1
Q
- The nurse needs to pull the portion of the ear that consists of movable cartilage and skin down and back when administering eardrops. This portion of the ear is called the:
a. Auricle.
b. Concha.
c. Outer meatus.
d. Mastoid process.
A
ANS: A
The external ear is called the auricle or pinna and consists of movable cartilage and skin.
2
Q
- The nurse is examining a patient’s ears and notices cerumen in the external canal. Which of these statements about cerumen is correct?
a. Sticky honey-colored cerumen is a sign of infection.
b. The presence of cerumen is indicative of poor hygiene.
c. The purpose of cerumen is to protect and lubricate the ear.
d. Cerumen is necessary for transmitting sound through the auditory canal.
A
ANS: C
The ear is lined with glands that secrete cerumen, which is a yellow waxy material that lubricates and protects the ear.
3
Q
- When examining the ear with an otoscope, the nurse notes that the tympanic membrane should appear:
a. Light pink with a slight bulge.
b. Pearly gray and slightly concave.
c. Pulled in at the base of the cone of light.
d. Whitish with a small fleck of light in the superior portion.
A
ANS: B
The tympanic membrane is a translucent membrane with a pearly gray color and a prominent cone of light in the anteroinferior quadrant, which is the reflection of the otoscope light. The tympanic membrane is oval and slightly concave, pulled in at its center by the malleus, which is one of the middle ear ossicles.
4
Q
- The nurse is reviewing the structures of the ear. Which of these statements concerning the eustachian tube is true?
a. The eustachian tube is responsible for the production of cerumen.
b. It remains open except when swallowing or yawning.
c. The eustachian tube allows passage of air between the middle and outer ear.
d. It helps equalize air pressure on both sides of the tympanic membrane.
A
ANS: D
The eustachian tube allows an equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture during, for example, altitude changes in an airplane. The tube is normally closed, but it opens with swallowing or yawning.
5
Q
- A patient with a middle ear infection asks the nurse, “What does the middle ear do?” The nurse responds by telling the patient that the middle ear functions to:
a. Maintain balance.
b. Interpret sounds as they enter the ear.
c. Conduct vibrations of sounds to the inner ear.
d. Increase amplitude of sound for the inner ear to function.
A
ANS: C
Among its other functions, the middle ear conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear. The other responses are not functions of the middle ear.
6
Q
- The nurse is reviewing the function of the cranial nerves (CNs). Which CN is responsible for conducting nerve impulses to the brain from the organ of Corti?
a. I
b. III
c. VIII
d. XI
A
ANS: C
The nerve impulses are conducted by the auditory portion of CN VIII to the brain.
7
Q
- The nurse is assessing a patient who may have hearing loss. Which of these statements is true concerning air conduction?
a. Air conduction is the normal pathway for hearing.
b. Vibrations of the bones in the skull cause air conduction.
c. Amplitude of sound determines the pitch that is heard.
d. Loss of air conduction is called a conductive hearing loss.
A
ANS: A
The normal pathway of hearing is air conduction, which starts when sound waves produce vibrations on the tympanic membrane. Conductive hearing loss results from a mechanical dysfunction of the external or middle ear. The other statements are not true concerning air conduction.
8
Q
- A patient has been shown to have a sensorineural hearing loss. During the assessment, it would be important for the nurse to:
a. Speak loudly so the patient can hear the questions.
b. Assess for middle ear infection as a possible cause.
c. Ask the patient what medications he is currently taking.
d. Look for the source of the obstruction in the external ear.
A
ANS: C
A simple increase in amplitude may not enable the person to understand spoken words. Sensorineural hearing loss may be caused by presbycusis, which is a gradual nerve degeneration that occurs with aging and by ototoxic drugs, which affect the hair cells in the cochlea.
9
Q
- During an interview, the patient states he has the sensation that “everything around him is spinning.” The nurse recognizes that the portion of the ear responsible for this sensation is the:
a. Cochlea.
b. CN VIII.
c. Organ of Corti.
d. Labyrinth.
A
ANS: D
If the labyrinth ever becomes inflamed, then it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo.
