Auditory Problems

The nurse is assessing the auditory system of a newly admitted older adult patient. Which of these are age-related changes may be anticipated in the auditory system? Select all that apply.

Age-related changes in the auditory system include tinnitus, collapsed ear canal, increased sensitivity to loud sounds, diminished sensitivity to high-pitched sounds, and drier cerumen.

The nurse performs an otoscopic examination of the patient's left ear, which indicates the presence of an exostosis. What does the nurse anticipate will occur after this finding?

An exostosis is a bony growth into the ear canal that normally does not require intervention or correction. Therefore, surgery, electrocochleography, or irrigation of the ear canal are unnecessary.

The nurse is conducting an assessment for a patient with hearing loss. Which cranial nerve is associated with the processing of sound?

Cranial nerve VIII is associated with hearing and balance. Cranial nerve III controls eye movement, pupillary constriction, and upper eye lid elevation. Cranial nerve VI controls the sense of smell. Cranial nerve VII controls the expression in the forehead, eyes, and mouth, taste, salivation, and tearing.

A patient is diagnosed with sensorineural hearing loss. What potential causes of this disorder should the nurse discuss with the patient? Select all that apply.

Damage to the inner ear or damage to the vestibulocochlear nerve that lines the inner ear results in sensorineural hearing loss. An increase in cerumen will result in central loss of hearing because the auditory canal is blocked. The tympanic membrane is found in the external ear; impairment of the tympanic membrane is associated with impaired transmission of sound waves. Impairment of the auditory pathway will result in central loss of hearing.

A nurse is assessing a patient's hearing ability. Which findings would indicate compromised hearing? Select all that apply.

If the patient is lip reading or asks to have certain words repeated, the patient may have hearing loss. A patient with compromised hearing may look at the examiner intently but may miss a comment when not looking directly at the examiner. If the patient feels dizzy on standing up, it may indicate impaired equilibrium. While some people with hearing loss may speak loudly, this alone is not an indication of hearing loss.

Which abnormality does the nurse suspect if, while performing an otoscopic examination, a nurse has trouble visualizing the tympanum because of the presence of a bony growth?

Interference with visualization of the tympanum by a bony growth indicates that the patient has exostosis. The presence of hard nodules in the helix or antihelix indicates tophi. Swelling of the pinna is associated with infection of the glands of skin, which in turn is associated with trauma. A patient with impacted cerumen will have impaired hearing because the wax is not properly excreted from the ear.

A patient is diagnosed with a collapsed ear canal. What type of complication does the nurse associate with this diagnosis?

Loss of cartilage elasticity results in collapse of the ear canal, which in turn causes the canal to lose the ability to transmit sound waves. Calcification of ossicles results in tinnitus (ringing in the ears) because ossicles transmit sound waves. Increased hair growth results in visible hair in the ear. Reduced blood supply to the cochlea results in impaired speech reception because the cochlea is the center for reception.

A patient tells the nurse, "I always need my fan on while I'm sleeping." Which ear abnormality may be indicated?

Patients with chronic tinnitus often use a fan, radio or television, or some other source of background noise to drown out the tinnitus and help achieve peaceful sleep. Exostosis is a bony growth that causes narrowing of the canal. Otitis media is a chronic ear infection that manifests as fluid in a bulging red or blue eardrum. Ménière's disease is an abnormality of the ear associated with an increase of fluid in the ear.

The nurse is performing an assessment of the auditory system for a patient diagnosed with sensorineural hearing loss. Which findings should the nurse expect to assess? Select all that apply.

Sensorineural hearing loss is caused by damage to or an abnormality of the inner ear or the nerve pathways. This condition is characterized by distortion or faintness of sound or inability to understand speech, and it can cause complete hearing loss. Patients with central hearing loss experience difficulty in understanding the meaning of spoken speech. Patients with tinnitus hear a ringing in the ears.

