.

The nurse is providing instructions to a nursing assistant 2) D

regarding care of an older client with hearing loss. The - Otoscopic examination in a client with mastoiditis reveals
nurse tells the assistant that clients with a hearing loss: a red, dull, thick, and immobile tympanic membrane, with
a) are often distracted or without perforation. Postauricular lymph nodes are
b) have middle ear changes tender and enlarged. Clients also have a low-grade fever,
c) respond to low-pitched tones malaise, anorexia, swelling behind the ear, and pain with
d) develop moist cerumen production minimal movement of the head.

2. The nurse is performing an otoscopic examination on a 3) B

client with mastoiditis. On examination of the tympanic - Tinnitus is the most common complaint of clients with
membrane, which of the following would the nurse expect otological disorders, especially disorders involving the
to observe? inner ear. Symptoms of tinnitus range from mild ringing in
the ear, which can go unnoticed during the day, to a loud
a) a pink-colored tympanic membrane roaring in the ear, which can interfere with the client’s
b) a pearly colored tympanic membrane thinking process and attention span. Options A, C, and D
c) a transparent and clear tympanic membrane are not associated specifically with disorders of the inner
d) a red, dull, thick and immobile tympanic membrane ear.

4) C
- In the voice test, the examiner stands 1 to 2 feet away
3. The client is diagnosed with a disorder involving the from the client and asks the client to block one external
inner ear. Which of the following is the most common ear canal. The nurse whispers a statement and asks the
client complaint associated with a disorder involving this client to repeat it. Each ear is tested separately.
part of the ear?
5) C
a) pruritus - In the Weber tuning fork test, the nurse places the
b) tinnitus vibrating tuning fork in the middle of the client’s head, at
c) hearing loss the midline of the forehead, or above the upper lip over
d) burning in the ear the teeth. Normally, the sound is heard equally in both
ears by bone conduction. If the client has a sensorineural
4. The nurse is performing a voice test to assess hearing. hearing loss in one ear, the sound is heard in the other ear.
Which of the following describes the accurate procedure If the client has a conductive hearing loss in one ear, the
for performing this test? sound is heard in that ear.

a) whisper a statement while the client blocks both ears 6. The nurse is caring for a hearing-impaired client. Which
b) whisper a statement with the examiner's back facing of the following approaches will facilitate communication?
the client
c) whisper a statement and ask the client to repeat it while a) speak loudly
blocking one ear b) speak frequently
d) stand 4 feet away from the client to ensure that the c) speak at a normal volume
client can hear at this distance d) speak directly into the impaired ear

5. During a hearing assessment, the nurse notes that the 7. A client arrives at the emergency room with a foreign
sound lateralizes to the client's left ear with the Weber body in the left ear that has been determined to be an
test. The nurse analyzes these results as: insect. Which intervention would the nurse anticipate to
be prescribed initially?
a) a normal finding
b) the presence of nystagmus a) irrigation of the ear
c) a sensorineural or conductive loss b) instillation of diluted alcohol
d) a conductive loss in the right ear c) instillation of antibiotic ear drops
d) instillation of corticosteroid ointment

