EAR DISORDERS sensorineural hearing loss in one ear, the sound is heard in the other
ear. If the client has a conductive hearing loss in one ear, the sound is
1. The nurse is providing instructions to a nursing assistant regarding
care of an older client with hearing loss. The nurse tells the assistant
that clients with a hearing loss:
a) are often distracted
b) have middle ear changes
c) respond to low-pitched tones
d) develop moist cerumen production
Presbycusis refers to the age-related irreversible degenerative
changes of the inner ear that lead to decreased hearing ability. As a
result of these changes, the older client has a decreased response to
high-frequency sounds. Low-pitched voice tones are heard more
easily and can be interpreted by the older client. Options A, B, and D
are not accurate.
2. The nurse is performing an otoscopic examination on a client with
mastoiditis. On examination of the tympanic membrane, which of the
following would the nurse expect to observe?
a) a pink-colored tympanic membrane
b) a pearly colored tympanic membrane
c) a transparent and clear tympanic membrane
d) a red, dull, thick and immobile tympanic membrane
Otoscopic examination in a client with mastoiditis reveals a red,
dull, thick, and immobile tympanic membrane, with or without
perforation. Postauricular lymph nodes are tender and enlarged.
Clients also have a low-grade fever, malaise, anorexia, swelling
behind the ear, and pain with minimal movement of the head.
3. The client is diagnosed with a disorder involving the inner ear. Which
of the following is the most common client complaint associated
with a disorder involving this part of the ear?
a) pruritus
b) tinnitus
c) hearing loss
d) burning in the ear
Tinnitus is the most common complaint of clients with
otological disorders, especially disorders involving the inner ear.
Symptoms of tinnitus range from mild ringing in the ear, which can
go unnoticed during the day, to a loud roaring in the ear, which can
interfere with the client’s thinking process and attention span.
Options A, C, and D are not associated specifically with disorders of
the inner ear.
4. The nurse is performing a voice test to assess hearing. Which of the
following describes the accurate procedure for performing this test?
a) whisper a statement while the client blocks both ears
b) whisper a statement with the examiner's back facing the client
c) whisper a statement and ask the client to repeat it while
blocking one ear
d) stand 4 feet away from the client to ensure that the client can
hear at this distance
In the voice test, the examiner stands 1 to 2 feet away from the
client and asks the client to block one external ear canal. The nurse
whispers a statement and asks the client to repeat it. Each ear is
tested separately.
5. During a hearing assessment, the nurse notes that the sound
lateralizes to the client's left ear with the Weber test. The nurse
analyzes these results as:
a) a normal finding
b) the presence of nystagmus
c) a sensorineural or conductive loss
d) a conductive loss in the right ear
In the Weber tuning fork test, the nurse places the vibrating
tuning fork in the middle of the client’s head, at the midline of the
forehead, or above the upper lip over the teeth. Normally, the sound
is heard equally in both ears by bone conduction. If the client has a
heard in that ear.
6. The nurse is caring for a hearing-impaired client. Which of the
following approaches will facilitate communication?
a) speak loudly
b) speak frequently
c) speak at a normal volume
d) speak directly into the impaired ear
Speaking in a normal tone to the client with impaired hearing
and not shouting are important. The nurse should talk directly to the
client while facing the client and speak clearly. If the client does not
seem to understand what is said, the nurse should express it
differently. Moving closer to the client and toward the better ear may
facilitate communication, but the nurse should avoid talking directly
into the impaired ear.
7. A client arrives at the emergency room with a foreign body in the left
ear that has been determined to be an insect. Which intervention
would the nurse anticipate to be prescribed initially?
a) irrigation of the ear
b) instillation of diluted alcohol
c) instillation of antibiotic ear drops
d) instillation of corticosteroid ointment
Insects are killed before removal unless they can be coaxed out
by a flashlight or a humming noise. Mineral oil or diluted alcohol is
instilled into the ear to suffocate the insect, which then is removed
using ear forceps. When the foreign object is vegetable matter,
irrigation is not used, because this material expands with hydration
and the impaction becomes worse.
8. The nurse notes that the physician has documented a diagnosis of
presbycusis on the client's chart. The nurse plans care knowing that
the condition is:
a) tinnitus that occurs with aging
b) nystagmus that occurs with aging
c) a conductive hearing loss that occurs with aging
d) a sensorineural hearing loss that occurs with aging
Presbycusis is a type of hearing loss that occurs with aging.
