Assessment of the Ear

A client has Darwin tubercle. What is this?

A small painless nodule on the helix explanation: Small painless nodules on the helix are a variation of normal anatomy known as darwinian tubercle.

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 story his wife is telling him

A nurse is assessing a client with referred otalgia. In order to identify the associated manifestations of this problem, the nurse should ask which question?

"Have you had any recent infectious contacts? explanation:The associated manifestations are factors that may have aggravated the otalgia. Given that the client is presenting with referred otalgia, the origin of the problem is most likely in the throat, mouth, or neck. Asking about recent infectious contacts can help the nurse identify if the otalgia is referred from a sore throat secondary to infection.

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?" explanation:Otalgia and yellow-green discharge from the external ear canal suggest a ruptured tympanic membrane. In order to identify the cause of the rupture, it would be most effective to ask the client about trauma to the inside of the ear.

The client 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."

A client calls the clinic and tells the nurse that the doctor told her that she has "otalgia." The client 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 conduction > air conduction. How should the nurse explain these findings to the client?

"You have a conductive hearing loss." explanation:The Rinne test tests for conductive hearing loss. The client's results indicate that bone conduction is greater than air conduction which indicates conductive hearing loss. Air conduction should be twice as long as bone conduction. The whisper test evaluates loss of high frequency sounds. An audiogram can reveal a nerve related or unilateral hearing loss.

When providing client education on hearing, the nurse should remind clients to utilize ear plugs when they are what? (Select all that apply.)

-At train stations -At concerts -Using lawnmowers explanation:As nurses, prevention is key, and clients should be reminded to utilize ear plugs when exposed to loud noises in their daily lives (e.g., lawnmowers, leaf blowers, chainsaws, concerts, train stations, battlefields, and sirens) and to limit exposure (iPod buds and cell phones).

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.) (1)Have the client sit on the examination table (2)Place the client in semi-Fowler's position on the examination table (3)Make sure the client is comfortable in a quiet room (4)Perform the whisper, Weber, and Rinne tests before inspection (5)Place the client's ears at the nurse's eye level

1,2,3,4

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

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 antibiotic therapy explanation:The client's symptoms are consistent with otitis externa, usually treated with antibiotics and pain medication. The inflammation can cause temporary deafness, but permanent deafness is not common. Tympanostomy tubes are placed for middle ear effusions, not otitis externa.

Which of the following describes a condition characterized by abnormal spongy bone formation around the stapes?

Otosclerosis

You are a pediatric nurse caring for a child who has been brought to the clinic with otitis externa. What assessment finding is characteristic of otitis externa?

Pain on manipulation of the auricle

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 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 no retraction is a normal finding in the tympanic membrane.

During a physical examination the nurse performs the action shown. What assessment is the nurse performing? (Flip Card to see picture)

Rinne test explanation: The first part of the Rinne test is to place the handle of a vibrating tuning fork on the mastoid process.

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. EXPLANATION:Using Weber's test, the nurse activates the tuning fork and places it on the midline of the parietal bone in line with both ears to differentiate the cause of unilateral hearing loss. In Rinne's test, the nurse strikes the tuning fork and places it on the client's mastoid process to measure bone conduction. When examining the inner ear, the nurse uses a bulb insufflator attached to an otoscope to observe movement of the tympanic membrane. In the Whisper test, the nurse shields their mouth and whispers a simple sentence approximately 18 inches from the client's ear.

Which action by the nurse is consistent with the Rinne test?

The nurse strikes the tuning fork and places it on the client's mastoid process to measure bone conduction explanation:In the Rinne test, the nurse strikes the tuning fork and places it on the client's mastoid process to measure bone conduction. Using Weber's test, the nurse activates the tuning fork and places it on the midline of the parietal bone in line with both ears to differentiate the cause of unilateral hearing loss. When examining the inner ear, the nurse uses a bulb insufflator attached to an otoscope to observe movement of the tympanic membrane. In the Whisper test, the nurse shields their mouth and whispers a simple sentence approximately 18 inches from the client's ear.