10
Q
- A patient in her first trimester of pregnancy is diagnosed with rubella. Which of these statements is correct regarding the significance of this in relation to the infant’s hearing?
a. Rubella may affect the mother’s hearing but not the infant’s.
b. Rubella can damage the infant’s organ of Corti, which will impair hearing.
c. Rubella is only dangerous to the infant in the second trimester of pregnancy.
d. Rubella can impair the development of CN VIII and thus affect hearing.
A
ANS: B
If maternal rubella infection occurs during the first trimester, then it can damage the organ of Corti and impair hearing.
11
Q
- The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. What would be an appropriate response by the nurse?
a. “It is unusual for a small child to have frequent ear infections unless something else is wrong.”
b. “We need to check the immune system of your son to determine why he is having so many ear infections.”
c. “Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear.”
d. “Your son’s eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily.”
A
ANS: D
The infant’s eustachian tube is relatively shorter and wider than the adult’s eustachian tube, and its position is more horizontal; consequently, pathogens from the nasopharynx can more easily migrate through to the middle ear. The other responses are not appropriate.
12
Q
- A 31-year-old patient tells the nurse that he has noticed a progressive loss in his hearing. He says that it does seem to help when people speak louder or if he turns up the volume of a television or radio. The most likely cause of his hearing loss is:
a. Otosclerosis.
b. Presbycusis.
c. Trauma to the bones.
d. Frequent ear infections.
A
ANS: A
Otosclerosis is a common cause of conductive hearing loss in young adults between the ages of 20 and 40 years. Presbycusis is a type of hearing loss that occurs with aging. Trauma and frequent ear infections are not a likely cause of his hearing loss.
13
Q
- A 70-year-old patient tells the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says that he “can’t always tell where the sound is coming from” and the words often sound “mixed up.” What might the nurse suspect as the cause for this change?
a. Atrophy of the apocrine glands
b. Cilia becoming coarse and stiff
c. Nerve degeneration in the inner ear
d. Scarring of the tympanic membrane
A
ANS: C
Presbycusis is a type of hearing loss that occurs in 60% of those older than 65 years of age, even in those living in a quiet environment. This sensorineural loss is gradual and caused by nerve degeneration in the inner ear. Words sound garbled, and the ability to localize sound is also impaired. This communication dysfunction is accentuated when background noise is present.
14
Q
- During an assessment of a 20-year-old Asian patient, the nurse notices that he has dry, flaky cerumen in his canal. What is the significance of this finding? This finding:
a. Is probably the result of lesions from eczema in his ear.
b. Represents poor hygiene.
c. Is a normal finding, and no further follow-up is necessary.
d. Could be indicative of change in cilia; the nurse should assess for hearing loss.
A
ANS: C
Asians and Native Americans are more likely to have dry cerumen, whereas Blacks and Whites usually have wet cerumen.
15
Q
- The nurse is taking the history of a patient who may have a perforated eardrum. What would be an important question in this situation?
a. “Do you ever notice ringing or crackling in your ears?”
b. “When was the last time you had your hearing checked?”
c. “Have you ever been told that you have any type of hearing loss?”
d. “Is there any relationship between the ear pain and the discharge you mentioned?”
A
ANS: D
Typically with perforation, ear pain occurs first, stopping with a popping sensation, and then drainage occurs.
16
Q
- A 31-year-old patient tells the nurse that he has noticed pain in his left ear when people speak loudly to him. The nurse knows that this finding:
a. Is normal for people of his age.
b. Is a characteristic of recruitment.
c. May indicate a middle ear infection.
d. Indicates that the patient has a cerumen impaction.
A
ANS: B
Recruitment is significant hearing loss occurring when speech is at low intensity, but sound actually becomes painful when the speaker repeats at a louder volume. The other responses are not correct.
17
Q
- While discussing the history of a 6-month-old infant, the mother tells the nurse that she took a significant amount of aspirin while she was pregnant. What question would the nurse want to include in the history?
a. “Does your baby seem to startle with loud noises?”
b. “Has your baby had any surgeries on her ears?”
c. “Have you noticed any drainage from her ears?”
d. “How many ear infections has your baby had since birth?”