Presbycusis is a gradual sensorineural loss caused by nerve
degeneration in the inner ear or auditory nerve. Options A, B, and C
are incorrect.
9. The nurse has conducted discharge teaching for a client who has had
a fenestration procedure for the treatment of otosclerosis. Which of
the following, if stated by the client, would indicate that teaching
was effective?
a) it is okay to take a shower and wash my hair
b) I can resume my tennis lessons starting next week
c) I will take stool softeners as prescribed by my doctor
d) I should drink liquids through a straw fo the next 2 to 3 weeks
Following ear surgery, the client needs to avoid straining when
having a bowel movement. The client needs to be instructed to avoid
drinking with a straw for 2 to 3 weeks, air travel, and coughing
excessively. The client needs to avoid getting his or her head wet,
washing hair, showering for 1 week, and rapidly moving the head,
bouncing, and bending over for 3 weeks.
10. A client with Meniere's disease is experiencing severe vertigo. Which
instruction should the nurse give to the client to assist in controlling
the vertigo?
a) increase sodium in the diet
b) avoid sudden head movements
c) lie still and watch the television
d) increase fluid intake to 3L a day
The nurse instructs the client to make slow head movements to
prevent worsening of the vertigo. Dietary changes such as salt and
 fluid restrictions that reduce the amount of endolymphatic fluid are
sometimes prescribed. Lying still and watching television will not
control vertigo.
11. The nurse is caring for a client following craniotomy for removal of an
acoustic neuroma. Assessment of which of the following cranial
nerves would identify a complication specifically associated with this
surgery?
a) cranial nerve I, olfactory
b) cranial nerve IV, trochlear
c) cranial nerve III, oculomotor
d) cranial nerve VII, facial nerve
Treatment for acoustic neuroma is surgical removal via a
craniotomy. Extreme care is taken to preserve remaining hearing and
preserve the function of the facial nerve. Acoustic neuromas rarely
recur following surgical removal.
12. The nurse assesses the client with a blunt injury sustained from a
motor vehicle accident. Which assessment sign would indicate a
basal skull fracture as a result of the injury?
a) epistaxis
b) periorbital edema
c) purulent drainage from the auditory canal
d) bloody or clear drainage from the auditory canal
Bloody or clear watery drainage from the auditory canal
indicates a cerebrospinal fluid leak following trauma and suggests a
basal skull fracture. This warrants immediate attention. Options A, B,
and C are not specific to a basal skull fracture.
13. A client was just admitted to the hospital to rule out a
gastrointestinal (GI) bleed. The client has brought several bottles of
medications prescribed by different specialists. During the admission
assessment, the client states, "Lately, I have been hearing some
roaring sounds in my ears, especially when I am alone." Which
medication would the nurse determine could be the cause of the
client's complaint?
a) doxycycline (Vibramycin)
b) acetazolamide (Diamox)
c) acetylsalicylic acid (aspirin)
d) diltiazem hydrochloride (Cardizem)
Aspirin is contraindicated for gastrointestinal bleed and is
potentially ototoxic. The client should be advised to notify the
prescribing physician so the medication can be discontinued and/or a
substitute that is less toxic to the ear can be taken instead. Options
A, B, and D do not have side effects that are potentially associated
with hearing difficulties.
14. The nurse prepares the client for an ear irrigation as prescribed by
the physician. In performing the procedure, the nurse:
a) warms the irrigating solution to 98F
b) position the client with the affected side up following the
irrigation
c) directs a slow steady stream of irrigation solution toward the
eardrum
d) ssists the client to turn his or her head so that the ear to be
irrigated is facing upward
Irrigation solutions that are not close to the client’s body
temperature can be uncomfortable and may cause injury, nausea,
and vertigo. The client is positioned so that the ear to be irrigated is
facing downward, because this allows gravity to assist in the removal
of the ear wax and solution. Following the irrigation, the client is to
lie on the affected side to finish draining the irrigating solution. A
slow steady stream of solution should be directed toward the upper
wall of the ear canal and not toward the eardrum. Too much force
could cause the tympanic membrane to rupture.
15. Ear drops are prescribed for an infant with otitis media. The most
appropriate method to administer the ear drops to the infant is to:
a) pull up and back on the pinna and direct the solution onto the
eardrum
b) pull down and back on the pinna and direct the solution onto
the eardrum
c) pull down and back on the pinna and direct he solution toward
the wall of the canal
d) pull up and back on the ear lobe and direct the solution toward
the wall of the canal
In a child younger than 3 years, the pinna is pulled down and
