Chapter 16: Ears
The nurse assesses the hearing of a 7-month-old by clapping hands. What is the expected response? a. The infant shows no obvious response to the noise. b. The infant shows a startle and acoustic blink reflex. c. The infant turns his or her head to localize the sound. d. The infant stops any movement, and appears to listen for the sound.
ANS: C With a loud sudden noise, the nurse should notice the infant turning his or her head to localize the sound and to respond to his or her own name. A startle reflex and acoustic blink reflex is expected in newborns; at age 3 to 4 months, the infant stops any movement and appears to listen. A 7-month-old infant should respond to noise. With a loud sudden noise, the nurse should notice the infant turning his or her head (not stopping any movement) to localize the sound and to respond to his or her own name.
The nurse is testing the hearing of a 78-year-old man and is reminded of the changes in hearing that occur with aging that include which of the following? (Select all that apply.) a. Progression of hearing loss is slow. b. The aging person has low-frequency tone loss. c. Sounds may be garbled and difficult to localize. d. Hearing loss r/t aging begins in the mid-40s. e. Hearing loss reflects nerve degeneration of the middle ear. f. The aging person may find it harder to hear consonants than vowels.
ANS: A, C, F Presbycusis is a type of hearing loss that occurs with aging and is found in 60% of those older than 65 years. It is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve, and it slowly progresses after the age of 50 years. The person first notices a high-frequency tone loss; it is harder to hear consonants (high-pitched components of speech) than vowels, which makes words sound garbled. The ability to localize sound is also impaired.
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 that air bubbles are visible behind the tympanic membrane. The child reports occasional hearing loss and a popping sound with swallowing. Based on this data, what does the nurse conclude? a. An acute purulent otitis externa b. Most likely a serous otitis media c. Evidence of a resolving cholesteatoma d. Experiencing the early stages of perforation
ANS: B An amber-yellow color to the tympanic membrane suggests serum or pus in the middle ear. Air or fluid or bubbles behind the tympanic membrane are often visible. The patient may have feelings of fullness, transient hearing loss, and a popping sound with swallowing. These findings most likely suggest that the child has serous otitis media. The other responses are not correct. The manifestation of otitis externa is a sticky, yellow discharge (not an amber-yellow tympanic membrane). Cholesteatoma is an overgrowth of epidermal tissue in the middle ear or temporal bone that has a pearly white, cheesy appearance (not an amber-yellow color). A perforation typically begins with ear pain and stops with a popping sensation and then drainage occurs. This patient's amber-yellow color to the tympanic membrane suggests serum or pus in the middle ear. Air or fluid or bubbles behind the tympanic membrane are often visible.
A patient has been admitted after an accident at work. During the assessment, the patient is having trouble hearing and states, "I don't know what is the matter. All of a sudden I can't hear you out of my left ear!" What should the nurse do next? a. Irrigate the ear with rubbing alcohol. b. Notify the patient's health care provider. c. Prepare to remove cerumen from the patient's ear. d. Make note of this finding for the report to the next shift.
ANS: B Any sudden loss of hearing in one or both ears that is not associated with an upper respiratory infection needs to be reported at once to the patient's health care provider. Hearing loss associated with trauma is often sudden. Irrigating the ear or removing cerumen is not appropriate at this time. This is not a normal finding.
The nurse is performing a middle ear assessment on a 15-year-old patient who has had 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. What should the nurse do? a. Refer the patient for the possibility of a fungal infection. b. Recognize that these are scars caused from frequent ear infections. c. Consider that these findings may represent the presence of blood in the middle ear. d. Be concerned about the ability to hear because of this abnormality on the tympanic membrane.
ANS: B Dense white patches on the tympanic membrane are sequelae of repeated ear infections. They do not necessarily affect hearing. A fungal infection manifests as a colony of black or white dots on the eardrum or canal walls (not dense white patch). Blood behind the tympanic membrane would cause the tympanic membrane to appear blue or dark red.
