Ch. 14 Ears

A 55-year-old client is being evaluated for a hearing impairment. Which question would be most appropriate to provide the most useful information? "Are you having difficulty hearing high-frequency sounds?" "Do you notice any drainage from your ears?" "Are you experiencing any pain in your ears?" "Have you felt any popping sensations?"

"Are you having difficulty hearing high-frequency sounds?" Asking the client about changes in hearing ability with different frequency sounds would be most appropriate because the client is over age 50 and may be experiencing presbycusis, a loss of ability to hear high-frequency sounds. Asking about drainage would provide information about a possible infection; asking about pain would provide information about possible ear infection, cerumen blockage, sinus infections, or teeth and gum problems. Asking about a popping sensation may be appropriate if otitis media and perforation are suspected.

A client has sought care at the clinic, telling the nurse, "This ringing in my ears has gone on for weeks, and it's driving me crazy." The patient denies exposure to excessive noise levels. The nurse recognizes the likely presence of tinnitus and should follow up with which of the following questions? "Did your parents even complain of something similar?" "What medications are you currently taking?" "How would you describe your overall level of health?" "How do you usually clean your ears?"

"What medications are you currently taking?" Tinnitus may be associated with certain ototoxic medications. There is not usually a family history of this problem. Cerumen buildup can contribute, but hygiene is not a common etiology of tinnitus. The client's overall perception of health is important but is less likely to explain why he is experiencing tinnitus.

A nurse is interviewing a client as part of a routine examination of his ears and hearing. The nurse notes that this client has high blood pressure. Which of the following questions regarding his hearing should the nurse ask that is associated with his high blood pressure? "Do you have any ear pain?" "Do you experience any ringing, roaring, or crackling in your ears?" "Do you have any ear drainage?" "Are you ever concerned that you may be losing your ability to hear well?"

"Do you experience any ringing, roaring, or crackling in your ears?" Ringing in the ears (tinnitus) may be associated with excessive ear wax buildup, high blood pressure, or certain ototoxic medications. None of the other questions pertains to conditions related to high blood pressure. Ear pain is associated with ear infections, cerumen blockage, sinus infections, teeth and gum problems, and swimmer's ear. Drainage usually indicates infection. Hearing loss may be related to any number of causes but is not associated with high blood pressure.

The mother of a small child with tubes in both eardrums asks the nurse if it is okay if the child travels by airplane. What is the nurse's best response? "He should avoid flying for 6 months after tube placement." "The child must wear ear plugs while flying." "It's safe to fly because the tubes will equalize pressure." "He shouldn't fly with anyone who is immunocompromised."

"It's safe to fly because the tubes will equalize pressure." Pressure equalization tubes equalize pressure on either sides of the eardrum; so it's a great time to fly if one has tubes in the ears. The child should wear ear plugs to keep water out of the ears when swimming. Wearing ear plugs while flying may diminish the pressure equalization advantage of the tubes. Clients do not have to avoid flying for any period of time after tube placement. Ear tubes do not have an effect on immunocompromised clients.

The results of a client's Rinne test are as follows: bone condcution > air conduction. How should the nurse explain these findings to the client? "You have a high frequency hearing loss." "You have a conductive hearing loss." "You have nerve damage in your ears." "You have a unilateral hearing loss."

"You have a conductive hearing loss." The Rinne test tests for conductive hearing loss. The client's results indicate that bone conduction is greater than air conduction which indicates conductive hearing loss. Air conduction should be twice as long as bone conduction. The whisper test evaluates loss of high frequency sounds. An audiogram can reveal a nerve related or unilateral hearing loss.

The nurse notes a tophus of the ear of an older adult. Which assessment data is consistent with a tophus? A hard nodule composed of uric acid crystals A sac with a membranous lining filled with fluid Scarring of the tympanic membrane Redness and bulging of the eardrum

A hard nodule composed of uric acid crystals A tophus is a hard nodule composed of uric acid crystals. A cyst on the ear would present as a fluid-filled sac. Redness and bulging of the eardrum is characteristic of otitis media with effusion. Scarring of the tympanic membrane occurs with repeated ear infections with perforation of the tympanic membrane

Otoscopic examination of a 69-year-old client's tympanic membrane reveals that it is red, bulging, and distorted. The nurse also notes a diminished light reflex. To what should the nurse most likely attribute this assessment finding? Repeated ear infections Trauma Age-related changes Acute otitis media

Acute otitis media A red, bulging eardrum coupled with distorted, diminished, or absent light reflex is associated with acute otitis media. Repeated ear infections usually cause the formation of white scar tissue. Trauma causes the accumulation of blood behind the eardrum, which appears blue or dark red.

