Chapter 70
1. A client is admitted with a ruptured tympanic membrane in the right ear. This may result in
a hearing loss in the right ear because the main function of the tympanic membrane is to:
1. Vibrate with sound waves.
2. Separate the outer and inner ear.
3. Cover the eustachian tube.
4. Cover the mastoid process.
Answer: Vibrate with sound waves.
Rationale:
The tympanic membrane vibrates from sound waves from the external ear canal. The
vibrations are transmitted to the bones of the middle ear. A rupture in the membranes
interferes with the ability to vibrate, which results in decreased hearing in that ear. The
tympanic membrane separates the outer and middle ear, not the outer and inner ear. The
tympanic membrane does not cover the eustachian tube, which connects with the middle ear.
The mastoid process is part of the outer ear but it is not covered by the mastoid process.
2. A client complains of feeling “off balance.” The nurse should consider that the client might
have a disorder affecting the:
1. Vestibular system.
2. Cochlea.
3. Middle ear.
4. Organ of Corti.
Answer: Vestibular system.
Rationale:
The vestibular system, which is part of the inner ear, is responsible for balance. The cochlea,
which is also located in the inner ear, is responsible for hearing. The bones in the middle ear
vibrate with sound and do not affect balance. The organ of Corti is located in the cochlea,
which is responsible for hearing.
3. The malleus is attached to the:
1. Tympanic membrane and incus.
2. Stapes and cochlea.
3. Semicircular canals and organ of Corti.
4. Pinna and tympanic membrane.
Answer: Tympanic membrane and incus.
Rationale:
The malleus is located in the middle ear and attaches to tympanic and incus. When the
tympanic membrane vibrates, it causes the malleus to vibrate, which in turn causes the incus
to vibrate. The stapes is located in the middle ear, but the cochlea is located in the inner ear.
The semicircular canals and organ of Corti are located in the inner ear. The pinna is part of
the outer ear.
4. A client does not like to wear a ski helmet while skiing because he is unable to hear other
skiers around him as clearly. The ski helmet would interfere with the ¬¬¬¬__________ of
sound.
1. Air conduction
2. Bone conduction
3. Nerve conduction
4. Middle ear conduction
Answer: Air conduction
Rationale:
Air conduction begins when noise enters the external ear canal and travels to the middle ear.
Material covering the external auditory canal would interfere with sound waves entering the
canal. The nerves related to hearing are located in the inner ear. Sound is interpreted by
vibrations in the inner ear. Middle ear conduction is not a mechanism of hearing. Bone
conduction occurs when the bones of the middle ear vibrate.
5. A diver is admitted complaining of ear pain. On examination, the nurse notes a rupture in
the tympanic membrane. This hearing loss is the result of an interference with:
1. Bone conduction.
2. Air conduction.
3. Nerve conduction.
4. Middle ear conduction.
Answer: Bone conduction.
Rationale:
Bone conduction is the conduction of sound to the inner ear through the bones of the skull. If
the tympanic membrane is ruptured, the vibrations caused by sound waves are decreased.
This results in the vibrations of the bones of the middle ear being decreased and, in turn,
conduction of sound by the bones is decreased. Sensorineural losses are caused by damage to
auditory nerves or small hair cells in the inner ear. Middle ear conduction is not a mechanism
of hearing. Bone conduction occurs when the bones of the middle ear vibrate.
6. During the examination of a client’s right ear, the nurse notes that there is scarring on the
tympanic membrane. The nurse realizes that the client may have difficulty with:
1. Hearing.
2. Balance.
3. Vertigo.
4. Equilibrium.
Answer: Hearing.
Rationale:
Scarring of the tympanic membrane can result in decreased vibrations from sound and
decreased vibrations transmitted to the bones of the middle ear. This would be a decrease in
the bone conduction of the sound. Vertigo is caused by disorders of the inner ear. Balance and
equilibrium are also controlled by the inner ear.