A patient in her first trimester of pregnancy is diagnosed with rubella. Which of these statements is correct regarding the significance of this in relation to the infant's hearing? a. Rubella may affect the mother's hearing but not the infant's. b. Rubella can damage the infant's organ of Corti, which will impair hearing. c. Rubella can impair the development of cranial nerve VIII and thus affect hearing. d. Rubella is especially dangerous to the infant's hearing in the second trimester of pregnancy.
ANS: B If maternal rubella infection occurs during the first trimester, then it can damage the organ of Corti and impair hearing. Maternal rubella can affect the infant's hearing, not the mother's hearing, if it occurs in the first trimester of pregnancy. Hearing is impaired due to damage to the organ of Corti, not cranial nerve VIII. Rubella does not impair the development of cranial nerve VIII.
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 of a television or radio. What is the most likely cause of this hearing loss? a. Presbycusis b. Otosclerosis c. Trauma to the bones d. Frequent ear infections
ANS: B Otosclerosis is a common cause of conductive hearing loss in young adults between the ages of 20 and 40 years. Presbycusis is a type of hearing loss that occurs with aging. Trauma and frequent ear infections are not a likely cause of his hearing loss. Instead, a common cause of conductive hearing loss (mechanical dysfunction of the external or middle ear which causes partial hearing loss that can be compensated for with an increase in amplitude) in young adults between the ages of 20 and 40 years is otosclerosis.
When examining the ear with an otoscope, how should the tympanic membrane look? a. Light pink with a slight bulge b. Pearly gray and slightly concave c. Whitish with black flecks or dots d. Pulled in at the base of the cone of light
ANS: B The tympanic membrane is a translucent membrane with a pearly gray color and a prominent cone of light in the anteroinferior quadrant, which is the reflection of the otoscope light. The tympanic membrane is oval and slightly concave, pulled in at its center by the malleus, which is one of the middle ear ossicles. A light pink color and a slight bulge of the tympanic membrane indicate otitis media. It should not look white and if there are tiny black flecks or dots, that is indicative of a fungal infection, or otomycosis. The tympanic membrane does not appear pulled in at the base of the cone of light, but should instead appear flat and slightly pulled in at the center. A normal tympanic membrane should appear a pearly gray color and have a prominent cone of light in the anteroinferior quadrant, which is the reflection of the otoscope light. The tympanic membrane is oval and slightly concave, pulled in at its center by the malleus, which is one of the middle ear ossicles.
A 17-year-old student is a swimmer on her high school's swim team. She has had three bouts of otitis externa this season and wants to know what to do to prevent it. What should the nurse include in the instructions? a. Use a cotton-tipped swab to dry ear canals thoroughly after each swim. b. Use rubbing alcohol or 2% acetic acid eardrops after every swim. c. Irrigate the ears with warm water and a bulb syringe after each swim. d. Rinse the ears with a warmed solution of mineral oil and hydrogen peroxide.
ANS: B With otitis externa (swimmer's ear), swimming causes the external canal to become waterlogged and swell; skinfolds are set up for infection. The rubbing alcohol and acetic acid mix with the water in the ear and then evaporate. The use of cotton-tip swabs in the ears is not recommended as cotton can be left in the ear and it can also impact cerumen. Irrigating the ears is done to clean the ears, not prevent otitis externa. Otitis externa can be prevented by using rubbing alcohol or 2% acetic acid eardrops after every swim.
In performing a voice test to assess hearing, which of these actions would the nurse perform? a. Shield the lips so that the sound is muffled. b. Whisper a set of random numbers and letters, and then ask the patient to repeat them. c. Ask the patient to place his or her finger in their ear to occlude outside noise. d. Stand approximately 4 feet away to ensure that the patient can really hear at this distance.