straight back. The infant should be turned on the side with the
affected ear uppermost. With the nondominant hand, the pinna is
pulled down and back. The medication is administered by aiming it at
the wall of the canal rather than directly onto the eardrum. The
infant should remain with the affected ear uppermost for 10 to 15
minutes to retain the solution. In the adult or a child older than 3
years, the pinna is pulled up and back to straighten the auditory
canal.
16. The nurse is preparing to perform an otoscopic examination on an
adult client. The nurse does which of the following to perform this
examination?
a) pulls the pinna up and back before inserting the speculum
b) pulls the earlobe down and back before inserting the speculum
c) uses the smallest speculum available to decrease the
discomfort of the exam
d) tilts the clients head forward and down before inserting the
speculum
The nurse tilts the client’s head slightly away and holds the
otoscope upside down as if it were a large pen. The pinna is pulled up
and back and the nurse visualizes the external canal while slowly
inserting the speculum. Options B, C, and D are incorrect.
17. A nurse is providing diet instructions to a client with Meniere's
disease who is being discharged from the hospital after admission for
an acute attack. Which statement if made by the client indicates an
understanding of the dietary measures to take to prevent further
attacks?
a) I need to drink at least 3 liters of fluid per day
b) I need to restrict my carbohydrates intake
c) I need to maintain a low-fat and low-cholesterol diet
d) I need to be sure to consume foods that are low in sodium
Dietary changes such as salt and fluid restrictions that reduce
the amount of endolymphatic fluid are sometimes prescribed for the
client with Ménière’s disease. The client should be instructed to
consume a low-sodium diet and restrict fluids as prescribed. Low-fat,
low-carbohydrate, and low-cholesterol diets are not specifically
prescribed for the client with Ménière’s disease.
18. A nurse in the health care clinic is providing instructions to a client
regarding the use of a hearing aid. Which of the following statements
would be appropriate for the nurse to include?
a) the ear mold for the hearing aid should be washed with mild
soap and water once a month
b) the hearing aid should be removed from the ear at the end of
the day then turned off after removal
c) the hearing aid contains a lifelong battery so you will not need
to be concerned about changing batteries
d) the hearing aid should not be worn if an ear infection is
present
The client should be instructed that the hearing aid should not
be worn if an ear infection is present. The client should be instructed
to turn the hearing aid off before removing it from the ear to prevent
any squealing feedback. The hearing aid should be turned off when
not in use and the client should keep extra batteries on hand at all
times. The client should wash the ear mold frequently with mild soap
and water, with the use of a pipe cleaner to clean the cannula of the
hearing aid.
19. A nurse is caring for a client with acute otitis media. In order to
reduce pressure and allow fluid to drain, the nurse anticipates that
which of the following would most likely be recommended to the
client?
a) the administration of diphenhydramine (Benadryl) capsules
b) a myringotomy
c) strict bedrest
d) a mastoidectomy
A myringotomy is a surgical procedure that will allow fluid to
drain from the middle ear. Benadryl is an antihistamine with
antiemetic properties. Strict bedrest is not necessary, although
activity may be restricted. Additionally, bedrest would not assist in
reducing pressure or allowing fluid to drain. In some cases, the
mastoid bone is removed or partially removed for chronic otitis
media.
20. A nurse is developing a plan of care for a client with a diagnosis of
Meniere's disease who is being admitted to the hospital. The priority
nursing intervention in the plan of care should focus on:
a) safety measures
b) self-care measures
c) knowledge about medication therapy
d) food items to avoid
Ménière’s disease can cause severe vertigo in the client. The
priority in the nursing care plan should focus on safety issues to
prevent falls or injury in the client. Although self-care measures,
medication therapy, and dietary therapy may be components of the
plan of care, safety is the priority issue.
21. A nurse is assigned to care for a client after a mastoidectomy. Which
nursing intervention would be appropriate in the care of this client?
a) maintain a supine position
b) position the client on the affected side to promote drainage
c) change the ear dressing daily
d) monitor for signs of facial nerve injury
After mastoidectomy, the nurse should monitor vital signs and
inspect the dressing for drainage or bleeding. The nurse also should
assess for signs of facial nerve injury (cranial nerve VII). The nurse
also should monitor for signs of pain, dizziness, or nausea. The head
of the bed should be elevated at least 30 degrees, and the client
should be instructed to lie on the unaffected side. The client probably
