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A client has a hearing aid. What care instructions does the nurse provide the unlicensed assistive personnel (UAP) in the care of this client? (Select all that apply.)
- A. Be careful not to drop the hearing aid when handling.
- B. Soak the hearing aid in hot water for 20 minutes.
- C. Turn the hearing aid off when the client goes to bed.
- D. Use a toothpick to clean debris from the device.
- E. Wash the device with soap and a small amount of warm water.
Correct Answer: A,C,D,E
Rationale: All these actions except soaking the hearing aid in hot water are proper instructions for the nurse to give to the UAP. While some water is used to clean the hearing aid, excessive wetting should be avoided.
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A client is scheduled for a stapedectomy in 2 weeks. What teaching instructions are most appropriate? (Select all that apply.)
- A. Avoid alcohol use before surgery.
- B. Blow the nose gently if needed.
- C. Use ear drops daily to prevent infection.
- D. Stop taking aspirin 1 week before surgery.
- E. Keep the ear dry after surgery.
Correct Answer: B,D,E
Rationale: Clients undergoing a stapedectomy should blow the nose gently if needed, stop taking aspirin 1 week before surgery to reduce bleeding risk, and keep the ear dry after surgery to prevent infection. Avoiding alcohol is not specific to this surgery, and prophylactic ear drops are not typically required.
A client is going on a cruise but has had motion sickness in the past. What suggestion does the nurse make to this client?
- A. Avoid alcohol on the cruise ship.
- B. Change positions slowly on the ship.
- C. Change your travel plans.
- D. Try scopolamine (Transderm Scop).
Correct Answer: D
Rationale: Scopolamine can successfully treat the vertigo and dizziness associated with motion sickness. Avoiding alcohol and changing positions slowly are not effective. Telling the client to change travel plans is not a caring suggestion.
The student nurse is performing a Weber tuning fork test. What technique is most appropriate?
- A. Holding the vibrating tuning fork 10 to 12 inches from the clients ear
- B. Placing the vibrating fork in the middle of the clients head
- C. Placing the vibrating fork in the middle of the clients head
- D. Tapping the vibrating tuning fork against the bridge of the nose
Correct Answer: B
Rationale: The Weber tuning fork test involves placing the vibrating tuning fork in the middle of the client's head and asking in which ear the client hears the vibrations loudest. The other techniques are incorrect.
A client is scheduled for a tympanoplasty. What actions by the nurse are most appropriate? (Select all that apply.)
- A. Administer preoperative antibiotics
- B. Assess for allergies to local anesthetics
- C. Ensure that informed consent is on the chart
- D. Teach that hearing improves immediately
- E. Administer antivertigo medications
Correct Answer: A,B,C
Rationale: Preoperatively, the nurse administers antibiotics, assesses for allergies to anesthetics, and ensures that informed consent is on the chart. Antivertigo medications are not used, and hearing improvement is not immediate until the ear packing is removed.
A client with labyrinthitis is prescribed antibiotics. What instruction is most important for the nurse to include?
- A. Immediately report headache or stiff neck.
- B. Keep all follow-up appointments.
- C. Take the antibiotics with a full glass of water.
- D. Take the antibiotic on an empty stomach.
Correct Answer: A
Rationale: Meningitis is a complication of labyrinthitis. The client should be taught to take all antibiotics as prescribed and to report manifestations of meningitis such as fever, headache, or stiff neck. Keeping follow-up appointments is important for all clients. Without knowing what antibiotic was prescribed, the nurse cannot instruct the client on how to take it.