Chapter 59 Assessment and Management of Patients with Hearing and Balance

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Chapter 59  Assessment and Management of Patients with Hearing and Balance

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

Multiple Choice

1. You are a pediatric nurse caring for a child who has been brought to the clinic with 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

Ans: C
Chapter: 59
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 4
Page and Header: 1812, External Otitis (Otitis External)

Feedback: Tophi are deposits of uric acid crystals and are generally painless; they are a common physical assessment finding in clients diagnosed with gout. Cerumen is a normal finding during assessment of the ear canal. Its presence does not necessarily indicate that

inflammation is present. Pain when the nurse pulls gently on the auricle in preparation for an otoscopic examination of the ear canal is a characteristic finding in clients with otitis externa. Air bubbles in the middle ear may be visualized with the otoscope; however, these do not indicate a problem involving the ear canal. Aural tenderness or pain is not usually associated with middle ear disorders.

2. While reviewing the health history of a 72-year-old client experiencing hearing loss the nurse notes the patient has had no trauma or loss of balance. What data is likely to be linked to the client’s 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 as a result of a high dive

Ans: B
Chapter: 59
Client Needs: D-3
Cognitive Level: Analysis Difficulty: Moderate
Integrated Process: Nursing Process Objective: 1
Page and Header: 1823, Ototoxicity

Feedback: Long-term, regular use of quinine for management of leg cramps is associated with loss of hearing acuity. Radiation therapy for cancer should not affect hearing; however, hearing can be significantly compromised by chemotherapy. Allergy to hair products may be associated with otitis externa; however, it is not linked to hearing loss. An ear drum that perforates spontaneously due to the sudden drop in altitude associated with a high dive usually heals well and is not likely to become infected. Recurrent otitis media with perforation can affect hearing as a result of chronic inflammation of the ossicles in the middle ear.

3. A nurse is planning preoperative teaching for a client with conductive hearing loss due to otosclerosis. The client is scheduled for a stapedectomy with insertion of a prosthesis. What information is most crucial to include in the client’s preoperative teaching?
A) 35% of clients will not experience restoration of hearing.

B) Noticeable improvement in hearing may not be experienced for up to 6 weeks after surgery. C) The nurse must assist the client to get out of bed on the first postoperative day.
D) Close-captioned TV programs are available at the hospital to meet the needs of hearing- impaired clients.

Ans: B
Chapter: 59
Client Needs: C
Cognitive Level: Comprehension Difficulty: Moderate
Integrated Process: Teaching/Learning Objective: 5
Page and Header: 1817, Otosclerosis

Feedback: Stapedectomy is a very successful procedure; approximately 95% of clients experience restoration of hearing. However, hearing returns gradually and can continue to improve for several weeks after surgery. It is important that the client understand this in order to prevent disappointment, anxiety, or depression after surgery. While it is important that a member of the nursing staff assist all postoperative clients who are getting out of bed for the first time after surgery, this information is routinely provided and is not specific to the client undergoing stapedectomy. Availabilty of close-captioned TV programs is very advantageous; however, it is not crucial information related to surgical outcomes.

4. Which of the following nursing interventions would be most likely to facilitate effective communication with a hearing-impaired client?
A) Ask the client to repeat what was said in order to evaluate understanding.
B) Stand directly in front of the client to facilitate lip reading.

C) Reduce environmental noise and distractions before communicating. D) Raise the voice to project sound at a higher frequency.

Ans: C
Chapter: 59
Client Needs: A-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication Objective: 3
Page and Header: 1816, Chronic Otitis Media

Feedback: Communication with the hearing impaired can be facilitated by talking in a quiet space free of competing noise stimuli and other distractions. Asking the client to repeat what was said is likely to provoke frustration in the client. A more effective strategy would be to repeat the question or statement choosing different words. Raising the voice to project sound at higher frequency would make understanding more difficult. The nurse cannot assume that the client reads lips. If the client does read lips, on average he or she will understand only 50% of words accurately.

5. The nurse is caring for a client with Ménière’s disease. The client is scheduled to go home tomorrow, so the nurse is preparing the client’s discharge teaching. Dietary guidelines will be included. What foods should the client be instructed to limit or avoid?
A) Sweet pickles

B) Frozen yogurt C) Citrus fruit D) Red meat

Ans: A
Chapter: 59
Client Needs: D-3
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning Objective: 6
Page and Header: 1819, Ménière’s Disease

Feedback: The client with Ménière’s disease should avoid foods high in salt and/or sugar; sweet pickles are high in both. Milk products are not contraindicated. Fresh citrus fruit is permitted. Any type of meat, fish, or poultry is permitted with the exception of canned or pickled varieties. In general, the client with Ménière’s disease should avoid or limit canned and processed foods.

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