

8. The nurse notes that the physician has documented a diagnosis of presbycusis on the client's chart. The nurse plans care knowing that the condition is:

a) tinnitus that occurs with agingb) nystagmus that occurs with agingc) a conductive hearing loss that occurs with agingd) a sensorineural hearing loss that occurs with aging

9. The nurse has conducted discharge teaching for a client who has had a fenestration procedure for the treatment of otosclerosis. Which of the following, if stated by the client, would indicate that teaching was effective?

a) it is okay to take a shower and wash my hairb) I can resume my tennis lessons starting next weekc) I will take stool softeners as prescribed by my doctord) I should drink liquids through a straw fo the next 2 to 3 weeks

10. A client with Meniere's disease is experiencing severe vertigo. Which instruction should the nurse give to the client to assist in controlling the vertigo?

a) increase sodium in the dietb) avoid sudden head movementsc) lie still and watch the televisiond) increase fluid intake to 3L a day

6) C- Speaking in a normal tone to the client with impaired hearing and not shouting are important. The nurse should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said, the nurse should express it differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse should avoid talking directly into the impaired ear.

7) B- Insects are killed before removal unless they can be coaxed out by a flashlight or a humming noise. Mineral oil or diluted alcohol is instilled into the ear to suffocate the insect, which then is removed using ear forceps. When the foreign object is vegetable matter, irrigation is not used, because this material expands with hydration and the impaction becomes worse.

8) D- Presbycusis is a type of hearing loss that occurs with aging. Presbycusis is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve. Options A, B, and C are incorrect.

9) C- Following ear surgery, the client needs to avoid straining when having a bowel movement. The client needs to be instructed to avoid drinking with a straw for 2 to 3 weeks, air travel, and coughing excessively. The client needs to avoid getting his or her head wet, washing hair, showering for 1 week, and rapidly moving the head, bouncing, and bending over for 3 weeks.

10) B- The nurse instructs the client to make slow head movements to prevent worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid are sometimes prescribed. Lying still and watching television will not control vertigo.

11.The nurse is caring for a client following craniotomy for removal of an acoustic neuroma. Assessment of which of the following cranial nerves would identify a complication specifically associated with this surgery?

a) cranial nerve I, olfactoryb) cranial nerve IV, trochlearc) cranial nerve III, oculomotord) cranial nerve VII, facial nerve

12. The nurse assesses the client with a blunt injury sustained from a motor vehicle accident. Which assessment sign would indicate a basal skull fracture as a result of the injury?

a) epistaxisb) periorbital edemac) purulent drainage from the auditory canald) bloody or clear drainage from the auditory canal

13. A client was just admitted to the hospital to rule out a gastrointestinal (GI) bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication would the nurse determine could be the cause of the client's complaint?

a) doxycycline (Vibramycin)b) acetazolamide (Diamox)c) acetylsalicylic acid (aspirin)d) diltiazem hydrochloride (Cardizem)

14. The nurse prepares the client for an ear irrigation as prescribed by the physician. In performing the procedure, the nurse:

a) warms the irrigating solution to 98Fb) position the client with the affected side up following the irrigationc) directs a slow steady stream of irrigation solution toward the eardrumd) assists the client to turn his or her head so that the ear to be irrigated is facing upward

15. Ear drops are prescribed for an infant with otitis media. The most appropriate method to administer the ear drops to the infant is to:

a) pull up and back on the pinna and direct the solution onto the eardrumb) pull down and back on the pinna and direct the solution onto the eardrumc) pull down and back on the pinna and direct he solution toward the wall of the canald) pull up and back on the ear lobe and direct the solution toward the wall of the canal

11) D- Treatment for acoustic neuroma is surgical removal via a craniotomy. Extreme care is taken to preserve remaining

hearing and preserve the function of the facial nerve. Acoustic neuromas rarely recur following surgical removal.

12) D- Bloody or clear watery drainage from the auditory canal indicates a cerebrospinal fluid leak following trauma and suggests a basal skull fracture. This warrants immediate attention. Options A, B, and C are not specific to a basal skull fracture.