1) C
- Presbycusis refers to the age-related irreversible 8. The nurse notes that the physician has documented a
degenerative changes of the inner ear that lead to diagnosis of presbycusis on the client's chart. The nurse
decreased hearing ability. As a result of these changes, the plans care knowing that the condition is:
older client has a decreased response to high-frequency
sounds. Low-pitched voice tones are heard more easily a) tinnitus that occurs with aging
and can be interpreted by the older client. Options A, B, b) nystagmus that occurs with aging
and D are not accurate. c) a conductive hearing loss that occurs with aging
d) a sensorineural hearing loss that occurs with aging
 11.The nurse is caring for a client following craniotomy for
9. The nurse has conducted discharge teaching for a client removal of an acoustic neuroma. Assessment of which of
who has had a fenestration procedure for the treatment of the following cranial nerves would identify a complication
otosclerosis. Which of the following, if stated by the client, specifically associated with this surgery?
would indicate that teaching was effective?
a) cranial nerve I, olfactory
a) it is okay to take a shower and wash my hair b) cranial nerve IV, trochlear
b) I can resume my tennis lessons starting next week c) cranial nerve III, oculomotor
c) I will take stool softeners as prescribed by my doctor d) cranial nerve VII, facial nerve
d) I should drink liquids through a straw fo the next 2 to 3
weeks 12. The nurse assesses the client with a blunt injury
sustained from a motor vehicle accident. Which
10. A client with Meniere's disease is experiencing severe assessment sign would indicate a basal skull fracture as a
vertigo. Which instruction should the nurse give to the result of the injury?
client to assist in controlling the vertigo?
a) epistaxis
a) increase sodium in the diet b) periorbital edema
b) avoid sudden head movements c) purulent drainage from the auditory canal
c) lie still and watch the television d) bloody or clear drainage from the auditory canal
d) increase fluid intake to 3L a day
13. A client was just admitted to the hospital to rule out a
6) C gastrointestinal (GI) bleed. The client has brought several
- Speaking in a normal tone to the client with impaired bottles of medications prescribed by different specialists.
hearing and not shouting are important. The nurse should During the admission assessment, the client states,
talk directly to the client while facing the client and speak "Lately, I have been hearing some roaring sounds in my
clearly. If the client does not seem to understand what is ears, especially when I am alone." Which medication
said, the nurse should express it differently. Moving closer would the nurse determine could be the cause of the
to the client and toward the better ear may facilitate client's complaint?
communication, but the nurse should avoid talking directly
into the impaired ear. a) doxycycline (Vibramycin)
b) acetazolamide (Diamox)
7) B c) acetylsalicylic acid (aspirin)
- Insects are killed before removal unless they can be d) diltiazem hydrochloride (Cardizem)
coaxed out by a flashlight or a humming noise. Mineral oil
or diluted alcohol is instilled into the ear to suffocate the 14. The nurse prepares the client for an ear irrigation as
insect, which then is removed using ear forceps. When the prescribed by the physician. In performing the procedure,
foreign object is vegetable matter, irrigation is not used, the nurse:
because this material expands with hydration and the
impaction becomes worse. a) warms the irrigating solution to 98F
b) position the client with the affected side up following
8) D the irrigation
- Presbycusis is a type of hearing loss that occurs with c) directs a slow steady stream of irrigation solution
aging. Presbycusis is a gradual sensorineural loss caused by toward the eardrum
nerve degeneration in the inner ear or auditory nerve. d) assists the client to turn his or her head so that the ear
Options A, B, and C are incorrect. to be irrigated is facing upward

