Weber Chapter 17

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 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 patient asks the nurse why the nurse put the tuning fork on the bone behind the ear. Which is the best response by the nurse?

"It identifies a problem with the normal pathways for sound to travel to your inner ear." Placing the tuning fork on the mastoid bone is one part of the Rinne's test, which assesses the normal pathways for sound to travel to the inner ear. Equilibrium is assessed with the Romberg test. Multiple sources of assessment data are used to determine whether hearing loss is caused by degeneration of nerves in the inner ear or repeated ear infections.

Which characteristic feature of the tympanic membrane should a nurse anticipate finding in a client with acute otitis media?

A client with acute otitis media would have a red, bulging eardrum, with absent light reflex. A pearly, translucent membrane, with no bulging is a normal finding in the tympanic membrane. A yellowish, bulging membrane, with bubbles is seen in serous otitis media. A gray, translucent membrane, with no retraction is a normal finding in the tympanic membrane.

The nurse notes a tophus of the ear of an older adult. Which assessment data is consistent with a tophus?

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

When providing client education on hearing, the nurse should remind clients to utilize ear plugs when they are what? (Select all that apply.)

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 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?

Ask the mother how long the tubes have been in place.

High doses of this medication can produce bilateral tinnitus?

At high doses, aspirin toxicity can produce bilateral tinnitus. Antivert and Dramamine is used for nausea and vomiting related to motion sickness. Antiemetics such as promethazine (Phernergan) suppositories help control the nausea and vomiting and the vertigo because of the antihistamine effect.

The transmission of sound waves through the external ear and the middle ear is known as

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

The nurse is documenting an objective assessment of the client's ears. Which of the following would be the most appropriate documentation?

Documentation of the whisper test should be "hearing intact bilaterally on whisper test." Documentation of the Rinne and Weber test results usually validates normal findings (e.g., "No unexpected findings on Weber and Rinne tests."). The report from the client is a subjective assessment finding.

Which precaution should a nurse take to ensure the safety of a client when performing the Romberg test?

During the Romberg test, the nurse should put his or her arms around the client without touching to prevent the client from falling. The eyes are closed to assess the client's ability to maintain equilibrium without looking or holding onto something. The client should not be instructed to hold on to a chair during the test as it may interfere with the assessment of equilibrium. The nurse should not hold the client's arm as it would give support to the client and affect the result.

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

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 preparing a community education session on hearing loss. Which information should the nurse include?

Hearing loss can lead to mental health problems. Hearing is a critical sense with which one can experience the world. Loss of hearing is associated with social and emotional isolation which can lead to mental health problems. All ethnic groups do not experience hearing loss in the same way. African Americans experience less hearing loss due to higher amounts of melanin in the cochlea. Unlike vision prerequisites for driving, there is no mandate for widespread testing of hearing. Hearing loss can begin at any age, not just after 40.

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?

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.

Which of the following is a priority patient teaching topic related to the ears?

How to prevent skin cancer The ear is commonly forgotten when it comes to sun protection. For this reason, 20% of all melanomas are found in the head and neck region. The ears are the third most common site of basal cell carcinoma. The sun-exposed areas of the ear are often not protected.

After examining the client's tympanic membranes, the nurse documents "Right tympanic membrane, red and bulging with no light reflex." The nurse recognizes that these are signs of

In acute otitis media there is a bulging red membrane with decreased or absent light reflex.

Which action by the nurse is consistent with the Rinne test?

In the Rinne test, the nurse strikes the tuning fork and places it on the patient's mastoid process to measure bone conduction. 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. 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.

When teaching a class of school-age children about hygiene, the nurse should include which information about the ears?

Never put anything smaller than your elbow in your ears. The nurse should reinforce proper cleaning techniques such as cleaning the bowl of the helix and never introducing anything into the external auditory canal. An elbow will not fit into an ear canal; therefore stating not to put anything smaller than an elbow into the ears, eliminates putting anything into the external ear canal. It's also a fun way to educate school age children. Cotton tipped applicators can cause complications and should not be used to clean the ears. An increased amount of earwax, not decreased, can lead to conductive hearing loss.

Which of the following describes a condition characterized by abnormal spongy bone formation around the stapes?

Otosclerosis is more common in females than males and is frequently hereditary. A middle ear effusion is denoted by fluid in the middle ear without evidence of infection. Chronic otitis media is defined as repeated episodes of acute otitis media causing irreversible tissue damage and persistent tympanic membrane perforation. Otitis externa refers to inflammation of the external auditory canal.

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

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

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

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.

Which terms refers to the progressive hearing loss associated with aging?

Presbycusis Both middle and inner ear age-related changes result in hearing loss. Exostoses refers to small, hard, bony protrusions in the lower posterior bony portion of the ear canal. Otalgia refers to a sensation of fullness or pain in the ear. Sensorineural hearing loss is loss of hearing related to damage of the end organ for hearing and/or cranial nerve VIII.

