Chapter 14- Ear

10. A nurse is preparing to perform a general assessment of a 47-year-old patient who is new to the clinic. How would the nurse prepare to obtain objective data about the patient's ears? (Select all that apply.) A) Have the patient sit on the examination table B) Place the patient in semi-Fowler's position on the examination table C) Make sure the patient is comfortable in a quiet room D) Perform the whisper, Weber, and Rinne tests before inspection E) Place the patient's ears at the nurse's eye level

A) Have the patient sit on the examination table C) Make sure the patient is comfortable in a quiet roomE) Place the patient's ears at the nurse's eye level

1. The eustachian tube is a passage between the middle ear and the nasopharynx. What is the function of the eustachian tube? A) Helps to regulate pressure in the middle ear B) Protects the middle ear C) Allows for drainage of fluid from the middle ear D) Maintains fluid in the middle ear

A) Helps to regulate pressure in the middle ear

8. When providing patient teaching about the ears, what should the nurse be sure to include? A) How the patient cleans the ears B) Basic anatomy and physiology of the ears C) How to use cotton-tipped applicators safely D) Potential infection from self-cleaning of ears

A) How the patient cleans the ears

18. An APRN is assessing the ears of an 18-month-old patient who has had tympanostomy tubes in place for 6 months. Where in the tympanic membrane would the APRN expect to find the tympanostomy tubes? A) Inferior portion B) Superior portion C) Medial portion D) Upper right quadrant

A) Inferior portion

12. The pathophysiology instructor is discussing ear problems. What would the instructor indicate is an abnormal finding? A) Tenderness of the mastoid process B) Atrophied lymph nodes C) Tenderness of the apex D) Sclerotic tympanic membrane

A) Tenderness of the mastoid process

15. A nurse is admitting a 35-year-old man with pneumonia. When reviewing the patient's medical record, the nurse notes that this patient had abnormal findings during the Weber test. What would the nurse know this means? A) The patient has unilateral hearing loss B) The patient has loss of high-frequency sounds C) The patient has loss of low-frequency sounds D) The patient has bilateral hearing loss

A) The patient has unilateral hearing loss

17. A female patient, 23 years old, comes to the ED with excruciating pain in her left ear. On assessment, the nurse notes that the patient experiences extreme pain during palpation of the tragus. Which of the following would the nurse suspect? A) Otitis media B) Furuncle C) Foreign body D) Impacted cerumen

B) Furuncle

9. Objective assessment of a patient's ears reveals small, painless nodules on the left helix. How would the nurse note this finding in the patient's medical record? A) Left external ear abnormal; Darwin's tubercle noted at the midpoint of helix B) Left external ear within normal limits C) Small nodules on the left helix indicating inflammation of the external ear D) Small, painless nodules on the left helix; further evaluation for carcinoma indicated

B) Left external ear within normal limits

16. The APRN is assessing the tympanic membrane of a patient. Once the tympanic membrane has been visualized, the APRN uses the bulb insufflator to observe the movement of the tympanic membrane. When forcing air into the ear canal, what would the APRN expect to note? A) Negative pressure pulling the tympanic membrane B) Positive pressure pushing down the tympanic membrane C) Negative pressure pushing down the tympanic membrane D) Positive pressure pulling the tympanic membrane

B) Positive pressure pushing down the tympanic membrane

5. An advanced practice registered nurse is working in a family practice clinic with a patient who reports that drainage from her ear is no better despite finishing three courses with prescribed antibiotics. After reviewing the patient's records, what would be the nurse's most appropriate action? A) Prescribe a different antibiotic B) Refer the patient to an otolaryngologist C) Reassess the patient's ear D) Perform the Rinne test.

