Deck 16: Ears

Question 1

A colleague is assessing an 80-year-old patient who has ear pain and asks him to hold his nose and swallow.Which of the following about this technique is true?

A)This should not be done in an 80-year-old patient.
B)This technique is helpful in assessing for otitis media.
C)This is especially useful in assessing a patient with an upper respiratory infection.
D)This will cause the eardrum to bulge slightly and make landmarks more visible.

Answer 1

This should not be done in an 80-year-old patient.

Question 2

The nurse is taking history from 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 you have any type of hearing loss?"
D)"Was there any relationship between the ear pain and the discharge you mentioned?"

Answer 2

"Was there any relationship between the ear pain and the discharge you mentioned?"

Question 3

When examining the ear with an otoscope,the nurse would expect to find that the tympanic membrane is:

A)light pink with a slight bulge.
B)pearly grey 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.

Answer 3

pearly grey and slightly concave.

Question 4

The mother of a 2-year-old is concerned because her son has had three ear infections in the past year.Which of the following would be an appropriate response by the nurse?

A)"It is unusual for a small child to have frequent ear infections unless there is something else wrong."
B)"We need to check the immune system of your son to see 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 child's eustachian tube is shorter and wider than that in an adult,which allows infections to develop more easily."

Question 5

A patient in her first trimester of pregnancy is diagnosed with rubella.Which of the following indicates the significance of this in relation to the infant's hearing?

A)Rubella may affect the mother's hearing but not the child's.
B)Rubella can damage the organ of Corti in the fetus,which will result in impaired hearing.
C)Rubella is dangerous to the fetus only when it occurs in the second trimester of pregnancy.
D)Rubella can impair the development of CN VIII and thus affect hearing.

Question 6

The nurse is examining a patient's ears and notices cerumen in the external canal.Which of the following statements about cerumen is correct?

A)Sticky,honey-coloured 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.

Question 7

The nurse is assessing a 16-year-old patient with head injuries from a recent motor vehicle accident.Which of the following statements indicates the most important reason for assessing for any drainage from the canal?

A)If the drum has ruptured,there will be purulent drainage.
B)Bloody or clear watery drainage can indicate a basal skull fracture.
C)The auditory canal many be occluded from increased cerumen.
D)There may be occlusion of the canal caused by foreign bodies from the accident.

Question 8

Which of the following statements about air conduction is true?

A)It is the most efficient pathway for hearing.
B)It is caused by the vibrations of bones in the skull.
C)The amplitude of sound determines the pitch that is heard.
D)A loss of air conduction is called a conductive hearing loss.

Question 9

The nurse is performing an otoscopic examination on an adult.Which of the following is true?

A)Tilt the person's head forward during the examination.
B)Once the speculum is in the ear,release the traction.
C)Pull the pinna up and back before inserting the speculum.
D)Use the smallest speculum to decrease the amount of discomfort.

Question 10

A 70-year-old patient reports to the nurse that he is having trouble hearing,especially when he is in large groups.He says 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?

A)Atrophy of the apocrine glands
B)Cilia becoming coarse and stiff
C)Degeneration of nerves in the inner ear
D)Scarring of the tympanic membrane

Question 11

Which of the following statements about the eustachian tube is true?

A)It is responsible for the production of cerumen.
B)It remains open except during swallowing or yawning.
C)It allows passage of air between the middle and outer ear.
D)It helps equalize air pressure on both sides of the tympanic membrane.

Question 12

While discussing the history of a 6-month-old infant,the mother tells the nurse that she took a great deal of aspirin while she was pregnant.What question would the nurse want to include in the history?

A)"Does your baby startle at loud noises?"
B)"Has the 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?"

Question 13

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 that age.
B)is a characteristic of recruitment.
C)may indicate a middle ear infection.
D)indicates that the patient has a cerumen impaction.

Question 14

Tests have shown that a patient has sensorineural hearing loss.During the assessment,it would be important for the nurse to:

A)speak loudly so he 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.

Question 15

During an assessment of a 20-year-old Aboriginal patient,the nurse notices that he has dry,flaky cerumen in his ear canal.What is the significance of this finding?

A)This is probably the result of eczema lesions in his ear.
B)This indicates poor hygiene.
C)This is a normal finding,and no further follow-up is necessary.
D)This could be indicative of change in cilia;the nurse should assess for conductive hearing loss.

Question 16

A 31-year-old patient tells the nurse that he is experiencing a progressive loss of hearing.He says that it does seem to help when people speak more loudly or if he turns up the volume.The most likely cause of his hearing loss is:

A)otosclerosis.
B)presbycusis.
C)trauma to the bones.
D)frequent ear infections.

Question 17

A patient with a middle ear infection asks the nurse,"What does the middle ear do?" The nurse says that the function of the middle ear is 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 to enable the inner ear to function.

Question 18

During an interview,the patient says that he experiences a sensation as if "everything around him is spinning." The nurse recognizes that the portion of the ear responsible for this sensation is:

A)the cochlea.
B)CN VIII.
C)the organ of Corti.
D)the bony labyrinth.

Question 19

The portion of the ear that consists of movable cartilage and skin is called the:

A)auricle.
B)concha.
C)outer meatus.
D)mastoid process.

Question 20

Which of the following cranial nerves (CNs)is responsible for conducting nerve impulses to the brain from the organ of Corti?

A)CN I
B)CN III
C)CN VIII
D)CN XI

Question 21

Which of the following statements about otoscopic examination of a newborn would be true?

A)Immobility of the drum is a normal finding.
B)An "injected" membrane would indicate infection.
C)The normal membrane may appear thick and opaque.
D)The appearance of the membrane is identical to that of an adult.

