Nokea
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.
You may also like to solve these questions
What aspect should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?
- A. Signs of hypotension
- B. Reduced urinary output
- C. Tinnitus and sensorineural hearing loss
- D. Impaired facial movement
Correct Answer: C
Rationale: It is important that nurses are knowledgeable about the ototoxic effects of certain medications such as salicylates, loop diuretics, quinidine, quinine, and aminoglycosides. Signs and symptoms of ototoxicity include tinnitus and sensorineural hearing loss. Hypotension, reduced urinary output, and impaired facial movement are not signs of ototoxicity.
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 caring for a client with symptoms of ototoxicity from aminoglycoside administration. On which structure does the medication produce the ototoxic effect?
- A. The auditory canal
- B. The eighth cranial nerve
- C. The tympanic membrane
- D. The cochlear nerve
Correct Answer: B
Rationale: Ototoxicity describes the detrimental effect of aminoglycosides on the eighth cranial nerve. Signs and symptoms include tinnitus and sensorineural bearing. The other options are not related to the ototoxic effects.
The nurse is instructing a client on the benefits of a cochlear implant. The client asks, 'How am I able to interpret sound?' The nurse credits which of the following as significant in the production of hearing?
- A. External microphone
- B. Internal processor
- C. Amplifier
- D. Auditory nerve
Correct Answer: D
Rationale: The nurse credits stimulation of the auditory nerve in the transmission of the electrical signals to the brain for interpretation. The external processor and internal processor bring the sounds from the environment and send them to the internal processor, which converts to the electrical signal. An amplifier is used with typical hearing aids.
A client comes to the walk-in clinic reporting feeling a 'bug in my ear.' What action should be taken when there is an insect in the ear?
- A. Instillation of mineral oil
- B. Instillation of carbamide peroxide
- C. Instillation of hot water
- D. Use of a small forceps
Correct Answer: A
Rationale: Mineral oil is instilled into the ear to smother an insect. Carbamide peroxide is used to soften dried cerumen, and small forceps are used to remove solid objects. Hot liquids cause dizziness and should not be instilled in the ear.