Health Assesment Ears

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 mother of a small child with tubes in both eardrums asks the nurse if it is okay if the child travels by airplane. What is the nurse's best response?

"It's safe to fly because the tubes will equalize pressure."

When assessing the tympanic membrane, where would the nurse expect to see a cone of light?

Anterior quadrant In the anterior quadrant of the tympanic membrane, a distinct cone of light is visible, which is caused by the light of the otoscope reflecting off the posterior wall of the middle ear. The outer rim of the tympanic membrane, the annulus, is thicker and more fibrous than the rest. Most of the tympanic membrane, pars tensa, is stretched tightly and easy to see through. Pars flaccida, a small portion of the tympanic membrane above the short process of the malleus, is more relaxed and opaque.

Upon inspection of an elderly client's ears using an otoscope, the nurse observes a cloudy appearance to the tympanic membranes with prominent landmarks. What action should the nurse perform first?

Ask whether the client is experiencing ear pain or pressure The older client's eardrums may appear cloudy with prominent landmarks due to the atrophy of the tympanic membranes associated with normal aging. The nurse should ask the client about ear pain because prominent landmarks can also be a sign of negative pressure associated with obstructed eustachian tubes. An ear infection should be ruled out and problems with hearing and balance assessed before making a clinical judgment that this is a normal finding. All objective information should be documented by the nurse.

An alternate pathway that bypasses the external and middle ear is called what?

Bone Conduction

A 55-year-old male presents to the health care clinic with reports of decreased hearing over the past year. Which subjective data in the client's review of systems should the nurse recognize as risk factors for hearing loss? Select all that apply.

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

A client presents at the clinic with a chief complaint of right ear pain. The nurse notes a rash in the right ear canal. What should the nurse know is a possible cause of these symptoms?

Chronic otitis media Unusually soft wax, debris from inflammation or rash in the ear canal, or discharge through a perforated eardrum may be secondary to acute or chronic otitis media.

A nurse is inspecting the ears of an Asian client and observes that her earlobes appear soldered, or tightly attached to adjacent skin with no apparent lobe. Which of the following should the nurse do next?

Continue with the examination Earlobes may be free, attached, or soldered (tightly attached to adjacent skin with no apparent lobe). Most African Americans and Caucasians have free lobes, whereas most Asians have attached or soldered lobes, although any type is possible in all cultural groups. Thus, this finding is normal and does not need to be reported to the physician, followed up on with a question to the client about an ear injury, or recorded and followed up on at a later visit.

An avid swimmer presents with ear pain. Her history includes pain and drainage from the left ear. On examination, she has pain when the ear, including the tragus, is manipulated. The canal is narrowed and erythematous with some white debris in the canal. The rest of the examination is normal. What diagnosis would be most appropriate for this client?

External otitis This is a classic history and examination of a client suffering from external otitis. Otitis media would not usually include pain with movement of the external ear or drainage unless the eardrum was perforated. In this case, the examination of the eardrum is recorded as normal. Cholesteatoma is a growth behind the eardrum and would not account for these symptoms. Otitis media would classically be accompanied by a bulging, erythematous eardrum.

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?

Fluid collects in the middle ear causing an obstruction of the auditory tube. 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 client has been receiving intravenous antibiotics for several weeks. Which prevention strategy would be best for the nurse to recommend for this client?

Formal hearing test

A client has been receiving intravenous antibiotics for several weeks. Which prevention strategy would be best for the nurse to recommend for this client?

Formal hearing test One group at risk for developing a hearing loss is those who are receiving intravenous antibiotics. The prevention strategy that would be applicable for this client would be a formal hearing test. Although the other tests including whisper hearing test, rubbing fingers test and tuning fork test can be used to test hearing, these are not considered the gold standard. These tests would not be the best prevention strategy to rule out hearing loss in this case.

The nurse is assessing a 5-month-old Asian American infant whose mother has brought him to the clinic with reports that the baby is pulling at the ear and is sleepless and crying at night. When assessing the infant's ears, what color cerumen would the nurse expect to find?

Grey grey to white cerumen is often flakey and misdiagnosed as eczema. This type of cerumen, called dry cerumen, is most prevalent in Asians and Native Americans. Dark brown, light yellow, or gold cerumen is less common in Asian Americans.