Question 22

The nurse is preparing to do an otoscopic examination on a 2-year-old child.Which of the following reflects correct procedure?

A)Pull the pinna down.
B)Pull the pinna up and back.
C)Tilt the child's head slightly toward the examiner.
D)Have the child touch his chin to his chest.

Question 23

During ear examination,the patient reports that he is hears a buzzing sound that is "driving me crazy!" The nurse recognizes that this symptom is:

A)vertigo.
B)pruritus.
C)tinnitus.
D)cholesteatoma.

Question 24

Which of the following traditionally used hearing tests have been recently found to yield unreliable data?

A)Weber
B)Romberg
C)Whisper
D)Audiometer

Question 25

A 65-year-old male has reported a crusty nodule behind the pinna.Over the past 6 months,the nodule has been bleeding intermittently and has not healed.On physical assessment,the nurse finds an ulcerated crusted nodule with an indurated base.The preliminary analysis in this situation would be that this:

A)is most likely a benign sebaceous cyst.
B)is most likely a Darwin's tubercle and is not significant.
C)could be potential carcinoma and warrants referral.
D)is a tophus,which is common in older adults,and is a sign of gout.

Question 26

During the ear examination of an 80-year-old patient,which of the following would be a normal finding?

A)Loss of high-tone frequency hearing
B)Increased elasticity of the pinna
C)A thin,translucent membrane
D)A shiny pink tympanic membrane

Question 27

Which of the following is a risk factor for ear infections in young children?

A)Family history
B)Air conditioning
C)Excessive cerumen
D)Second-hand cigarette smoke

Question 28

An assessment of a 23-year-old patient reveals the following: an auricle that is tender and reddish blue in colour and has small vesicles.What additional information would the nurse need to know?

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

Question 29

While performing a voice test to assess hearing in a patient,which of the following would the nurse do?

A)Shield the lips while speaking so that the sound is muffled to the patient.
B)Whisper two-syllable words,and ask the patient to repeat them.
C)Ask the patient to place his finger in his ear to occlude outside noise.
D)Stand about 120 cm (4 ft)away to ensure that the patient can really hear at this distance.

Question 30

The nurse is assessing the hearing of a 7-month-old.What would be the expected response to clapping of hands?

A)Turns the head to localize the sound
B)No obvious response to noise
C)A startle and acoustic blink reflex
D)Stops all movement and appears to listen

Question 31

When performing an otoscopic examination on a 5-year-old child with a history of chronic ear infections,the nurse sees that his right tympanic membrane is amber-yellow in colour and there are air bubbles behind the tympanic membrane.The child reports occasional hearing loss and a popping sound with swallowing.The preliminary analysis based on this information would be that:

A)this is most likely serous otitis media.
B)the child has acute purulent otitis media.
C)there is evidence of a resolving cholesteatoma.
D)the child is experiencing the early stages of perforation.

Question 32

A 17-year-old student is a swimmer on her high school's swim team.She has had three bouts of otitis externa so far this season and wants to know how 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 suction with a bulb syringe after each swim.
D)rinse the ears with a warmed solution of mineral oil and hydrogen peroxide.

Question 33

Which of the following signs would the nurse expect to find on assessment of an individual with otitis externa?

A)Rhinorrhea
B)Periorbital edema
C)Pain over the maxillary sinuses
D)Enlarged regional lymph nodes

Question 34

During an otoscopic examination,the nurse notes an area of black and white dots on the tympanic membrane and ear canal wall.What does this finding suggest?

A)Malignancy
B)Viral infection
C)Blood in the middle ear
D)Yeast or fungal infection

Question 35

The mother of a 2-year-old is concerned about tympanostomy tubes that are going to be inserted in her son's ears.Which of the following would the nurse include 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.

Question 36

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 the light reflex is not visible.The most likely cause is:

A)fungal infection.
B)acute otitis media.
C)rupture of the drum.
D)blood behind the drum.

Question 37

The nurse is performing middle ear assessment on a 15-year-old patient who has a history of chronic ear infections.When examining the right tympanic membrane,the nurse sees dense white patches.The tympanic membrane is otherwise unremarkable.It is pearly,with the light reflex at 5 o'clock and visible landmarks.The nurse should:

A)refer the patient for investigating the possibility of a fungal infection.
B)know that these are scars caused from frequent ear infections.
C)consider that these findings may be an indication of blood in the middle ear.
D)be concerned about the patient's ability to hear because of this abnormality of the tympanic membrane.

Question 38

While performing an examination of a 3-year-old with a suspected ear infection,the nurse would:

A)omit the otoscopic exam 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.

Question 39

The nurse is conducting a hearing assessment using the Romberg test.The nurse is assessing for:

A)a conductive hearing loss in the right ear.
B)lateralization of hearing.
C)a sensorineural loss.
D)the maintenance of standing balance.

Question 40

The nurse suspects that a patient has otitis media.Which of the following findings of the tympanic membrane are early signs of otitis media?

A)Red and bulging
B)Hypomobility
C)Retraction with landmarks clearly visible
D)Flat,slightly pulled in at the centre,and moves with insufflation

Question 41

The nurse is testing the hearing of a 78-year-old man.Which of the following age-related hearing changes should the nurse keep in mind? (Select all that apply. )

A)Age-related hearing loss begins in the mid-40s.
B)The progression of hearing loss is slow.
C)Low-frequency tone loss occurs with aging.
D)It may be harder to hear consonants than vowels.
E)Sounds may be garbled and difficult to localize.
F)Hearing loss reflects nerve degeneration in the middle ear.