prep U 14 Ears Assessment

Equalizes the pressure in the middle ear with atmospheric pressure. The eustachian tube opens during swallowing or yawning. Its function is to equalize the pressure in the middle ear with atmospheric pressure so that there is equal pressure on both sides of the tympanic membrane to allow the drum to vibrate freely. The stapes transmits the vibration to the fluid-filled inner ear at the oval window. The vestibule sends information to the cerebellum and the midbrain. The tympanic membrane separates the external from the middle ear.

A nurse is educating a client about the function of the parts of the auditory system. Which is the function of the eustachian tube?

ear infection

A yellow appearance is suggestive of

serous otitis media

A yellowish bulging membrane would suggest

Ask the mother how long the tubes have been in place. Ear tubes generally fall out spontaneously in 2-5 years after placement, and the membrane most often closes. The client does not need manual removal in the office or operating room unless the child is experiencing problems. Antibiotics are indicated for infection and are not necessary for removal. Page 370

A mother of a small child calls the clinica and asks to schedule an appointment for ear tube removal. The call is transferred to the nurse. What is the nurse's best action? A. Schedule first available office appointment. B. Schedule appointment at hospital for tubes to be removed surgically. C. Ask healthcare provider about prescribing antibiotics before removal. D. Ask the mother how long the tubes have been in place.

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.

7s A nurse palpates a client's ear and finds that the tragus is tender. The nurse suspects which of the following?

Dark red or bluish tympanic membrane A blue or dark red tympanic membrane indicates blood behind the eardrum due to trauma. A yellow appearance is suggestive of ear infection, and white spots or streaks are caused by recurrent infections.

A 12-year-old boy was brought to the emergency department after being hit in the head with a ball during a baseball game. What assessment finding would suggest to the nurse trauma to the middle ear or inner ear?

"Are you having difficulty hearing high-frequency sounds?" Asking the client about changes in hearing ability with different frequency sounds would be most appropriate. This is 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 55-year-old client is being evaluated for a suspected hearing impairment. Which of the nurse's health interview questions is most likely to yield relevant data?

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. 354

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? A Vertigo B Otalgia C Tinnitus D Presbycusis

Finish the entire course of antibiotic therapy. The client's symptoms are consistent with otitis externa, usually treated with antibiotics and pain medication. The inflammation can cause temporary deafness, but permanent deafness is not common. Tympanostomy tubes are placed for middle ear effusions, not otitis externa.

A client exhibits purulent drainage in the right external ear canal. The client complains of pain that increases when the ear is touched. Which client teaching instructions should the nurse provide?

"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.

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?"

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 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 information would the nurse describe?

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.

A nurse palpates a client's ear and finds that the tragus is exquisitely tender. The nurse should suspect what health problem?

"Otalgia is pain in the ear." Otalgia usually indicates ear dysfunction, most commonly otitis media or otitis externa. Pain in the ear can be referred from the pharynx. It is not uncommon for a patient recovering from tonsil surgery to complain of ear pain. Severe pain followed by relief and drainage indicates a ruptured TM.

A patient calls the clinic and tells the nurse that the doctor told her that she has "otalgia." The patient cannot remember what the doctor explained this to be. How would the nurse most appropriately respond? A. "Otalgia is a dysfunction of the ear." B. "Otalgia is pain in the ear." C."Otalgia is the beginning of hearing loss." D. "Otalgia is a disease of the inner ear."

Otitis externa Pain with auricle movement or tragus palpation indicates otitis externa or furuncle.

A patient comes to the clinic and reports pain when he touches his ear. With what is this finding most consistent?

A small painless nodule on the helix Small painless nodules on the helix are a variation of normal anatomy known as darwinian tubercle.

A patient has Darwin tubercle. What is this?

ear pain and a popping sensation

A ruptured tympanic membrane would be associated with

Weber and Rinne tests

A tuning fork is needed to perform what test?

Client maintains the position during the exam A negative Romberg test is documented when the client maintains position for 20 seconds without swaying or with minimal swaying. The test is positive if the client moves the feet apart to prevent falls, or starts to fall from loss of balance.

After having a client perform a Romberg test, which of the following would indicate to the nurse that the test is negative?