ANS: B With the examiner's head 30 to 60 cm (1 to 2 feet) from the patient's ear, have the patient place one finger on the tragus of the ear and push it in and out of the auditory meatus. While the patient is doing this, the examiner exhales and slowly whispers a set of random numbers and letters, such as "5, B, 6." Normally the patient is asked to repeat each number and letter correctly after hearing the examiner say them. Shielding the lips to muffle the sound, asking the patient to place a finger in their ear to occlude outside noise, and the examiner standing 4 feet away from the patient are not techniques used to perform the voice test. The voice test is performed with the examiner's head 30 to 60 cm (1 to 2 feet) from the patient's ear and having the patient place one finger on the tragus of the ear and push it in and out of the auditory meatus. While the patient is doing this, the examiner exhales and slowly whispers a set of random numbers and letters, such as "5, B, 6." Normally, the patient is asked to repeat each number and letter correctly after hearing the examiner say them and then exhaling and slowly whispering a set of random numbers and letters, such as "5, B, 6." Normally the patient is asked to repeat each number and letter correctly after hearing the examiner say them
While performing the otoscopic examination 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 that the light reflex is not visible. What do these findings indicate? a. Cholesteatoma b. A fungal infection c. An acute otitis media d. A perforation of the eardrum
ANS: C Absent or distorted light reflex and a bright red color of the eardrum are indicative of acute otitis media. Cholesteatoma is an overgrowth of epidermal tissue in the middle ear or temporal bone that has a pearly white, cheesy appearance (not bright red). A fungal infection manifests as a colony of black or white dots on the eardrum or canal walls (not bright red). A perforated eardrum usually appears as a round or oval darkened area on the drum. This patient's absent light reflex and bright red color indicate acute otitis media.
A patient with a middle ear infection asks the nurse, "What does the middle ear do?" Which is the best response by the nurse? a. It helps maintain balance. b. It interprets sounds as they enter the ear. c. It conducts vibrations of sounds to the inner ear. d. It increases the amplitude of sound for the inner ear to function.
ANS: C Among its other functions, the middle ear conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear. The other responses are not functions of the middle ear. The inner ear, not the middle ear, helps with balance. Sound is interpreted in the cerebral cortex, not the middle ear. The middle ear reduces the amplitude of loud sounds, not increase them, to protect the inner year. The functions of the middle ear are to conduct sound vibrations from the outer ear to the central hearing apparatus in the inner ear; protect the inner ear by reducing the amplitude of loud sounds; and allow equalization of air pressure on each side of the tympanic membrane via the eustachian tubes so that the membrane does not rupture.
The nurse is examining a patient's ears and notices cerumen in the external canal. Which of these statements about cerumen is correct? a. Wet, honey-colored cerumen is a sign of infection. b. The presence of cerumen is indicative of poor hygiene. c. The purpose of cerumen is to protect and lubricate the ear. d. Cerumen is necessary for transmitting sound through the auditory canal.
ANS: C The ear is lined with glands that secrete cerumen. Cerumen is genetically determined, with two distinct types. Wet, honey-brown occurs in Caucasians and African Americans, and a dry, flaky white is found in East Asians and American Indians. Cerumen is supposed to be present-to lubricate, waterproof, and clean the external auditory canal. It also is antibacterial, and traps foreign bodies. Wet, honey-colored cerumen is not a sign of infection. Cerumen is not a sign of poor hygiene. It is supposed to be present-to lubricate, waterproof, and clean the external auditory canal. It also is antibacterial, and traps foreign bodies. It is not necessary for transmitting sound through the auditory canal and too much cerumen can impair hearing.
The nurse is reviewing the function of the cranial nerves (CNs). Which CN is responsible for conducting nerve impulses to the brain from the organ of Corti? a. I b. III c. VIII d. XI
ANS: C The nerve impulses are conducted by the auditory portion of CN VIII to the brain. Cranial nerve I, the olfactory nerve, is responsible for the sense of smell. Cranial nerve III, the oculomotor, innervates the superior, inferior, and medial rectus and the inferior oblique muscles of the eye. Cranial nerve XI, the accessory nerve, controls the muscles of the neck. The nerve that conducts nerve impulses from the organ of Corti to the brain is CN VIII, the vestibulocochlear nerve.
The nurse is performing an otoscopic examination on an adult. Which of these actions is correct? a. Tilt the person's head forward during the examination. b. Once the speculum is in the ear, releasing the traction. c. Pulling the pinna up and back before inserting the speculum. d. Using the smallest speculum to decrease the amount of discomfort.