When examining the patient's ear with an otoscope, there is discharge in the canal and the patient reports pain with the examination. For what should the nurse next assess the patient?

Swimmer's ear, an infection of the external ear, probably is the cause of the discharge and pain. Asking the patient about swimming, ear protection, and exposure to types of water can identify contact with contaminated water. A sebaceous cyst and metabolic disorders would not cause drainage or discomfort in the external ear canal. After clearing the discharge, the tympanic membrane can be assessed for otitis media.

Which assessment finding supports the nurse's conclusion that a patient has altered function of the external ear?

The auditory canal is located in the external ear, so damage to the auditory canal results in altered function of the external ear. The cochlea and eustachian tube are located in the middle ear. Damage to the cochlea will result in altered function of the middle ear, not the external ear. The auditory ossicles are the bones in the middle ear; damage to the auditory ossicles results in altered function of the middle ear, not the external ear.

A patient tells a nurse, "I'm becoming more and more sensitive to loud noises." Which auditory system change does the nurse suspect?

The brain is the main component of the auditory system, filtering unwanted and unnecessary sounds. A patient with increased sensitivity to sound will have changes in the brain. The inner ear is involved in reception of sound, balance, and body orientation. A patient with impaired middle ear function will have conductive loss of hearing. Damage to the external ear will result in collapse of the ear canal and, potentially, hearing loss.

A patient reports difficulty swallowing and chewing, and the nurse finds purulent drainage from the ear. How does the nurse interpret these findings?

The patient with otalgia will have difficulty swallowing and chewing and purulent drainage from the ear. Tinnitus is ringing of the ears that worsens with age because of the calcification of ossicles and may result in loss of hearing. Presbycusis is hearing loss associated with cumulative exposure to noise with increasing age. The patient with reduced blood supply to the cochlea will have impaired speech reception.

A nurse is conducting a tuning fork test on a patient. The nurse has 4 forks, each with a different frequency: 500 Hz; 506 Hz; 512 Hz; and 520 Hz. Which fork should the nurse use?

The tuning fork test helps to differentiate between conductive and sensorineural hearing loss. The frequency of the fork is specific in order to get the desired effect. The fork that is used in this test is 512 Hz.

Which auditory system change does the nurse suspect in a patient who has alterations in balance and body orientation?

The vestibular balance system is located in the inner ear. Therefore changes in the inner ear will result in alterations in balance and body orientation. Changes in the brain will increase the difficulty of hearing in a noisy environment and heighten sensitivity to sound. A patient with changes in the middle ear will have conductive hearing loss. A patient with changes in the external ear may have impacted cerumen or a collapsed ear canal.

A patient is advised to undergo a caloric test stimulus. How should a nurse explain the test to the patient? Select all that apply.

This test is carried out to diagnose diseases of the labyrinth and vestibular systems. The patient is positioned in a sitting or supine position. In the process, a warm or cold solution is poured in the ear of the patient to stimulate the semicircular canals. If there is abnormality of the labyrinth, it may be manifested as nystagmus or nausea. Any abnormal response by the patient is recorded. This test is not performed with the patient standing. A tuning fork test is done to differentiate between conductive and sensorineural loss.

The nurse is assessing a patient hearing by testing bone conduction. Which test will the nurse perform? Select all that apply.

Tuning fork tests such as the Rinne and Weber tests help detect hearing loss by differentiating between conductive and sensorineural loss. Audiometry is used to assess hearing acuity and to determine the degree and type of hearing loss. Tympanometry aids diagnosis of middle ear effusions through the application of positive and negative pressure on the probe placed in the ear. Electrocochleography is used to assess electrical activity in the cochlea and auditory nerve.

The nurse observes a patient ambulating with a stumbling gait. What conditions should the nurse be aware may cause this patient's condition?

Vertigo is stimulated by movement; this condition can cause an unsteady gait. Presbycusis is hearing loss due to aging. Nystagmus is an abnormal eye movement or twitching of the eye. Tinnitus is ringing in the ears.