A
ANS: A
Children at risk for a hearing deficit include those exposed in utero to a variety of conditions, such as maternal rubella or to maternal ototoxic drugs.
18
Q
- The nurse is performing an otoscopic examination on an adult. Which of these actions is correct?
a. Tilting the person’s head forward during the examination
b. Once the speculum is in the ear, releasing the traction
c. Pulling the pinna up and back before inserting the speculum
d. Using the smallest speculum to decrease the amount of discomfort
A
ANS: C
The pinna is pulled up and back on an adult or older child, which helps straighten the S-shape of the canal. Traction should not be released on the ear until the examination is completed and the otoscope is removed.
19
Q
- The nurse is assessing a 16-year-old patient who has suffered head injuries from a recent motor vehicle accident. Which of these statements indicates the most important reason for assessing for any drainage from the ear canal?
a. If the drum has ruptured, then purulent drainage will result.
b. Bloody or clear watery drainage can indicate a basal skull fracture.
c. The auditory canal many be occluded from increased cerumen.
d. Foreign bodies from the accident may cause occlusion of the canal.
A
ANS: B
Frank blood or clear watery drainage (cerebrospinal leak) after a trauma suggests a basal skull fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media.
20
Q
- In performing a voice test to assess hearing, which of these actions would the nurse perform?
a. Shield the lips so that the sound is muffled.
b. Whisper a set of random numbers and letters, and then ask the patient to repeat them.
c. Ask the patient to place his finger in his ear to occlude outside noise.
d. Stand approximately 4 feet away to ensure that the patient can really hear at this distance.
A
ANS: B
With the head 30 to 60 cm (1 to 2 feet) from the patient’s ear, the examiner exhales and slowly whispers a set of random numbers and letters, such as “5, B, 6.” Normally, the patient is asked to repeat each number and letter correctly after hearing the examiner say them.
21
Q
- In performing an examination of a 3-year-old child with a suspected ear infection, the nurse would:
a. Omit the otoscopic examination if the child has a fever.
b. Pull the ear up and back before inserting the speculum.
c. Ask the mother to leave the room while examining the child.
d. Perform the otoscopic examination at the end of the assessment.
A
ANS: D
In addition to its place in the complete examination, eardrum assessment is mandatory for any infant or child requiring care for an illness or fever. For the infant or young child, the timing of the otoscopic examination is best toward the end of the complete examination.
22
Q
- The nurse is preparing to perform an otoscopic examination of a newborn infant. Which statement is true regarding this examination?
a. Immobility of the drum is a normal finding.
b. An injected membrane would indicate an infection.
c. The normal membrane may appear thick and opaque.
d. The appearance of the membrane is identical to that of an adult.
A
ANS: C
During the first few days after the birth, the tympanic membrane of a newborn often appears thickened and opaque. It may look injected and have a mild redness from increased vascularity. The other statements are not correct.
23
Q
- The nurse assesses the hearing of a 7-month-old by clapping hands. What is the expected response? The infant:
a. Turns his or her head to localize the sound.
b. Shows no obvious response to the noise.
c. Shows a startle and acoustic blink reflex.
d. Stops any movement, and appears to listen for the sound.
A
ANS: A
With a loud sudden noise, the nurse should notice the infant turning his or her head to localize the sound and to respond to his or her own name. A startle reflex and acoustic blink reflex is expected in newborns; at age 3 to 4 months, the infant stops any movement and appears to listen.
24
Q
- The nurse is performing an ear examination of an 80-year-old patient. Which of these findings would be considered normal?
a. High-tone frequency loss
b. Increased elasticity of the pinna
c. Thin, translucent membrane
d. Shiny, pink tympanic membrane
A
ANS: A
A high-tone frequency hearing loss is apparent for those affected with presbycusis, the hearing loss that occurs with aging. The pinna loses elasticity, causing earlobes to be pendulous. The eardrum may be whiter in color and more opaque and duller in the older person than in the younger adult.