ANS: C The pinna is pulled up and back on an adult or older child, which helps straighten the S-shape of the canal. Traction should not be released on the ear until the examination is completed and the otoscope is removed. The nurse should tilt the patient's head slightly away from them and toward the opposite shoulder, not forward. The traction on the pinna of the ear should not be released until the examination is finished and the otoscope has been removed. The largest speculum that fits comfortably in the ear, not the smallest, should be used. The correct action is to pull the pinna up and back on an adult or older child (down and back on an infant or child under the age of 3), which helps straighten the S-shape of the canal.
During an examination, the patient states he is hearing a buzzing sound and says that it is "driving me crazy!" What does this indicate? a. Vertigo b. Pruritus c. Tinnitus d. Cholesteatoma
ANS: C Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders. Vertigo is a strong spinning, whirling sensation; pruritus is itching; and cholesteatoma is an overgrowth of epidermal tissue in the middle ear or temporal bone that has a pearly white, cheesy appearance. The buzzing sound this patient is hearing is tinnitus.
During an examination, the nurse notices that the patient stumbles a little while walking, and, when she sits down, she holds on to the sides of the chair. The patient states, "It feels like the room is spinning!" What do this signs and symptoms indicate? a. Tinnitus b. Dizziness c. Objective vertigo d. Subjective vertigo
ANS: C With objective vertigo, the patient feels like the room spins; with subjective vertigo, the person feels like he or she is spinning. Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders. Dizziness is not the same as true vertigo; the person who is dizzy may feel unsteady and light-headed. With subjective vertigo, the person feels like he or she is spinning. The symptom this patient has, that the room is spinning, is objective vertigo.
During an otoscopic examination, the nurse notices an area of black and white dots on the tympanic membrane and the ear canal wall. What does this finding suggest? a. Malignancy b. Viral infection c. Blood in the middle ear d. Yeast or fungal infection
ANS: D A colony of black or white dots on the drum or canal wall suggests a yeast or fungal infection (otomycosis). A colony of black and white dots on the eardrum is not a manifestation of malignancy, a viral infection, of blood in the middle year. Blood in the middle year would cause a blue or dark red appearance of the eardrum.
The nurse is conducting a child safety class for new mothers. Which factor places young children at risk for ear infections? a. Family history b. Air conditioning c. Excessive cerumen d. Passive cigarette smoke
ANS: D Exposure to passive and gestational smoke is a risk factor for ear infections in infants and children. A family history of ear infections, air conditioning, or excessive cerumen are at not risk factors for ear infections.
The nurse is performing an assessment on a 65-year-old man. He reports a crusty nodule behind the pinna. It intermittently bleeds and has not healed over the past 6 months. On physical assessment, the nurse finds an ulcerated crusted nodule with an indurated base. Based on these findings, what does the nurse suspect? a. Most likely a keloid b. Probably a benign sebaceous cyst c. Could be a potential carcinoma, and the patient should be referred for a biopsy d. A tophus, which is common in the older adult and is a sign of gout
ANS: C An ulcerated crusted nodule with an indurated base that fails to heal is characteristic of a carcinoma. These lesions fail to heal and intermittently bleed. Individuals with such symptoms should be referred for a biopsy. The other responses are not correct. A keloid is an overgrowth of scar tissue which in the ear is common at lobule at the site of a pierced ear. A sebaceous cyst is a nodule filled with waxy sebaceous material, is painful if it becomes infected, and is often multiple of them. A tophus is a hard uric acid deposit under the skin. The ulcerated crusted nodule with an indurated base that fails to heal that this patient has is characteristic of a carcinoma.
During an assessment of a 20-year-old Asian patient, the nurse notices that he has dry, flaky, white cerumen in his canal. What is the significance of this finding? a. It represents poor hygiene. b. It is probably the result of lesions from eczema in his ear. c. It is a normal finding, and no further follow-up is necessary. d. It could be indicative of change in cilia; the nurse should assess for hearing loss.