A nurse is assessing a patient with chronic tinnitus. Which question is appropriate to ask when exploring the patient's sleep habits?

While assessing a patient with tinnitus, it is necessary to ask if tinnitus causes sleeplessness. This gives a clue about the seriousness of the disorder. The position and time of sleep is irrelevant in tinnitus. Whether the patient wakes up frequently for urination at night is not related to tinnitus.

The nurse is assessing a patient's hearing problems. What actions should the nurse take in order to perform the assessment? Select all that apply.

While assessing any patient with hearing problems, it is important to collect subjective data as well as objective data. Subjective data are what the patient says regarding complaints. These consist of modalities of pain or discharge. Objective information is the information that the nurse can see or perceive. The nurse can assess the patient's ability to hear by testing for the ability to hear a clock ticking in the room. Checking the external auditory meatus helps the nurse observe if any discharge is present. The patient's auditory ability is assessed based on the ability to hear low sounds. There is no test for checking hearing ability based on loud noises. Wearing ear jewelry may cause inflammation but does not affect hearing capacity.

The nurse is assessing a patient's ears. What normal findings should the nurse document? Select all that apply.

`The TM is normally pearl gray, white, or pink, shiny, and translucent. The handle (manubrium) of the malleus and its short process (umbo) should be visible through the membrane. The TM is a concave or dome shape normally. Hairline fluid level is indicative of serous otitis media. If the TM is bulging or retracted, the edges of the light reflex will be fuzzy (diffuse) and may spread over the TM.

A patient is found to have acoustic neuromas. Which diagnostic test will the nurse prepare the patient for to aid in assessment?

An acoustic neuroma is a tumor that develops in the nerve of the inner ear. Auditory brainstem response is the diagnostic test used to assess the inner pathway of the ear or detect tumors in the inner ear. Posturography is a balance test, useful in assessing vestibular function. Electrocochlography allows electrical activity in the cochlea to be recorded and analyzed. Pure-tone audiometry is useful in assessing sensorineural hearing loss.

The nurse assesses a bulging, red eardrum on otoscopic examination with a middle ear filled with pus and blood. What does the nurse infer from this finding?

A bulging red eardrum and middle ear filled with pus and blood indicate that the patient has acute otitis media. Serous otitis media, caused by transudation of blood and serum, manifests as yellow-amber bubbles above the fluid level. Seborrheic dermatitis is marked by scaling or lesions on the skin. Eustachian tube blockage is indicated by retraction of the eardrum and the cone of light is bent.

A patient comes to the clinic reporting a ringing sensation in the ears. Which questions should a nurse ask to find out more about the patient's problem? Select all that apply.

A ringing sensation in the ears is known as tinnitus. While assessing a patient for tinnitus, the nurse should try to get sufficient information about the complaint. Tinnitus may present as a buzzing, roaring, or ringing noise. Knowing the time or circumstances in which ringing occurs helps to know the cause or any concomitant modality. Asking the patient about the measures that have been taken for the complaints gives an insight to the severity of the problem and knowledge of any medications taken by the patient. Straining to defecate is not related to tinnitus. Dizziness is not seen in tinnitus because tinnitus doesn't affect the brain or blood supply to the brain.

The nurse is performing an assessment of a patient's ear with an otoscope and observes a retracted eardrum. What does the nurse determine the cause of this to be?

A vacuum in the middle ear will cause the malleus to appear shorter and more horizontal. A patient with sebaceous cysts behind the ear will exhibit drainage from the ear, not a retracted eardrum. A patient with seborrheic dermatitis will have scales and lesions on the skin. Infection of the external ear may result in discharge from the ear canal. `

During an auditory assessment, the nurse finds that the patient is able to hear a low whisper at a distance of 30 cm. How does the nurse interpret this information in the patient's report?