A nurse is preparing to perform a general assessment of an adult client who is new to the clinic. How would the nurse prepare to obtain objective data about the client's ears? (Select all that apply.)

Have the client sit on the examination table To obtain objective data about the ears, it is best to make sure the client is comfortable and the room is quiet. It is ideal for the client's ears to be at the nurse's eye level to facilitate inspection that does not cause discomfort for the client. For adults and older children, nurses can perform the examination with the patient sitting on the examination table. The nurse would inspect before performing the whisper, Weber, and Rinne tests. The client would sit in the upright position, not semi-Fowler's position for the exam.

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

Hearing intact bilaterally on whisper test 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.

A registered nurse is working with a nurse practitioner at a local walk-in clinic. The nurse practitioner needs to perform an objective assessment of a client's left ear. What equipment would the RN make sure is in the room? Select all that apply.

High-pitched tuning fork Otoscope

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?

Hold the ear at the helix and lift up and back

When providing client teaching about the ears, what should the nurse be sure to include?

How the client cleans the ears

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.

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?

Left external ear within normal limits Small, painless nodules on the helix are a variation of normal anatomy known as Darwin's tubercle. The other options do not accurately describe the relevance of the nodules.

A client with hearing loss by whisper test is further examined with a tuning fork, using the Weber and Rinne maneuvres. The abnormal results are as follows: bone conduction is greater than air on the left, and the client hears the tuning fork better on the left. Which of the following is most likely?

Otosclerosis of the left ear The above pattern is consistent with a conductive loss on the left side. Causes would include foreign body, otitis media, perforation, and otosclerosis of the involved side.

A client has been diagnosed with conductive hearing loss. The nurse understands that which of the following could be the cause of this type of hearing loss?

Perforated eardrum The transmission of sound waves through the external and middle ear is referred to as conductive hearing and the transmission of sound waves in the inner ear is referred to as perceptive or sensorineural hearingTherefore, a conductive hearing loss would be related to a dysfunction of the external or middle ear (e.g., impacted ear wax, otitis media, foreign object, perforated eardrum, drainage in the middle ear, or otosclerosis). A sensorineural loss would be related to dysfunction of the inner ear (i.e., cranial nerve VIII, temporal lobe of brain, or organ of Corti).

The nurse is assessing the hearing of an older adult. Which type of hearing problem might the nurse expect to find in the older adult?

Presbycusis results from gradual degeneration of nerves and sensory hair cells of the organ of Corti and may be related either aging or use of ototoxic drugs. Tinnitus is a perception of buzzing or ringing in the ear(s) that does not correspond to an external sound. Disruption of sound wave transmission through the external or middle ear results in conductive hearing loss. Sensorineural hearing loss results from a problem from the inner ear to the auditory cortex.

When moving a client's left auricle up and back, the client reports pain. What should the nurse do?

Press on the left tragus to confirm the presence of discharge. Pain on movement of the auricle suggests otitis externa; the presence of discharge would confirm an infectious process and should be assessed. It is not likely necessary to abandon or change the sequence of otoscopic examination.

The nurse notes otitis media with effusion in the left ear of a 3-year-old child. Which assessment data is consistent with otitis media with effusion? You Selected:

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

A nurse is caring for a client that was in a motor vehicle accident and suffered damage to the external ear. The client asks the nurse how hearing will be affected on a long-term basis. Based on this information, what is the best description the nurse can tell the client about the function of the external ear?

Responsible for protecting internal structures of the ear from foreign substances.

A nurse performs a Rinne test on a client who relates a history of decreased hearing in the right ear. The test demonstrates that the client has conductive hearing loss in the right ear. What is the correct documentation of this test by the nurse?

Right: BC greater than AC; left AC greater than BC With normal hearing, air conduction should be heard longer than bone conduction. With hearing loss, bone conduction becomes longer than or equal to air conduction. The correct documentation of this finding is Right: BC greater than AC; left AC greater than BC.

Which of the following tests use a tuning fork between two positions to assess hearing?

