Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 21 - Assessment and Management: Auditory Problems
1. To decrease the risk for future hearing loss, which action should the nurse who is
working with college students at the on-campus health clinic implement?
A. Arrange to include otoscopic examinations for all patients.
B. Administer influenza immunizations to all students at the clinic.
C. Discuss the importance of limiting exposure to amplified music.
D. Perform tympanometry on all patients between the ages of 18 to 24.
Answer: C
Explanation: Prolonged exposure to loud, amplified music is a significant risk factor for
noise-induced hearing loss in young adults. Education about limiting exposure is a key
preventive measure.
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?
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.
D. I can use warm compresses to the outside of the ear for comfort.
Answer: C
Explanation: Inserting cotton-tipped applicators or other objects into the ear canal can cause
trauma, push debris further in, and worsen the infection. This action should be avoided.
3. A patient who has undergone a left tympanoplasty should be instructed to
A. remain on bed rest.
B. keep the head elevated.
C. avoid blowing the nose.
D. irrigate the left ear canal.
Answer: C
Explanation: Blowing the nose increases pressure in the eustachian tube and middle ear,
which can disrupt the surgical graft and impair healing.
, 4. The nurse is assessing a patient who has recently been treated with amoxicillin
for acute otitis media of the right ear. Which finding is a priority to report to the
health care provider?
A. The patient has a temperature of 100.6 F.
B. The patient complains of popping in the ear.
C. The patient frequently asks the nurse to repeat information.
D. The patient states that the right ear has a feeling of fullness.
Answer: A
Explanation: A persistent or recurrent fever suggests that the infection may not be fully
resolved and could require a change in antibiotic therapy.
5. A 42-year-old woman with Meniere'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 patients room.
B. Encourage increased oral fluid intake.
C. Change the patients position every 2 hours.
D. Keep the head of the bed elevated 30 degrees.
Answer: A
Explanation: Reducing sensory stimulation by dimming lights and minimizing noise can help
decrease the severity of vertigo and nausea during an acute Meniere's attack.
6. Which statement by the patient to the home health nurse indicates a need for
more teaching about self-administering eardrops?
A. I will leave the ear wick in place while administering the drops.
B. I should lie down before and for 5 minutes after administering the drops.
C. I will hold the tip of the dropper above the ear while administering the drops.
D. I should keep the medication refrigerated until I am ready to administer the drops.
Answer: D
Explanation: Administering cold eardrops can stimulate the vestibular system and cause
dizziness. Eardrops should be at room temperature unless otherwise directed.
7. An 82-year-old 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?
A. Overenunciate while speaking.
B. Speak normally but more slowly.
C. Increase the volume when speaking.
D. Use more facial expressions when talking.
,Answer: B
Explanation: Speaking at a normal volume but at a slower pace can improve comprehension
for older adults with presbycusis, who often have difficulty processing rapid speech.
8. A 75-year-old 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. Experiment with volume and hearing ability in a quiet environment initially.
B. Keep the volume low on the hearing aids for the first week while adjusting to them.
C. Add a second hearing aid after making the initial adjustment to the first hearing
aid.
D. Wear the hearing aids for about an hour a day at first, gradually increasing the time
of use.
Answer: A
Explanation: Starting in a quiet environment allows the patient to adjust to amplified sounds
and learn to control volume settings without the distraction of background noise.
9. Which information will the nurse include for a patient contemplating a cochlear
implant?
A. Cochlear implants require training in order to receive the full benefit.
B. Cochlear implants are not useful for patients with congenital deafness.
C. Cochlear implants are most helpful as an early intervention for presbycusis.
D. Cochlear implants improve hearing in patients with conductive hearing loss.
Answer: A
Explanation: Extensive auditory rehabilitation and training are necessary after cochlear
implantation to help the brain interpret the new signals and maximize hearing benefit.
10. Unlicensed assistive personnel (UAP) perform all the following actions when
caring for a patient with Meniere's disease who is experiencing an acute attack.