B) Refer the patient to an otolaryngologist

13. An APRN is assessing the tympanic membrane of a 15-year-old boy who has come to the clinic. What would the APRN expect to visualize if the patient has a normal otoscopic evaluation? A) The arm of the stapes B) The short process of the malleus C) The head of the incus D) The long process of the stapes

B) The short process of the malleus

2. What components of sound does the cochlea interpret? (Select all that apply.) A) Tone B) Direction C) Amplitude D) Decibel E) Frequency

C) Amplitude E) Frequency

6. A patient presents to the emergency department following a motor vehicle collision in which he sustained a significant blow to the area of the right ear. The patient tells the nurse that something is leaking from the right ear. What should the nurse suspect? A) Nasal fracture B) Intracranial bleed C) Basilar skull fracture D) Fractured clavicle

C) Basilar skull fracture

19. A 76-year-old woman presents at the clinic, reporting otalgia in her right ear. Physical assessment reveals cerumen impacted in the patient's ear. Removing this mechanical blockage may do what for this patient? (Select all that apply.) A) Increase the size of ear canal B) Provide less rigidity in outer ear C) Improve hearing D) Enhance socialization E) Prevent injury

C) Improve hearing D) Enhance socialization E) Prevent injury

3. When assessing the tympanic membrane, where would the nurse expect to visualize the malleus? A) In the anterior aspect B) In the area of the cone of light C) Near the center D) To the left of the cone of light

C) Near the center

11. While performing an otoscopic examination of a patient's ear, the APRN finds white patches on the tympanic membrane. How would the APRN note this finding in the chart? A) Tympanic membrane abnormal; white, patchy areas noted B) Tympanic membrane scarred, indicating loss of hearing C) Tympanic membrane visualized with areas of opacity noted D) Tympanic membrane within normal limits

C) Tympanic membrane visualized with areas of opacity noted

4. When reviewing ear assessment, a student nurse would learn that the cone of light should be visible where on the tympanic membrane? A) Anterior proximal quadrant B) Anterior superior quadrant C) Anterior medial quadrant D) Anterior inferior quadrant

D) Anterior inferior quadrant

14. Student nurses are spending time in the laboratory learning the proper use of an otoscope. What technique would these students learn for best visualization of the tympanic membrane in an adolescent? A) Hold the ear at the tragus and lift up and back B) Hold the ear at the pinna and pull down and back C) Hold the ear at the auricle and pull down and back D) Hold the ear at the helix and lift up and back

D) Hold the ear at the helix and lift up and back

it helps to differentiate the cause of unilateral hearing loss. you must activate the fork, and place the handle on the midline of the parietal bone

What does the weber test do?

it is the most efficient method. it is the normal pathway for sounds to travel to the inner ear.

describe air conduction.

it bypasses the external ear and delivering sound waves/vibrations directly to the inner through the skull

describe bone conduction.

by clearing the obstruction

how do you remedy external auditory blockage?

hold the patient's ear at the helix and lift up and back to align the canal for best visualization of the tympanic membrane. after visualizing the TM,

how should you position the patients ear in order to look inside with the otoscope?

sensorineural loss in the ear in which the patient does not hear or had reduced perception of sound.

unilateral identification of the sound indicates what?

the cochlea organ of Corti auditory nerve auditory cortex

what are different sites of dysfunction?

farmers firefighters police EMT heavy machinery operator military personnel music industry members

what are some examples of workers that are at high risk for harmful noise exposure?

lifestyle choices environmental risks

what are some risk factors that can be influenced?

age gender heredity family history

what are some risk factors that cannot be controlled?

tiny bones responsible for conducting sound waves to the inner ear

what are stapes?

the tympanic membrane the cochlear window- connects the middle and inner ear oval window- the stapes rests here which completes the connection to the cochlea eustachian tube- allows for pressure regulation of the middle ear

what are the four openings of the middle ear?

external ear-visualized easily without tools middle ear- a small space behind the tympanic membrane extended to the pharyngotympanic tube. inner ear- vestibular portion

what are the three distinct portions of the ear?

amplitude (volume) and frequency (pitch)

what are the two components of sound that the cochlea interprets?

hearing and sustaining equilibrium

what are the two separate functions of the ear?

microtia macrotia edematous ear cartilaginous Pseudomonas carcinoma on auricles cyst frostbite

what are unexpected findings when inspecting the ear?

examines the difference between air and bone conduction

what does the Rinne test do?

