CH 21 EAQ Auditory Problems

CH 21 EAQ Auditory Problems Which is the most powerful hearing aid available for use by patients with hearing loss? a. In the ear b. In the canal c. Behind the ear d. Completely in the canal ️ANS: C A behind-the-ear hearing aid is the most powerful hearing aid and is used for all types of hearing loss. An in-the-ear hearing aid is used for mild to severe hearing loss, which provides powerful amplification. An in-the-canal hearing aid is also used for mild to severe hearing loss. A hearing aid set completely in the canal is used for mild to moderate hearing loss. Which auditory disorder is caused by an excessive accumulation of endolymph in the membranous labyrinth? a. Otitis Media b. Otosclerosis c. Ménière's disease d. Acoustic neuroma ️ANS: C Ménière's disease, also called endolymphatic hydrops, results in an excessive accumulation of endolymph in the membranous labyrinth. The volume of endolymph increases until the membranous labyrinth ruptures. Otitis media is caused by an infection of the tympanum, ossicles, and space of the middle ear. Otosclerosis is a hereditary autosomal dominant disease caused by the vascular and bony changes in the middle ear. Otoscopic examination may reveal Schwartz's sign. Acoustic neuroma is a disorder of cranial nerve VIII, on which a unilateral benign tumor grows. Which type of presbycusis is associated with the loss of sensory hair cells? a. Neural b. Sensory c. Cochlear d. Metabolic ️ANS: B Sensory presbycusis is associated with atrophy of the auditory nerve and loss of sensory hair cells. Neural presbycusis is associated with degenerative changes in the cochlea and spinal ganglion. Cochlear presbycusis is associated with stiffening of basilar membrane. Metabolic presbycusis is associated with atrophy of the blood vessels in the wall of cochlea. Which nonverbal aids can the nurse adopt to effectively communicate with a patient with hearing loss? a. Refraining from touching the client b. Having a light source behind the speaker c. Maintaining equal distance from both ears d. Refraining from covering the mouth or face with hands ️ANS: D The nurse should not cover his or her mouth or face with the hands to communicate effectively with a patient with hearing loss. Using touch can be an effective strategy in this situation. The nurse should refrain from having light behind the speaker. The nurse should move close to the better ear while communicating with the patient with hearing loss. Which surgical procedure involves an incision in the tympanum to release the increased pressure and exudate from the middle ear? a. Myringotomy b. Stapedotomy c. Tympanoplasty d. Mastoidectomy ️ANS: A A myringotomy is a surgical procedure being performed on a patient with acute otitis media. It involves an incision in the tympanum to release the increased pressure and exudate from the middle ear. A stapedotomy is a microdrill or laser surgical treatment that involves opening the footplate as a part of collaborative care of otosclerosis. A tympanoplasty, also called a myringoplasty, involves reconstruction of the tympanic membrane and/or the ossicles of a patient with otitis media. A mastoidectomy is a surgery performed along with a tympanoplasty to remove the infected portions of the mastoid bone in a patient with chronic otitis media. What instructions would the nurse teach a patient and caregiver regarding the prevention of external otitis? Select all that apply. a. Report any decrease in cerumen production. b. Do not dry the ears with a cotton-tipped applicator. c. Report itching of the cochlea if it becomes a problem. d. Use earplugs if the patient is prone to swimmer's ear. e. Do not put anything in the ear canal unless instructed by the healthcare provider. ️ANS: B D E Wearing earplugs can prevent contaminated water from contacting the external canal, thereby preventing the alteration of normal flora leading to bacterial growth. Ears should be cleaned and dried with a washcloth, as cotton-tipped applicators can cause serious injury to the tympanic membrane. Putting objects into the ear canal can cause impaction of cerumen, impairing hearing, or penetration of the middle ear. An increase, not decrease, in cerumen production has been shown to have an effect on development of external otitis. Itching ears are a common symptom with external otitis; however, the cochlea is in the inner ear and does not itch. Which instruction should the nurse provide while teaching the patient and caregiver how to reduce the risk of external otitis? a. "Report if you notice earwax in the ear canal." b. "Dry your ears with cotton-tipped applicators." c. "Never use a hair dryer to speed up water evaporation from the ear." d. "Turn your head to each side for 30 seconds to drain water from the ear." ️ANS: D Swimming and showering may alter the flora of the external canal because of chemicals and contaminated water, and thus cause external otitis. The nurse should instruct the patient to turn his or her head to each side for 30 seconds at a time to help water run out of the ears. This would help keep the ear dry. Earwax is normal, and it protects the ear canal. Chronic excessive cerumen should be reported if it impairs the patient's hearing. If water gets inside the ears, they should not be dried with cotton-tipped applicators. Instead, a hair dryer set to low and held at least six inches from the ear can speed water evaporation. Which decibel loss indicates moderately severe hearing impairment?