CH17-NURSE
Which question asked by the nurse is assessing problems with vertigo?
"Do you ever have problems with balance"
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."
Which question asked by the nurse is assessing problems with tinnitus?
"Do you experience buzzing in your ears?"
A 61-year-old man has visited the clinic at the prompting of his wife, who states that his hearing is becoming less acute. Which of the following assessment questions is most useful in determining whether the man's hearing loss is sensorineural or conductive?
"Do you find that you have particular difficulty understanding people's speech?"
A client presents with otalgia and yellow-green discharge from the external ear canal. Which question should the nurse ask to determine the cause of this problem?
"Have you had any recent trauma to the inside of your ear?"
A client reports the onset of tinnitus. What question should the nurse ask the client to further assess this condition?
"Have you taken any antibiotics in the past few weeks?"
The patient asks the nurse why the nurse put the tuning fork on the bone behind the ear. Which is the best response by the nurse?
"It identifies a problem with the normal pathways for sound to travel to your inner ear."
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"
A patient calls the clinic and tells the nurse that the doctor told her that she has "otalgia." The patient cannot remember what the doctor explained this to be. How would the nurse most appropriately respond?
"Otalgia is pain in the ear"
The results of a client's Rinne test are as follows: bone condcution > air conduction. How should the nurse explain these findings to the client?
"You have a conductive hearing loss."
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
An older adult client presents at the clinic, reporting otalgia in the right ear. Physical assessment reveals cerumen impacted in the client's ear. Removing this mechanical blockage may do what for this client? (Select all that apply.)
-Enhance socialization -Improve hearing -Prevent injury
In examining a client's external auditory canal with an otoscope, the nurse discovers impacted ear wax, known as cerumen. Which of the following is characteristic of cerumen? Select all that apply.
-Has a sticky consistency -Keeps the tympanic membrane soft -Has bacteriostatic properties -Serves as a defense against foreign bodies
A nurse practitioner is assessing a client in the ED following a motor vehicle accident. The client complains of ear pain. The nurse practitioner is performing an otoscopic examination. What would demonstrate the correct technique for using the otoscope?
-Holding the otoscope so that the thumb is by the window -Holding the clients ear at the helix -Rotating the otoscope slightly
A 55-year-old male presents to the health care clinic with reports of decrease hearing over the past year. Which subjective data in client's review of systems should the nurse recognize as risk factors for hearing loss? Select all that apply.
-Increased cerumen production -Repeated episodes of otitis media as a child -History of measles at age 3 years of age
Functionally, the most important range for hearing is the range of human speech. What is the range of human speech?
500 Hz to 3000 Hz
The nurse notes a tophus of the ear of an older adult. Which assessment data is consistent with a tophus?
A hard nodule composed of uric acid crystals
An increased risk of falls is dangerous for any patient. What patient would be at an increased risk of falls?
A patient with vertigo
You are teaching a class on diseases of the ear. What would you teach the class is the most characteristic symptom of otosclerosis?
A progressive, bilateral loss of hearing
A 55-year-old male client has just been diagnosed with presbycusis. In the interview with the client, the nurse should most expect the client to complain of having trouble hearing which of the following in the initial stages of this condition? a) The sound of his car engine starting b) A story his wife is telling him c) The bass speakers of his stereo system d) His son giving him directions to a restaurant
A story his wife is telling him Explanation: Presbycusis often begins with a loss of high-frequency sounds (woman's voice) followed later by the loss of low-frequency sounds. The bass speakers, his son's voice, and the engine starting would all have lower-frequency sounds than his wife's voice.
After examining the client's tympanic membranes, the nurse documents "Right tympanic membrane, red and bulging with no light reflex." The nurse recognizes that these are signs of
Acute otitis media
When reviewing ear assessment, a student nurse would learn that the cone of light should be visible where on the tympanic membrane?
Anterior inferior quadrant
A mother of a small child calls the clinica and asks to schedule an appointment for ear tube removal. The call is transferred to the nurse. What is the nurse's best action?