7. A client with otosclerosis would have a __________ hearing loss.
1. Conductive
2. Mixed
3. Sensorineural
4. Cochlear
Answer: Conductive
Rationale:
A conductive hearing loss occurs when there is a problem conducting sound waves through
the outer ear, tympanic membrane, or middle ear. Otosclerosis is a condition in which the
structures of the ear begin to harden, which would interfere with their ability to vibrate.
Sensorineural losses are caused by damage to auditory nerves or small hair cells in the inner
ear. A mixed hearing loss refers to both a conductive and sensorineural loss. Cochlear is not a
type of hearing loss.
8. Presbycusis is the loss of hearing that gradually occurs in most individuals as they grow
older. This is usually a __________ hearing disorder.
1. Sensorineural
2. Conductive
3. Mixed
4. Air conduction
Answer: Sensorineural
Rationale:
Presbycusis is usually a sensorineural hearing disorder caused by gradual changes in the inner
ear as a result of loss of hair cells in the organ of Corti. There can be conductive causes of
hearing loss, but sensorineural disorders are more common. There could also be mixed causes
of hearing loss, but these are not as common as sensorineural. Interference of air conduction
is not the result of aging.
9. The hearing loss that can occur from noise exposure is permanent because:
1. Nerve endings do not regenerate.
2. The bones in the middle ear have become hardened.
3. The tympanic membrane is ruptured.
4. There is chronic inflammation of the middle ear.
Answer: Nerve endings do not regenerate.
Rationale:
The hearing loss that results from noise exposure is sensorineural. Noise exposure over time
will damage or destroy the nerve endings in the inner ear. The hearing loss is permanent
because the nerve endings will not regenerate. It does not cause the bones of the middle ear to
harden. A very loud noise could possibly cause the tympanic membrane to rupture, but this
would not cause a permanent hearing loss. Chronic inflammation is not caused by noise
exposure.
10. When taking a health history, the nurse asks a client about taking over-the-counter
medications. The client reports taking large doses of aspirin to try to relieve daily headaches.
This comment should alert the nurse to further assess the client’s hearing because:
1. Aspirin can be ototoxic.
2. The client has not received medical care.
3. The headaches are probably caused by a hearing disorder.
4. Most headaches are caused by disorders of the ear.
Answer: Aspirin can be ototoxic.
Rationale:
Some medications, including salicylates (aspirin), are ototoxic. They can cause permanent
sensorineural hearing loss by damaging the nerves in the inner ear. The client may not have
received medical care, but the “large doses of aspirin” is the relevant information. A hearing
disorder may cause a headache, but most headaches are not caused by hearing-related
disorders.
11. Most teenagers are at risk for developing a hearing loss related to:
1. Noise exposure.
2. Repeated ear infection.
3. Lack of adequate health care.
4. Swimming.
Answer: Noise exposure.
Rationale:
Most teenagers listen to very loud music. Noise exposure can cause a sensorineural hearing
loss. Parents should encourage their children to lower the volume of the music. Repeated ear
infections can cause damage to the ear, but most teenagers do not have repeated ear
infections. The majority of teenagers in the United States have adequate health care. More
teenagers probably listen to loud music than swim.
12. A patient tells the nurse that the only way he can adequately clean his ears is to use Qtips. The best action by the nurse is to:
1. Educate the patient about the danger of using Q-tips.
2. Instruct the patient on proper use of Q-tips.
3. Check to see if the ears are clean.
4. Instruct the patient to use Q-tips only when necessary.
Answer: Educate the patient about danger of using Q-tips.
Rationale:
Q-tips, or any small object, should never be used to clean inside the ears because of the risk
of tympanic membrane rupture. Such objects may also force cerumen further into the ear,
causing a blockage. There is not a proper way to use Q-tips since they should never be used
to clean the ears. Checking the ears to check for a blockage is appropriate for any exam, but
educating the client about the dangers of using Q-tips has a higher priority. Q-tips should
never be used to clean the ears under any circumstances.
13. A client is scheduled to have a stapedectomy to treat otosclerosis. Otosclerosis is
categorized as a __________ disorder.
