Chapter 51: Care of Patients with Ear and Hearing Problems

Chapter 51: Care of Patients with Ear and Hearing Problems

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse is caring for a client with external otitis. Which assessment finding indicates to the nurse that the client’s infection has worsened?

a.	The client now reports tinnitus and vertigo at night.
b.	The client now has a positive Rinne test, with AC > BC.
c.	The tympanic membrane is pearly gray with white patches.
d.	The auricular lymph nodes have increased in size over the last 24 hours.

 

 

ANS:  D

Enlargement of the auricular lymph nodes indicates that the client’s external otitis is becoming more widespread and that current therapy is insufficient. Tinnitus, vertigo, and a positive Rinne test all indicate middle to inner ear problems not related to external otitis media. The tympanic membrane is normally pearly gray in color. White patches on the tympanic membrane are called tympanosclerosis and generally have no clinical importance.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

 

2. The nurse is caring for a client with a furuncle on the pinna at the opening of the ear canal. The nurse is reviewing home care instructions with the client. Which statement by the client indicates that additional teaching is needed?

a.	“I will put the bacitracin ointment on the sore three times a day.”
b.	“I will gently squeeze the sore to drain the liquid out once a day.”
c.	“I will take Tylenol (acetaminophen) if my ear starts to hurt a lot.”
d.	“I will put a warm compress on the sore for 15 minutes three times a day.”

 

 

ANS:  B

Compressing or squeezing the furuncle can traumatize tissues and can force infective material deeper into the tissue layers, spreading the infection. Tylenol may be taken to reduce pain, and a warm compress will facilitate drainage and healing of the furuncle. Bacitracin ointment is an anti-infective and will help clear the infection.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Illness Management)  MSC:           Integrated Process: Nursing Process (Evaluation)

 

3. The nurse is caring for a client with otitis media. The client reports that the pain was severe during the night but was gone upon awakening in the morning. Which finding does the nurse expect to observe during the client’s physical assessment?

a.	The tympanic membrane is bluish-gray.
b.	Purulent fluid is present in the ear canal.
c.	The pinna and the tragus are reddened and swollen.
d.	Sounds are lateralized toward the affected ear.

 

 

ANS:  B

Spontaneous perforation of the tympanic membrane during acute otitis media relieves the pressure on middle ear structures and results in a sudden decrease in or elimination of pain. Purulent drainage is often present in the ear canal as the fluid drains away from the tympanic membrane. Bluish-gray coloring of the tympanic membrane indicates blood behind the eardrum. A reddened pinna and tragus indicate otitis externa. Lateralization of sounds toward the affected ear would not be expected.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

 

4. The nurse is caring for a client with otitis media and notes purulent drainage in the ear canal during the physical assessment. Which is the nurse’s priority intervention?

a.	Obtain a specimen of the drainage for culture.
b.	Irrigate the ear canal with sterile normal saline.
c.	Gently examine the client’s ear with an otoscope.
d.	Place a cotton ball in the ear canal to absorb the drainage.

 

 

ANS:  C

The nurse should use an otoscope to determine whether the client’s tympanic membrane has ruptured. Until the tympanic membrane is examined and is found to be intact, syringing is not performed. A specimen is obtained only if the infection has failed to respond to standard antibiotic therapy. A cotton ball should not be placed in the ear canal to absorb the drainage.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Illness Management)  MSC:           Integrated Process: Nursing Process (Assessment)