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)

5. A client with a ruptured tympanic membrane asks the nurse whether hearing will be affected permanently. Which is the nurse’s best response?

a.            “Possibly. The eardrum usually heals in 1 to 2 weeks. Any persistent hearing problem should be evaluated.”

b.            “No. Antibiotics will help resolve the infection and cure your hearing impairment.”

c.             “Yes. It will be important for you to be fitted with a hearing aid as soon as possible.”

d.            “Yes. Any time the eardrum is ruptured it will form a scar, which will cause some degree of permanent hearing loss.”

ANS: A

An uncomplicated rupture of the tympanic membrane usually heals spontaneously within 1 to 2 weeks and does not result in a permanent hearing impairment. Antibiotics may not be effective in restoring hearing fully. Hearing aids may be prescribed for the client only if hearing loss is determined to be permanent.

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

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Alterations in Body Systems) MSC: Integrated Process: Teaching/Learning

6. The nurse is caring for a client with Ménière’s disease. The client asks the nurse how to prevent another acute episode from occurring. Which is the nurse’s best response?

a.            “Stop or reduce cigarette smoking.”

b.            “Use aspirin rather than acetaminophen (Tylenol) for pain.”

c.             “Reduce the quantity of saturated fats in your diet.”

d.            “Avoid crowds and people with upper respiratory infection.”

ANS: A

The vasoconstrictive effects of cigarette smoking promote acute episodes of Ménière’s disease. Aspirin and other NSAIDs can be ototoxic and should be avoided. Avoiding saturated fats and people with upper respiratory infection will not help prevent a recurrence of Ménière’s disease. A hydrops diet may stabilize body fluid levels to prevent excess endolymph accumulation.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1096

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Illness Management) MSC: Integrated Process: Teaching/Learning

7. When performing a client’s physical assessment, the nurse notes that the client has conductive hearing loss. Which finding does the nurse expect to see in the client’s medical history?

a.            History of diabetes with peripheral neuropathy

b.            Frequent episodes of otitis media during childhood

c.             History of frequent impactions of cerumen in the ear canals

d.            History of osteomyelitis treated with IV gentamicin (Garamycin)

ANS: B

Chronic middle ear infections can thicken the tympanic membrane, leading to conductive hearing loss. Gentamicin and diabetes mellitus damage the eighth cranial nerve and cause sensorineural hearing loss. Cerumen impaction results in temporary conduction hearing loss.

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

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)