1. Mechanical
2. Inflammatory
3. Obstructive
4. Sensorineural
Answer: Mechanical
Rationale:
The cause of hearing impairment can be categorized as mechanical, inflammatory, or an
obstructive disorder. A mechanical cause is the result of problems with the structures of the
ear. Otosclerosis is a condition in which the structures of the ear begin to harden. This leads
to a conductive hearing loss. An inflammatory cause of hearing loss is the result of an
inflammatory process caused by an infection. An obstructive cause is a partial or complete
blockage of the ear canal. Sensorineural is a type of hearing loss, not a cause.
14. A client has a hearing loss resulting from chronic mastoiditis. The cause of this type of
hearing loss is:
1. Inflammatory.
2. Mechanical.
3. Obstructive.
4. Sensorineural.
Answer: Inflammatory.
Rationale:
The cause of hearing impairment can be categorized as mechanical, inflammatory, or an
obstructive disorder. An inflammatory cause of hearing loss is the result of an inflammatory
process caused by an infection. Mastoiditis is a bacterial infection of the mastoid bone. Acute
or chronic infection of the mastoid process can lead to changes in hearing and balance. A
mechanical cause is the result of problems with the structures of the ear. An obstructive cause
is a partial or complete blockage of the ear canal. Sensorineural is a type of hearing loss, not a
cause.
15. A client is diagnosed with an acoustic neuroma in the right ear. The neuroma is removed,
but the client still has unilateral hearing loss. The cause of the hearing loss from an acoustic
neuroma is categorized as a(n) ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬__________ disorder.
1. Obstructive
2. Mechanical
3. Inflammatory
4. Sensorineural
Answer: Obstructive
Rationale:
The cause of hearing impairment can be categorized as mechanical, inflammatory, or an
obstructive disorder. An obstructive cause is a partial or complete blockage of the ear canal.
An acoustic neuroma is a benign tumor of the eighth cranial nerve. As the tumor grows, it
extends from the internal auditory canal to the cerebellopontine angle. A mechanical cause is
the result of problems with the structures of the ear. An inflammatory cause of hearing loss is
the result of an inflammatory process caused by an infection. Sensorineural is a type of
hearing loss, not a cause.
16. A nurse is working with a client who experienced the sudden onset of dizziness, nausea,
and hearing loss. A diagnosis of Meniere’s disease was made. The nurse should instruct the
client to:
1. Avoid tobacco, alcohol, and caffeine.
2. Take OTC medications for the nausea.
3. Stay in bed until symptoms subside.
4. Use tranquilizers to help in coping with the disease.
Answer: Avoid tobacco, alcohol, and caffeine.
Rationale:
Any drug or medication that may cause vertigo should be avoided. Tobacco, alcohol, and
caffeine can cause dizziness. A client should not self-medicate with OTC medications. The
symptoms of Meniere’s disease can range from several minutes to hours or days in length.
Bed rest should be avoided. Tranquilizers, or any medication that may cause vertigo, should
be avoided.
17. The nurse is caring for a client with a hearing deficit who will be discharged soon. Which
of the following should be included in discharge planning to ensure the home is
environmentally safe?
1. Visual fire safety provisions
2. Housekeeping services
3. Sign language classes
4. An interpreter
Answer: Visual fire safety provisions
Rationale:
It is important to ensure that the home environment is environmentally safe. Since smoke
detectors indicate when smoke is present, it is necessary to install a device that alerts the
client with a visual signal. Housekeeping services are not a need specific to a client with a
hearing deficit. Sign language classes and an interpreter are not factors in making an
environment safe.
18. A client has a noise-induced hearing loss that occurred after he repeatedly fired a rifle
during target practice. In additional to being counseled to avoid behaviors that cause a
hearing deficit, the client should also be counseled about:
1. Wearing protective devices.
2. Gun safety.
3. Low-frequency hearing losses.
4. Sign language.
Answer: Wearing protective devices.
Rationale:
A noised-induced hearing loss resulting from a single exposure will usually resolve with rest
and removal of the noise. Continuous exposure can cause permanent damage. Protective
devices are essential in preventing hearing loss. Gun safety is important, but only the noise
factors into a hearing loss. Loud noises cause high-frequency hearing losses. The client does
not have a permanent loss at this point; sign language classes are premature.