will have sutures, an outer ear packing, and a bulky dressing, which is
removed on approximately the sixth day postoperatively.
22. A nurse is performing an assessment on a client with a diagnosis of
Meniere's disease. The nurse anticipates that the client is most likely
to report which of the following symptoms during an acute attack?
a) tinnitus
b) headache
c) fatigue
d) insomnia
Ménière’s disease results in a disturbance of the fluid of the
endolymphatic system. The cause of the disturbance is not known.
Attacks may be preceded by feelings of fullness in the ear or by
tinnitus. Headaches, fatigue, and insomnia are not associated with
this disorder.
23. A nurse has admitted a client with a diagnosis of an acute attack of
Meniere's disease to the hospital. The nurse reviews the physician's
orders for the client. Which order should the nurse question?
a) diphenhydramine (Benadryl)
b) diazepam (Valium)
c) atropine sulfate
d) ambulation 4 times daily
Medical interventions during the acute phase of Ménière’s
disease include using atropine sulfate or diazepam to decrease the
autonomic nervous system function. Diphenhydramine may be
prescribed for its antihistamine effects, and a vasodilator also will be
prescribed. The client will remain on bedrest during the acute attack.
When allowed out of bed, the client will need assistance with
walking, sitting, or standing.
24. A nurse in the health care clinic is preparing to perform an otoscopic
examination on adult client. In performing the examination, the
nurse should:
a) position the client lying flat on the side of the ear be examined
b) pull the ear lobe down and back before inserting the speculum
c) tilt the client's head forward before inserting the speculum
d) pull the pinna up and back before inserting the speculum
The correct procedure for performing an otoscopic examination
on an adult is to pull the pinna up and back to allow visualization of
the external canal while slowly inserting the speculum. The nurse
would tilt the client’s head slightly away and hold the otoscope
upside down as if it were a large pen. The examination would be
performed with the client in a sitting position. If the client were lying
on the side to be examined, examination of the affected ear would
not be possible.
25. A nurse is providing discharge instructions to the client being
discharged after a fenestration procedure for the treatment of
otosclerosis. Which statement if made by the client indicates a need
for further instruction?
a) I should take stool softeners to avoid straining when having a
bowel movement
b) I need to avoid washing my hair and showering for at least 1
week
c) I should avoid movements requiring bending over for at least 3
weeks
d) I should use a straw to drink liquids for the next 2 to 3 weeks
After ear surgery, clients need to be instructed to avoid drinking
with a straw for 2 to 3 weeks, to avoid air travel, and to avoid
coughing excessively. The client also should be instructed to avoid
straining when having a bowel movement and should be instructed
to take stool softeners as prescribed. The client should avoid getting
the head wet, washing the hair, or showering for at least 1 week, and
to avoid rapidly moving the head, bouncing, and bending over for at
least 3 weeks.
26. The clinic nurse is preparing to provide care for a client who will need
an ear irrigation to remove impacted cerumen. Which of the
following will the nurse avoid when performing the irrigation?
a) position the client to turn the head so that the ear be irrigated
is facing upward
b) warm the irrigating solution to a temperature that is close to
body temperature
c) direct a slow steady stream of irrigation solution toward the
upper wall of the ear canal
d) position the client with the affected side down after irrigation
During the irrigation, the client is positioned so that the ear to
be irrigated is facing downward, because this allows gravity to assist
in the removal of the earwax and solution. Delivery of irrigation
solutions at temperatures that are not close to body temperature
can cause discomfort for the client and may result in tissue injury,
nausea, and vertigo. A slow, steady stream of solution should be
directed toward the upper wall of the ear canal, not toward the
tympanic membrane. After the irrigation, the client should lie on the
affected side for a period of time that is necessary to allow the
irrigating solution to finish draining (usually 10 to 15 minutes). Too
much force could cause the tympanic membrane to rupture.
27. A nursing student is performing an otoscopic examination in an adult
client. The nursing instructor observes the student perform this
procedure. Which observation by the instructor indicates that the
student is using correct technique for the procedure?
a) pulling the pinna down and back before inserting the speculum
b) pulling the earlobe down and back before inserting the
speculum
c) using the smallest speculum available
d) tilting the client's head slightly away and holding the otoscope
upside before inserting the speculum