25
25. An assessment of a 23-year-old patient reveals the following: an auricle that is tender and reddish-blue in color with small vesicles. The nurse would need to know additional information that includes which of these?
a. Any change in the ability to hear
b. Any recent drainage from the ear
c. Recent history of trauma to the ear
d. Any prolonged exposure to extreme cold
ANS: D
Frostbite causes reddish-blue discoloration and swelling of the auricle after exposure to extreme cold. Vesicles or bullae may develop, and the person feels pain and tenderness.
26
26. While performing the otoscopic examination of a 3-year-old boy who has been pulling on his left ear, the nurse finds that his left tympanic membrane is bright red and that the light reflex is not visible. The nurse interprets these findings to indicate a(n):
a. Fungal infection.
b. Acute otitis media.
c. Perforation of the eardrum.
d. Cholesteatoma.
ANS: B
Absent or distorted light reflex and a bright red color of the eardrum are indicative of acute otitis media.
27
27. The mother of a 2-year-old toddler is concerned about the upcoming placement of tympanostomy tubes in her son’s ears. The nurse would include which of these statements in the teaching plan?
a. The tubes are placed in the inner ear.
b. The tubes are used in children with sensorineural loss.
c. The tubes are permanently inserted during a surgical procedure.
d. The purpose of the tubes is to decrease the pressure and allow for drainage.
ANS: D
Polyethylene tubes are surgically inserted into the eardrum to relieve middle ear pressure and to promote drainage of chronic or recurrent middle ear infections. Tubes spontaneously extrude in 6 months to 1 year.
28
28. In an individual with otitis externa, which of these signs would the nurse expect to find on assessment?
a. Rhinorrhea
b. Periorbital edema
c. Pain over the maxillary sinuses
d. Enlarged superficial cervical nodes
ANS: D
The lymphatic drainage of the external ear flows to the parotid, mastoid, and superficial cervical nodes. The signs are severe swelling of the canal, inflammation, and tenderness. Rhinorrhea, periorbital edema, and pain over the maxillary sinuses do not occur with otitis externa.
29
29. When performing an otoscopic examination of a 5-year-old child with a history of chronic ear infections, the nurse sees that his right tympanic membrane is amber-yellow in color and that air bubbles are visible behind the tympanic membrane. The child reports occasional hearing loss and a popping sound with swallowing. The preliminary analysis based on this information is that the child:
a. Most likely has serous otitis media.
b. Has an acute purulent otitis media.
c. Has evidence of a resolving cholesteatoma.
d. Is experiencing the early stages of perforation.
ANS: A
An amber-yellow color to the tympanic membrane suggests serum or pus in the middle ear. Air or fluid or bubbles behind the tympanic membrane are often visible. The patient may have feelings of fullness, transient hearing loss, and a popping sound with swallowing. These findings most likely suggest that the child has serous otitis media. The other responses are not correct.
30
30. The nurse is performing an assessment on a 65-year-old man. He reports a crusty nodule behind the pinna. It intermittently bleeds and has not healed over the past 6 months. On physical assessment, the nurse finds an ulcerated crusted nodule with an indurated base. The preliminary analysis in this situation is that this:
a. Is most likely a benign sebaceous cyst.
b. Is most likely a keloid.
c. Could be a potential carcinoma, and the patient should be referred for a biopsy.
d. Is a tophus, which is common in the older adult and is a sign of gout.
ANS: C
An ulcerated crusted nodule with an indurated base that fails to heal is characteristic of a carcinoma. These lesions fail to heal and intermittently bleed. Individuals with such symptoms should be referred for a biopsy (see Table 15-2). The other responses are not correct.
31
31. The nurse suspects that a patient has otitis media. Early signs of otitis media include which of these findings of the tympanic membrane?
a. Red and bulging
b. Hypomobility
c. Retraction with landmarks clearly visible
d. Flat, slightly pulled in at the center, and moves with insufflation
ANS: B
An early sign of otitis media is hypomobility of the tympanic membrane. As pressure increases, the tympanic membrane begins to bulge.