13) C- Aspirin is contraindicated for gastrointestinal bleed and is potentially ototoxic. The client should be advised to notify the prescribing physician so the medication can be discontinued and/or a substitute that is less toxic to the ear can be taken instead. Options A, B, and D do not have side effects that are potentially associated with hearing difficulties.

14) A- Irrigation solutions that are not close to the client’s body temperature can be uncomfortable and may cause injury, nausea, and vertigo. The client is positioned so that the ear to be irrigated is facing downward, because this allows gravity to assist in the removal of the ear wax and solution. Following the irrigation, the client is to lie on the affected side to finish draining the irrigating solution. A slow steady stream of solution should be directed toward the upper wall of the ear canal and not toward the eardrum. Too much force could cause the tympanic membrane to rupture.

15) C- In a child younger than 3 years, the pinna is pulled down and straight back. The infant should be turned on the side with the affected ear uppermost. With the nondominant hand, the pinna is pulled down and back. The medication is administered by aiming it at the wall of the canal rather than directly onto the eardrum. The infant should remain with the affected ear uppermost for 10 to 15 minutes to retain the solution. In the adult or a child older than 3 years, the pinna is pulled up and back to straighten the auditory canal.

16. The nurse is preparing to perform an otoscopic examination on an adult client. The nurse does which of the following to perform this examination?

a) pulls the pinna up and back before inserting the speculumb) pulls the earlobe down and back before inserting the speculumc) uses the smallest speculum available to decrease the discomfort of the examd) tilts the clients head forward and down before inserting the speculum

17. A nurse is providing diet instructions to a client with Meniere's disease who is being discharged from the hospital after admission for an acute attack. Which statement if made by the client indicates an understanding of the dietary measures to take to prevent further attacks?

a) I need to drink at least 3 liters of fluid per dayb) I need to restrict my carbohydrates intakec) I need to maintain a low-fat and low-cholesterol dietd) I need to be sure to consume foods that are low in sodium

18. A nurse in the health care clinic is providing instructions to a client regarding the use of a hearing aid. Which of the following statements would be appropriate for the nurse to include?

a) the ear mold for the hearing aid should be washed with mild soap and water once a monthb) the hearing aid should be removed from the ear at the end of the day then turned off after removalc) the hearing aid contains a lifelong battery so you will not need to be concerned about changing batteriesd) the hearing aid should not be worn if an ear infection is present

19. A nurse is caring for a client with acute otitis media. In order to reduce pressure and allow fluid to drain, the nurse anticipates that which of the following would most likely be recommended to the client?

a) the administration of diphenhydramine (Benadryl) capsulesb) a myringotomyc) strict bedrestd) a mastoidectomy

20. A nurse is developing a plan of care for a client with a diagnosis of Meniere's disease who is being admitted to the hospital. The priority nursing intervention in the plan of care should focus on:

a) safety measuresb) self-care measuresc) knowledge about medication therapyd) food items to avoid

16) A- The nurse tilts the client’s head slightly away and holds the otoscope upside down as if it were a large pen. The pinna is pulled up and back and the nurse visualizes the external canal while slowly inserting the speculum. Options B, C, and D are incorrect.

17) D- Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid are sometimes prescribed for the client with Ménière’s disease. The client should be instructed to consume a low-sodium diet and restrict fluids as prescribed. Low-fat, low-carbohydrate, and low-cholesterol diets are not specifically prescribed for the client with Ménière’s disease.

18) D- The client should be instructed that the hearing aid should not be worn if an ear infection is present. The client should be instructed to turn the hearing aid off before

removing it from the ear to prevent any squealing feedback. The hearing aid should be turned off when not in use and the client should keep extra batteries on hand at all times. The client should wash the ear mold frequently with mild soap and water, with the use of a pipe cleaner to clean the cannula of the hearing aid.

19) B- A myringotomy is a surgical procedure that will allow fluid to drain from the middle ear. Benadryl is an antihistamine with antiemetic properties. Strict bedrest is not necessary, although activity may be restricted. Additionally, bedrest would not assist in reducing pressure or allowing fluid to drain. In some cases, the mastoid bone is removed or partially removed for chronic otitis media.

20) A- Ménière’s disease can cause severe vertigo in the client. The priority in the nursing care plan should focus on safety issues to prevent falls or injury in the client. Although self-care measures, medication therapy, and dietary therapy may be components of the plan of care, safety is the priority issue.