In the otoscopic examination, the nurse tilts the client’s head
slightly away and holds the otoscope upside down as if it were a
large pen. The pinna is pulled up and back and the nurse visualizes
the external canal while slowly inserting the speculum. A small
speculum is used in pediatric clients. The nurse may not be able to
adequately visualize the ear canal if a small speculum is used in the
adult client.
28. A nurse is preparing to perform a Weber test on a client. The nurse
obtains which item needed to perform this test?
a) a tongue blade
b) a stethoscope
c) a tuning fork
d) a reflex hammer
A tuning fork is needed to perform the Weber test, during
which the nurse places the vibrating tuning fork at the midline of the
client’s forehead or above the upper lip over the teeth. Normally, the
sound is heard equally in both ears by bone conduction. If the client
has a sensorineural hearing loss in one ear, the sound is heard in the
other ear. If the client has a conductive hearing loss in one ear, the
sound is heard in that ear. The items identified in options A, B, and D
are not needed to perform the Weber test.
29. The home care nurse is visiting a client who was recently diagnosed
with a hearing impairment. The nurse prepares to instruct the client's
spouse in which measure that will facilitate communication?
a) speak frequently to the client to provide sensory stimulation
b) speak loudly to the client to facilitate hearing
c) speak in a normal tone and face the client when speaking
d) speak directly into the impaired ear to facilitate hearing
Measures that facilitate hearing in the client with a hearing
impairment problem include speaking in a normal tone; avoiding
shouting; talking directly to the client while facing the client; and
speaking clearly. If the client does not seem to understand what is
said, the statement should be expressed differently. Moving closer to
the client and toward the better ear may facilitate communication,
but talking directly into the impaired ear should be avoided.
30. A nurse is providing discharge instructions to a client who had a
fenestration procedure for the treatment of otosclerosis. The nurse
instructs the client to:
a) drink liquids through a straw for the next 2 to 3 weeks
b) shower daily to prevent infection
c) avoid air travel
d) resume all normal activities in 1 week
After ear surgery, the client needs to be instructed to avoid air
travel, avoid drinking through a straw for 2 to 3 weeks, and to avoid
coughing excessively. In addition, the client should avoid straining
when having a bowel movement, as well as washing the hair, getting
the head wet, or showering for 1 week. The client also needs to avoid
rapidly moving the head, bouncing, and bending over for 3 weeks.
31. A clinic nurse is preparing to perform a Romberg test on a client
being seen in the clinic. The nurse performs this test for the purpose
of determining:
a) the client's ability to ambulate
b) the functional status of the vestibular apparatus in the inner
ear
c) the intactness of the retinal structure of the eye
d) the intactness of the tympanic membrane
The Romberg test assesses the ability of the vestibular
apparatus in the inner ear to help maintain standing balance. The
Romberg test also assesses intactness of the cerebellum and
proprioception. Options A, C, and D are incorrect.
32. A clinic nurse is performing an otoscopic examination on an
adolescent who was hit in the ear with a basketball during a
neighborhood game. A perforated eardrum is suspected. Which of
the following would the nurse expect to observe if the eardrum is
perforated?
a) a colony of black dots on the eardrum
b) dense white patches on the eardrum
c) a red bulging eardrum
d) a round or oval darkened area on the eardrum
A round or oval darkened area on the eardrum would be seen in
a client with a perforated eardrum. A red and bulging eardrum is
indicative of acute purulent otitis media. Dense white patches are
seen on the eardrum of a client with sequelae of repeated ear
infections. A colony of black dots on the eardrum suggests a yeast or
fungal infection.
33. A caloric test is ordered for a client suspected of having disease of
the labyrinth. The nurse would obtain which of the following
essential items in preparation for this test?
a) an otoscope
b) an opthalmoscope
c) a tongue blade
d) an emesis basin
A caloric test is contraindicated in a client with a perforated
tympanic membrane (air may be used as a substitute) or if the client
has an acute disease of the labyrinth. An otoscopic examination
should be performed before the caloric test to rule out perforation
and to determine if the ear canal contains cerumen, which must be
removed before the test. An ophthalmoscope, a tongue blade, and
an emesis basin are not essential items.
34. A nurse educator is conducting an in-service education session to the
nurses employed in the eye and ear surgical unit of a large trauma
center. In discussing the topic of cochlear implants, the educator
notes that this surgical procedure is contraindicated in which of the
following clients?
a) a client who became deaf before learning to speak
b) a client with bilateral profound hearing loss
c) a client who communicates primarily by speech
d) a client who received no benefit from conventional hearing aids
Adults who were born deaf or became deaf before learning to
speak usually are not candidates for this type of surgery. Criteria for a
cochlear implant procedure are bilateral profound hearing loss, use
of speech as the primary mode of communication, lack of benefit
from conventional hearing aids, evidence of strong family and social
support, and realistic client expectations for the outcome of the
implant procedure.
35. A nurse is observing a nursing assistant communicating with a client
who is deaf. The nurse will intervene if which of the following
behaviors is observed?
a) the nursing assistant is speaking directly to the client
b) the nursing assistant touches the client's arm to gain his or her
attention
c) the nursing assistant faces the client when speaking to the
client
d) the nursing assistant overenunciates words when speaking
Overenunciating words does not make lip reading easier and is
demeaning to the deaf person. It is best to speak in a normal manner.
Options A, B, and C are appropriate communication strategies for the
client who is deaf.
36. A nurse is planning a presentation on noise prevention and ear
protection for a display booth at a local health fair. The nurse plans to
incorporate which important concept regarding hearing loss in the
presentation?
a) siting near loud music is not harmful
b) ear plugs or other protectors are necessary only when use of
power tools
c) prolonged ringing in the ears after loud noises is normal
d) cup the hands over the ears if loud noise is expected suddenly
 A variety of ear protective devices are available commercially.
These include disposable and reusable plugs, headbands, and foam-
filled muffs. They should be used around any type of loud noise, such
as from power tools, machinery, lawn mowers, chain saws, or other
equipment. Sitting near loud music should be avoided whenever
possible. If a loud noise is suddenly anticipated, the ears should be
covered for protection. The client should see a physician for tinnitus
or hearing loss after exposure to a loud noise.
just the head, when spoken to. If vertigo does occur, the client
should immediately sit down or grasp the nearest piece of furniture.
The client should maintain the home without throw rugs and in a
state that is free of clutter, because the effort of trying to regain
balance after slipping could trigger the onset of vertigo.