9) C 15. Ear drops are prescribed for an infant with otitis media.
- Following ear surgery, the client needs to avoid straining The most appropriate method to administer the ear drops
when having a bowel movement. The client needs to be to the infant is to:
instructed to avoid drinking with a straw for 2 to 3 weeks,
air travel, and coughing excessively. The client needs to a) pull up and back on the pinna and direct the solution
avoid getting his or her head wet, washing hair, showering onto the eardrum
for 1 week, and rapidly moving the head, bouncing, and b) pull down and back on the pinna and direct the solution
bending over for 3 weeks. onto the eardrum
c) pull down and back on the pinna and direct he solution
10) B toward the wall of the canal
- The nurse instructs the client to make slow head d) pull up and back on the ear lobe and direct the solution
movements to prevent worsening of the vertigo. Dietary toward the wall of the canal
changes such as salt and fluid restrictions that reduce the
amount of endolymphatic fluid are sometimes prescribed. 11) D
Lying still and watching television will not control vertigo. - 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. a) I need to drink at least 3 liters of fluid per day
b) I need to restrict my carbohydrates intake
12) D c) I need to maintain a low-fat and low-cholesterol diet
- Bloody or clear watery drainage from the auditory canal d) I need to be sure to consume foods that are low in
indicates a cerebrospinal fluid leak following trauma and sodium
suggests a basal skull fracture. This warrants immediate
attention. Options A, B, and C are not specific to a basal 18. A nurse in the health care clinic is providing
skull fracture. instructions to a client regarding the use of a hearing aid.
Which of the following statements would be appropriate
13) C for the nurse to include?
- Aspirin is contraindicated for gastrointestinal bleed and is
potentially ototoxic. The client should be advised to notify a) the ear mold for the hearing aid should be washed with
the prescribing physician so the medication can be mild soap and water once a month
discontinued and/or a substitute that is less toxic to the b) the hearing aid should be removed from the ear at the
ear can be taken instead. Options A, B, and D do not have end of the day then turned off after removal
side effects that are potentially associated with hearing c) the hearing aid contains a lifelong battery so you will not
difficulties. need to be concerned about changing batteries
d) the hearing aid should not be worn if an ear infection is
14) A present
- Irrigation solutions that are not close to the client’s body
temperature can be uncomfortable and may cause injury, 19. A nurse is caring for a client with acute otitis media. In
nausea, and vertigo. The client is positioned so that the ear order to reduce pressure and allow fluid to drain, the
to be irrigated is facing downward, because this allows nurse anticipates that which of the following would most
gravity to assist in the removal of the ear wax and solution. likely be recommended to the client?
Following the irrigation, the client is to lie on the affected
side to finish draining the irrigating solution. A slow steady a) the administration of diphenhydramine (Benadryl)
stream of solution should be directed toward the upper capsules
wall of the ear canal and not toward the eardrum. Too b) a myringotomy
much force could cause the tympanic membrane to c) strict bedrest
rupture. d) a mastoidectomy

15) C 20. A nurse is developing a plan of care for a client with a

- In a child younger than 3 years, the pinna is pulled down diagnosis of Meniere's disease who is being admitted to
and straight back. The infant should be turned on the side the hospital. The priority nursing intervention in the plan
with the affected ear uppermost. With the nondominant of care should focus on:
hand, the pinna is pulled down and back. The medication
is administered by aiming it at the wall of the canal rather a) safety measures
than directly onto the eardrum. The infant should remain b) self-care measures
with the affected ear uppermost for 10 to 15 minutes to c) knowledge about medication therapy
retain the solution. In the adult or a child older than 3 d) food items to avoid
years, the pinna is pulled up and back to straighten the
auditory canal. 16) A
- The nurse tilts the client’s head slightly away and holds
16. The nurse is preparing to perform an otoscopic the otoscope upside down as if it were a large pen. The
examination on an adult client. The nurse does which of pinna is pulled up and back and the nurse visualizes the
the following to perform this examination? external canal while slowly inserting the speculum.
Options B, C, and D are incorrect.
a) pulls the pinna up and back before inserting the
speculum 17) D
b) pulls the earlobe down and back before inserting the - Dietary changes such as salt and fluid restrictions that
speculum reduce the amount of endolymphatic fluid are sometimes
c) uses the smallest speculum available to decrease the prescribed for the client with Ménière’s disease. The client
discomfort of the exam should be instructed to consume a low-sodium diet and
d) tilts the clients head forward and down before inserting restrict fluids as prescribed. Low-fat, low-carbohydrate,
the speculum and low-cholesterol diets are not specifically prescribed
for the client with Ménière’s disease.
17. A nurse is providing diet instructions to a client with
Meniere's disease who is being discharged from the 18) D
hospital after admission for an acute attack. Which - The client should be instructed that the hearing aid
statement if made by the client indicates an understanding should not be worn if an ear infection is present. The client
of the dietary measures to take to prevent further attacks? should be instructed to turn the hearing aid off before
removing it from the ear to prevent any squealing b) pull the ear lobe down and back before inserting the
feedback. The hearing aid should be turned off when not speculum
in use and the client should keep extra batteries on hand c) tilt the client's head forward before inserting the
at all times. The client should wash the ear mold speculum
frequently with mild soap and water, with the use of a d) pull the pinna up and back before inserting the
pipe cleaner to clean the cannula of the hearing aid. speculum