Ability to hear a low whisper of 20 dB at a short distance of 30 cm indicates that the patient has normal auditory function. Impairment of the cochlea will result in impairment of reception. The nurse palpates the mastoid area to detect tenderness and nodules. The tuning fork test, not the whisper test, helps detect sensorineural hearing loss.

The nurse has a suspicion that a patient is experiencing nystagmus. Which statement made by a patient supports the nurse's suspicion?

Abnormal eye movement indicates nystagmus. Blurring of vision with eye or head movement also indicates nystagmus. The patient with vertigo will have balance problems, which may result in dizziness and falls. Patients with tinnitus and ringing ears require white noise for distraction and peaceful sleep. Patients with Ménière's disease need assistance with activities such as bending and lifting objects.

Which diagnostic study is the nurse performing if, while performing an auditory assessment in a darkened room, the nurse places electrodes over the mastoid process, at the vertex, and on the forehead?

Auditory evoked potential is conducted in a darkened room and electrodes are placed over the mastoid process, vertex, and forehead to isolate auditory activity from other activities. Rotary chair testing is performed in a dark room to evaluate the peripheral vestibular system, but in this test the patient is seated in a chair driven by a motor under computer control. Electrocochleography records electrical activity in the cochlea and auditory nerves. Electronystagmography, in which specific eye movements are recorded, is used to diagnose diseases of the vestibular system.

The nurse is assessing a patient with a middle ear infection. Which structure located in the middle ear may cause a middle ear infection when it is blocked?

Blockage of the Eustachian tubes can occur with a middle ear infection. The tympanic membrane (ear drum), the auricle (pinna), and the sebaceous glands are all located in the external ear. These structures will not cause a middle ear infection.

A nurse assessing vestibular function places electrodes near the patient's eye to record specific eye movement. What does the nurse instruct the patient to do before performing the test?

By recording eye movement through electrodes, electronystagmography aids diagnosis of diseases of the vestibular system. The nurse instructs the patient to eat a light meal before the test to reduce the risk of nausea caused by electrode movement near the eye. The nurse will not instruct the patient to consume ice cream, because electronystagmography will not cause inflammation or irritation of the trachea. Gargling helps clear the throat and mouth but does not affect the eyes. Electronystagmography does not require excess hydration.

An adult patient has been treated for an ear infection. The nurse plans to examine the ear using an otoscope. What intervention should the nurse employ to lessen anxiety and discomfort associated with the examination?

By touching the tragus and moving the auricle (pinna), the nurse identifies sensitive areas and avoids pain while inserting the otoscope. A speculum slightly smaller than the ear canal is attached to the otoscope base and inserted without lubrication or warming. In adults, the auricle is pulled upward to straighten the ear canal and facilitate introduction of the otoscope.

The nurse suspects a disease of the vestibular system after an assessment of a patient's auditory system that involves instilling a warm solution into the ears to irrigate them. Which diagnostic test has the nurse performed?

Caloric test stimulus helps determine the patient's vestibular function by stimulating the endolymph of semicircular canal. The nurse introduces a warm solution into the patient's ears to irrigate them and watches for nystagmus to stimulate the endolymph. Posturography is a balance test that is performed in a boxlike device. Rotary chair testing is used to evaluate the peripheral vestibular system. Electronystagmography, in which electrodes track the movements of the eye over a graph, is used to assess the vestibular system.

An older adult patient reports not being able to hear very well. What should the nurse do first to determine the cause of the hearing loss?

Gerontologic differences in the assessment of the auditory system include increased production of drier cerumen, which can become impacted in the ear canal and contribute to hearing loss. Conductive hearing loss with impacted cerumen may lead to speaking softly because the patient's voice conducted through bone seems loud to the patient. Although increased hair growth occurs, it will not impact the hearing. Presbycusis may be occurring, but it should not be assumed. There is no reason to ask the patient if he has fallen because of dizziness; vertigo is not a normal change of aging of the ear.

