Nokea
The nurse is obtaining a history from a client complaining of ear pain and dizziness. Which assessment finding is the best evidence that the client has a perforated eardrum?
- A. Fluid draining in the external canal
- B. Pain has resolved
- C. Elevated white blood cell count
- D. Inflammation and a reddened eardrum
Correct Answer: A
Rationale: Noting the actual fluid in the ear canal alerts the nurse to the fact that there is a perforation in the tympanic membrane. The other options are also signs of a perforation but also signs of otitis media without perforation.
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A nurse anticipates that an 8-year-old client has otitis externa from symptoms stated on the history. Which symptom(s), from the history and physical examination, would confirm the diagnosis? Select all that apply.
- A. Discomfort in the ear
- B. Redness of the ear canal
- C. Pus noted in the ear canal
- D. Conductive hearing loss
- E. Tympanic membrane may appear normal
Correct Answer: A,B,C,D,E
Rationale: The diagnosis of otitis externa (inflammation of the tissue of the outer ear) is confirmed by reports of pain, discharge from the external auditory canal, aural tenderness (usually not present in middle ear infections), and occasionally fever, cellulitis, and lymphadenopathy. Other symptoms may include pruritus and conductive hearing loss or a feeling of fullness in the ear. On otoscopic examination, the ear canal is erythematous and edematous. Discharge may be yellow or green and foul smelling. In fungal infections, hairlike black spores may be visible.
Which symptom reported by a client would the nurse relate to a tentative diagnosis of objective vertigo?
- A. Frequency of a headache
- B. Pain in the outer ear
- C. Hearing ability fluctuations
- D. A sensation of things moving
Correct Answer: D
Rationale: Objective vertigo includes the sensation that the environment is moving or a sense that things are moving around oneself. The symptoms do not include a headache, pain in the outer ear, or difficulty hearing.
The nurse is teaching a family member how to instill ear drops to the client to remove impacted cerumen. What is important to teach this family member?
- A. Insert the irrigating syringe deeply.
- B. Direct the flow of the ear drops toward the eardrum.
- C. Refrigerate before instillation.
- D. Place the container in warm water before instillation.
Correct Answer: D
Rationale: If irrigation or instillation of liquids is ordered, the liquid should be warmed to body temperature by placing the container in warm water. Cold or hot liquids cause dizziness, and the potential for injury exists if the liquid is hot. The family member should avoid inserting the irrigating syringe too deeply so as not to close off the auditory canal. The family member should direct the flow toward the roof of the canal, rather than the eardrum.
The nurse is caring for a client experiencing hearing loss. The nurse uses the otoscope to assess the ear canal and tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be accurate?
- A. Conductive
- B. Mixed
- C. Central
- D. Sensorineural
Correct Answer: A
Rationale: Conductive hearing loss occurs from an obstruction in the outer or middle ear such as from cerumen. Mixed hearing loss is a combination of conductive and sensorineural problems. Central hearing loss involves injury or damage to the nerves or the nuclei of the central nervous system. Sensorineural involves damage to the inner ear.
The occupational nurse is advising a client on options to enhance workplace communication because the client has progressive hearing loss. The client works as a customer service representative. In discussing the options with the client, which type would be the last option offered by the nurse?
- A. Battery-operated hearing aid
- B. American sign language
- C. Headsets with amplifiers
- D. Text-based telecommunications
Correct Answer: B
Rationale: Although American sign language is an asset to use for communication, a client with an occupation of customer service representative needs accommodations to be able to understand the spoken word.