When providing client education on hearing, the nurse should remind clients to utilize ear plugs when they are what? (Select all that apply.) At train stations Cleaning their homes Using lawnmowers Working with children At concerts

At train stations Using lawnmowers At concerts As nurses, prevention is key, and patients should be reminded to utilize ear plugs when exposed to loud noises in their daily lives (e.g., lawnmowers, leaf blowers, chainsaws, concerts, train stations, battlefields, and sirens) and to limit exposure (iPod buds and cell phones).

A 55-year-old male presents to the health care clinic with reports of decreased hearing over the past year. Which subjective data in the client's review of systems should the nurse recognize as risk factors for hearing loss? Select all that apply. Use of antihypertensive medication Chronic ear infections as a child History of measles at 3 years of age Wax blocking the ear canal Drinks six cups of coffee daily Uses ear plugs at work because of the loud noises

Chronic ear infections as a child History of measles at 3 years of age Wax blocking the ear canal

The nurse would suspect a problem at which area when pressure builds up on either side of the tympanic membrane? Cochlea Eustachian tube Vestibulocochlear nerve Organ of Corti

Eustachian tube The eustachian tube equalizes the pressure on either side of the tympanic membrane, which separates the external ear from the middle ear. The chochlea, organ of Corti, and the vestibulocochlear nerve are part of the inner ear.

Which of the following denotes the correct procedure for using an otoscope when examining the ears of a 32-year-old client? Keeping the dominant hand away from the client's head Inserting the speculum down and forward into the ear canal Using the smallest speculum on the otoscope head Holding the otoscope in the non-dominant hand

Inserting the speculum down and forward into the ear canal

While inspecting the tympanic membrane, the nurse notes a pearly gray and shiny appearance. The nurse would interpret this finding as which of the following? Scarring from previous infections Serous otitis media Normal tympanic membrane Acute otitis media

Normal tympanic membrane The tympanic membrane is normally a pearly gray color with a shiny appearance. White spots would indicate scarring. <wbr />A yellowish bulging membrane would suggest serous otitis media; a red bulging membrane would suggest acute otitis media.

The nurse palpates a client's auricles and notes an elarged lymph node on one ear. No redness is observed, and the client denies pain or tenderness. What is the nurse's best action? Document the finding as an isolated benign node. Inform the client of the need for ear drops. Refer the client to an audiologist for an audiogram. Notify the healthcare provider about the finding.

Notify the healthcare provider about the finding. Lymph tissue should not be palpable on the ears. Enlarges lymph nodes indicate pathology or inflammation; and the healthcare provider should be notified. Ear drops are not indicated since the node is on the auricle, not in the canal. An audiogram is indicated for hearing loss.

The nurse is preparing to perform the Rinne test on a client. The nurse should place the tuning fork at which location first? Center of the client's forehead On the client's mastoid process In front of the client's external auditory canal At the base of the client's skull

On the client's mastoid process For the Rinne test, the tuning fork base is place on the client's mastoid process and then it is moved to the front of the external auditory canal when the client no longer hears the sound. The tuning fork is placed in the center of the client's forehead or head for the Weber test.

The nurse is preparing to perform the Rinne test on a client. The nurse would place the tuning fork at which location first? Center of client's forehead On the mastoid process In front of the external auditory canal At the base of the skull

On the mastoid process For the Rinne test, the tuning fork base is place on the client's mastoid process and then it is moved to the front of the external auditory canal when the client no longer hears the sound. The tuning fork is place in the center of the client's forehead or head for the Weber test.

A nurse palpates a client's ear and finds that the tragus is exquisitely tender. The nurse should suspect which of the following health problems? Otitis media Otitis externa Ruptured tympanic membrane Mastoiditis

Otitis externa A tender tragus is associated with otitis externa. Tenderness behind the ear would suggest otitis media. A ruptured tympanic membrane would be associated with ear pain and a popping sensation. Tenderness over the mastoid process would suggest mastoiditis.

You are a pediatric nurse caring for a child who has been brought to the clinic with otitis externa. What assessment finding is characteristic of otitis externa? Tophi on the pinna and ear lobe Dark yellow cerumen in the external auditory canal Pain on manipulation of the auricle Air bubbles visible in the middle ear

Pain on manipulation of the auricle Tophi are deposits of uric acid crystals and are generally painless; they are a common physical assessment finding in clients diagnosed with gout. Cerumen is a normal finding during assessment of the ear canal. Its presence does not necessarily indicate that inflammation is present. Pain when the nurse pulls gently on the auricle in preparation for an otoscopic examination of the ear canal is a characteristic finding in clients with otitis externa. Air bubbles in the middle ear may be visualized with the otoscope; however, these do not indicate a problem involving the ear canal. Aural tenderness or pain is not usually associated with middle ear disorders.

