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The nurse, employed in an ear, nose, and throat (ENT) physician's office, is obtaining a client history. The nurse documents the client's statements. Which symptom(s) may indicate a diagnosis of otosclerosis? Select all that apply.
- A. It seems that I increasingly could not hear my kids talk to me.'
- B. I woke up on Monday and had ear pain with a marked decrease in hearing.'
- C. I now notice a ringing in my ears especially when I lay down to sleep at night.'
- D. I can hear better when someone speaks in low tones.'
- E. I can hear best when you put the tuning fork behind my ear.'
Correct Answer: A,C,E
Rationale: Although the cause of otosclerosis is unknown, there are specific symptoms because of the interference of the vibrations in the ear. The symptoms of diagnosis of otosclerosis include a progressive, bilateral hearing loss; tinnitus especially noted at night; and the outcome of the Rinne test as being that sound is heard best with the tuning fork behind the ear. The nurse would not identify an abrupt onset of hearing loss or improvement of hearing in low tones.
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The nurse is caring for a client who is post-stapedectomy. What would the nurse include in the nursing care?
- A. Place the client on the operative side.
- B. Keep the affected ear packed with cotton.
- C. Encourage the client to exercise within 24 hours.
- D. Assess the facial nerve.
Correct Answer: D
Rationale: After surgery, the nurse positions the client on the nonoperative side and takes care to prevent dislodgment of the prosthesis as a result of coughing, sneezing, or vomiting. Nausea and dizziness are common problems. The nurse assesses facial nerve function by checking symmetry when the client smiles or frowns. The nurse does not keep the ear packed with cotton or encourage the client to exercise.
The nurse is instructing a client's family members on the most incapacitating symptom of M?©ni?¨re disease. Which nursing instruction associated with the symptom is most helpful?
- A. Assist the client when ambulating.
- B. Keep a bucket beside the bed.
- C. Ensure low lighting in the room.
- D. Sit in front of the client when speaking.
Correct Answer: A
Rationale: The most incapacitating symptom of M?©ni?¨re disease is vertigo. When the client is experiencing vertigo or dizziness, gait becomes unsteady. Having a person assist the client when ambulating is most helpful in preventing falls. Keeping a bucket at the bedside is helpful if the client is experiencing nausea. Photophobia is not a main symptom of M?©ni?¨re disease. If the client experiences hearing loss, being able to see the nurse's lips may be helpful.
The nurse is assisting the client in planning care during exacerbations of M?©ni?¨re disease. Which diet would the nurse identify as appropriate at this time?
- A. A high-protein diet
- B. A low-sodium diet
- C. A low-fat diet
- D. A calorie-controlled diet
Correct Answer: B
Rationale: Treatment for M?©ni?¨re disease is related to reducing fluid production in the inner ear, facilitating its drainage, and treating the symptoms that accompany the attack. A low-sodium and sodium-free diet lessens edema.
The nurse is teaching a class on diseases of the ear. What would the nurse teach the class is the most characteristic symptom of otosclerosis?
- A. The client being distressed in the mornings
- B. A progressive, bilateral loss of hearing
- C. A red and swollen ear drum
- D. The client describing a recent upper respiratory infection
Correct Answer: B
Rationale: A progressive, bilateral loss of hearing is the characteristic symptom of otosclerosis. Tinnitus appears as the loss of hearing progresses; it is especially noticeable at night, when surroundings are quiet, and may be quite distressing to the client. The eardrum appears pinkish-orange from structural changes in the middle ear. The client often describes a history of having had a recent upper respiratory infection in case of otitis media, not otosclerosis.
What kind of otitis media is a pathogen-free fluid behind the tympanic membrane, resulting from irritation associated with respiratory allergies and enlarged adenoids?
- A. Purulent otitis media
- B. Infectious otitis media
- C. Serous otitis media
- D. Sterile otitis media
Correct Answer: C
Rationale: Serous otitis media, a collection of pathogen-free fluid behind the tympanic membrane, results from irritation associated with respiratory allergies and enlarged adenoids. The other options are distractors for this question. Purulent otitis media usually results from the spread of microorganisms from the eustachian tube to the middle ear during upper respiratory infections.