A nurse is assessing a client who reports ear pain for the past three days that has suddenly resolved. The client has a new onset of otorrhea (drainage from the ear). The nurse should recognize the client has manifestations of which of the following conditions?
Ménière's disease
Mastoiditis
Perforated tympanic membrane
Acoustic neuroma
The Correct Answer is C
Choice A reason: Ménière's disease typically presents with vertigo, tinnitus, and hearing loss, not sudden resolution of ear pain with otorrhea.
Choice B reason: Mastoiditis may cause ear pain and drainage, but it is usually accompanied by fever and tenderness over the mastoid bone, not sudden pain resolution.
Choice C reason: A perforated tympanic membrane can lead to the sudden resolution of ear pain followed by drainage, as the pressure causing the pain is relieved when the eardrum ruptures.
Choice D reason: Acoustic neuroma typically presents with progressive hearing loss and tinnitus, not ear pain or otorrhea.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Keeping the client NPO (nothing by mouth) is not directly related to preventing a thyroid crisis. While it may be necessary in some situations, such as preoperative care, it does not address the hyperthyroid state.
Choice B reason: Observing the client for signs of hypocalcemia is important, especially after thyroid surgery, as hypocalcemia can occur due to accidental removal or damage to the parathyroid glands. However, it is not a preventive measure for a thyroid crisis.
Choice C reason: Providing a quiet, low stimulus environment can help reduce stress and agitation, which are potential triggers for a thyroid crisis. Stress can exacerbate hyperthyroid symptoms and precipitate a crisis.
Choice D reason: Aspirin is contraindicated in clients with hyperthyroidism as it can increase thyroid hormone levels by displacing them from their binding proteins. This can potentially worsen the condition and lead to a crisis.
Correct Answer is D
Explanation
Choice A reason: Stridor is a high-pitched sound heard with breathing and is not related to the pattern described.
Choice B reason: Kussmaul respirations are deep and labored, typically associated with metabolic acidosis, not the pattern described.
Choice C reason: Apneustic respirations are characterized by prolonged inspiratory phases, which is not the pattern described.
Choice D reason: This is the correct choice. Cheyne Stokes respirations are characterized by a cyclic pattern of increasing and decreasing tidal volumes followed by periods of apnea, fitting the description provided.
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