19) B 25. A nurse is providing discharge instructions to the client

- A myringotomy is a surgical procedure that will allow being discharged after a fenestration procedure for the
fluid to drain from the middle ear. Benadryl is an treatment of otosclerosis. Which statement if made by the
antihistamine with antiemetic properties. Strict bedrest is client indicates a need for further instruction?
not necessary, although activity may be restricted.
Additionally, bedrest would not assist in reducing pressure a) I should take stool softeners to avoid straining when
or allowing fluid to drain. In some cases, the mastoid bone having a bowel movement
is removed or partially removed for chronic otitis media. b) I need to avoid washing my hair and showering for at
least 1 week
20) A c) I should avoid movements requiring bending over for at
- Ménière’s disease can cause severe vertigo in the client. least 3 weeks
The priority in the nursing care plan should focus on safety d) I should use a straw to drink liquids for the next 2 to 3
issues to prevent falls or injury in the client. Although self- weeks
care measures, medication therapy, and dietary therapy 21) D
may be components of the plan of care, safety is the - After mastoidectomy, the nurse should monitor vital
priority issue. signs and inspect the dressing for drainage or bleeding.
The nurse also should assess for signs of facial nerve injury
1. A nurse is assigned to care for a client after a (cranial nerve VII). The nurse also should monitor for signs
mastoidectomy. Which nursing intervention would be of pain, dizziness, or nausea. The head of the bed should
appropriate in the care of this client? be elevated at least 30 degrees, and the client should be
instructed to lie on the unaffected side. The client
a) maintain a supine position probably will have sutures, an outer ear packing, and a
b) position the client on the affected side to promote bulky dressing, which is removed on approximately the
drainage sixth day postoperatively.
c) change the ear dressing daily
d) monitor for signs of facial nerve injury 22) A
- Ménière’s disease results in a disturbance of the fluid of
the endolymphatic system. The cause of the disturbance is
22. A nurse is performing an assessment on a client with a not known. Attacks may be preceded by feelings of
diagnosis of Meniere's disease. The nurse anticipates that fullness in the ear or by tinnitus. Headaches, fatigue, and
the client is most likely to report which of the following insomnia are not associated with this disorder.
symptoms during an acute attack?
23) D
a) tinnitus - Medical interventions during the acute phase of
b) headache Ménière’s disease include using atropine sulfate or
c) fatigue diazepam to decrease the autonomic nervous system
insomnia function. Diphenhydramine may be prescribed for its
antihistamine effects, and a vasodilator also will be
prescribed. The client will remain on bedrest during the
23. A nurse has admitted a client with a diagnosis of an acute attack. When allowed out of bed, the client will need
acute attack of Meniere's disease to the hospital. The assistance with walking, sitting, or standing.
nurse reviews the physician's orders for the client. Which
order should the nurse question? 24) D
- The correct procedure for performing an otoscopic
a) diphenhydramine (Benadryl) examination on an adult is to pull the pinna up and back to
b) diazepam (Valium) allow visualization of the external canal while slowly
c) atropine sulfate inserting the speculum. The nurse would tilt the client’s
d) ambulation 4 times daily head slightly away and hold the otoscope upside down as
if it were a large pen. The examination would be
24. A nurse in the health care clinic is preparing to perform performed with the client in a sitting position. If the client
an otoscopic examination on adult client. In performing were lying on the side to be examined, examination of the
the examination, the nurse should: affected ear would not be possible.