1. A nurse is assigned to care for a client after a mastoidectomy. Which nursing intervention would be appropriate in the care of this client?

a) maintain a supine positionb) position the client on the affected side to promote drainagec) change the ear dressing dailyd) monitor for signs of facial nerve injury

22. A nurse is performing an assessment on a client with a diagnosis of Meniere's disease. The nurse anticipates that the client is most likely to report which of the following symptoms during an acute attack?

a) tinnitusb) headachec) fatigueinsomnia

23. A nurse has admitted a client with a diagnosis of an acute attack of Meniere's disease to the hospital. The nurse reviews the physician's orders for the client. Which order should the nurse question?

a) diphenhydramine (Benadryl)b) diazepam (Valium)c) atropine sulfated) ambulation 4 times daily

24. A nurse in the health care clinic is preparing to perform an otoscopic examination on adult client. In performing the examination, the nurse should:

a) position the client lying flat on the side of the ear be examined

b) pull the ear lobe down and back before inserting the speculumc) tilt the client's head forward before inserting the speculumd) pull the pinna up and back before inserting the speculum

25. A nurse is providing discharge instructions to the client being discharged after a fenestration procedure for the treatment of otosclerosis. Which statement if made by the client indicates a need for further instruction?

a) I should take stool softeners to avoid straining when having a bowel movementb) I need to avoid washing my hair and showering for at least 1 weekc) I should avoid movements requiring bending over for at least 3 weeksd) I should use a straw to drink liquids for the next 2 to 3 weeks21) D- After mastoidectomy, the nurse should monitor vital signs and inspect the dressing for drainage or bleeding. The nurse also should assess for signs of facial nerve injury (cranial nerve VII). The nurse also should monitor for signs of pain, dizziness, or nausea. The head of the bed should be elevated at least 30 degrees, and the client should be instructed to lie on the unaffected side. The client probably will have sutures, an outer ear packing, and a bulky dressing, which is removed on approximately the sixth day postoperatively.

22) A- Ménière’s disease results in a disturbance of the fluid of the endolymphatic system. The cause of the disturbance is not known. Attacks may be preceded by feelings of fullness in the ear or by tinnitus. Headaches, fatigue, and insomnia are not associated with this disorder.

23) D- Medical interventions during the acute phase of Ménière’s disease include using atropine sulfate or diazepam to decrease the autonomic nervous system function. Diphenhydramine may be prescribed for its antihistamine effects, and a vasodilator also will be prescribed. The client will remain on bedrest during the acute attack. When allowed out of bed, the client will need assistance with walking, sitting, or standing.

24) D- The correct procedure for performing an otoscopic examination on an adult is to pull the pinna up and back to allow visualization of the external canal while slowly inserting the speculum. The nurse would tilt the client’s head slightly away and hold the otoscope upside down as if it were a large pen. The examination would be performed with the client in a sitting position. If the client were lying on the side to be examined, examination of the affected ear would not be possible.

25) D

- After ear surgery, clients need to be instructed to avoid drinking with a straw for 2 to 3 weeks, to avoid air travel, and to avoid coughing excessively. The client also should be instructed to avoid straining when having a bowel movement and should be instructed to take stool softeners as prescribed. The client should avoid getting the head wet, washing the hair, or showering for at least 1 week, and to avoid rapidly moving the head, bouncing, and bending over for at least 3 weeks.26. The clinic nurse is preparing to provide care for a client who will need an ear irrigation to remove impacted cerumen. Which of the following will the nurse avoid when performing the irrigation?

a) position the client to turn the head so that the ear be irrigated is facing upwardb) warm the irrigating solution to a temperature that is close to body temperaturec) direct a slow steady stream of irrigation solution toward the upper wall of the ear canald) position the client with the affected side down after irrigation

27. A nursing student is performing an otoscopic examination in an adult client. The nursing instructor observes the student perform this procedure. Which observation by the instructor indicates that the student is using correct technique for the procedure?

a) pulling the pinna down and back before inserting the speculumb) pulling the earlobe down and back before inserting the speculumc) using the smallest speculum available d) tilting the client's head slightly away and holding the otoscope upside before inserting the speculum