32
32. The nurse is performing a middle ear assessment on a 15-year-old patient who has had a history of chronic ear infections. When examining the right tympanic membrane, the nurse sees the presence of dense white patches. The tympanic membrane is otherwise unremarkable. It is pearly, with the light reflex at 5 o’clock and landmarks visible. The nurse should:
a. Refer the patient for the possibility of a fungal infection.
b. Know that these are scars caused from frequent ear infections.
c. Consider that these findings may represent the presence of blood in the middle ear.
d. Be concerned about the ability to hear because of this abnormality on the tympanic membrane.
ANS: B
Dense white patches on the tympanic membrane are sequelae of repeated ear infections. They do not necessarily affect hearing.
33
33. The nurse is preparing to do an otoscopic examination on a 2-year-old child. Which one of these reflects the correct procedure?
a. Pulling the pinna down
b. Pulling the pinna up and back
c. Slightly tilting the child’s head toward the examiner
d. Instructing the child to touch his chin to his chest
ANS: A
For an otoscopic examination on an infant or on a child under 3 years of age, the pinna is pulled down. The other responses are not part of the correct procedure.
34
34. The nurse is conducting a child safety class for new mothers. Which factor places young children at risk for ear infections?
a. Family history
b. Air conditioning
c. Excessive cerumen
d. Passive cigarette smoke
ANS: D
Exposure to passive and gestational smoke is a risk factor for ear infections in infants and children.
35
35. During an otoscopic examination, the nurse notices an area of black and white dots on the tympanic membrane and the ear canal wall. What does this finding suggest?
a. Malignancy
b. Viral infection
c. Blood in the middle ear
d. Yeast or fungal infection
ANS: D
A colony of black or white dots on the drum or canal wall suggests a yeast or fungal infection (otomycosis).
36
36. A 17-year-old student is a swimmer on her high school’s swim team. She has had three bouts of otitis externa this season and wants to know what to do to prevent it. The nurse instructs her to:
a. Use a cotton-tipped swab to dry the ear canals thoroughly after each swim.
b. Use rubbing alcohol or 2% acetic acid eardrops after every swim.
c. Irrigate the ears with warm water and a bulb syringe after each swim.
d. Rinse the ears with a warmed solution of mineral oil and hydrogen peroxide.
ANS: B
With otitis externa (swimmer’s ear), swimming causes the external canal to become waterlogged and swell; skinfolds are set up for infection. Otitis externa can be prevented by using rubbing alcohol or 2% acetic acid eardrops after every swim.
37
37. During an examination, the patient states he is hearing a buzzing sound and says that it is “driving me crazy!” The nurse recognizes that this symptom indicates:
a. Vertigo.
b. Pruritus.
c. Tinnitus.
d. Cholesteatoma.
ANS: C
Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders.
38
38. During an examination, the nurse notices that the patient stumbles a little while walking, and, when she sits down, she holds on to the sides of the chair. The patient states, “It feels like the room is spinning!” The nurse notices that the patient is experiencing:
a. Objective vertigo.
b. Subjective vertigo.
c. Tinnitus.
d. Dizziness.
ANS: A
With objective vertigo, the patient feels like the room spins; with subjective vertigo, the person feels like he or she is spinning. Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders. Dizziness is not the same as true vertigo; the person who is dizzy may feel unsteady and lightheaded.
39
39. A patient has been admitted after an accident at work. During the assessment, the patient is having trouble hearing and states, “I don’t know what the matter is. All of a sudden, I can’t hear you out of my left ear!” What should the nurse do next?
a. Make note of this finding for the report to the next shift.
b. Prepare to remove cerumen from the patient’s ear.
c. Notify the patient’s health care provider.
d. Irrigate the ear with rubbing alcohol.
ANS: C
Any sudden loss of hearing in one or both ears that is not associated with an upper respiratory infection needs to be reported at once to the patient’s health care provider. Hearing loss associated with trauma is often sudden. Irrigating the ear or removing cerumen is not appropriate at this time.