ANS: C Asians and American Indians are more likely to have dry cerumen, which appears white and flaky, whereas blacks and whites usually have wet cerumen that appears honey-brown. Dry, flaky cerumen in an Asian patient is not a result of poor hygiene, lesions from eczema, or change in cilia.
The nurse is preparing to perform an otoscopic examination of a newborn infant. Which statement is true regarding this examination? a. An injected membrane may indicate an infection. b. The eardrum will appear in the oblique position. c. The normal membrane may appear thick and opaque. d. The appearance of the membrane is identical to that of an adult.
ANS: C During the first few days after the birth, the tympanic membrane of a newborn often appears thickened and opaque. It may look injected and have a mild redness from increased vascularity. The eardrum of a neonated is more horizontal, making it more difficult to see completely. By one month of age the drum is in the oblique (more vertical) position as in the adult. During the first few days after the birth, the tympanic membrane of a newborn often appears thickened and opaque. It may look injected and have a mild redness from increased vascularity, but it is not due to infection. The eardrum of a neonated is more horizontal (not oblique), making it more difficult to see completely. By one month of age the drum is in the oblique (more vertical) position as in the adult.
The nurse is assessing a 16-year-old patient who has suffered head injuries from a recent motor vehicle accident. Which of these statements indicates the most important reason for assessing for any drainage from the ear canal? a. The auditory canal may be occluded from increased cerumen. b. If the drum has ruptured, then purulent drainage will result. c. Bloody or clear watery drainage can indicate a basal skull fracture. d. Foreign bodies from the accident may cause occlusion of the ear canal.
ANS: C Frank blood or clear watery drainage (cerebrospinal fluid) after a trauma suggests a basal skull fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media. An ear canal occluded from cerumen would not be draining, purulent drainage indicates otitis externa or otitis media, and it is not likely a foreign body from an accident would cause occlusion of the ear canal.
During an interview, the patient states he has the sensation that "everything around him is spinning." What part of the ear should the nurse recognize is responsible for this sensation? a. Cochlea b. CN VIII c. Labyrinth d. Organ of Corti
ANS: C If the labyrinth of the ear becomes inflamed, it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo. The cochlea, which contains the central hearing apparatus, and cranial nerve VIII, the vestibulocochlear nerve, which conducts nerve impulses from the organ of Corti to the brain, are all involved with hearing. The spinning sensation that this patient is experiencing is from the labyrinth of the ear.
A 70-year-old patient tells the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says "I can't always tell where the sound is coming from" and that the words often sound "mixed up." What might the nurse suspect as the cause for this change? a. Atrophy of the apocrine glands b. Cilia becoming coarse and stiff c. Nerve degeneration in the inner ear d. Scar tissue in the tympanic membrane
ANS: C Presbycusis is a type of hearing loss that occurs in 60% of those older than 65 years of age, even in those living in a quiet environment. This sensorineural loss is gradual and caused by nerve degeneration in the inner ear. Words sound garbled, and the ability to localize sound is also impaired. This communication dysfunction is accentuated when background noise is present. Atrophy of the apocrine glands causes cerumen to be more dry and cilia becoming coarse and stiff may cause cerumen to accumulate and oxidize and reduce hearing but they do cause this patient's symptoms of not being able to locate the source of sounds or sounds being mixed up. Scarring of the tympanic eardrum are sequelae of repeated ear infections but do not necessarily affect hearing.
A patient has been identified as having a sensorineural hearing loss. What would be important for the nurse to do during the assessment of this patient? a. Speak loudly so the patient can hear the questions. b. Assess for middle ear infection as a possible cause. c. Ask the patient what medications he is currently taking. d. Look for the source of the obstruction in the external ear.
ANS: C Sensorineural hearing loss may be caused by presbycusis, which is a gradual nerve degeneration that occurs with aging and by ototoxic drugs, which affect the hair cells in the cochlea. So the nurse should ask the patients about the medications they have been taking. A simple increase in amplitude may not enable the person to understand spoken words. The middle ear and obstruction of the external ear are not associated with sensorineural hearing loss so the nurse should not assess for a middle ear infection or external ear obstruction.
