A nursing student studying the auditory system learns about the structures of the inner ear. What structures does this include? (Select all that apply.)
- A. Cochlea
- B. Epitympanum
- C. Organ of Corti
- D. Semicircular canals
- E. Vestibule
Correct Answer: A,C,D,E
Rationale: The cochlea, organ of Corti, semicircular canals, and vestibule are all part of the inner ear. The epitympanum is in the middle ear.
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A client with Ménière's disease is in the hospital when the client has an attack of this disorder. What action by the nurse takes priority?
- A. Assess vital signs every 15 minutes.
- B. Dim or turn off lights in the client's room.
- C. Place the client in bed with the upper siderails up.
- D. Provide a cool, wet cloth for the client's face.
Correct Answer: C
Rationale: Clients with Ménière's disease can have vertigo so severe that they can fall. The nurse should assist the client into bed and raise the upper siderails to prevent falls due to the intense whirling feeling. The other actions are not warranted for clients with Ménière's disease.
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.
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 hospitalized client has Ménière's disease. What menu selections demonstrate good knowledge of the recommended diet for this disorder? (Select all that apply.)
- A. Chinese stir fry with vegetables.
- B. Broiled chicken breast.
- C. Chocolate espresso cookies.
- D. Chili with tortilla chips.
- E. Green herbal tea with meals.
Correct Answer: B,E
Rationale: The diet recommendations for Ménière's disease include low-sodium, caffeine-free foods and fluids distributed evenly throughout the day. Plenty of water is also needed. The broiled chicken breast and herbal tea are the best selections. The stir fry is high in sodium and possibly monosodium glutamate (MSG, also not recommended). The cookies and chili with tortilla chips are high in sodium.
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.
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