Deck 23: Disorders of Red Blood Cells

Question 1

During a procedure to remove impacted cerumen, the nurse should be assessing the patient for which of the following most critical complications?

A) Excessive bleeding from the ear
B) Pain related to instillation of warm fluids to soften the cerumen
C) Symptomatic bradycardia from vagal nerve innervation
D) Respiratory distress related to fluid entering bronchiole tubes

Answer 1

Symptomatic bradycardia from vagal nerve innervation

Question 2

A 60-year-old man has presented to his family physician following an earache that has become progressively more painful in recent days. Following a history and examination with an otoscope, the man has been diagnosed with otitis externa. Which of the physician's following statements to the man is most accurate?

A) "You'll need to avoid getting any water in your ear until you finish your course of antibiotic pills."
B) "I'm going to instill some warm water into your ear to flush out debris and bacteria."
C) "I'll prescribe some ear drops for you, and in the mean time, it's important not to use ear swabs."
D) "This likely happened because your ears aren't draining like they should, but antibiotics that you'll put in your ears will resolve this."

Answer 2

"I'll prescribe some ear drops for you, and in the mean time, it's important not to use ear swabs."

Question 3

During descent, an airplane passenger is complaining that his "ears are plugged." What aspect of the structure and function of the ear best accounts for the passenger's complaint?

A) The inner ear adjusts its volume in response to atmospheric pressure, increasing during low pressure and decreasing in high pressure.
B) The eustachian tubes must remain patent to equalize pressure between the middle ear and inner ear.
C) The tympanic membrane is selectively permeable in order to accommodate pressure changes, and this capacity is often impaired during upper respiratory infections.
D) Air must be able to flow between the middle ear and nasopharynx in order to accommodate pressure changes.

Answer 3

Air must be able to flow between the middle ear and nasopharynx in order to accommodate pressure changes.

Question 4

A 4-year-old boy has had otitis media with effusion (OME) for several weeks, and his condition has recently progressed to acute otitis media (AOM). Which of the following factors could have contributed to his AOM? Select all that apply.

A) Reflux of fluid from the boy's nose into his middle ear
B) A deficiency in immunoglobulin M
C) Accumulation of cerumen in the external acoustic meatus
D) Sensorineural deficits in the auditory control apparatus
E) Exposure to respiratory virus

Question 5

Which of the following would be considered an abnormal finding when the nurse practitioner uses an otoscope to look at a toddler's ear? The tympanic membrane is described as

A) "transparent."
B) "a shallow, oval cone pointing inward toward apex."
C) "small, whitish cord seen traversing the middle ear from back to front."
D) "yellow, amber discoloration noted."

Question 6

When educating the parents of a child who has just had tympanostomy tube insertion, the nurse should provide further teaching if the parents say which of the following statements?

A) "I will call the physician if I see that the tube has come out."
B) "I will be looking for any drainage coming from the ears."
C) "I'm so glad that we can take the child swimming next week when we go on vacation."
D) "I'm so glad we had the child tested for allergies prior to having these tubes placed."

Question 7

A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiological process has characterized her diagnosis?

A) New spongy bone has been formed around her stapes and oval window.
B) Her incus, malleus, and stapes have become disconnected from her normal neural pathways.
C) Her temporal bone is experiencing unusually rapid resorption.
D) Her tympanic cavity is becoming filled with bone due to inappropriate osteogenesis.

Question 8

Distraught at the persistent ringing in his ears and his inability to alleviate it, a 50-year-old man has visited his health care provider. After diagnostic testing, no bjective cause (like impacted cerumen or vascular abnormality) was found. Given these testing results, which of the following teaching points by the care provider is most appropriate?

A) "This is most often the result of a psychological disturbance, and therapy is often useful in relieving tinnitus."
B) "There are many drugs such as blood pressure pills, relaxants, heart medications, and antihistamines that can cause tinnitus."
C) "A specialist can listen with a sensitive microphone to determine whether you are actually hearing these sounds."
D) "There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success."

Question 9

Following focal seizures that have damaged the dominant hemisphere of a patient's auditory association cortex, the nurse may observe the patient displaying

A) receptive aphasia.
B) facial drooping.
C) auditory hallucinations.
D) delusions of grandeur.

