Deck 15: Ears

Question 1

The nurse is taking the history of a patient who may have a perforated eardrum.What would be an important question in this situation?
1)"Do you ever notice ringing or crackling in your ears?"
2)"When was the last time you had your hearing checked?"
3)"Have you ever been told you have any type of hearing loss?"
4)"Was there any relationship between the ear pain and the discharge you mentioned?"

Answer 1

4
Typically with perforation,ear pain occurs first,stopping with a popping sensation,and then drainage occurs.

Question 2

The portion of the ear that consists of movable cartilage and skin is called the:
1)auricle.
2)concha.
3)outer meatus.
4)mastoid process.

Answer 2

1
The external ear is called the auricle or pinna and consists of movable cartilage and skin.

Question 3

Which of the following statements concerning the eustachian tube is true?
1)It is responsible for the production of cerumen.
2)It remains open except when swallowing or yawning.
3)It allows passage of air between the middle and outer ear.
4)It helps equalize air pressure on both sides of the tympanic membrane.

Answer 3

4
The eustachian tube allows equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture (e.g. ,during altitude changes in an airplane).The tube is normally closed,but it opens with swallowing or yawning.

Question 4

A patient in her first trimester of pregnancy is diagnosed with rubella.The nurse recognizes that the significance of this in relation to the infant's hearing is which of the following?
1)Rubella may affect the mother's hearing but not the infant's.
2)Rubella can damage the infant's organ of Corti,which will impair hearing.
3)Rubella is only dangerous to the infant in the second trimester of pregnancy.
4)Rubella can impair the development of CN VIII and thus affect hearing.

Question 5

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?
1)This is probably the result of lesions from eczema in his ear.
2)This represents poor hygiene.
3)This is a normal finding and no further follow-up is necessary.
4)This could be indicative of change in cilia;the nurse should assess for conductive hearing loss.

Question 6

A 70-year-old patient tells the nurse that he has noticed that he is having trouble hearing,especially 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 change?
1)Atrophy of the apocrine glands
2)Cilia becoming coarse and stiff
3)Nerve degeneration in the inner ear
4)Scarring of the tympanic membrane

Question 7

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.The most likely cause of his hearing loss is:
1)otosclerosis.
2)presbycusis.
3)trauma to the bones.
4)frequent ear infections.

Question 8

When examining the ear with an otoscope,the nurse remembers that the tympanic membrane should appear:
1)light pink with a slight bulge.
2)pearly gray and slightly concave.
3)pulled in at the base of the cone of light.
4)whitish with a small fleck of light in the superior portion.

Question 9

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:
1)is normal for people of that age.
2)is a characteristic of recruitment.
3)may indicate a middle ear infection.
4)indicates that the patient has a cerumen impaction.

Question 10

A colleague is assessing an 80-year-old patient who has ear pain and asks him to hold his nose and swallow.The nurse knows that which of the following is true concerning this technique?
1)This should not be used in an 80-year-old patient.
2)This technique is helpful in assessing for otitis media.
3)This is especially useful in assessing a patient with an upper respiratory infection.
4)This will cause the eardrum to bulge slightly and make landmarks more visible.

Question 11

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

Question 12

Which of the following would be true regarding otoscopic examination of a newborn?
1)Immobility of the drum is a normal finding.
2)An injected membrane would indicate infection.
3)The normal membrane may appear thick and opaque.
4)The appearance of the membrane is identical to that of an adult.

Question 13

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?
1)"Does your baby seem to startle with loud noise?"
2)"Has the baby had any surgeries on the ears?"
3)"Have you noticed any drainage from her ears?"
4)"How many ear infections has your baby had since birth?"

Question 14

A patient has been shown to have a sensorineural hearing loss.During the assessment,it would be important for the nurse to:
1)speak loudly so he can hear the questions.
2)assess for middle ear infection as a possible cause.
3)ask the patient what medications he is currently taking.
4)look for the source of the obstruction in the external ear.

Question 15

The nurse is examining a patient's ears and notices cerumen in the external canal.Which of the following statements about cerumen is correct?
1)Sticky honey-colored cerumen is a sign of infection.
2)The presence of cerumen is indicative of poor hygiene.
3)The purpose of cerumen is to protect and lubricate the ear.
4)Cerumen is necessary for transmitting sound through the auditory canal.

Question 16

The nurse is performing an otoscopic examination on an adult.Which of the following is true?
1)Tilt the person's head forward during the exam.
2)Once the speculum is in the ear,release the traction.
3)Pull the pinna up and back before inserting the speculum.
4)Use the smallest speculum to decrease the amount of discomfort.