A nurse is assessing a patient with hearing loss that gives a history of taking various medications in the past few years. Which drugs taken by the patient may be ototoxic? Select all that apply.

Many drugs are ototoxic. They can damage the hearing of an individual. They can cause hearing loss, tinnitus, and other problems. These drugs include aspirin, chemotherapy drugs, antibiotics, antimalarial drugs, nonsteroidal antiinflammatory drugs (NSAIDs), and diuretics. Domperidone is an antiemetic drug and is not ototoxic. Similarly, nutritional supplements are food supplements to ensure adequate nutrition. Nutritional supplements are not ototoxic.

The nurse is educating a patient with Ménière's disease about care management after discharge. Which statement by the patient indicates effective learning about care management?

Ménière's disease is a middle ear infection associated with an increase of fluid in the ear. A low-sodium diet reduces the risk of water retention, which lowers the risk of Ménière's disease. Performing exercise in the evening will be tedious for patients with Ménière's disease. The patient will have difficulty with solid foods because chewing may cause ear pain. The patient with Ménière's disease should completely avoid alcohol, which causes dizziness and vertigo.

The nurse is performing an assessment of the patient's ear and places a probe in the external ear canal, applying positive and negative pressure. What does the nurse determine this will infer?

Placing a probe in the external ear canal and applying both positive and negative pressure is the procedure for tympanometry. This test is used to assess compliance of the middle ear and is useful in diagnosis of middle ear effusions. The caloric test stimulus is used to assess range of hearing. Electronystagmography, involving the recording of specific eye movements, aids identification of diseases of the vestibular system. Rotary chair testing, performed with the use of a motor-controlled chair, aids evaluation of the peripheral vestibular system.

The nurse is assisting with determination of the functioning of the vestibular system. What tests will the nurse prepare the patient for to test this function? Select all that apply.

Posturography is a balance test that can isolate one vestibular system from another. The caloric test stimulus helps identify vestibular diseases by stimulating the endolymph of the semicircular canals. Electronystagmography is used to diagnose diseases of the vestibular system by recording specific movement of eyes when the ear is irrigated. In electrocochleography, electrical activity in the cochlea and auditory nerves is recorded. Auditory evoked potential is used to isolate auditory activity from the activity of the brain and is not associated with vestibular function.

The nurse is assessing an older adult patient who just has been transferred to a long-term care facility. Which question will best allow the nurse to assess the woman for the presence of presbycusis?

Presbycusis is an age-related change in auditory acuity. Ringing in the ears is termed tinnitus, whereas dizziness and falls are related to balance and the function of the vestibular system. Presbycusis is not associated with pain during chewing and swallowing.

A patient who underwent ear surgery has sustained trauma and problems related to facial movement and eyelid closure. Which cranial nerve damage does the nurse suspect?

Problems with voluntary facial movement and eyelid closure resulting from trauma after ear surgery indicate that the patient has sustained damage to the facial cranial nerve, cranial nerve VII. Damage to cranial nerves III (oculomotor nerve) and IV (trochlear nerve) results in paralysis of extraocular muscles. Damage to cranial nerve VIII (vestibulocochlear nerve) results in impaired hearing reception.

A patient with suspected hearing loss is advised to undergo a pure-tone audiometry. How should the nurse explain the procedure to the patient? Select all that apply.

Pure-tone audiometry is a test carried out to diagnose conductive and sensorineural hearing loss and to determine the patient's hearing range. The patient is placed in a soundproof room and is made to hear varying sounds through earphones. Whenever the patient hears a sound, the patient needs to give a nonverbal response, which is recorded. This test is not used for diagnosing diseases of the labyrinth. Electrodes are used in electronystagmography, not in this test.

The nurse is performing an assessment of a patient's ear with an otoscope and finds that the light reflex is fuzzy. How does the nurse interpret this finding?

