A nurse is providing education to a client who has been newly diagnosed with fibromyalgia.
Which of the following should the nurse include in the teaching?

Choice A rationale

Otitis externa is an inflammation or infection of the external auditory canal, often referred to as swimmer ear. It is typically caused by bacterial or fungal overgrowth in the outer ear canal due to moisture or trauma. Aspirin use does not have a known physiological mechanism that would cause infection of the external ear structure. The symptoms mentioned, like hearing disturbances, originate in the inner ear or nerve pathways rather than the external canal.

Choice B rationale

Vertigo is a sensation of spinning or dizziness often associated with inner ear imbalances or vestibular nerve issues. While aspirin can sometimes cause dizziness as a side effect, the specific report of hearing disturbances is more indicative of damage to the cochlear system rather than just a balance issue. Vertigo alone does not capture the full scope of potential sensory damage to the cranial nerve VIII that high doses of acetylsalicylic acid can cause over time.

Choice C rationale

Nystagmus involves involuntary, rapid, and repetitive eye movements that can be horizontal, vertical, or rotary. It is often a sign of vestibular dysfunction or central nervous system pathology. Although aspirin toxicity can affect the neurological system, nystagmus is not the primary or most common indicator of salicylate-induced sensory damage. Hearing loss and tinnitus are the classic early warning signs of aspirin reaching toxic levels in the blood, which requires immediate dose adjustment.

Choice D rationale

Ototoxicity refers to the toxic effect that certain medications, including high-dose aspirin, have on the inner ear or the vestibulocochlear nerve. Salicylates can disrupt the electrochemical balance in the cochlea, leading to tinnitus and hearing impairment. Monitoring for these symptoms is crucial because the damage can sometimes become irreversible if the dose is not reduced. By decreasing the aspirin dosage, the nurse helps protect the delicate sensory hair cells from further chemical-induced injury.

Choice A rationale

Tonometry is the gold standard diagnostic procedure used to measure intraocular pressure by determining the resistance of the cornea to indentation or applanation. High intraocular pressure is a primary indicator of glaucoma, which can lead to optic nerve damage. This test specifically quantifies the fluid pressure inside the eye, helping clinicians monitor the effectiveness of treatments or the progression of the disease. It provides a numerical value that is critical for clinical decision making.

Choice B rationale

The Amsler grid is a diagnostic tool primarily used to detect vision problems resulting from damage to the macula or optic nerve, such as macular degeneration. It consists of a grid of horizontal and vertical lines used to monitor a central visual field. While useful for detecting metamorphopsia or central scotomas, it does not measure intraocular pressure. Therefore, it is not the correct test for the specific evaluation of pressure changes associated with glaucoma diagnosis.

Choice C rationale

The value 10-21 mm Hg represents the standard normal range for intraocular pressure in a healthy adult eye. Pressures exceeding 21 mm Hg are often suspicious for ocular hypertension or glaucoma. However, this numerical range is a measurement result or a physiological parameter rather than the name of a diagnostic test itself. The nurse must provide the name of the procedure, which is tonometry, rather than reciting the expected physiological reference values to the client.

Choice D rationale

Instilling a topical anesthetic into the eye is a procedural step often performed before contact tonometry to ensure patient comfort and prevent the blink reflex. While this is an important part of the preparation for certain types of pressure testing, it is a pharmacological intervention and not the name of the diagnostic test. Education should focus on the terminology of the procedure so the client understands what to expect during their clinical evaluation for visual changes.