A client visits a community clinic reporting severe allergies causing a "crackling sensation" in the ear. The physician diagnoses serous otitis media. Which of the following is a characteristic of this condition?

Serous otitis media results from fluid that collects in the middle ear, causing an obstruction of the auditory tube. This condition may stem from infection, allergy, tumors, or sudden changes in altitude. Symptoms include crackling sensations and fullness in the ear, with some hearing loss. Acute purulent otitis media is generally caused by an upper respiratory infection spreading through the auditory tube. Pus forms and collects in the middle ear to create pressure on the eardrum. Chronic otitis media can develop if acute purulent otitis media is not treated promptly. Chronic purulent otitis media is usually associated with a punctured eardrum or may be a complication of acute otitis media, mastoiditis, or a severe upper respiratory infection.

A patient has Darwin tubercle. What is this?

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

An objective assessment of a client's ears reveals small, painless nodules on the left helix. How would the nurse note this finding in the client's medical record?

Small, painless nodules on the helix are a variation of normal anatomy known as Darwin's tubercle. The other options are distracters for the question.

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?

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.

A client presents at the clinic complaining of a loss of balance. What test should the nurse expect the physician to carry out on a client with a loss of balance?

The Romberg test is used to evaluate a person's ability to sustain balance. The Audiometric test measures the hearing acuity precisely, while the Rinne test and the Weber test identify the types of hearing loss

The client is having a Weber test. During a Weber test, where should the tuning fork be placed?

The Weber test is performed by striking the tuning fork and placing its stem in the midline of the client's skull or in the center of the forehead. In the Rinne test, the tuning fork is struck and placed on the mastoid process behind the ear. The tuning fork is not placed near the external meatus of each ear or under the bridge of the nose.

The eustachian tube is a passage between the middle ear and the nasopharynx. What is the function of the eustachian tube?

The eustachian tube, a conduit that connects the middle ear to the nasopharynx, allows for pressure regulation of the middle ear. The other options are distracters for the question.

During a physical examination the nurse performs the action shown. What assessment is the nurse performing?

The first part of the Rinne test is to place the handle of a vibrating tuning fork on the mastoid process. This is assessing hearing through bone conduction. The Weber test is conducted by placing the handle of a vibrating tuning fork on the top of the head. It is used to differentiate the cause of unilateral hearing loss. Auditory acuity is determined through an audiogram in a soundproof room. Vestibular function or equilibrium is assessed through the Romberg test.

A six-month old male infant is brought to the emergency department by his parents for inconsolable crying and pulling at his right ear. When assessing this infant the nurse is aware that the tympanic membrane should be what color in a healthy ear?

The healthy tympanic membrane appears pearly gray and is positioned obliquely at the base of the ear canal.

When planning care for a client with an inner ear infection, the nurse will need to include interventions for which of the following potential problems?

The labyrinth within the inner ear senses the position and movements of the head and helps to maintain balance. If these structures are infected or inflamed, the patient could develop vertigo. Rhinorrhea, fever, and headache are not potential problems associated with an inner ear infection.

Which question asked by the nurse is assessing problems with tinnitus?

The nurse assesses tinnitus by asking, "Do you experience buzzing in your ears?" Problems with balance occur with vertigo. Drainage from the ear(s) occurs with otalgia. The question, "In what situations is it hard for you to hear?" assesses for general hearing loss.

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?

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.

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

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 comfortably into 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?

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.

A patient diagnosed with arthritis has been taking aspirin and now reports experiencing adverse effects. What adverse effect indicates that a decrease in dose may be necessary?

Tinnitus is a sign of ototoxicity, which can occur when a patient's dose is too high

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

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 of the following is a symptom related to vertigo?

Vertigo is defined as the misperception or illusion of motion of the person or the surroundings. Most people with vertigo describe a spinning sensation or say they feel although objects are moving around them.

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?

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 reports the onset of tinnitus. What question should the nurse ask the client to further assess this condition?

have you taken any antibiotics in the past few weeks Tinnitus is the feeling of ringing in the ears and may be associated with excessive wax buildup, high blood pressure, or certain ototoxic medications, such as antibiotics. Cleaning the ear with cotton-tipped applicators places the client at risk for ear damage. Ear infections can cause loss of hearing. Not hearing the p hone ring may be a sign of hearing loss.

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

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 direr and build up as t he cilia become more rigid. The pinna looses elasticity in older age. A bulging tympanic membrane is not a normal finding at any age.

An adult client visits the clinic and complains of tinnitus. The nurse should ask the client if she has been

taking antibiotics. Ringing in the ears (tinnitus) may be associated with excessive earwax buildup, high blood pressure, or certain ototoxic medications (such as streptomycin, gentamicin, kanamycin, neomycin, ethacrynic acid, furosemide, indomethacin, or aspirin), loud noises, or other causes.