ATI LPN
Test Bank for Medical Surgical Nursing: Concepts for Interprofessional Collaborative Care 10th Edition
Chapter 48 : Assessment and Care of Patients with Ear and Hearing Problems Questions
Question 1 of 5
A hospitalized client has Ménière's disease. What menu selections demonstrate good knowledge of the recommended diet for this disorder? (Select all that apply.)
Correct Answer: B,E
Rationale: The diet recommendations for Ménière's disease include low-sodium, caffeine-free foods and fluids distributed evenly throughout the day. Plenty of water is also needed. The broiled chicken breast and herbal tea are the best selections. The stir fry is high in sodium and possibly monosodium glutamate (MSG, also not recommended). The cookies and chili with tortilla chips are high in sodium.
Question 2 of 5
A client is scheduled for a stapedectomy in 2 weeks. What teaching instructions are most appropriate? (Select all that apply.)
Correct Answer: B,D,E
Rationale: Clients undergoing a stapedectomy should blow the nose gently if needed, stop taking aspirin 1 week before surgery to reduce bleeding risk, and keep the ear dry after surgery to prevent infection. Avoiding alcohol is not specific to this surgery, and prophylactic ear drops are not typically required.
Question 3 of 5
A nurse is teaching a client about ear hygiene and health. What client statement indicates a need for further teaching?
Correct Answer: A
Rationale: Clients should be taught not to put anything larger than their fingertip into their ears. Using a cotton swab, although soft, can cause damage to the ears and cerumen buildup. The other statements are accurate.
Question 4 of 5
The student nurse is performing a Weber tuning fork test. What technique is most appropriate?
Correct Answer: B
Rationale: The Weber tuning fork test involves placing the vibrating tuning fork in the middle of the client's head and asking in which ear the client hears the vibrations loudest. The other techniques are incorrect.
Question 5 of 5
The clients chart indicates a sensorineural hearing loss. What assessment question does the nurse ask to determine the possible cause?
Correct Answer: C
Rationale: Sensorineural hearing loss can occur from damage to the cochlea, the eighth cranial nerve, or the brain. Exposure to loud noises is one etiology. The other questions relate to conductive hearing loss.