Nokea
The advanced practice nurse is attempting to examine the patients ear with an otoscope. Because of impacted cerumen, the tympanic membrane cannot be visualized. The nurse irrigates the patients ear with a solution of hydrogen peroxide and water to remove the impacted cerumen. What nursing intervention is most important to minimize nausea and vertigo during the procedure?
- A. Maintain the irrigation fluid at a warm temperature.
- B. Instill short, sharp bursts of fluid into the ear canal.
- C. Follow the procedure with insertion of a cerumen curette to extract missed ear wax.
- D. Have the patient stand during the procedure.
Correct Answer: A
Rationale: Warm irrigation fluid prevents vertigo and nausea, which cold fluid can trigger. Forceful irrigation risks perforation, curettes require special training, and standing is unnecessary.
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A patient has been diagnosed with serous otitis media for the third time in the past year. How should the nurse best interpret this patients health status?
- A. For some patients, these recurrent infections constitute an age-related physiologic change.
- B. The patient would benefit from a temporary mobility restriction to facilitate healing.
- C. The patient needs to be assessed for nasopharyngeal cancer.
- D. Blood cultures should be drawn to rule out a systemic infection.
Correct Answer: C
Rationale: Recurrent unilateral serous otitis media in adults may indicate nasopharyngeal cancer obstructing the eustachian tube, requiring evaluation. It is not age-related, does not require mobility restriction, and is not systemic.
A child has been experiencing recurrent episodes of acute otitis media (AOM). The nurse should anticipate that what intervention is likely to be ordered?
- A. Ossiculoplasty
- B. Insertion of a cochlear implant
- C. Stapedectomy
- D. Insertion of a ventilation tube
Correct Answer: D
Rationale: Ventilation tubes are commonly used for recurrent AOM to equalize pressure and drain fluid, preventing further infections. Ossiculoplasty, cochlear implants, and stapedectomy address other conditions.
While reviewing the health history of an older adult experiencing hearing loss the nurse notes the patient has had no trauma or loss of balance. What aspect of this patients health history is most likely to be linked to the patients 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
Correct Answer: B
Rationale: Quinine is ototoxic and its long-term use is associated with hearing loss. Radiation therapy, hair product allergies, and a single healed eardrum perforation are less likely to cause hearing deficits.
Which of the following nursing interventions would most likely facilitate effective communication with a hearing-impaired patient?
- A. Ask the patient to repeat what was said in order to evaluate understanding.
- B. Stand directly in front of the patient to facilitate lip reading.
- C. Reduce environmental noise and distractions before communicating.
- D. Raise the voice to project sound at a higher frequency.
Correct Answer: C
Rationale: Reducing environmental noise enhances the patient's ability to hear and focus, improving communication. Asking to repeat may frustrate, raising the voice distorts sound, and not all patients lip-read effectively.
The nurse is reviewing the health history of a newly admitted patient and reads that the patient has been previously diagnosed with exostoses. How should the nurse accommodate this fact into the patients plan of care?
- A. The nurse should perform the Rinne and Weber tests.
- B. The nurse should arrange for audiometry testing as soon as possible.
- C. The nurse should collaborate with the pharmacist to assess for potential ototoxic medications.
- D. No specific assessments or interventions are necessary to addressing exostoses.
Correct Answer: D
Rationale: Exostoses are benign bony growths in the ear canal that typically do not affect hearing or require specific interventions. Testing or medication reviews are unnecessary unless other symptoms arise.