Rinne n the Rinne test, the examiner shifts the stem of a vibrating tuning fork between two positions to test air conduction of sound and bone conduction of sound. The whisper test involves covering the untested ear and, whispering from a distance of 1 or 2 feet from the unoccluded ear, and the ability of the patient to repeat what was whispered. The watch tick test relies on the ability of the patient to perceive the high-pitched sound made by a watch held at the patient's auricle. The Weber's test uses bone conduction to test lateralization of sound.

A patient is diagnosed with otosclerosis, a condition in which the auditory ossicles develop a spongy consistency, which results in conductive hearing loss. It appears that the worst site is the inner most bone, which transmits sound waves through the oval window. Which bone is this?

Stapes Sound waves are transmitted through auditory ossicles as the vibration of the eardrum causes the malleus, the incus, and then the stapes to vibrate. As the stapes vibrates at the oval window, the sound waves are passed to the fluid in the inner ear. The umbo is the base of the malleus.

The nursing instructor is discussing ear problems. What would the instructor indicate is an abnormal finding?

Tenderness of the mastoid process Normal ear findings on physical assessment are firm auricles without lumps, nonpalpable lymph tissue, nontender ears, and no pain elicited during palpation or manipulation of the auricle. No pain should occur with palpation of the mastoid process. Enlarged lymph nodes indicate pathology or inflammation. Pain with auricle movement or tragus palpation indicates otitis externa or furuncle. Sclerosis of the tympanic membrane is a variation of normal ear findings. Atrophied lymph nodes and tenderness of the apex are distracters for this question.

The nursing instructor is discussing the difference between sensorineural and conductive hearing loss with his class. The discussion turns to evaluation for determining what kind of hearing loss a client has. What Weber test results would indicate the presence of a sensorineural loss?

The sound is better in the ear in which he has better hearing. A client with sensorineural hearing loss hears the sound better in the ear in which he has better hearing. The Weber test assesses bone conduction of sound and is used for assessing unilateral hearing loss. A tuning fork is used. A client with normal hearing hears the sound equally in both ears or describes the sound as centered in the middle of the head. A client whose hearing loss is conductive hears the sound better in the affected ear.

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

In performing an otoscopic examination of a client's tympanic membrane, the nurse observes through the membrane the tip of a landmark at the center of the membrane. Which of the following landmarks is this?

Umbo The malleus is the nearest auditory ossicle that can be seen through the translucent membrane and includes a handle and short process, which are closer to the edge of the membrane, and the umbo, or base, which is a center point landmark of the tympanic membrane. Pars flaccida is the top portion of the membrane, which appears to be less taut than the bottom portion. Pars tensa is the bottom of the membrane, which appears to be taut.

A client tells the nurse that it is difficult to hear normal conversation when in a room with a lot of noise. Which test should the nurse perform to assess the hearing ability of the client? You Selected:

Weber If a client reports the inability to hear normal conversation because of background noise, the client may be experiencing conduction hearing loss. This occurs be cause background noise in the room distracts the good ear from hearing sound by air which the poor ear cannot hear. The Weber test helps to differentiate conduction from sensorineural hearing loss. The Rinne test compares air and bone conduction. An otoscopic examination looks at the tympanic membrane for infection and swelling but not test hearing loss. Romberg is a test for equilibrium.

Upon examination of the ear with an otoscope, the nurse documents the skin of the ear canal as thickened, red, and itchy. The nurse would expect this finding with a diagnosis of

chronic otitis media

In the hearing pathway, hair cells of the spiral organ of Corti are stimulated by movement of

fluid. As the stapes vibrates at the oval window, the sound waves are passed to the fluid in the inner ear. The movement of this fluid stimulates the hair cells of the spiral organ of Corti and initiates the nerve impulses that travel to the brain by way of the acoustic nerve.

While assessing the ears of an adult client, the nurse observes that the tympanic membrane is completely immobile. The nurse should further assess the client for signs and symptoms of

infection. With otitis media, the membrane does not move or flutter when the bulb is inflated.

hile positioning the head to examine the ears the client expresses pain when the area behind the ears is touched. On which health problem should the nurse focus during the assessment of this client?

otitis media Tenderness behind the ear occurs in otitis media. Movement of the pinna and tragus is painful in acute otitis externa. Bloody purulent draining is associated with a ruptured tympanic membrane. Tenderness may be present over the posterior cheek in temporomandibular joint dysfunction.

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.