A 66-year-old client states that he has increasing difficulty hearing high-pitched sounds. The patient's statement most likely suggests that he has what diagnosis? Vertigo Otalgia Tinnitus Presbycusis

Presbycusis Presbycusis, a gradual hearing loss that often begins with a loss of the ability to hear high-frequency sounds, is common after age 50. Vertigo refers to a true spinning motion. Otalgia refers to ear pain. Tinnitus refers to ringing in the ears.

The nurse notes otitis media with effusion in the left ear of a 3-year-old child. Which assessment data is consistent with otitis media with effusion? Redness and bulging of the eardrum Clear discharge in the ear canal Bloody discharge in the ear canal Dense white patches on the tympanic membrane

Redness and bulging of the eardrum Redness and bulging of the eardrum are characteristic of otitis media with effusion. Clear or bloody discharge occurs with rupture of the tympanic membrane. Dense white patches on the tympanic membrane are noted with scarring of the tympanic membrane.

A client admitted to the health care facility is diagnosed with vertigo. Which test is appropriate for the nurse to perform to assess for equilibrium in the client? Weber Rinne Romberg Whisper

Romberg The nurse should perform the Romberg test to assess equilibrium in the client. The Weber test and the Rinne test are used to distinguish between sensorineural and conductive hearing loss. The whisper test is used to assess hearing loss in a client.

In which position should the nurse place the toddler when examining the ear? Sitting on the parent's lap with parent steadying the head Side-lying position on the examination table Supine on the examination table Sitting position on the examination table

Sitting on the parent's lap with parent steadying the head The toddler should sit on the parent's lap with the parent steadying the head. Preschoolers often need to be held down on the examination table in a supine position with the head turned toward the parent. Older children can sit on the examination table.

The nurse is presenting an educational event for gardeners. When discussing the ears, what would be an important topic to cover? Skin cancer prevention Otalgia Tinnitus Sound control

Skin cancer prevention

A nurse is preparing a teaching session for a group of new parents about ear infections and measures to prevent them. The nurse is planning to address the reasons why children are more susceptible to these infections than adults. Which of the following would the nurse describe? Young children have a tendency to stick objects into their ear canal. The size and shape of children's eustachian tubes makes them vulnerable. Children's immune systems lack the maturity to fight infections. Children generally have poorer hygiene than adults.

The size and shape of children's eustachian tubes makes them vulnerable. The fact that children are more susceptible than adults to otitis media is due mostly to the shorter, straighter, narrower eustachian tubes of children. Otitis media in children is not normally associated with putting things in their ears, immature immune systems, or poor hygiene.

A 52-year-old patient fails the Romberg test. The nurse explains that this might indicate a dysfunction in what part of the ear? The bones of the middle ear The eustachian tubes The pinna The vestibular portion of the inner ear

The vestibular portion of the inner ear Failure of the Romberg test may indicate dysfunction in the vestibular portion of the inner ear, semicircular canals, and vestibule.

During a Weber test, the client reports lateralization of sound to the good ear. How should the nurse interpret this assessment finding? The good ear cannot receive sound vibrations. There is a dysfunction of the middle ear. The poor ear is receiving sound vibrations by air. There is a sensorineural hearing impairment.

There is a sensorineural hearing impairment. With the Weber test, lateralization of sound to the good ear suggests sensorineural hearing loss because of the limited perception of sound due to nerve damage in the affected ear, making sound seem louder in the unaffected ear. Lateralization to the poor ear suggests conductive hearing loss.

During a Weber test, the client reports lateralization of sound to the good ear. The nurse interprets this as which the following? The good ear cannot receive sound vibrations. There is a dysfunction of the middle ear. The poor ear is receiving sound vibrations by air. There is a sensorineural hearing impairment.

There is a sensorineural hearing impairment. With the Weber test, lateralization of sound to the good ear suggests sensorineural hearing loss because of the limited perception of sound due to nerve damage in the affected ear, making sound seem louder in the unaffected ear. Lateralization to the poor ear suggests conductive hearing loss.

Upon examination of the ear with an otoscope, the nurse documents the skin of the ear canal as thickened, red, and itchy. The nurse would expect this finding with a diagnosis of chronic otitis media acute otitis media purulent otitis media otitis media with serous effusion

chronic otitis media

The nurse is planning to conduct the Weber test on an adult male client. To perform this test, the nurse should plan to

strike a tuning fork and place it on the center of the client's head or forehead. Perform Weber's test if the client reports diminished or lost hearing in one ear. The test helps to evaluate the conduction of sound waves through bone to help distinguish between conductive hearing (sound waves transmitted by the external and middle ear) and sensorineural hearing (sound waves transmitted by the inner ear). Strike a tuning fork softly with the back of your hand and place it at the center of the client's head or forehead.