Question 10

Following a serious bout of bacterial meningitis, the parents of a 14-month-old has noted the child is not responding to verbal commands. The nurse will explain the pathophysiologic principle behind this by educating the patients by which of the following statements?

A) "This could be caused by the same organism that caused the meningitis, infecting the child's tympanic membrane."
B) "This may be due to a loss of hair cells and damage to the auditory nerve."
C) "The ear and the lining of the brain that was infected are all connected together."
D) "It is common for meningitis to use up all the natural killer cells and therefore increase the risk of having brain tumors develop."

Question 11

Which of the following questions is most likely to be clinically useful in the differential diagnosis of sensorineural versus conductive hearing loss?

A) "What medications do you currently take?"
B) "What effect is this hearing loss having on your quality of life?"
C) "Has your hearing loss developed quickly or more slowly?"
D) "Do you ever hear a persistent ringing in your ears?"

Question 12

Otitis media (OM), which can occur in any age group, is the most common diagnosis made by health care providers who care for children. Which bacterial pathogen causes the largest proportion of cases that result in sensorineural hearing loss?

A) Streptococcus pneumoniae
B) Acoustic neuromas
C) Haemophilus influenzae
D) Parainfluenza

Question 13

As part of a health promotion initiative, a public health nurse is meeting with a group of older adult residents of an assisted living facility. Which of the following teaching points about hearing loss in the elderly should the nurse include in the teaching session?

A) "It is actually a myth that seniors have worse and worse hearing as they age."
B) "Most hearing loss in older adults is the result of easily fixed problems, such as impacted ear wax."
C) "Experts don't quite know what causes seniors to lose their hearing with age, but drugs like aspirin can contribute to the problem."
D) "With older adults, the goal is to adjust lifestyle to accommodate diminished hearing rather than trying to treat the hearing loss itself."

Question 14

A stroke affecting which of the following areas of the brain would be most likely to leave an individual's vestibular system intact and posture and balance maintained?

A) The brain stem
B) The thalamus
C) The temporal and parietal cortex
D) The limbic system of the cerebrum

Question 15

Which of the following individuals is most likely to be diagnosed with a central vestibular disorder?

A) A man who got up quickly from his bed and sustained an injury after he "blacked out"
B) A woman who has ongoing difficulty in balancing herself when walking
C) A woman who suffered a loss of consciousness after being struck on the head during a soccer game
D) A man who states that he feels car sick whenever he rides in the back seat of a vehicle

Question 16

While a travel during a vacation via car, the mother notes that her 14-year-old child is getting sick. The mother suspects motion sickness. Which of the following clinical manifestations would confirm this diagnosis? Select all that apply.

A) Rapid breathing
B) Feeling faint
C) Red, flushed face
D) Rapid pulse rate
E) Severe balance problems

Question 17

A 70-year-old woman with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond?

A) "Unfortunately there aren't any proven treatments for your condition."
B) "There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo."
C) "Although they involve some risks, there are some options for ear surgery that can prevent future vertigo."
D) "We usually don't actively treat BPPV unless it starts to affect your hearing."

Question 18

A 30-year-old woman has presented to her family doctor complaining of three distressing episodes over the last several months during which she got extremely dizzy, had loud ringing in her ears, and felt like her ears were full of fluid. She states that her hearing diminishes, and she feels nauseous during these episodes. What diagnosis is the physician most likely to first suspect?

A) Acute otitis media
B) Acute vestibular neuronitis
C) Benign paroxysmal positional vertigo (BPPV)
D) Ménière disease

Question 19

When assessing a patient diagnosed with brain stem ischemia complaining of vertigo, the nurse will likely observe which of the following clinical manifestations? Select all that apply.

A) Inability to coordinate voluntary muscular movements
B) Difficulty in articulating words
C) Feelings of ear fullness
D) Deafness
E) Facial weakness

Question 20

As part of the diagnostic workup for a client's long-standing vertigo, a clinician wants to gauge the eye movements that occur in the client. Which of the following tests is the clinician most likely to utilize?

A) Romberg test
B) Rotational tests
C) Electronystagmography (ENG)
D) Caloric stimulation