presbycusis. this can be related to aging or ototoxic drugs

what is a common sensorineural loss, resulting form gradual degeneration of nerves and sensory hair cells of the organ of Corti?

tinnitus

what is a perception of buzzing or ringing in one or both ears that does not correspond with an external sound?

yellow or dark brown, varying from liquid to firm paste

what is a usual color for cerumen?

the change in atmospheric pressure against the tympanic membrane

what is amplitude?

eustachian tube which connects the middle ear to the nasopharynx

what is another name for the pharyngotympanic tube?

an abnormal accumulation of squamous epithelium within the middle ear. this growth can erode the auditory ossicles and cause damage

what is cholesteatoma?

it occurs when sound wave transmission through the external or middle ear is disrupted. it may result in either blockage of the external auditory canal by cerumen or fluid in the middle ear

what is conductive hearing loss?

otitis externa which may result from induced trauma

what is external ear sensitivity?

the number of cycles per second the sound wave makes is measured in units of hertz

what is frequency?

results from the slow fusion of any combination of the ossicles in the middle ear. The fusion leads to obstruction of the transmission of sound waves from the TM to the oval window and inner ear

what is ostosclerosis?

pain in the ear (earache). this can be referred from the pharynx.

what is otalgia?

a natural sensorineural loss

what is presbycusis?

a small painless nodule on the helix of the ear

what is the darwinian tubercle?

its design guides the sound waves into the meatus of the external auditory canal, which is a chamber that transitions from firm cartilage to bone and ends at the tympanic membrane

what is the function of the external ear?

to act as a volume dampener to protect the inner ear

what is the function of the inner ear?

auditory trauma related to excessive noise exposure

what is the most common cause of conductive hearing loss in adults?

it may be quiet and a minor annoyance or so loud that it makes hearing normal conversation or restful sleep impossible

what is the perceived sound of tinnitus?

to evaluate for skin breakdown or lesions, edema, erythema, or discharge

what is the purpose of inspecting for the size, shape, and condition of the skin on an external ear?

to evaluate cerumen, discharge, foreign bodies, erythema, or lesions

what is the purpose of inspecting the external canal using the otoscope

to evaluate for congenital problems

what is the purpose of inspecting the external ear position

to note color, characteristics, position, and integrity

what is the purpose of inspecting the tympanic membrane?

to identify cues that might indicate hearing loss

what is the purpose of observing behavioral responses to speech?

to note lumps, masses, and tenderness

what is the purpose of palpating the external ear?

to evaluate air conduction and bone conduction

what is the purpose of performing the rinne test?

to evaluate unilateral hearing loss

what is the purpose of performing the weber test?

to evaluate for high pitch hearing loss

what is the purpose of performing the whisper test?

the translation of sound to CN VIII (auditory nerve) which transmits it to the brainstem

what is the responsibility of the inner ear?

a problem somewhere beyond the middle ear, from inner ear to auditory cortex

what is the result of sensorineural hearing loss?

*the external ear channels sound waves into the external auditory canal through the tympanic membrane, to ossicles in the inner ear via the oval window, then the cochlea. *the basal membrane of the cochlea vibrates the receptor hair cells of the organ of Corti, which transfer the signal into electrical impulses of the auditory nerve *The auditory nerve then delivers those impulses to the auditory complex of the temporal lobe

what is the steps towards being able to hear?

an inability to filter internaal noise from the external input of sound

what is tinnitus?

the sensation of the room spinning, which indicates dysfunction of the bony labyrinth in the inner ear

what is vertigo

a disease where the labyrinth is inflamed, causing loss of equilibrium

what is vertigo?

hemotympanum otorrhea tympanic membrane

what may indicate barotrauma from pressure changes or basilar skull fracture?

the eustachian tube

what opens briefly during swallowing and yawning?

semicircular canal and vestibule (utricle and saccule)

what provides the body with proprioception and equilibrium?

romberg test

what test assesses equilibrium?

air conduction and bone conduction

what two ways are sounds perceived?

in the semicircular canal and vestibule

where is vestibular function maintained?

mumps

wht can cause sensorineural deafness in people who do not get vaccinated, did not develop immunity, or had decreased immunity over time?