28. A nurse is preparing to perform a Weber test on a client. The nurse obtains which item needed to perform this test?

a) a tongue bladeb) a stethoscopec) a tuning forkd) a reflex hammer

29. The home care nurse is visiting a client who was recently diagnosed with a hearing impairment. The nurse prepares to instruct the client's spouse in which measure that will facilitate communication?

a) speak frequently to the client to provide sensory stimulationb) speak loudly to the client to facilitate hearingc) speak in a normal tone and face the client when speakingd) speak directly into the impaired ear to facilitate hearing

30. A nurse is providing discharge instructions to a client who had a fenestration procedure for the treatment of otosclerosis. The nurse instructs the client to:

a) drink liquids through a straw for the next 2 to 3 weeksb) shower daily to prevent infectionc) avoid air traveld) resume all normal activities in 1 week

26) A- During the irrigation, the client is positioned so that the ear to be irrigated is facing downward, because this allows gravity to assist in the removal of the earwax and solution. Delivery of irrigation solutions at temperatures that are not close to body temperature can cause discomfort for the client and may result in tissue injury, nausea, and vertigo. A slow, steady stream of solution should be directed toward the upper wall of the ear canal, not toward the tympanic membrane. After the irrigation, the client should lie on the affected side for a period of time that is necessary to allow the irrigating solution to finish draining (usually 10 to 15 minutes). Too much force could cause the tympanic membrane to rupture.

27) D- In the otoscopic examination, the nurse tilts the client’s head slightly away and holds the otoscope upside down as if it were a large pen. The pinna is pulled up and back and the nurse visualizes the external canal while slowly inserting the speculum. A small speculum is used in pediatric clients. The nurse may not be able to adequately visualize the ear canal if a small speculum is used in the adult client.

28) C- A tuning fork is needed to perform the Weber test, during which the nurse places the vibrating tuning fork at the midline of the client’s forehead or above the upper lip over the teeth. Normally, the sound is heard equally in both ears by bone conduction. If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear. If the client has a conductive hearing loss in one ear, the sound is heard in that ear. The items identified in options A, B, and D are not needed to perform the Weber test.

29) C- Measures that facilitate hearing in the client with a hearing impairment problem include speaking in a normal tone; avoiding shouting; talking directly to the client while facing the client; and speaking clearly. If the client does not seem to understand what is said, the statement should be expressed differently. Moving closer to the client and toward the better ear may facilitate communication, but talking directly into the impaired ear should be avoided.

30) CAfter ear surgery, the client needs to be instructed to avoid air travel, avoid drinking through a straw for 2 to 3 weeks, and to avoid coughing excessively. In addition, the client should avoid straining when having a bowel movement, as well as washing the hair, getting the head wet, or showering for 1 week. The client also needs to avoid rapidly moving the head, bouncing, and bending over for 3 weeks.

1. A clinic nurse is preparing to perform a Romberg test on a client being seen in the clinic. The nurse performs this test for the purpose of determining:

a) the client's ability to ambulateb) the functional status of the vestibular apparatus in the inner earc) the intactness of the retinal structure of the eyed) the intactness of the tympanic membrane

32. A clinic nurse is performing an otoscopic examination on an adolescent who was hit in the ear with a basketball during a neighborhood game. A perforated eardrum is suspected. Which of the following would the nurse expect to observe if the eardrum is perforated?

a) a colony of black dots on the eardrumb) dense white patches on the eardrumc) a red bulging eardrumd) a round or oval darkened area on the eardrum

33. A caloric test is ordered for a client suspected of having disease of the labyrinth. The nurse would obtain which of the following essential items in preparation for this test?

a) an otoscopeb) an opthalmoscopec) a tongue bladed) an emesis basin

34. A nurse educator is conducting an in-service education session to the nurses employed in the eye and ear surgical unit of a large trauma center. In discussing the topic of cochlear implants, the educator notes that this surgical procedure is contraindicated in which of the following clients?

a) a client who became deaf before learning to speakb) a client with bilateral profound hearing lossc) a client who communicates primarily by speechd) a client who received no benefit from conventional hearing aids

35. A nurse is observing a nursing assistant communicating with a client who is deaf. The nurse will intervene if which of the following behaviors is observed?

a) the nursing assistant is speaking directly to the clientb) the nursing assistant touches the client's arm to gain his or her attentionc) the nursing assistant faces the client when speaking to the clientd) the nursing assistant overenunciates words when speaking

31) B- The Romberg test assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance. The Romberg test also assesses intactness of the cerebellum and proprioception. Options A, C, and D are incorrect.