19. An elderly client with a hearing deficit due to presbycusis would benefit from wearing
hearing aids, but has been resistant to wearing them. Which of the following would be the
most likely reason the client is not wearing hearing aids?
1. Inability to afford the devices
2. Does not comprehend advantage of devices
3. Does not feel they will help
4. Concerned about appearance
Answer: Inability to afford the devices
Rationale:
The client might not be able to financially afford them. Hearing aids are expensive, and an
elderly client might not have the financial resources needed. Not comprehending the
advantage of hearing aids and not feeling they will help could possibly be reasons, but most
clients understand the advantages and know the devices would improve hearing. Hearing
devices now are so small that it is often difficult to see them.
20. When caring for an elderly client, the nurse must be familiar with medications that might
increase the symptoms of a balance disorder. Which of the following medications might
cause an adverse interaction?
1. Beta-blockers
2. Antibiotics
3. Cholestatins
4. NSAIDs
Answer: Beta-blockers
Rationale:
Beta-blockers can increase the symptoms of a balance disorder because they may cause
dizziness. Cholestatins do not cause dizziness. Antibiotics and NSAIDs can be ototoxic, but
do not cause dizziness.
21. A nurse caring for an elderly client who is in a coma and facing an inevitable death
cautions the family that it is most important not to have inappropriate conversations near the
client because:
1. Hearing may be the last sense “to go.”
2. It shows disrespect for the client.
3. Family members should get along.
4. It interferes with adequate care of the client.
Answer: Hearing may be the last sense “to go.”
Rationale:
It is believed that the sense of hearing is the last sense “to go” when an individual is facing an
inevitable death. Therefore, if this is the case, it is the nurse’s responsibility to control the
environment and not allow inappropriate conversations where the client can hear. While
inappropriate conversations do show disrespect for the client, the fact that the client may hear
what is occurring is most important. Hopefully, family members do get along; the nurse
cannot control this, but can control the environment to keep the family from interfering with
the care of the client.
22. A nurse is working with a client with newly diagnosed benign paroxysmal positional
vertigo. In developing a plan of care for this client, the nurse should instruct the client
regarding:
1. Modifications in daily activities.
2. Adapting to long-term balance disorder.
3. Importance of medication regimen.
4. Importance of bed rest.
Answer: Modifications in daily activities.
Rationale:
Modifications in daily activities, such as avoiding bending down to pick up objects, may be
necessary to cope with the dizziness. Benign paroxysmal positional vertigo (BPPV) is not life
threatening and is frequently self-limiting because symptoms often subside or disappear
within 2 months of onset. Therefore, it is not a long-term balance disorder. Nausea may be
associated with BPPV and antiemetic medications may be used, but they do not prevent the
dizziness. BPPV is not treated with medications. Bed rest should be avoided because it causes
skeletal muscle weakness.
23. The nurse is working with a client who recently began wearing hearing aids. The nurse
should instruct the client on:
1. Care and cleaning requirements.
2. Wearing the devices when needed.
3. Wearing the devices at night.
4. Leaving the devices on at all times.
Answer: Care and cleaning requirements.
Rationale:
Hearing aids are delicate devices that need careful handling and care in order to work
properly. The nurse needs to instruct the client on care and cleaning requirements for the
hearing aid. The client should wear the devices daily, and not just when the client wants to
hear something. The devices are not worn at night. The hearing aids should be turned off
when not in use.
24. The nurse is developing a long-range care plan for a client diagnosed with a hereditary
hearing disorder that is progressive. The nurse should include which of the following in the
plan?
1. Communication instruction
2. Learning to avoid same exposure that caused the disorder
3. Delaying use of assistive devices
4. Minimize effects of hearing disorder
Answer: Communication instruction
Rationale:
Since the disorder will result in a change in ability to hear, the plan should include
communication instruction such as sign language and use of hearing aids. The disorder is
hereditary and was not caused by an exposure. Assistive devices should be used as soon as
they can be of benefit. The client should understand the disorder and the changes that will
result so that effective long-range planning can be done.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