Retraction of the tympanic membrane will cause the edges of the light reflex to appear fuzzy. Degeneration of hair cells will reduce sensitivity to sound. Blockage of the eustachian tube results in a retracted eardrum but does not make the light reflex appear fuzzy. Degeneration of auditory neurons will reduce sensitivity to high-pitched sound.

A patient is due for rotary chair testing to assess vestibular function. What action by the nurse is most appropriate?

Rotary chair testing is done to evaluate the peripheral vestibular system. Testing is usually done in the dark; therefore, in order to ensure safety, the nurse should not leave the patient alone. The patient should be advised to eat a light meal before the test to avoid nausea. The nurse should monitor the patient for vomiting. The length of the test is not relevant.

A patient comes to a clinic with hairline fluid level in the tympanum. There are yellowish bubbles above the fluid level. The nurse recognizes that what condition is most likely present?

Serous otitis media is characterized by inflammation of the middle ear and is accompanied by discharge. Inspection of the tympanum reveals presence of fluid, level with the hairline. A sebaceous cyst is seen as a black dot on the skin. Impacted cerumen is accumulated wax in the ear. This accumulation of wax often blocks the canal and makes it difficult to see the tympanum. Conductive hearing loss manifests as an inability to hear and is not associated with symptoms like fluid in the tympanum.

When interviewing a patient with hearing loss about past and present medications, which medications should the nurse ask the patient about directly? Select all that apply.

The nurse should ask the patient specifically about salicylates, aminoglycosides, and antimalarial agents, because they may cause ototoxicity and lead to hearing loss. With some medications, the hearing loss may be reversible when treatment is stopped. Herbal drugs and vitamin supplements are not associated with hearing loss.

Which structural impairment of the ear does the nurse suspect in a patient who has a nasopharyngeal infection?

The eustachian tube continues from the nasal pharynx, where the presence of a nasopharyngeal infection may result in blockage. Damage to cranial nerve VII results in loss of voluntary facial movement. Damage to cranial nerve VIII is associated with excess calcium deposition, but not nasopharyngeal infection. A nasopharyngeal infection does not result in impairment such as reduced blood supply to the cochlea.

A nurse is obtaining a health history from a patient. The nurse suspects that the patient could have hearing loss. What findings may have led the nurse to this suspicion? Select all that apply.

The patient's body language and actions often provide signs of underlying hearing trouble. The patient tries to lip read the nurse's words in order to guess the question. The patient is often unable to hear the question and asks the nurse to repeat it. The patient looks intently at the nurse when trying to lip read. The patient tends to miss out on words when not looking at the nurse. These are some signs which suggest hearing loss. Blinking too often is not a sign of hearing loss. Similarly, if the patient avoids eye contact with the nurse, it is not suggestive of hearing loss. It may suggest that the patient has low confidence or interest or is disoriented.

An older adult patient reports hearing loss. During the assessment, a student nurse is teaching the patient about normal changes of aging of the auditory system. Which statement requires correction from the nursing instructor?

The production of cerumen increases, not decreases, with age and dries out, which causes difficulty hearing. A patient's ability to filter sound is reduced as he or she ages. In addition, the tympanic membrane atrophies with aging, and there is an increase in hair growth in the auditory canal when a patient ages.

Which organs of the auditory system are involved in balance? Select all that apply.

The vestibule, an organ in the inner ear, comprises the labyrinth and is an organ of balance. The semicircular canal, a structure present in the inner ear, comprises the membranous labyrinth and is an organ of balance. The malleus, the smallest bone in the human body, is found in the middle ear and aids transmission of sound waves. The cochlea, a coiled structure, is a receptor organ for hearing. The tympanum, in the external ear, collects and transmits sound waves.

While completing a health history, the nurse learns that a patient has symptoms of tinnitis. Which follow-up question should the nurse ask?