Which action by UAP indicates that the nurse should intervene immediately?
A. UAP raise the side rails on the bed.
B. UAP turn on the patients television.
C. UAP turn the patient to the right side.
D. UAP place an emesis basin at the bedside.
Answer: B
Explanation: Visual stimuli like television can exacerbate vertigo and nausea during an acute
Meniere's attack. The environment should be kept quiet and dimly lit.
, 11. Which information about a patient who had a stapedotomy yesterday is most
important for the nurse to communicate to the health care provider?
A. The patient complains of fullness in the ear.
B. The patients oral temperature is 100.8 F (38.1 C).
C. The patient says My hearing is worse now than it was right after surgery.
D. There is a small amount of dried bloody drainage on the patients dressing.
Answer: B
Explanation: An elevated temperature may indicate a postoperative infection, which requires
prompt intervention to prevent serious complications.
12. The priority nursing diagnosis for a patient experiencing an acute attack with
Meniere's disease is
A. risk for falls related to dizziness.
B. impaired verbal communication related to tinnitus.
C. self-care deficit (bathing and dressing) related to vertigo.
D. imbalanced nutrition: less than body requirements related to nausea.
Answer: A
Explanation: Sudden, severe vertigo can cause loss of balance and falls, making injury
prevention the highest priority during an acute attack.
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. Use a sterile applicator to clean the ear canal before irrigating.
D. Occlude the ear canal completely with the syringe while irrigating.
Answer: B
Explanation: Using solution at body temperature prevents vestibular stimulation and
dizziness. The patient should be seated, and the ear canal should not be completely occluded
during irrigation.
14. Which action will the nurse include in the plan of care for a patient with benign
paroxysmal positional vertigo (BPPV)?
A. Teach the patient about use of medications to reduce symptoms.
B. Place the patient in a dark, quiet room to avoid stimulating BPPV attacks.
C. Teach the patient that canalith repositioning may be used to reduce dizziness.
Chapter 21 - Assessment and Management: Auditory Problems
1. To decrease the risk for future hearing loss, which action should the nurse who is
working with college students at the on-campus health clinic implement?
A. Arrange to include otoscopic examinations for all patients.
B. Administer influenza immunizations to all students at the clinic.
C. Discuss the importance of limiting exposure to amplified music.
D. Perform tympanometry on all patients between the ages of 18 to 24.
Answer: C
Explanation: Prolonged exposure to loud, amplified music is a significant risk factor for
noise-induced hearing loss in young adults. Education about limiting exposure is a key
preventive measure.
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?
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.
D. I can use warm compresses to the outside of the ear for comfort.
Answer: C
Explanation: Inserting cotton-tipped applicators or other objects into the ear canal can cause
trauma, push debris further in, and worsen the infection. This action should be avoided.
3. A patient who has undergone a left tympanoplasty should be instructed to
A. remain on bed rest.
B. keep the head elevated.
C. avoid blowing the nose.
D. irrigate the left ear canal.
Answer: C
Explanation: Blowing the nose increases pressure in the eustachian tube and middle ear,
which can disrupt the surgical graft and impair healing.
, 4. The nurse is assessing a patient who has recently been treated with amoxicillin
for acute otitis media of the right ear. Which finding is a priority to report to the
health care provider?
A. The patient has a temperature of 100.6 F.
B. The patient complains of popping in the ear.
C. The patient frequently asks the nurse to repeat information.
D. The patient states that the right ear has a feeling of fullness.
Answer: A
Explanation: A persistent or recurrent fever suggests that the infection may not be fully
resolved and could require a change in antibiotic therapy.
5. A 42-year-old woman with Meniere'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 patients room.
B. Encourage increased oral fluid intake.
C. Change the patients position every 2 hours.
D. Keep the head of the bed elevated 30 degrees.
Answer: A
Explanation: Reducing sensory stimulation by dimming lights and minimizing noise can help
decrease the severity of vertigo and nausea during an acute Meniere's attack.