a) position the client lying flat on the side of the ear be 25) D
examined
- After ear surgery, clients need to be instructed to avoid a) drink liquids through a straw for the next 2 to 3 weeks
drinking with a straw for 2 to 3 weeks, to avoid air travel, b) shower daily to prevent infection
and to avoid coughing excessively. The client also should c) avoid air travel
be instructed to avoid straining when having a bowel d) resume all normal activities in 1 week
movement and should be instructed to take stool
softeners as prescribed. The client should avoid getting the 26) A
head wet, washing the hair, or showering for at least 1 - During the irrigation, the client is positioned so that the
week, and to avoid rapidly moving the head, bouncing, ear to be irrigated is facing downward, because this allows
and bending over for at least 3 weeks. gravity to assist in the removal of the earwax and solution.
26. The clinic nurse is preparing to provide care for a client Delivery of irrigation solutions at temperatures that are
who will need an ear irrigation to remove impacted not close to body temperature can cause discomfort for
cerumen. Which of the following will the nurse avoid when the client and may result in tissue injury, nausea, and
performing the irrigation? vertigo. A slow, steady stream of solution should be
directed toward the upper wall of the ear canal, not
a) position the client to turn the head so that the ear be toward the tympanic membrane. After the irrigation, the
irrigated is facing upward client should lie on the affected side for a period of time
b) warm the irrigating solution to a temperature that is that is necessary to allow the irrigating solution to finish
close to body temperature draining (usually 10 to 15 minutes). Too much force could
c) direct a slow steady stream of irrigation solution toward cause the tympanic membrane to rupture.
the upper wall of the ear canal
d) position the client with the affected side down after 27) D
irrigation - In the otoscopic examination, the nurse tilts the client’s
head slightly away and holds the otoscope upside down as
27. A nursing student is performing an otoscopic if it were a large pen. The pinna is pulled up and back and
examination in an adult client. The nursing instructor the nurse visualizes the external canal while slowly
observes the student perform this procedure. Which inserting the speculum. A small speculum is used in
observation by the instructor indicates that the student is pediatric clients. The nurse may not be able to adequately
using correct technique for the procedure? visualize the ear canal if a small speculum is used in the
adult client.
a) pulling the pinna down and back before inserting the
speculum 28) C
b) pulling the earlobe down and back before inserting the - A tuning fork is needed to perform the Weber test,
speculum during which the nurse places the vibrating tuning fork at
c) using the smallest speculum available the midline of the client’s forehead or above the upper lip
d) tilting the client's head slightly away and holding the over the teeth. Normally, the sound is heard equally in
otoscope upside before inserting the speculum both ears by bone conduction. If the client has a
sensorineural hearing loss in one ear, the sound is heard in
28. A nurse is preparing to perform a Weber test on a the other ear. If the client has a conductive hearing loss in
client. The nurse obtains which item needed to perform one ear, the sound is heard in that ear. The items
this test? identified in options A, B, and D are not needed to perform
the Weber test.
a) a tongue blade
b) a stethoscope 29) C
c) a tuning fork - Measures that facilitate hearing in the client with a
d) a reflex hammer hearing impairment problem include speaking in a normal
tone; avoiding shouting; talking directly to the client while
29. The home care nurse is visiting a client who was facing the client; and speaking clearly. If the client does
recently diagnosed with a hearing impairment. The nurse not seem to understand what is said, the statement should
prepares to instruct the client's spouse in which measure be expressed differently. Moving closer to the client and
that will facilitate communication? toward the better ear may facilitate communication, but
talking directly into the impaired ear should be avoided.
a) speak frequently to the client to provide sensory
stimulation 30) C
b) speak loudly to the client to facilitate hearing After ear surgery, the client needs to be instructed to
c) speak in a normal tone and face the client when avoid air travel, avoid drinking through a straw for 2 to 3
speaking weeks, and to avoid coughing excessively. In addition, the
d) speak directly into the impaired ear to facilitate hearing client should avoid straining when having a bowel
movement, as well as washing the hair, getting the head
30. A nurse is providing discharge instructions to a client wet, or showering for 1 week. The client also needs to
who had a fenestration procedure for the treatment of avoid rapidly moving the head, bouncing, and bending
otosclerosis. The nurse instructs the client to: over for 3 weeks.
1. A clinic nurse is preparing to perform a Romberg test on 32) D
a client being seen in the clinic. The nurse performs this A round or oval darkened area on the eardrum would be
test for the purpose of determining: seen in a client with a perforated eardrum. A red and
bulging eardrum is indicative of acute purulent otitis
a) the client's ability to ambulate media. Dense white patches are seen on the eardrum of a
b) the functional status of the vestibular apparatus in the client with sequelae of repeated ear infections. A colony of
inner ear black dots on the eardrum suggests a yeast or fungal
c) the intactness of the retinal structure of the eye infection.
d) the intactness of the tympanic membrane
33) A
32. A clinic nurse is performing an otoscopic examination - A caloric test is contraindicated in a client with a
on an adolescent who was hit in the ear with a basketball perforated tympanic membrane (air may be used as a
during a neighborhood game. A perforated eardrum is substitute) or if the client has an acute disease of the
suspected. Which of the following would the nurse expect labyrinth. An otoscopic examination should be performed
to observe if the eardrum is perforated? before the caloric test to rule out perforation and to
determine if the ear canal contains cerumen, which must
a) a colony of black dots on the eardrum be removed before the test. An ophthalmoscope, a tongue
b) dense white patches on the eardrum blade, and an emesis basin are not essential items.
c) a red bulging eardrum
d) a round or oval darkened area on the eardrum 34) A
- Adults who were born deaf or became deaf before
33. A caloric test is ordered for a client suspected of having learning to speak usually are not candidates for this type
disease of the labyrinth. The nurse would obtain which of of surgery. Criteria for a cochlear implant procedure are
the following essential items in preparation for this test? bilateral profound hearing loss, use of speech as the
primary mode of communication, lack of benefit from
a) an otoscope conventional hearing aids, evidence of strong family and
b) an opthalmoscope social support, and realistic client expectations for the
c) a tongue blade outcome of the implant procedure.
d) an emesis basin
35) D
34. A nurse educator is conducting an in-service education - Overenunciating words does not make lip reading easier
session to the nurses employed in the eye and ear surgical and is demeaning to the deaf person. It is best to speak in
unit of a large trauma center. In discussing the topic of a normal manner. Options A, B, and C are appropriate
cochlear implants, the educator notes that this surgical communication strategies for the client who is deaf.
procedure is contraindicated in which of the following
clients? 36. A nurse is planning a presentation on noise prevention
and ear protection for a display booth at a local health fair.
a) a client who became deaf before learning to speak The nurse plans to incorporate which important concept
b) a client with bilateral profound hearing loss regarding hearing loss in the presentation?
c) a client who communicates primarily by speech
d) a client who received no benefit from conventional a) siting near loud music is not harmful
hearing aids b) ear plugs or other protectors are necessary only when
use of power tools
35. A nurse is observing a nursing assistant communicating c) prolonged ringing in the ears after loud noises is normal
with a client who is deaf. The nurse will intervene if which d) cup the hands over the ears if loud noise is expected
of the following behaviors is observed? suddenly