Question 17

Which of the following cranial nerves is responsible for conducting nerve impulses to the brain from the organ of Corti?
1)CN I
2)CN III
3)CN VIII
4)CN XI

Question 18

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:
1)maintain balance.
2)interpret sounds as they enter the ear.
3)conduct vibrations of sounds to the inner ear.
4)increase amplitude of sound for the inner ear to function.

Question 19

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?
1)"It is unusual for a small child to have frequent ear infections unless there is something else wrong."
2)"We need to check the immune system of your son to see why he is having so many ear infections."
3)"Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear."
4)"Your son's eustachian tube is shorter and wider than yours because of his age,which allows for infections to develop more easily."

Question 20

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:
1)the cochlea.
2)cranial nerve VIII.
3)the organ of Corti.
4)the bony labyrinth.

Question 21

While performing the otoscopic exam 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:
1)fungal infection.
2)acute otitis media.
3)rupture of the drum.
4)blood behind the drum.

Question 22

Which of the following is a risk factor for ear infections in young children?
1)Family history
2)Air conditioning
3)Excessive cerumen
4)Secondhand cigarette smoke

Question 23

In an individual with otitis externa,which of the following signs would the nurse expect to find on assessment?
1)Rhinorrhea
2)Periorbital edema
3)Pain over the maxillary sinuses
4)Enlarged superficial cervical nodes

Question 24

The nurse is performing a 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 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:
1)refer the patient for the possibility of a fungal infection.
2)know that these are scars caused from frequent ear infections.
3)consider that these findings may represent the presence of blood in the middle ear.
4)be concerned about the ability to hear because of this abnormality on the tympanic membrane.

Question 25

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 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 is that:
1)this is most likely a serous otitis media.
2)the child has an acute purulent otitis media.
3)there is evidence of a resolving cholesteatoma.
4)the child is experiencing the early stages of perforation.

Question 26

The nurse suspects that a patient has otitis media.Early signs of otitis media include which of the following findings of the tympanic membrane?
1)Red and bulging
2)Hypomobility
3)Retraction with landmarks clearly visible
4)Flat,slightly pulled in at the center,and moves with insufflation

Question 27

During a hearing assessment the nurse finds that sound lateralizes to the patient's left ear with the Weber test.What can the nurse conclude from this?
1)The patient has a conductive hearing loss in the right ear.
2)Lateralization is a normal finding with the Weber test.
3)The patient could have either a sensorineural or a conductive loss.
4)A mistake has occurred;the test must be repeated.

Question 28

An assessment of a 23-year-old patient reveals the following: an auricle that is tender and reddish-blue in color with small vesicles.Additional information the nurse would need to know includes which of the following?
1)Any change in the ability to hear
2)Any recent drainage from the ear
3)Recent history of trauma to the ear
4)Any prolonged exposure to extreme cold

Question 29

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?
1)Malignancy
2)Viral infection
3)Blood in the middle ear
4)Yeast or fungal infection

Question 30

During the ear examination of an 80-year-old patient,which of the following would be a normal finding?
1)A high-tone frequency loss
2)Increased elasticity of the pinna
3)A thin,translucent membrane
4)A shiny,pink tympanic membrane

Question 31

The mother of a 2-year-old is concerned about the upcoming placement of tympanostomy tubes in her son's ears.The nurse would include which of the following in the teaching plan?
1)The tubes are placed in the inner ear.
2)The tubes are used in children with sensorineural loss.
3)The tubes are permanently inserted during a surgical procedure.
4)The purpose of the tubes is to decrease the pressure and allow for drainage.

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 what to do to prevent it.The nurse instructs her to:
1)use a cotton-tipped swab to dry the ear canals thoroughly after each swim.
2)use rubbing alcohol or 2% acetic acid eardrops after every swim.
3)irrigate the ears with warm water and a bulb syringe after each swim.
4)rinse the ears with a warmed solution of mineral oil and hydrogen peroxide.

Question 33

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 is:
1)vertigo.
2)pruritus.
3)tinnitus.
4)cholesteatoma.

Question 34

The nurse is testing the hearing of a 78-year-old man and keeps in mind the changes in hearing that occur with aging,such as: (Select all that apply. )
1)Hearing loss related to aging begins in the mid 40s.
2)The progression is slow.
3)The aging person has low-frequency tone loss.
4)The aging person may find it harder to hear consonants than vowels.
5)Sounds may be garbled and difficult to localize.
6)Hearing loss reflects nerve degeneration of the middle ear.