6. Which statement by the patient to the home health nurse indicates a need for
more teaching about self-administering eardrops?
A. I will leave the ear wick in place while administering the drops.
B. I should lie down before and for 5 minutes after administering the drops.
C. I will hold the tip of the dropper above the ear while administering the drops.
D. I should keep the medication refrigerated until I am ready to administer the drops.
Answer: D
Explanation: Administering cold eardrops can stimulate the vestibular system and cause
dizziness. Eardrops should be at room temperature unless otherwise directed.
7. An 82-year-old 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?
A. Overenunciate while speaking.
B. Speak normally but more slowly.
C. Increase the volume when speaking.
D. Use more facial expressions when talking.
,Answer: B
Explanation: Speaking at a normal volume but at a slower pace can improve comprehension
for older adults with presbycusis, who often have difficulty processing rapid speech.
8. A 75-year-old 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. Experiment with volume and hearing ability in a quiet environment initially.
B. Keep the volume low on the hearing aids for the first week while adjusting to them.
C. Add a second hearing aid after making the initial adjustment to the first hearing
aid.
D. Wear the hearing aids for about an hour a day at first, gradually increasing the time
of use.
Answer: A
Explanation: Starting in a quiet environment allows the patient to adjust to amplified sounds
and learn to control volume settings without the distraction of background noise.
9. Which information will the nurse include for a patient contemplating a cochlear
implant?
A. Cochlear implants require training in order to receive the full benefit.
B. Cochlear implants are not useful for patients with congenital deafness.
C. Cochlear implants are most helpful as an early intervention for presbycusis.
D. Cochlear implants improve hearing in patients with conductive hearing loss.
Answer: A
Explanation: Extensive auditory rehabilitation and training are necessary after cochlear
implantation to help the brain interpret the new signals and maximize hearing benefit.
10. Unlicensed assistive personnel (UAP) perform all the following actions when
caring for a patient with Meniere's disease who is experiencing an acute attack.
Which action by UAP indicates that the nurse should intervene immediately?
A. UAP raise the side rails on the bed.
B. UAP turn on the patients television.
C. UAP turn the patient to the right side.
D. UAP place an emesis basin at the bedside.
Answer: B
Explanation: Visual stimuli like television can exacerbate vertigo and nausea during an acute
Meniere's attack. The environment should be kept quiet and dimly lit.
, 11. Which information about a patient who had a stapedotomy yesterday is most
important for the nurse to communicate to the health care provider?
A. The patient complains of fullness in the ear.
B. The patients oral temperature is 100.8 F (38.1 C).
C. The patient says My hearing is worse now than it was right after surgery.
D. There is a small amount of dried bloody drainage on the patients dressing.
Answer: B
Explanation: An elevated temperature may indicate a postoperative infection, which requires
prompt intervention to prevent serious complications.
12. The priority nursing diagnosis for a patient experiencing an acute attack with
Meniere's disease is
A. risk for falls related to dizziness.
B. impaired verbal communication related to tinnitus.
C. self-care deficit (bathing and dressing) related to vertigo.
D. imbalanced nutrition: less than body requirements related to nausea.
Answer: A
Explanation: Sudden, severe vertigo can cause loss of balance and falls, making injury
prevention the highest priority during an acute attack.
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. Use a sterile applicator to clean the ear canal before irrigating.
D. Occlude the ear canal completely with the syringe while irrigating.
Answer: B
Explanation: Using solution at body temperature prevents vestibular stimulation and
dizziness. The patient should be seated, and the ear canal should not be completely occluded
during irrigation.
14. Which action will the nurse include in the plan of care for a patient with benign
paroxysmal positional vertigo (BPPV)?
A. Teach the patient about use of medications to reduce symptoms.
B. Place the patient in a dark, quiet room to avoid stimulating BPPV attacks.
C. Teach the patient that canalith repositioning may be used to reduce dizziness.