a) the nursing assistant is speaking directly to the client 37. A nurse instructs a client in the use of a hearing aid.
b) the nursing assistant touches the client's arm to gain his The nurse includes which of the following in the
or her attention instructions?
c) the nursing assistant faces the client when speaking to
the client a) check the battery to ensure that it is working before use
d) the nursing assistant overenunciates words when b) leave the hearing aid in place while showering
speaking c) hearing aids do not require any care
d) a water-soluble lubricant is used on the hearing aid
31) B before insertion
- The Romberg test assesses the ability of the vestibular
apparatus in the inner ear to help maintain standing 38. A nurse has given a client at risk for motion sickness
balance. The Romberg test also assesses intactness of the suggestions about medications that can prevent an
cerebellum and proprioception. Options A, C, and D are occurrence. The nurse determines that the client has
incorrect. correctly learned the information if the client states to
take medication at what time before the triggering event?
 - Otitis media (middle ear infection) is associated with
a) at least 1/2 day before colds, allergies, sore throats, and blockage of the
b) at least 1 hour before eustachian tube. Risk factors include a young age (usually a
c) at least the day before childhood disease), congenital abnormalities, immune
d) at least 2 days before deficiencies, exposure to cigarette smoke, family history of
otitis media, recent upper respiratory infections, and
39. An adult client makes an appointment with an ear allergies. Options A, B, and D can cause hearing loss.
specialist because of the frequent recurrence of middle Hearing loss can occur as a result of an acute loud noise
ear infections. In performing an intake assessment of the (acoustic trauma) or by the chronic exposure to loud noise
client, the nurse would ask about which of the following as (noise-induced hearing loss).
a risk factor related to infection of the ears?
40) C
a) exposure to loud noise - The client with chronic vertigo should avoid driving and
b) use of drilling and other power tools using public transportation. The sudden movements
c) congenital abnormalities involved in each could precipitate an attack. To further
d) occupational noise prevent vertigo attacks, the client should change positions
slowly and should turn the entire body, not just the head,
40. A nurse is planning to instruct a client with chronic when spoken to. If vertigo does occur, the client should
vertigo about safety measures to prevent exacerbation of immediately sit down or grasp the nearest piece of
symptoms or injury. Teaching for this client will include furniture. The client should maintain the home without
which of the following statements? throw rugs and in a state that is free of clutter, because
the effort of trying to regain balance after slipping could
a) drive only when feelings of dizziness have not been trigger the onset of vertigo.
experienced for several hours
b) go to the bedroom and lie down when vertigo is 41. A nurse is preparing a plan of care for a client being
experienced admitted to the hospital with exacerbation of Meniere's
c) remove throw rugs and clutter in the home disease. Which of the following would the nurse include in
d) turn the head slowly when spoken to the plan of care?

