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- AQE Private College, Pretoria, Gauteng
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abirb.com/testChapter 21: Assessment and Management: Auditory Problems
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Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE abirb.com/test
1. To decrease the risk for future hearing loss, which action should the nurse implement with
college students at the on-campus health clinic?
a. Perform tympanometry. abirb.com/test
b. Schedule otoscopic examinations.
c. Administer influenza immunizations.
d. Discuss exposure to amplified music.
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ANS: D
The nurse should discuss the impact of amplified music on hearing with young adults and
discourage listening to highly amplified music, especially for prolonged periods.
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Tympanometry measures the ability of the eardrum to vibrate and would not help prevent
future hearing loss. Although students are at risk for the influenza virus, being vaccinated
does not help prevent future hearing loss. Otoscopic examinations are not necessary for all
patients. abirb.com/test
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
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2. A patient diagnosed with external otitis is being discharged from the emergency department
with an ear wick in place. Which statement by the patient indicates a need for further
teaching? abirb.com/test
a. “I will apply the eardrops to the cotton wick in the ear canal.”
b. “I can use aspirin or acetaminophen (Tylenol) for pain relief.”
c. “I will clean the ear canal daily with a cotton-tipped applicator.”
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d. “I can use warm compresses to the outside of the ear for comfort.”
ANS: C
Insertion of instruments such as cotton-tipped applicators into the ear should be avoided. The
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other patient statements indicate that the teaching has been successful.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
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3. What should the nurse include when teaching a patient who has undergone a left
tympanoplasty?
a. “Remain on bed rest.” abirb.com/test
b. “Keep your head elevated.”
c. “Avoid blowing your nose.”
d. “Irrigate your left ear canal.”
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ANS: C
Coughing or blowing the nose increases pressure in the eustachian tube and middle ear cavity
and disrupts postoperative healing. There is no postoperative need for prolonged bed rest,
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elevation of the head, or continuous antibiotic irrigation.
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, abirb.com/test
DIF: Cognitive Level: Apply (application)
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TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. The nurse is assessing a patient who was recently treated with amoxicillin for acute otitis
media of the right ear. Which finding is a priority to report to the health care provider?
a. abirb.com/test
The patient has a temperature of 100.6° F.
b. The patient report frequent “popping” in the ear.
c. Clear fluid is visible through the tympanic membrane.
d. The patient frequently asks the nurse to repeat information.
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ANS: A
The fever indicates that the infection may not be resolved, and the patient might need further
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antibiotic therapy. A feeling of fullness, “popping” of the ear, decreased hearing, and fluid in
the middle ear are indications of otitis media with effusion. These symptoms are normal for
weeks to months after an episode of acute otitis media and usually resolve without treatment.
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DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
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5. A patient who has Ménière’s disease is admitted with vertigo, nausea, and vomiting. Which
nursing intervention will be included in the care plan?
a. Dim the lights in the patient’s room.
b. abirb.com/test
Encourage increased oral fluid intake.
c. Change the patient’s position every 2 hours.
d. Keep the head of the bed elevated 45 degrees.
ANS: A abirb.com/test
A darkened, quiet room will decrease the symptoms of the acute attack of Ménière’s disease.
Because the patient will be nauseated during an acute attack, fluids are administered IV.
Position changes will cause vertigo and nausea. The head of the bed can be positioned for
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patient comfort.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning
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MSC: NCLEX: Physiological Integrity
6. Which statement by the patient to the home health nurse indicates a need for further teaching
about self-administering eardrops?
a. abirb.com/test
“I will leave the ear wick in place while administering the drops.”
b. “I will hold the tip of the dropper above the ear to administer the drops.”
c. “I will refrigerate the medication until I am ready to administer the drops.”
d. “I should lie down before and for 5 minutes after administering the drops.”
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ANS: C
Administration of cold eardrops can cause dizziness because of stimulation of the semicircular
canals. The other patient actions are appropriate.