Possible basilar skull fracture Hemotympanum, otorrhea, or tympanic membrane rupture may indicate barotrauma from pressure changes or a basilar skull fracture. Otitis externa is a outer ear infection. Otitis media is an inner ear infection. The drainage from the ear is a classic sign of a possible basilar skull fracture. Possible mass in the ear is a distracter to the question.

An adult farm worker presents at the ED after falling out of a hay loft. The client states falling approximately 4 hours ago and did not lose consciousness. The client is experiencing only a mild headache. When asked why the client came to the ED, the patient states that he had a clear discharge from the right ear ever since the accident. What should this finding indicate to the nurse? Possible basilar skull fracture Possible otitis externa Possible otitis media Possible mass in the ear

a nerve related or unilateral hearing loss

An audiogram can reveal

Audiometry is done by an audiologist. Audiometric testing measures hearing acuity precisely. Options A, B and D can screen hearing but they cannot do audiometric testing

Audiometry is testing that measures hearing acuity precisely. Who does the nurse know can perform audiometric testing? A. School nurse B. Hearing aide salesperson C. Audiologist D. Nursing assistant

conductive hearing loss

Bone conduction > air conduction on Rinne

Tinnitus and sensorineural hearing loss It is important that nurses are knowledgeable about the ototoxic effects of certain medications such as salicylates, loop diuretics, quinidine, quinine, and aminoglycosides. Signs and symptoms of ototoxicity include tinnitus and sensorineural hearing loss. Hypotension, reduced urinary output, and impaired facial movement are not signs of ototoxicity.

During a pharmacology class the students are told that some drugs need to be closely monitored. What aspect should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?

(tympanic rupture) Ear leaking after trauma- may help diagnosis brain injury especially basilar skull fractures.

Hemotympanum is

barotrauma from pressure changes or a basilar skull fracture.

Hemotympanum, otorrhea, or tympanic membrane rupture may indicate

the patient must be referred to the emergency department for immediate object removal.

If the object appears to be a button battery,

Preschoolers often need to be held down on the examination table in a supine position with the head turned toward the parent.

In which position should the nurse place the preschooler when examining the ear?

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.

In which position should the nurse place the toddler when examining the ear?

why do you get vertigo?

Inflamed labyrinth causes loss of equilibrium

ear pain

It is not uncommon for a patient recovering from tonsil surgery to complain of what type of pain?

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.357

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? a.. Repeated ear infections b. Trauma c. Age-related changes d. Acute otitis media

Pharynx

Pain in the ear can be referred from where?

evaluation for injury to nearby structures, including brain injury, basilar skull fracture, and neck injury.

Patients with ear trauma also need

otitis media with effusion.

Redness and bulging of the eardrum is characteristic of what?

Otitis Media with Effusion (OME)

Redness and bulging of the eardrum is characteristic of?

white scar tissue.

Repeated ear infections usually cause the formation of what?

repeated ear infections with perforation of the tympanic membrane

Scarring of the tympanic membrane occurs with

perforation of the tympanic membrane

Scarring of the tympanic membrane occurs with?

a ruptured TM

Severe pain followed by relief and drainage indicates?

innitus and sensorineural hearing loss.

Signs and symptoms of ototoxicity include

Protect the client from injury

Some clients with acoustic neuromas have vertigo. What is a priority nursing action with clients with vertigo?

otitis media.

Tenderness behind the ear would suggest

Conductive hearing loss test

Tests used to evaluate are the unilateral and air versus bone are Weber, Rinne, Whisper and inspection of the tympanic membrane for infection.

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

place the handle of a vibrating tuning fork on the mastoid process.

The first part of the Rinne test is to

Transmits information on the body's position to the brain The semicircular canal transmits information on the body's position to the brain. The vestibule sends sensory information to the cerebellum and midbrain, whereas the transmission of nerve stimuli begins in the cochlea, and the auditor tube equalizes the pressure in the middle ear with the atmospheric pressure. The semicircular canal does not send sensory information to the cerebellum and the midbrain, begin the transmission of nerve stimuli related to sound, or equalize the pressure in the middle ear with atmospheric pressure.

The nurse assists and educates client about the structure and function of the sensory system. When educating clients on the parts and functions of the ear, what is the nurse's best description of the function of the semicircular canal?

Ineffective health maintenance related to denial of hearing problem and inadequate resources for additional testing A nursing diagnosis of ineffective health maintenance would be most appropriate based on the data. There is nothing to suggest that the client is having difficulty with social interaction. A soft speaking voice does not indicate a problem with impaired verbal communication. The client has a problem, so a health promotion diagnosis of readiness for enhanced communication would be inappropriate.

