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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.
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The nurse on a cruise ship is assessing clients for motion sickness. Which is a common misconception regarding motion sickness?
- A. Repeated motion is the cause.
- B. Once symptoms occur, they will always be present.
- C. Medications help the symptoms.
- D. Pallor and diaphoresis is a first symptom.
Correct Answer: B
Rationale: When the client experiences motion sickness, the client will use that data to avoid further symptoms in the future. The client can use medication, change location or position, and recognize symptoms earlier for symptom management. The other options are correct and teachable statements.
The nurse is caring for a client with recurrent ear infections. The nurse assesses the client for further infectious processes traveling deeper into the tissue and becoming more lethal. Which infection, originated in the ear, is of most concern?
- A. Mastoiditis
- B. Meningitis
- C. Sinusitis
- D. Labyrinthitis
Correct Answer: B
Rationale: The infection stemming from the ear may extend to the meninges, causing meningitis, or a brain abscess could occur. This could be life threatening. The other options are also potential complications of an ear infection but not as much of a concern as meningitis.
The nurse is caring for a client being treated for M?©ni?¨re disease. Which medication is monitored closely due to its addictive properties?
- A. Meclizine
- B. Hydrochlorothiazide
- C. Diazepam
- D. Promethazine
Correct Answer: C
Rationale: Diazepam is used to treat the client with M?©ni?¨re disease to help control vertigo. Diazepam is a tranquilizer that has addictive properties. The other options, used in the treatment of M?©ni?¨re's disease, do not have any or significant addictive properties.
The nurse is instructing the client with dried cerumen blocking the ear canal on potential methods to reduce symptoms. Which at-home methods of cerumen removal are discouraged?
- A. Instilling 1 to 2 drops of half-strength peroxide in the ear
- B. Using warm glycerin or mineral oil to soften the cerumen
- C. Removing the cerumen by means of a cotton tip applicator
- D. Irrigating the ear with warm water and a rubber-bulb syringe
Correct Answer: C
Rationale: The nurse is an important resource person to consult when a client has an issue with the ear structure or hearing. The nurse is correct to discourage placing anything down the ear canal that could push the cerumen deeper toward or puncture the tympanic membrane. The other options are appropriate to soften and lubricate the cerumen or to irrigate the cerumen from the ear.
The nurse is caring for a client in the triage section of a walk-in clinic. Which triad of common symptoms suggests a diagnosis of M?©ni?¨re disease?
- A. Blurred vision, vertigo, nausea
- B. Syncope, vertigo, ear pain
- C. Disorientation, vertigo, nausea
- D. Hearing loss, vertigo, tinnitus
Correct Answer: D
Rationale: Hearing loss, vertigo, and tinnitus are common symptoms of many disease processes but, when placed together, indicate M?©ni?¨re disease. The other options do not include the accurate triad of symptoms.