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DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
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7. An older patient who is being admitted to the hospital repeatedly asks the nurse to “speak up
so that I can hear you.” Which action should the nurse take?
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a. Increase the speaking volume.
b. abirb.com/test
Overenunciate while speaking.
c. Speak normally but more slowly.
d. Use more facial expressions when talking.
ANS: C abirb.com/test
Patient understanding of the nurse’s speech will be enhanced by speaking at a normal tone,
but more slowly. Increasing the volume, overenunciating, and exaggerating facial expressions
will not improve the patient’s ability to comprehend.
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DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
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8. A patient with presbycusis is fitted with binaural hearing aids. Which information will the
nurse include when teaching the patient how to use the hearing aids?
a. Keep the volume low on the hearing aids for the first week.
b. abirb.com/test
Experiment with volume and hearing in a quiet environment.
c. Add the second hearing aid after making adjustments to the first hearing aid.
d. Begin wearing the hearing aids for an hour a day, gradually increasing the use.
ANS: B abirb.com/test
Initially the patient should use the hearing aids in a quiet environment such as the home,
experimenting with increasing and decreasing the volume as needed. There is no need to
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gradually increase the time of wear. The patient should experiment with the level of volume to
find what works well in various situations. Both hearing aids should be used.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning
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MSC: NCLEX: Physiological Integrity
9. Which information will the nurse include for a patient considering a cochlear implant?
Cochlear implants:
a. abirb.com/test
are not useful for patients with congenital deafness.
b. are most helpful as an early intervention for presbycusis.
c. improve hearing in patients with conductive hearing loss.
d. require extensive training in order to reach the full benefit.
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ANS: D
Extensive rehabilitation is required after cochlear implants for patients to receive the
maximum benefit. Hearing aids, rather than cochlear implants, are used initially for
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presbycusis. Cochlear implants are used for sensorineural hearing loss and would not be
helpful for conductive loss. They are appropriate for some patients with congenital deafness.
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DIF: Cognitive Level: Understand (comprehension) TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
10. Unlicensed assistive personnel (UAP) perform the following actions when caring for a patient
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with Ménière’s disease who is experiencing an acute attack. Which action by UAP indicates
that the nurse should intervene?
a. UAP raises the side rails on the bed.
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b. UAP turns on the patient’s television.
c. UAP places an emesis basin at the bedside.
d. UAP helps the patient turn to the right side.
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ANS: B
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Watching television may exacerbate the symptoms of an acute attack of Ménière’s disease.
The other actions are appropriate because the patient will be at high fall risk and may suffer
from nausea during the acute attack.
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DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
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11. What is the priority problem for a patient experiencing an acute attack with Meniere’s
disease?
a. Being at risk for falls abirb.com/test
b. Imbalanced nutritional intake
c. Difficulty performing self-care
d. Impaired verbal communication
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ANS: A
All the problems are appropriate, but because sudden attacks of vertigo can lead to “drop
attacks,” the major focus of nursing care is to prevent injuries associated with dizziness.
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DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis
MSC: NCLEX: Physiological Integrity
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12. Which information about a patient who had a stapedotomy yesterday is most important for the
nurse to communicate to the health care provider?
a. abirb.com/test
The patient reports ear “fullness.”
b. Oral temperature is 100.8° F (38.1° C).
c. Small amount of dried drainage on dressing.
d. The patient reports that hearing has gotten worse.
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ANS: B
An elevated temperature may indicate a postoperative infection. Although the nurse would
report all the data, a temporary decrease in hearing, bloody drainage on the dressing, and a
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feeling of congestion (because of the accumulation of blood and drainage in the ear) are
common after this surgery.
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DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
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13. Which action will the nurse take when performing ear irrigation for a patient with cerumen
impaction?
a. Assist the patient to a supine position for the irrigation.
b. Fill the irrigation syringe with body-temperature solution.
c.
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Use a sterile applicator to clean the ear canal before irrigating.
d. Occlude the ear canal completely with the syringe while irrigating.
ANS: B abirb.com/test
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