Ask the mother how long the tubes have been in place
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? a) Assess for balance using the Romberg test b) Perform hearing test to assess for conductive hearing loss c) Document these findings as normal changes in the older adult d) Ask whether the client is experiencing ear pain or pressure
Ask whether the client is experiencing ear pain or pressure Explanation: 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.
As a part of the ear examination for hearing loss, a nurse conducts a Weber test on a client. To accurately perform this test, the nurse should place the base of the tuning fork in which of the following locations?
At the center of the client's forehead
An alternate pathway that bypasses the external and middle ear is called what? a) Bone conduction b) Air conduction c) Neuro conduction d) Sensory conduction
Bone conduction Correct Explanation: An alternate pathway, known as bone conduction, bypasses the external and middle ear and is used for testing purposes
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
The transmission of sound waves through the external ear and the middle ear is known as
Conductive hearing
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
A nurse is educating a client about the function of the parts of the auditory system. Which is the function of the eustachian tube
Equalizes the pressure in the middle ear with atmospheric pressure
A nurse is educating a client about the function of the parts of the auditory system. Which is the function of the eustachian tube?
Equalizes the pressure in the middle ear with atmospheric pressure
The nursing student hopefuls are taking a pre-nursing anatomy and physiology class. What will they learn is the anatomical feature that equalizes air pressure in the middle ear?
Eustachian tube
A client exhibits purulent drainage in the right external ear canal. The client complains of pain that increases when the ear is touched. Which client teaching instructions should the nurse provide?
Finish the entire course of the antibiotic therapy
The nurse is preparing to examine the ears of an adult client with an otoscope. The nurse should plan to
Firmly pull the auricle out, up and back
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.
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 six-month old male infant is brought to the emergency department by his parents for inconsolable crying and pulling at his right ear. When assessing this infant the nurse is aware that the tympanic membrane should be what color in a healthy ear?
Gray
When inspecting the tympanic membrane, which of the following structures does the nurse expect to identify? a) Pars tensa, pars flaccida, vestibule, cone of light b) Handle of malleus, short process of malleus, cone of light c) Pars tensa, umbo, handle of malleus, ossicles d) Cone of light, incus, umbo, cochlea
Handle of malleus, short process of malleus, cone of light Explanation: Visualization of the tympanic membrane using an otoscope includes inspection of the cone of light, the short process of the malleus, and the handle of the maleus. The cochlea, vestibule, and stapes (part of the ossicles) are not normally visualizable
Which finding should a nurse recognize as normal when assessing the ears of an elderly client?
High-tone frequency loss
Which of the following is a priority patient teaching topic related to the ears?
How to prevent skin cancer
The client is having a Weber test. During a Weber test, where should the tuning fork be placed?
In the midline of the client's skull or in the center of the forehead
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
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?
Ostesclerosis of the ear
A nurse obtains an objective assessment on a child who presents to the clinic with reports of right ear pain. The nurse observes the following: painful movement of the pinna and tragus; ear canal is red and swollen with presence of purulent discharge from the external canal; temperature 101.8°F. The mother states that the family was on vacation at the beach last week. The nurse recognizes these findings as an indication of what acute ear condition?
Otitis externa
A patient comes to the clinic and reports pain when he touches his ear. With what is this finding most consistent?
Otitis externa
While 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
Which of the following describes a condition characterized by abnormal spongy bone formation around the stapes?
Otosclerosis
Which statement reflects accurate documentation by the nurse of a normal, left tympanic membrane?
Pearly gray, translucent, with cone of light at 7 o'clock position
Transmission of sound waves in the inner ear is known as
Perceptive hearing
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? a) Injury to the organ of Corti b) Damage to cranial nerve VIII c) Dysfunction of the temporal lobe of the brain d) Perforated eardrum
Perforated eardrum Explanation: 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 hearing." Therefore, 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).
Which precaution should a nurse take to ensure the safety of a client when performing the Romberg test?
Place arms around the client without touching
Which terms refers to the progressive hearing loss associated with aging?