The nurse is performing an ear examination of an 80-year-old patient. Which of these findings would be considered normal? a. High-tone frequency loss b. Thin, translucent membrane c. Shiny, pink tympanic membrane d. Increased elasticity of the pinna
ANS: A A high-tone frequency hearing loss is apparent for those affected with presbycusis, the hearing loss that occurs with aging. The pinna loses elasticity (not increases), causing ear lobes to be pendulous. The eardrum may be whiter in color and more opaque and duller (not translucent or shiny, pink) in the older person than in the younger adult.
The nurse suspects that a patient has otitis media. Early signs of otitis media include which of these findings of the tympanic membrane? a. Hypomobility b. Fiery red and bulging of entire eardrum c. Retraction with landmarks clearly visible d. Flat, slightly pulled in at the center, and moves with insufflation
ANS: A An early sign of otitis media is hypomobility of the tympanic membrane. As pressure increases, the tympanic membrane begins to bulge. A fiery red color and bulging of the entire eardrum is not an early sign of otitis media but occurs a little later. A retracted tympanic membrane with landmarks clearly visible indicates a blocked eustachian tube which is not an early sign of otitis media. A tympanic membrane that is flat, slightly pulled in at the center, and moves with insufflation is a normal eardrum, not a manifestation of otitis media.
While discussing the history of a 6-month-old infant, the mother tells the nurse that she took a significant amount of aspirin while she was pregnant. What question would the nurse want to include in the history? a. "Does your baby seem to startle with loud noises?" b. "Has your baby had any surgeries on her ears?" c. "Have you noticed any drainage from her ears?" d. "How many ear infections has your baby had since birth?"
ANS: A Children exposed in utero to a variety of conditions, such as maternal rubella or to maternal ototoxic drugs are at risk for hearing deficits. Aspirin can be ototoxic, so the nurse should ask if the baby seems to startle with loud noises.
The nurse is preparing to do an otoscopic examination on a 2-year-old child. Which one of these reflects the correct procedure? a. Pulling the pinna down b. Pulling the pinna up and back c. Slightly tilting the child's head toward the examiner d. Instructing the child to touch their chin to their chest
ANS: A For an otoscopic examination on an infant or a child under 3 years of age, the pinna is pulled down. The other responses are not part of the correct procedure. The pinna should be pulled up and back for an otoscopic exam of an adult, not a child under 3 years of age. The child's head should be tilted slightly away from the examiner towards the opposite shoulder, not towards the examiner or to their chin. For an otoscopic examination on an infant or on a child under 3 years of age, the pinna is pulled down.
The nurse is assessing a patient who may have hearing loss. Which of these statements is true concerning air conduction? a. Air conduction is the normal pathway for hearing. b. Amplitude of sound determines the pitch that is heard. c. Vibrations of the bones in the skull cause air conduction. d. Loss of air conduction is called a conductive hearing loss.
ANS: A The normal pathway of hearing is air conduction, which starts when sound waves produce vibrations on the tympanic membrane. Conductive hearing loss results from a mechanical dysfunction of the external or middle ear. The other statements are not true concerning air conduction. The frequency of sound waves is what determines pitch, not the amplitude. Vibrations of the bones in the skull are bone conduction, not air conduction. Conductive hearing loss involves mechanical dysfunction of the external or middle ear and is caused by impacted cerumen, foreign bodies, a perforated tympanic membrane, pus or serum in the middle ear, and otosclerosis, not loss of air conduction.
How should the nurse perform an examination of a 2-year-old child with a suspected ear infection? a. Pull the ear up and back before inserting the speculum. b. Omit the otoscopic examination if the child has a fever. c. Ask the mother to leave the room while examining the child. d. Perform the otoscopic examination at the end of the assessment.