40
1. The nurse is testing the hearing of a 78-year-old man and is reminded of the changes in hearing that occur with aging that include which of the following? Select all that apply.
a. Hearing loss related to aging begins in the mid 40s.
b. Progression of hearing loss is slow.
c. The aging person has low-frequency tone loss.
d. The aging person may find it harder to hear consonants than vowels.
e. Sounds may be garbled and difficult to localize.
f. Hearing loss reflects nerve degeneration of the middle ear.
ANS: B, D, E
Presbycusis is a type of hearing loss that occurs with aging and is found in 60% of those older than 65 years. It is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve, and it slowly progresses after the age of 50 years. The person first notices a high-frequency tone loss; it is harder to hear consonants (high-pitched components of speech) than vowels, which makes words sound garbled. The ability to localize sound is also impaired.
41
1. Binaural interaction at the level of the brainstem permits:
A. interpretation of sound.
B. identification and location of the direction of the sound.
C. amplification of sound.
D. direction of sound toward the appropriate conduction pathway.
B. identification and location of the direction of the sound.
The function at the brainstem level is binaural interaction, which permits locating the direction of a sound in space as well as identifying the sound.
42
2. Which of the following behaviors demonstrated by an individual may be indicative of hearing loss?
A. Not looking at the examiner when being questioned
B. Frequently asking for the question to be repeated
C. Talking in a high-pitched voice
D. Speaking slowly with well-articulated consonants
B. Frequently asking for the question to be repeated
| Hearing loss is indicated when a person frequently asks to have statements repeated.
43
3. Which of the following children is at risk of recurrent otitis media (OM)?
A. An 18-month-old infant who lives with a smoker
B. A 2-year-old child who has had two ear infections in the past 6 months
C. A 6-month-old infant who has a sibling who had tubes inserted at 3 years of age
D. An 18-month-old infant who has had three episodes of ear infections in a 5-month period
D. An 18-month-old infant who has had three episodes of ear infections in a 5-month period
A first episode of OM that occurs within 3 months of life increases risk of recurrent OM. Recurrent OM is three episodes within the past 3 months or four episodes within the past year.
44
```
4.The external structure of the ear is identified as the:
A. auricle.
B. atrium.
C. aureole.
D. auriga.
```
A. auricle.
| The auricle or pinna is the external structure of the ear.
45
```
5.The labyrinth of the inner ear is responsible for maintaining the body’s:
A. binaural interaction.
B. air conduction.
C. equilibrium.
D. pressure equalization.
```
C. equilibrium.
46
6.When an otoscopic examination is performed on an older adult patient, the tympanic membrane may be:
A. pinker than that of a younger adult.
B. thinner than that of a younger adult.
C. whiter than that of a younger adult.
D. more mobile than that of a younger adult.
C. whiter than that of a younger adult.
During otoscopy, the tympanic membrane of an older adult may be whiter in color than that of a younger adult. The tympanic membrane may also appear more opaque and dull.
47
```
7. Which of the following tests provides a precise quantitative measure of hearing?
A. Tuning fork tests
B. Romberg test
C. Audiometer test
D. Whispered voice test
```
C. Audiometer test
An audiometer gives a precise quantitative measure of hearing by assessing the person’s ability to hear sounds of varying frequency.
48
```
8. The position of the tympanic membrane in the neonate is more ________________, making it more difficult to visualize with the otoscope.
A. horizontal
B. vertical
C. perpendicular
D. oblique
```
A. horizontal
The position of the eardrum is more horizontal in the neonate, making it more difficult to see completely and harder to differentiate from the canal wall.
49
9. The tympanic membrane of a child with acute otitis media would be:
A. flat and slightly pulled in at the center.
B. mobile and would flutter with the Valsalva maneuver.
C. bulging with a distinct red color.
D. shiny and translucent, with a pearly gray color.
C. bulging with a distinct red color.
| The tympanic membrane would be bulging and red with acute otitis media.
50
10. If the tympanic membrane has white dense areas, the examiner suspects:
A. perforation from a ruptured membrane.
B. scarring from recurrent ear infections.
C. serous fluid from serous otitis media.
D. a fungal infection.
B. scarring from recurrent ear infections. Correct
| White dense areas indicate scarring on the tympanic membrane from recurrent ear infections.
HA Exam 2
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