Nokea
A client is scheduled to have a tumor of the middle ear removed. What teaching topic is most important for the nurse to cover?
- A. Expecting hearing loss in the affected ear
- B. Managing postoperative pain
- C. Ensuring proper wound care
- D. Understanding which medications are allowed the day of surgery
Correct Answer: A
Rationale: Removal of an inner ear tumor will likely destroy hearing in the affected ear. The other teaching topics are appropriate for any surgical client but are not the most critical in this case.
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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.
An older adult in the family practice clinic reports a decrease in hearing over a week. What action by the nurse is most appropriate?
- A. Assess for cerumen buildup.
- B. Applying ice four times a day
- C. Perform tuning fork tests.
- D. Review the medication list.
Correct Answer: A
Rationale: All options are possible actions for the client with hearing loss. The first action the nurse should take is to assess for cerumen buildup, as it is a common cause of sudden hearing loss in older adults. The other actions may follow but are not the priority.
A client has external otitis. On what comfort measure does the nurse instruct the client?
- A. Applying ice four times a day
- B. Instilling vinegar-and-water drops
- C. Using a home humidifier
- D. Wearing ear plugs during sleep
Correct Answer: C
Rationale: A heating pad on low or a warm moist pack can provide comfort to the client with otitis externa. The other options are not warranted.
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.
The nurse works with clients who have hearing problems. Which action by a client best indicates goals for an important diagnosis have been met?
- A. Babysitting the grandchildren several times a week
- B. Having an adaptive hearing device for the television
- C. Being active in community groups and volunteer work
- D. Responding agreeably to suggestions for adaptive devices
Correct Answer: C
Rationale: Clients with hearing problems can become frustrated and withdrawn. The client who is actively engaged in the community shows the best evidence of psychosocial adjustment to hearing loss. Babysitting the grandchildren is a positive sign but does not indicate involvement outside the home. Having an adaptive device is not the same as being actively engaged outside the home. Responding agreeably does not indicate the client will actually follow through.