37. A nurse instructs a client in the use of a hearing aid. The nurse
includes which of the following in the instructions?
a) check the battery to ensure that it is working before use
b) leave the hearing aid in place while showering
c) hearing aids do not require any care
d) a water-soluble lubricant is used on the hearing aid before
insertion

The battery of the hearing aid should be checked before use.

The hearing aid should be removed for showering, because it should
not get wet. It also should be put away in its case at night. It should
be cleaned according to manufacturer’s directions, which usually
consist of washing with warm soapy water, followed by thorough
drying. Lubricants or other solvents are not used on the hearing aid.

38. A nurse has given a client at risk for motion sickness suggestions
about medications that can prevent an occurrence. The nurse
determines that the client has correctly learned the information if the
client states to take medication at what time before the triggering
event?
a) at least 1/2 day before
b) at least 1 hour before
c) at least the day before
d) at least 2 days before

To be maximally effective, medications to prevent motion

sickness should be taken at least 1 hour before the triggering event.
Medications that are commonly used for this purpose include
dimenhydrinate (Dramamine), scopolamine (Transderm-Scop),
promethazine (Phenergan), and prochlorperazine (Compazine).
Options A, C, and D are incorrect.

39. An adult client makes an appointment with an ear specialist because

of the frequent recurrence of middle ear infections. In performing an
intake assessment of the client, the nurse would ask about which of
the following as a risk factor related to infection of the ears?
a) exposure to loud noise
b) use of drilling and other power tools
c) congenital abnormalities
d) occupational noise

Otitis media (middle ear infection) is associated with colds,

allergies, sore throats, and blockage of the eustachian tube. Risk
factors include a young age (usually a childhood disease), congenital
abnormalities, immune deficiencies, exposure to cigarette smoke,
family history of otitis media, recent upper respiratory infections, and
allergies. Options A, B, and D can cause hearing loss. Hearing loss can
occur as a result of an acute loud noise (acoustic trauma) or by the
chronic exposure to loud noise (noise-induced hearing loss).

40. A nurse is planning to instruct a client with chronic vertigo about

safety measures to prevent exacerbation of symptoms or injury.
Teaching for this client will include which of the following
statements?
a) drive only when feelings of dizziness have not been
experienced for several hours
b) go to the bedroom and lie down when vertigo is experienced
c) remove throw rugs and clutter in the home
d) turn the head slowly when spoken to

The client with chronic vertigo should avoid driving and using
public transportation. The sudden movements involved in each could
precipitate an attack. To further prevent vertigo attacks, the client
should change positions slowly and should turn the entire body, not