a) increase fluid intake to 3000 ml a day

36) D b) tell the client to avoid moving the head suddenly
- A variety of ear protective devices are available c) maintain a quiet environment, and allow the client to
commercially. These include disposable and reusable read and watch TV
plugs, headbands, and foam-filled muffs. They should be d) increase foods high in sodium in the diet
used around any type of loud noise, such as from power
tools, machinery, lawn mowers, chain saws, or other 42. A nurse is performing an assessment of a client
equipment. Sitting near loud music should be avoided suspected of having mastoiditis. Which finding would the
whenever possible. If a loud noise is suddenly anticipated, nurse expect to note if this disorder is present?
the ears should be covered for protection. The client
should see a physician for tinnitus or hearing loss after a) an elevated temperature
exposure to a loud noise. b) a red, dull, thick, and immobile tympanic membrane
c) a clear tympanic membrane
37) A d) a transparent tympanic membrane
- The battery of the hearing aid should be checked before
use. The hearing aid should be removed for showering, 43. A nurse is performing an admission assessment of a
because it should not get wet. It also should be put away client with a disorder involving the inner ear. Which of the
in its case at night. It should be cleaned according to following questions will the nurse ask the client to
manufacturer’s directions, which usually consist of determine if the common symptom of this type of ear
washing with warm soapy water, followed by thorough disorder is present?
drying. Lubricants or other solvents are not used on the
hearing aid. a) do you have any hearing loss?
b) do you have any itching around your ear?
38) B c) do you have any ringing in the ears?
- To be maximally effective, medications to prevent motion d) do you have any pain in the ear?
sickness should be taken at least 1 hour before the
triggering event. Medications that are commonly used for 44. A new nursing graduate has been hired by the health
this purpose include dimenhydrinate (Dramamine), care clinic to assist in conducting hearing tests in a local
scopolamine (Transderm-Scop), promethazine neighborhood. The clinic nurse is observing the nursing
(Phenergan), and prochlorperazine (Compazine). Options graduate perform a voice test to assess hearing in a client.
A, C, and D are incorrect. Which of the following observations indicates that the
graduate is performing the procedure correctly?
39) C
a) start 10 feet away from the client to determine if the insect, which is then removed with ear forceps in the
client can hear clearly emergency department. It is not appropriate to ask the
b) asks the cleint to block one ear, quietly whispers a spouse to irrigate the ear. Suggesting the use of antibiotics
statement, and asks the client to repeat it is inappropriate. Option D is also inappropriate and may
c) whispers a statement with the back facing the client cause additional discomfort.
d) asks the client to block the ears, faces the client,
verbalizes a statement, and asks the client to repeat the 46. A nurse is caring for a hospitalized client with an acute
statement attack of Meniere's disease. The client verbalizes concern
because the client has experienced a hearing loss as a
45. A clinic nurse receives a telephone call form a client result of the attack. Which of the following responses
who states that an insect has somehow flown into her ear would the nurse make to the client regarding the hearing
and that a buzzing sound can be heard. The client asks the loss?
nurse how to remove the insect. Which of the following
instructions should the nurse initially provide to the client? a) it will take several weeks before the hearing returns
b) the hearing loss will fluctuate for a period of 1 week
a) have her spouse irrigate ear to kill the insect c) the attack leaves a hearing loss in the involved ear
b) use a flashlight to try to coax the insect out of the ear d) the hearing will return to normal
c) instill antibiotic eardrops if they are available
d) get into the shower and allow the ear to run into the 47. A nurse is reviewing the physician's orders on a client
ear to flush out the insect admitted to the hospital with a diagnosis of an acute
attack of Meniere's disease. Which of the following orders,
41) B if noted on the client's chart, would the nurse question?
Exacerbation of Ménière's disease is characterized by
severe vertigo. The nurse instructs the client to make slow a) the administration of a sedative
head movements to prevent worsening of the vertigo. b) the administration of an antihistamine
Dietary changes such as salt and fluid restrictions that c) the administration of vasoconstrictor
reduce the amount of endolymphatic fluid are sometimes d) bedrest
prescribed. Activities such as reading and watching TV will
worsen the vertigo. Clients are advised to stop smoking 48. A nurse is providing discharge instructions to the client
because of its vasoconstrictive effects. who was hospitalized for an acute attack of Meniere's
disease. Which of the following statements, if made by the
42) B client, indicates a need for further instructions?
- Otoscopic examination in a client with mastoiditis reveals
a red, dull, thick, and immobile tympanic membrane with a) I need to take the diuretics to decrease the fluid in the
or without perforation. Postauricular lymph nodes are ear
tender and enlarged. Clients also have a low-grade fever, b) I need to take antihistamine as prescribed
malaise, anorexia, swelling behind the ear, and pain with c) I need to take a vasodilator
minimal movement of the head. d) it is not necessary to restrict salt in my diet