32) DA round or oval darkened area on the eardrum would be seen in a client with a perforated eardrum. A red and bulging eardrum is indicative of acute purulent otitis media. Dense white patches are seen on the eardrum of a client with sequelae of repeated ear infections. A colony of black dots on the eardrum suggests a yeast or fungal infection.

33) A- A caloric test is contraindicated in a client with a perforated tympanic membrane (air may be used as a substitute) or if the client has an acute disease of the labyrinth. An otoscopic examination should be performed before the caloric test to rule out perforation and to determine if the ear canal contains cerumen, which must be removed before the test. An ophthalmoscope, a tongue blade, and an emesis basin are not essential items.

34) A- Adults who were born deaf or became deaf before learning to speak usually are not candidates for this type of surgery. Criteria for a cochlear implant procedure are bilateral profound hearing loss, use of speech as the primary mode of communication, lack of benefit from conventional hearing aids, evidence of strong family and social support, and realistic client expectations for the outcome of the implant procedure.

35) D- Overenunciating words does not make lip reading easier and is demeaning to the deaf person. It is best to speak in a normal manner. Options A, B, and C are appropriate communication strategies for the client who is deaf.

36. A nurse is planning a presentation on noise prevention and ear protection for a display booth at a local health fair. The nurse plans to incorporate which important concept regarding hearing loss in the presentation?

a) siting near loud music is not harmfulb) ear plugs or other protectors are necessary only when use of power toolsc) prolonged ringing in the ears after loud noises is normald) cup the hands over the ears if loud noise is expected suddenly

37. A nurse instructs a client in the use of a hearing aid. The nurse includes which of the following in the instructions?

a) check the battery to ensure that it is working before useb) leave the hearing aid in place while showeringc) hearing aids do not require any cared) a water-soluble lubricant is used on the hearing aid before insertion

38. A nurse has given a client at risk for motion sickness suggestions about medications that can prevent an occurrence. The nurse determines that the client has correctly learned the information if the client states to take medication at what time before the triggering event?

a) at least 1/2 day beforeb) at least 1 hour beforec) at least the day befored) at least 2 days before

39. An adult client makes an appointment with an ear specialist because of the frequent recurrence of middle ear infections. In performing an intake assessment of the client, the nurse would ask about which of the following as a risk factor related to infection of the ears?

a) exposure to loud noiseb) use of drilling and other power toolsc) congenital abnormalitiesd) occupational noise

40. A nurse is planning to instruct a client with chronic vertigo about safety measures to prevent exacerbation of symptoms or injury. Teaching for this client will include which of the following statements?

a) drive only when feelings of dizziness have not been experienced for several hoursb) go to the bedroom and lie down when vertigo is experiencedc) remove throw rugs and clutter in the homed) turn the head slowly when spoken to

36) D- A variety of ear protective devices are available commercially. These include disposable and reusable plugs, headbands, and foam-filled muffs. They should be used around any type of loud noise, such as from power tools, machinery, lawn mowers, chain saws, or other equipment. Sitting near loud music should be avoided whenever possible. If a loud noise is suddenly anticipated, the ears should be covered for protection. The client should see a physician for tinnitus or hearing loss after exposure to a loud noise.

37) A- The battery of the hearing aid should be checked before use. The hearing aid should be removed for showering, because it should not get wet. It also should be put away in its case at night. It should be cleaned according to manufacturer’s directions, which usually consist of washing with warm soapy water, followed by thorough drying. Lubricants or other solvents are not used on the hearing aid.

38) B- To be maximally effective, medications to prevent motion sickness should be taken at least 1 hour before the triggering event. Medications that are commonly used for this purpose include dimenhydrinate (Dramamine), scopolamine (Transderm-Scop), promethazine (Phenergan), and prochlorperazine (Compazine). Options A, C, and D are incorrect.