A 52-year-old client 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 explanation: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?

The woman takes aspirin 4 times daily to treat her rheumatoid arthritis.

A client 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 explanation:Tinnitus is a sign of ototoxicity, which can occur when a client's dose is too high

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 explanation:It is important that nurses are knowledgeable about the ototoxic effects of certain medications such as salicylates, loop diuretics, quinidine, quinine, and aminoglycosides. Signs and symptoms of ototoxicity include tinnitus and sensorineural hearing loss. Hypotension, reduced urinary output, and impaired facial movement are not signs of ototoxicity.

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 explanation:The labyrinth within the inner ear senses the position and movements of the head and helps to maintain balance. If these structures are infected or inflamed, the client could develop vertigo. Rhinorrhea, fever, and headache are not potential problems associated with an inner ear infection.

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

Which of the following is inconsistent with acute otitis media? - The infection usually lasts less than 6 weeks. - It is a relatively uncommon childhood infection. - A purulent exudates is usually present in the middle ear. - Conductive hearing loss may occur.

it is relatively uncommon childhood infection

The nurse is planning to perform an ear examination on an adult client. After explaining the procedures to the client, the nurse should

observe the client's response to the explanations

Transmission of sound waves in the inner ear is known as

perceptive hearing explanation:The transmission of sound waves in the inner ear is referred to as "perceptive" or "sensorineural hearing."

While assessing the ears of an adult client, the nurse observes bloody drainage in the client's ear. The nurse should

refer the client to a physician.

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 client's head or forehead explanation:Perform Weber's test if the client reports diminished or lost hearing in one ear. The test helps to evaluate the conduction of sound waves through bone to help distinguish between conductive hearing (sound waves transmitted by the external and middle ear) and sensorineural hearing (sound waves transmitted by the inner ear). Strike a tuning fork softly with the back of your hand and place it at the center of the client's head or forehead.

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

The nurse assessing for unilateral hearing loss by using a tuning fork. What test is the nurse performing?

Weber's test

Which question asked by the nurse is assessing problems with vertigo?

"Do you ever have problems with balance?"

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

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 explanation: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 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 client comes to the clinic and reports pain when he touches his ear. With what is this finding most consistent?

Otitis externa explanation:pain with auricle movement or tragus palpation indicates otitis externa or furuncle.

A client 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?

strapes

Which question asked by the nurse is assessing problems with tinnitus?

"Do you experience buzzing in your ears?" explanation: buzzing, ringing, whistling sound. Also noticeable at night.

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? explanation:A hallmark of sensorineural hearing loss is difficulty in understanding speech.

A mother of a small child calls the clinic 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.

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 EXPLANATION:The healthy tympanic membrane appears pearly gray, translucent and is positioned obliquely at the base of the ear canal.

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?

Presbycusis Both middle and inner ear age-related changes result in hearing loss. Exostoses refers to small, hard, bony protrusions in the lower posterior bony portion of the ear canal. Otalgia refers to a sensation of fullness or pain in the ear. Sensorineural hearing loss is loss of hearing related to damage of the end organ for hearing and/or cranial nerve VIII.

The nurse is presenting an educational event for gardeners. When discussing the ears, what would be an important topic to cover?

Skin cancer prevention

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

A nurse performs an initial examination of a client brought to the emergency department after sustaining a head injury in an automobile accident. Which characteristic of discharge from the ears should alert the nurse that the client has a cerebrospinal fluid leak?

Watery or bloody The presence of watery or bloody discharge in the external auditory canal indicates leakage of cerebrospinal fluid in the client with a head injury. Sticky, yellow discharge is found in cases of otitis externa. Bloody, purulent discharge is found in otitis media with ruptured tympanic membrane. Brown, odorless discharge is a normal finding in the external auditory canal.

High doses of this medication can produce bilateral tinnitus?