The nurse has completed a focused ear and hearing assessment and gathered the following data: the client speaks very softly, denies hearing loss, and has never had and cannot afford additional hearing tests; the client fails the whisper test. Which nursing diagnosis would be most appropriate?

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.

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.

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

acute otitis media.

a red bulging membrane would suggest

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.

The nurse is planning to conduct the Weber test on an adult male client. To perform this test, the nurse should plan to A. strike a tuning fork and place it at the base of the client's mastoid process. B. whisper a word with two distinct syllables to the client. C.ask the client to close his eyes while standing with feet together. D. strike a tuning fork and place it on the center of the client's head or forehead.

observe the client's response to the explanations. As you prepare the client for the ear examination, carefully note how the client responds to your explanations.

The nurse is planning to perform an ear examination on an adult client. After explaining the procedures to the client, the nurse should

Otoscope An otoscope is needed to examine a client's internal ear. A watch with a second hand would be important when performing the Romberg test. A tuning fork is needed to perform the Weber and Rinne tests. A measuring tape would not be needed for any portion of the ear assessment.

The nurse is preparing to examine a client's internal ear. Which equipment would be necessary?

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 should place the tuning fork at which location first?

Skin cancer prevention Many melanomas develop near or on the helix of the ear. Teaching clients how to protect themselves from unnecessary sun exposure increases the likelihood of preventative behaviors. Otalgia is an earache. Tinnitus is ringing in the ears. Sound control would be related to environmental loud noises. None of the three would be a topic for gardeners.

The nurse is presenting an educational event for gardeners. When discussing the ears, what would be an important topic to cover?

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

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 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

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

Nausea Vertigo Vomiting Dizziness Benign paroxysmal positional vertigo causes nausea, vomiting, vertigo, and dizziness. This is due to injury or damage to balance organs and dislodging of the crystals in the otolith organs. Otalgia or ear pain is not a symptom of benign paroxysmal positional vertigo.

The nurse notes that a client is diagnosed with benign paroxysmal positional vertigo. What should the nurse expect to assess in this client? Select all that apply. A. Otalgia B. Nausea C. Vertigo D. Vomiting E. Dizziness

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.

The nurse would suspect a problem at which area when pressure builds up on either side of the tympanic membrane?

Otitis media The key to this question is that the hearing loss is conductive which is more likely to be from otitis media. If the loss was sensory-neural, the loss would be more likely to be age-related.

The nurse's assessment of an older adult client's ears and hearing suggests the possible presence of conductive hearing loss. Which of the following is the most likely etiology of this abnormal assessment finding? A. Cranial nerve VIII damage B. Trauma to the temporal lobe C. Age-related hearing changes D. Otitis media

Eustachain tube The eustachian tube extends from the floor of the middle ear to the pharynx and is lined with mucous membrane. It equalizes air pressure in the middle ear. Options B, C and D do not equalize pressure in the middle ear.

The nursing student hopefuls are taking a pre-nursing anatomy and physiology class. What will they learn is the anatomical feature that equalizes air pressure in the middle ear? A. Eustachian tube B. The malleus C. The pinna D. The meatus

Conductive hearing Conductive hearing is sound waves transmitted by the external and middle ear.

The transmission of sound waves through the external ear and the middle ear is known as perceptive hearing. conductive hearing. external hearing. connective hearing.

Loss of high frequency sounds

The whisper test evaluates

the Romberg test.

Vestibular function or equilibrium is assessed through what test?

Otalgia usually indicates

WHAT usually indicates ear dysfunction, most commonly otitis media or otitis externa?

Pull the auricle out, up, and back. The nurse should pull the auricle out, up, and back to straighten the external auditory canal. This is because the external auditory canal is S-shaped in the adult. The outer part of the canal curves up and back, and the inner part of the canal curves down and forward. The nurse should choose the largest speculum that fits the client's ear. The nurse should hold the speculum in the dominant hand and insert the speculum gently down and forward.

What action should the nurse implement when assessing the ear of an adult client using an otoscope?