39) C

- Otitis media (middle ear infection) is associated with colds, allergies, sore throats, and blockage of the eustachian tube. Risk factors include a young age (usually a childhood disease), congenital abnormalities, immune deficiencies, exposure to cigarette smoke, family history of otitis media, recent upper respiratory infections, and allergies. Options A, B, and D can cause hearing loss. Hearing loss can occur as a result of an acute loud noise (acoustic trauma) or by the chronic exposure to loud noise (noise-induced hearing loss).

40) C- The client with chronic vertigo should avoid driving and using public transportation. The sudden movements involved in each could precipitate an attack. To further prevent vertigo attacks, the client should change positions slowly and should turn the entire body, not just the head, when spoken to. If vertigo does occur, the client should immediately sit down or grasp the nearest piece of furniture. The client should maintain the home without throw rugs and in a state that is free of clutter, because the effort of trying to regain balance after slipping could trigger the onset of vertigo.

41. A nurse is preparing a plan of care for a client being admitted to the hospital with exacerbation of Meniere's disease. Which of the following would the nurse include in the plan of care?

a) increase fluid intake to 3000 ml a dayb) tell the client to avoid moving the head suddenlyc) maintain a quiet environment, and allow the client to read and watch TVd) increase foods high in sodium in the diet

42. A nurse is performing an assessment of a client suspected of having mastoiditis. Which finding would the nurse expect to note if this disorder is present?

a) an elevated temperatureb) a red, dull, thick, and immobile tympanic membranec) a clear tympanic membraned) a transparent tympanic membrane

43. A nurse is performing an admission assessment of a client with a disorder involving the inner ear. Which of the following questions will the nurse ask the client to determine if the common symptom of this type of ear disorder is present?

a) do you have any hearing loss?b) do you have any itching around your ear?c) do you have any ringing in the ears?d) do you have any pain in the ear?

44. A new nursing graduate has been hired by the health care clinic to assist in conducting hearing tests in a local neighborhood. The clinic nurse is observing the nursing graduate perform a voice test to assess hearing in a client. Which of the following observations indicates that the graduate is performing the procedure correctly?

a) start 10 feet away from the client to determine if the client can hear clearlyb) asks the cleint to block one ear, quietly whispers a statement, and asks the client to repeat itc) whispers a statement with the back facing the clientd) asks the client to block the ears, faces the client, verbalizes a statement, and asks the client to repeat the statement

45. A clinic nurse receives a telephone call form a client who states that an insect has somehow flown into her ear and that a buzzing sound can be heard. The client asks the nurse how to remove the insect. Which of the following instructions should the nurse initially provide to the client?

a) have her spouse irrigate ear to kill the insectb) use a flashlight to try to coax the insect out of the earc) instill antibiotic eardrops if they are availabled) get into the shower and allow the ear to run into the ear to flush out the insect

41) BExacerbation of Ménière's disease is characterized by severe vertigo. The nurse instructs the client to make slow head movements to prevent worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid are sometimes prescribed. Activities such as reading and watching TV will worsen the vertigo. Clients are advised to stop smoking because of its vasoconstrictive effects.

42) B- Otoscopic examination in a client with mastoiditis reveals a red, dull, thick, and immobile tympanic membrane with or without perforation. Postauricular lymph nodes are tender and enlarged. Clients also have a low-grade fever, malaise, anorexia, swelling behind the ear, and pain with minimal movement of the head.

43) C- Tinnitus is the most common complaint of clients with otological disorders, especially those involving the inner ear. This symptom can range from mild ringing in the ear, which can go unnoticed during the day, to a loud roaring in the ear, which can interfere with the client's thinking process and attention span. The client may experience some pain or hearing loss, depending on the disorder, but these are not the most common symptoms. Itching around the ear may be associated with a disorder other than an inner ear disorder.

44) B- In a voice test, the nurse stands 1 to 2 feet away from the client and asks the client to block one external ear canal. The nurse quietly whispers a statement and asks the client to repeat it. Each ear is tested separately. Options A, C, and D are incorrect procedures.