Tinnitis, a sensation of ringing or buzzing in the ears, may result from high aspirin intake. Hand washing prevents infection. Cotton-tipped applicators should not be inserted inside the ear canal because this could impact cerumen or traumatize the ear canal. Straining is not a causative factor of tinnitus.

The nurse observes an inconsistent nonverbal response from the patient as part of an auditory assessment in a soundproof room where sound is provided through headphones. How does the nurse interpret this finding?

Tinnitus is an abnormal ringing of ears that results in an inconsistent response on pure-tone audiometry because the patient will not be able to hear the sound consistently. Otalgia is pain in the ears, which may cause discomfort and result in nutritional disturbance. Vertigo is a spinning sensation, stimulated by motion of the head that results in impaired balance. Nystagmus is abnormal movement of the eye, observed as twitching of the eyeball.

A patient tells a nurse, "I take an aspirin every two days because I'm always getting headaches." Which ear abnormality does the nurse expect?

Tinnitus, a continuous ringing in the ears, is associated with calcification of the ossicles. Heavy intake of aspirin, an analgesic medication, often results in tinnitus because of its toxic effect on cranial nerve VIII. Vertigo is a sense of moving or spinning that is associated with imbalances in the vestibular system. Presbycusis is the loss of hearing with age. A patient who has damage to the cochlea will exhibit impaired speech reception.

The nurse is performing an otoscopic examination on a patient. When observing the tympanic membrane, what does the nurse anticipate documenting if considered normal?

Tympanic membrane (ear drum) should appear white, pink, or pearly gray in color, shiny, and translucent. The surface should appear intact and smooth. The tympanic membrane has a crater appearance if a rupture from infection has occurred. The inner ear is not visible with an otoscope. The tympanic membrane appears retracted when otitis media with effusion occurs. Cerumen (ear wax) is produced in the ear canal and should not obstruct viewing the tympanic membrane. A reddened tympanic membrane occurs with otitis media (ear infection). The handle of the malleus is visible through the normally transparent tympanic membrane.

A patient seeks assistance from the primary health care provider because of episodes of vertigo. Which diagnostic test will determine whether the vertigo is related to a problem of the inner ear?

Vertigo is the sensation that one is whirling in space and often is associated with nausea and vomiting. In the caloric stimulus test, cold or warm water is inserted in the ear canal to stimulate the semicircular canals in the labyrinth of the inner ear. The response to the stimulation causes nystagmus (eye ball jerking movement), nausea and vomiting, and vertigo, and is used to determine disease of the vestibular system. The carotid ultrasound determines the patency of the carotid arteries and adequate circulation to the brain. Audiometry is a screening test for hearing acuity and determines the severity and type of hearing loss. Tympanometry is used to diagnose middle ear effusion (fluid in the middle ear), which causes noncompliance and conductive hearing loss.

While interviewing a patient, the nurse finds that the patient keeps the head skewed while talking. The patient could be experiencing what condition?

When a person suffers from diplopia, he keeps his head skewed in an attempt to see a single image. Color blindness is tested by asking the patient to identify specific colors. A patient who has corneal abrasion and inflammation of the eyes will try to keep his eyes closed to avoid light.

The nurse is assessing an adult patient's external ear canal and tympanum. How should the nurse proceed?

When assessing an adult, grasp and gently pull the auricle up and backward to straighten the canal. With children under age three, pull the auricle back and down. When examining a patient's external ear canal and tympanum, ask the patient to tilt the head toward the opposite shoulder. A healthy, normal tympanic membrane will appear pearl gray, white, or pink and have a cone-shaped light reflex.

The nurse is testing a patient for hearing acuity using a whisper test. Which actions by the nurse are appropriate? Select all that apply.

When testing for hearing acuity, the nurse should stand 12 to 24 inches to the side of the patient and, after exhaling, speak in a low whisper. Ask the patient to repeat numbers or words or answer questions. Use a louder whisper if the patient does not respond correctly. Test each ear separately. The ear not being tested is covered by the patient.