Turn off the television and radio when communicating Close the door if the hallway noise is loud Provide visual aids for detailed discussions Examples of nursing interventions for the ear and hearing are to turn off the television and radio when communicating, close the door if the hallway noise is loud, and provide a communication board and visual aids for detailed discussions. Nurses would not automatically provide hearing aids for clients with impaired hearing, that is, the responsibility of the client and the client's family. The nurse also would not teach the clients and staff a modified sign language.

What interventions might the staff educator at a long-term care facility suggest to improve the status of clients with hearing loss? Select all that apply. Provide visual aids for detailed discussions Turn off the television and radio when communicating Close the door if the hallway noise is loud Provide hearing aids for affected clients

the auditor tube

What structure equalizes the pressure in the middle ear with the atmospheric pressure?

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).

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

The nurse activates the tuning fork and places it on the midline of the parietal bone in line with both ears. Using Weber's test, the nurse activates the tuning fork and places it on the midline of the parietal bone in line with both ears to differentiate the cause of unilateral hearing loss. In Rinne's test, the nurse strikes the tuning fork and places it on the patient's mastoid process to measure bone conduction. When examining the inner ear, the nurse uses a bulb insufflator attached to an otoscope to observe movement of the tympanic membrane. In the Whisper test, the nurse shields their mouth and whispers a simple sentence approximately 18 inches from the patient's ear.

Which action by the nurse is consistent with Weber's test?

High-tone frequency loss Presbycusis, a gradual hearing loss, is common after the age of 50 years. It begins with a loss of the ability to hear high-frequency tones. Cerumen production may increase in older age or become drier and build up as the cilia become more rigid. The earlobes become elongated in older age. A bulging tympanic membrane is not a normal finding at any age.

Which finding should a nurse recognize as normal when assessing the ears of an elderly client?

Inserting the speculum down and forward into the ear canal The nurse should insert the speculum gently down and forward into the canal. Using the dominant hand, the nurse should position the hand holding the otoscope against the client's head or face. The largest speculum that fits comfortably into the client's ear canal is used.

Which of the following denotes the correct procedure for using an otoscope when examining the ears of a 32-year-old client?

Use of cotton swabs inside the ear

Which of the following, if obtained during the health history, would alert the nurse to a possible ear-related problem?

Frequent use of cotton-tipped applicators Use of cotton-tipped applicators inside the ear can cause earwax to become impacted and cause ear damage. Factors such as showering rather than bathing or having poor hygiene practices do not normally cause ear-related problems. Acetaminophen is not ototoxic.

Which of the following, if obtained during the health history, would alert the nurse to a possible risk factor for ear-related problems?

Normal tympanic membrane The tympanic membrane is normally a pearly gray color with a shiny appearance. White spots would indicate scarring. A yellowish bulging membrane would suggest ; a red bulging membrane would suggest acute otitis media. Otitis externa does not directly affect the appearance of the tympanic membrane.

While inspecting the client's tympanic membrane, the nurse notes a pearly gray and shiny appearance. The nurse would interpret this finding as what?

eustachian tube middle ear

is a conduit. is important because it connects middle ear to the nasopharynx and allows for pressure regulation. Ie. In an Airplane- our eyes feel the effect of the pressure.

tinnitus

ringing in the ears

mastoiditis.

tenderness over the mastoid process would suggest

cochlea

the transmission of nerve stimuli begins where?

symptoms of Ménière disease include

vertigo with severe nausea, vomiting Exacerbation periods often last 24 hours. Followed by periods of remission

Trauma

what causes the accumulation of blood behind the eardrum, which appears blue or dark red?

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).

what does the Webers test for hearing evaluate?

Tophus

what is a hard nodule composed of uric acid crystals?

Auditory acuity

what is determined through an audiogram in a soundproof room?

cyst

what is on the ear would present as a fluid-filled sac?

A watch

what item would be important when performing the Romberg test?

The stapes

what part of the ear transmits the vibration to the fluid-filled inner ear at the oval window?

vertigo refers to a true spinning motion

what refers to a true spinning motion?

Otalgia refers to ear pain.

what refers to ear pain?

Tinnitus refers to ringing in the ears.

what refers to ringing in the ears?

the vestibule

what structure sends sensory information to the cerebellum and midbrain?

the Weber test

what test is conducted by placing the handle of a vibrating tuning fork on the top of the head and It is used to differentiate the cause of unilateral hearing loss?

A cyst on the ear would present as a fluid-filled sac.

what would a cyst on the ear would present as?

recurrent infections

white spots or streaks are caused by