Prebycusis (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)
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
A nurse examines the ear of a client diagnosed with an obstructed eustachian tube. What finding should the nurse anticipate upon assessment?
Prominent landmarks on the tympatic membrane
Some clients with acoustic neuromas have vertigo. What is a priority nursing action with clients with vertigo?q
Protect the client from injury
What action should the nurse implement using an otoscope when assessing the ear of an adult client?
Pull the auricle out, up and back
What action should the nurse implement when assessing the ear of an adult client using an otoscope?
Pull the surgical out, up, and back.
Which characteristic feature of the tympanic membrane should a nurse anticipate finding in a client with acute otitis media?
Red, bulging, with an absent light reflex
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?
Redness and bulging of the eardrum
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? a) Right: AC> BC; left BC> AC b) Right: AC> BC; left AC= BC c) Right: BC> AC; left BC= AC d) Right: BC> AC; left AC> BC
Right: BC> AC; left AC> BC Explanation: 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> AC; left AC> BC.
A client with advanced presbycusis admits to the nurse that he was nearly involved in a car accident because he could not hear the siren of an ambulance that was crossing an intersection through which he was driving. The client says that he lives alone and has no one else to drive him. Which of the following diagnoses can the nurse make at this time?
Risk for injury related to hearing impairment
A client admitted to the health care facility is diagnosed with vertigo. Which test is appropriate for the nurse to perform to assess for equilibrium in the client?
Romberg
A client presents at the clinic complaining of a loss of balance. What test should the nurse expect the physician to carry out on a client with a loss of balance?
Romberg test
When assessing the tympanic membrane, a variation of normal is a tympanic membrane with what?
Sclerosis
The nurse is presenting an educational event for gardeners. When discussing the ears, what would be an important topic to cover?
Skin cancer prevention
Which of the following is a symptom related to vertigo?
Spinning sensation
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
The ossicles contained in the middle ear include the malleus, the incus, and the
Stapes
The nurse is planning to conduct the Weber test on an adult male client. To perform this test, the nurse should plan to
Strike a tuning fork and place it on the center of the clients head or forehead
A nurse is admitting a client to the hospital. When reviewing the client's medical record, the nurse notes that this client had abnormal findings during the Weber test. What would the nurse know this means?
The client has unilateral hearing loss
What structure in the inner ear senses the position and movements of the head and helps to maintain balance?
The labyrinth
Which action by the nurse is consistent with Weber's test?
The nurse activates the tuning fork and places it on the midline of the parietal bone in line with both ears
Which action by the nurse is consistent with the Rinne test?
The nurse strikes the tuning fork and places it on the patient's mastoid process to measure bone conduction
An nurse practitioner is assessing the tympanic membrane of a client who has come to the clinic. What would the nurse practitioner expect to visualize if the client has a normal otoscopic evaluation?
The short process of the malleus
what are the openings to the middle ear? Select all that apply.
The tympanic membrane The round window The oval window The eustachian tube
A 52-year-old patient fails the Romberg test. The nurse explains that this might indicate a dysfunction in what part of the ear?
The vestibular portion of the inner ear (Failure of the Romberg test may indicate dysfunction in the vestibular portion of the inner ear, semicircular canals, and vestibule.)
Which of the following findings from the health history of a 70-year-old woman with tinnitus is likely most significant to her diagnosis? a) The woman was diagnosed with oral cancer 12 years prior, which responded well to treatment. b) The woman has experienced transient ischemic attacks in recent years. c) The woman takes a beta-blocker to treat hypertension. d) The woman takes aspirin 4 times daily to treat her rheumatoid arthritis.
The woman takes aspirin 4 times daily to treat her rheumatoid arthritis. Explanation: Excessive use of aspirin can cause tinnitus. A history of TIAs and cancer is not likely to be related, nor is the use of antihypertensives.
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 (Aspirin Explanation: At high doses, aspirin toxicity can produce bilateral tinnitus. Antivert and Dramamine is used for nausea and vomiting related to motion sickness. Antiemetics such as promethazine (Phernergan) suppositories help control the nausea and vomiting and the vertigo because of the antihistamine effect.)