43) C 49. A client with a diagnosis of otosclerosis is admitted to

- Tinnitus is the most common complaint of clients with the ambulatory care unit for stapedectomy, and the nurse
otological disorders, especially those involving the inner prepares instructions for the client regarding home care
ear. This symptom can range from mild ringing in the ear, after the procedure. Which statement by the client
which can go unnoticed during the day, to a loud roaring in indicates a need for further instructions?
the ear, which can interfere with the client's thinking
process and attention span. The client may experience a) I need water out of the ear canal for at least 3 weeks
some pain or hearing loss, depending on the disorder, but b) I need to avoid air travel for at least 1 year
these are not the most common symptoms. Itching around c) I need to notify the physician if I experience any
the ear may be associated with a disorder other than an persistent dizziness
inner ear disorder. d) I need to avoid bending and lifting heavy objects for at
least 3 weeks
44) B
- In a voice test, the nurse stands 1 to 2 feet away from the 50. A community health nurse is conducting a health-
client and asks the client to block one external ear canal. screening clinic and is scheduled to perform hearing tests
The nurse quietly whispers a statement and asks the client on the clients who attend the screening session. Several
to repeat it. Each ear is tested separately. Options A, C, nurses have volunteered to assist with the screening clinic.
and D are incorrect procedures. The community health nurse instructs the nurses to
perform a voice test to assess hearing in the clients and
45) B tells the nurses to do which of the following?
- Insects are killed before removal unless they can be
coaxed out by a flashlight or a humming noise. Mineral oil a) with back to the client, whisper a statement, and
or diluted alcohol is instilled into the ear to suffocate the determine if the client can clearly repeat it
b) face the client, and whisper a statement while the client
blocks both ears
c) stand 4 feet away from the client when talking to the
client, and determine if the client can hear at this distance
d) 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.