ANS: D In addition to its place in the complete examination, eardrum assessment is mandatory for any infant or child requiring care for an illness or fever. For the infant or young child, the timing of the otoscopic examination is best toward the end of the complete examination because many young children protest vigorously during this procedure and it is difficult to re-establish cooperation afterward. When performing an ear examination on a 2-year-old child, with or without a suspected ear infection, the pinna should be pulled down (not up) and back. In addition to its place in the complete examination, eardrum assessment is mandatory for any infant or child requiring care for an illness or fever, so should not be omitted. Rather than asking the parent to leave the room, the nurse should enlist the parent's help in holding the child to protect the eardrum from injury.
The mother of a 2-year-old toddler is concerned about the upcoming placement of tympanostomy tubes in her son's ears. The nurse would include which of these statements in the teaching plan? a. The tubes are placed in the inner ear. b. The tubes are used in children with sensorineural loss. c. The tubes are permanently inserted during a surgical procedure. d. The purpose of the tubes is to decrease the pressure and allow for drainage.
ANS: D Polyethylene tubes are surgically inserted into the eardrum (not the inner ear) to relieve middle ear pressure and to promote drainage of chronic or recurrent middle ear infections (not for sensorineural hearing loss). The tube is not permanent but spontaneously extrudes in 6 months to 1 year.
A 31-year-old patient tells the nurse that he has noticed pain in his left ear when people speak loudly to him. What does this finding indicate? a. A cerumen impaction b. Normal for people of his age c. Possible middle ear infection d. A characteristic of recruitment
ANS: D Recruitment is significant hearing loss occurring when speech is at low intensity, but sound actually becomes painful when the speaker repeats at a louder volume. The other responses are not correct. A cerumen impaction and ear infection do not cause these symptoms and these are not normal findings. Instead, this patient's symptoms are a characteristic of recruitment.
An assessment of a 23-year-old patient reveals the following: an auricle that is tender and reddish-blue in color with small vesicles. The nurse would need to know additional information that includes which of these? a. Any change in ability to hear b. Any recent drainage from the ear c. Recent history of trauma to the ear d. Any prolonged exposure to extreme cold
ANS: D Reddish-blue discoloration and swelling of the auricle are manifestations of frostbite so the nurse should ask about any prolonged exposure to extreme cold rather than changes in ability to hear or drainage or recent trauma to the ear. Frostbite causes reddish-blue discoloration and swelling of the auricle after exposure to extreme cold. Vesicles or bullae may develop, and the person feels pain and tenderness.
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? a. "It is unusual for a small child to have frequent ear infections unless something else is wrong." b. "We need to check the immune system of your son to determine why he is having so many ear infections." c. "Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear." d. "Your son's eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily."
ANS: D The infant's eustachian tube is relatively shorter and wider than the adult's eustachian tube, and its position is more horizontal; consequently, pathogens from the nasopharynx can more easily migrate through to the middle ear. The other responses are not appropriate. It is not unusual for a small child to have frequent ear infections, thus, it is not necessary to check the immune system. The reason that ear infections in infants and toddlers is not uncommon is not due to more cerumen but because the infant's eustachian tubes are relatively shorter and wider than the adult's eustachian tube, and its position is more horizontal; consequently, pathogens from the nasopharynx can more easily migrate through to the middle ear.
In an individual with otitis externa, which of these signs would the nurse expect to find on assessment? a. Rhinorrhea b. Periorbital edema c. Pain over the maxillary sinuses d. Enlarged superficial cervical nodes
ANS: D The lymphatic drainage of the external ear flows to the parotid, mastoid, and superficial cervical nodes. The signs are severe swelling of the canal, inflammation, and tenderness. Rhinorrhea, periorbital edema, and pain over the maxillary sinuses do not occur with otitis externa
The nurse is taking the history of a patient who may have a perforated eardrum. What would be an important question in this situation? a. "Do you ever notice ringing or crackling in your ears?" b. "When was the last time you had your hearing checked?" c. "Have you ever been told that you have any type of hearing loss?" d. "Is there any relationship between the ear pain and the discharge you mentioned?"
ANS: D Typically with perforation, ear pain occurs first and resolves after a popping sensation, then drainage occurs.