During a pharmacology class the students are told that some drugs need to be closely monitored. What aspect should the nurse closely monitor for in clients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?
Tinnitus and sensorineural hearing loss
Which portion of the middle ear equalizes pressure? a) Cochlea b) Auricle c) Ossicles d) Tympanic membrane
Tympanic membrane Explanation: The tympanic membrane of the middle ear equalizes pressure. Ossicles, which are held in place by joints, muscles, and ligaments, assist in the transmission of sound. The auricle collects the sound waves and directs vibrations into the external auditory canal. The cochlea is a winding, snail-shaped bony tube that forma a portio of the inner ear and containss the organ of Corti; the transducer of hearing
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?
Tympanic membrane visualized with areas of opacity noted
A 30-year-old client arrives at the community healthcare center complaining of dizziness and a feeling of the room spinning. Based on the client's symptoms, which condition best describes what the client most likely experiencing?
Vertigo
A client complains, "I feel like the whole room is spinning around me, and it makes me nauseous sometimes." What term should the nurse use to document the client's symptom?
Vertigo
The clinic nurse is assessing an older adult client who fell. The nurse asks if the client ever feels dizzy or has problems with balance. For what is the nurse assessing?
Vertigo
When planning care for a client with an inner ear infection, the nurse will need to include interventions for which of the following potential problems?
Vertigo
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?
Weber
The nurse assessing for unilateral hearing loss by using a tuning fork. What test is the nurse performing?
Webers test
A nurse performs a hearing test on an elderly client. Which result should the nurse recognize as an indication that presbycusis is present? An inability to hear:
Whispered sounds
A 55-year-old male presents to the health care clinic with reports of decrease hearing over the past year. Which subjective data in client's review of systems should the nurse recognize as risk factors for hearing loss? Select all that apply. History of measles at age 3 years of age Drinks six cups of coffee daily Use of antihypertensive medication Uses ear plugs at work because of the loud noises Repeated episodes of otitis media as a child Increased cerumen production
a,e,f
When providing client education on hearing, the nurse should remind clients to utilize ear plugs when they are what? (Select all that apply.) Working with children At train stations Using lawnmowers At concerts Cleaning their homes
b,c,d
The nurse has performed the Rinne test on an older adult client. After the test, the client reports that her bone conduction sound was heard longer than the air conduction sound. The nurse determines that the client is most likely experiencing a) normal hearing. b) central hearing loss. c) conductive hearing loss. d) sensorineural hearing loss.
conductive hearing loss. Explanation: With conductive hearing loss, bone conduction (BC) sound is heard longer than or equally as long as air conduction (AC) sound (BC ? AC).
Which characteristic feature of the tympanic membrane should a nurse anticipate finding in a client with otitis media? a) Pearly, translucent with no bulging b) Yellowish, bulging with fluid bubbles c) Gray, translucent with retraction d) Red, bulging with an absent light reflex
d (Explanation: A client with acute otitis media would have a red, bulging eardrum with absent light reflex. A pearly, translucent membrane with no bulging is a normal finding in the tympanic membrane. A yellowish, bulging membrane with bubbles is seen in serous otitis media. A gray, translucent membrane with retraction is a normal finding in the tympanic membrane.)
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
The nurse is planning to perform an ear examination on an adult client. After explaining the procedures to the client, the nurse should a) observe the client's response to the explanations. b) show the client the otoscope. c) ask the client to remove his contact lenses. d) ask the client to remain standing.
observe the client's response to the explanations. Explanation: As you prepare the client for the ear examination, carefully note how the client responds to your explanations
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? a) Pars flaccida b) Umbo c) Pars tensa d) Handle and short process of the malleus
umbo Explanation: 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.
What components of sound does the cochlea interpret? (Select all that apply.)
• Amplitude • Frequency Explanation: The cochlea interprets two components of sound: amplitude (volume) and frequency (pitch). The cochlea does not interpret tone, direction, or decibel.