45) B- Insects are killed before removal unless they can be coaxed out by a flashlight or a humming noise. Mineral oil or diluted alcohol is instilled into the ear to suffocate the

insect, which is then removed with ear forceps in the emergency department. It is not appropriate to ask the spouse to irrigate the ear. Suggesting the use of antibiotics is inappropriate. Option D is also inappropriate and may cause additional discomfort.

46. A nurse is caring for a hospitalized client with an acute attack of Meniere's disease. The client verbalizes concern because the client has experienced a hearing loss as a result of the attack. Which of the following responses would the nurse make to the client regarding the hearing loss?

a) it will take several weeks before the hearing returnsb) the hearing loss will fluctuate for a period of 1 weekc) the attack leaves a hearing loss in the involved eard) the hearing will return to normal

47. A nurse is reviewing the physician's orders on a client admitted to the hospital with a diagnosis of an acute attack of Meniere's disease. Which of the following orders, if noted on the client's chart, would the nurse question?

a) the administration of a sedativeb) the administration of an antihistaminec) the administration of vasoconstrictord) bedrest

48. A nurse is providing discharge instructions to the client who was hospitalized for an acute attack of Meniere's disease. Which of the following statements, if made by the client, indicates a need for further instructions?

a) I need to take the diuretics to decrease the fluid in the earb) I need to take antihistamine as prescribedc) I need to take a vasodilatord) it is not necessary to restrict salt in my diet

49. A client with a diagnosis of otosclerosis is admitted to the ambulatory care unit for stapedectomy, and the nurse prepares instructions for the client regarding home care after the procedure. Which statement by the client indicates a need for further instructions?

a) I need water out of the ear canal for at least 3 weeksb) I need to avoid air travel for at least 1 yearc) I need to notify the physician if I experience any persistent dizzinessd) I need to avoid bending and lifting heavy objects for at least 3 weeks

50. A community health nurse is conducting a health-screening clinic and is scheduled to perform hearing tests on the clients who attend the screening session. Several nurses have volunteered to assist with the screening clinic. The community health nurse instructs the nurses to perform a voice test to assess hearing in the clients and tells the nurses to do which of the following?

a) with back to the client, whisper a statement, and determine if the client can clearly repeat it

b) face the client, and whisper a statement while the client blocks both earsc) stand 4 feet away from the client when talking to the client, and determine if the client can hear at this distanced) quietly whisper a statement, and ask the client to repeat it to determine the hearing ability

46) C- After the acute phase, remission occurs, but symptoms of the disease will recur with two or three acute attacks occurring per year. As this pattern of attacks and remissions develops, fewer symptoms occur during the acute phase. A complete remission eventually occurs with some degree of hearing loss, varying from slight to complete. It takes several weeks before all symptoms subside after an attack, leaving a loss of hearing in the involved ear. Options A, B, and D are incorrect.

47) C- Medical interventions during the acute phase of Meniere's disease include using atropine or diazepam (Valium) to decrease the autonomic nervous system function. Diphenhydramine (Benadryl) may be prescribed for its antihistamine effects, and a vasodilator also will be prescribed. The client will remain on bedrest during the acute attack, and when allowed to be out of bed, the client will need assistance with walking, sitting, or standing.

48) D- Management during remission includes the use of diuretics to decrease the fluid and thereby decrease pressure in the endolymph. Antihistamines, vasodilators, and diuretics may be prescribed for the client. A low-salt diet is prescribed for the client to reduce fluid retention. The major goal of treatment is to preserve the client's hearing, and careful medical management helps achieve this in most clients with Ménière's disease.

49) B- After stapedectomy, the client is instructed to keep water out of the ear canal for at least 3 weeks and to avoid swimming for 6 weeks. The client also is instructed to avoid coughing and sneezing and to avoid bending and lifting heavy objects or other strenuous activities for at least 3 weeks. Air travel is avoided for 4 weeks. If sudden hearing loss, fever, or severe persistent vertigo or dizziness develops, the physician should be notified.

50) D- The examiner should stand 1 to 2 feet away from the client and ask the client to block one external ear canal. The nurse quietly whispers a statement and asks the client to repeat it. Each ear is tested separately. Options A, B, and C are incorrect.