Aspirin

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

An adult client tells the nurse that his 80-year-old father is almost completely deaf. After an explanation to the client about risk factors for hearing loss, the nurse determines that the client needs further instruction when the client says

It is difficult to prevent hearing loss or worsening of hearing.

When teaching a class of school-age children about hygiene, the nurse should include which information about the ears?

Never put anything smaller than your elbow in your ears

The nurse palpates a client's auricles and notes an enlarged lymph node on one ear. No redness is observed, and the client denies pain or tenderness. What is the nurse's best action?

Notify the healthcare provider about the finding.

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

which structure on the diagram should the nurse identify that connects the throat to the ear?

The proximal end of the Eustachian tube connects the middle ear to the nasopharynx.

A 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? A. The arm of the stapes B. The short process of the malleus C. The head of the incus D. The long process of the stapes

The short process of the malleus explanation:During visualization of the normal tympanic membrane, it is intact and translucent and the short process of the malleus is visible. The nurse practitioner would not expect to see the stapes or the head of the incus.

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

The transmission of sound waves through the external ear and the middle ear is known as

conductive hearing

The nurse assists and educates clients about the structure and function of the sensory system. The nurse is showing the client the path taken by sound waves to reach the brain. The nurse dropped the note cards with the correct sequence on the floor. The sequence of steps is scrambled and need to be placed in the correct order. Which is the correct order of the steps in the path taken by sound waves to the brain?

1- Sound waves enter though the ear's external auditory canal and strike the tympanic membrane. 2- The tympanic membrane vibrates at various speeds in response to various pitches of sounds. 3- The ossicles within the middle ear act as a moveable bridge to transmit these vibrations to the oval window, which amplifies the sound waves. 4- The stapes vibrates against the membrane, setting the fluid of the cochlea in motion, which in turn passes on to the hair like nerve ending in the organ of Corti. 5- The stimuli in the organ of Corti are sent to the vestibulocochlear nerve and to the temporal lobe in the cerebral cortex, where the sounds are interpreted.

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 explanation:A progressive, bilateral loss of hearing is the characteristic symptom of otosclerosis. Tinnitus appears as the loss of hearing progresses; it is especially noticeable at night, when surroundings are quiet, and may be quite distressing to the client. The eardrum appears pinkish-orange from structural changes in the middle ear. The client often describes a history of having had a recent upper respiratory infection in case of otitis media, not otosclerosis.

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 explanation:The eustachian tube extends from the floor of the middle ear to the pharynx and is lined with mucous membrane. It equalizes air pressure in the middle ear.

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. explanation: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

The eustachian tube is a passage between the middle ear and the nasopharynx. What is the function of the eustachian tube?

Helps to regulate pressure in the middle ear

Which finding should a nurse recognize as normal when assessing the ears of an elderly client?

High-tone frequency loss

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

What action should the nurse implement using an otoscope when assessing the ear of an adult client?

Pull the auricle out, up, and back explanation:The nurse should pull the auricle out, up, and back to straighten the external auditory canal. This is because the external auditory canal is S-shaped in the adult. The outer part of the canal curves up and back, and the inner part of the canal curves down and forward. The nurse should choose the largest speculum that fits comfortably into the client's ear. The nurse should hold the speculum in the dominant hand and insert the speculum gently down and forward.

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

After conducting a health history, the nurse decides to perform the assessment shown. What finding did the nurse use to make this clinical determination?

Reduced hearing in one ear explanation:The Weber test is used to determine unilateral hearing loss. With conductive hearing loss, the client reports hearing the tuning fork sound better in the poor ear. With sensorineural hearing loss, the client hears the sound better in the good ear. The Weber test is not used to assess a sore throat. There are many reasons for a rigid tympanic membrane. A Weber test is used to test for hearing only. This test will not help diagnose the reason for edematous neck lymph nodes

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

Rinne explanation:In 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 client to repeat what was whispered. The watch tick test relies on the ability of the client to perceive the high-pitched sound made by a watch held at the client's auricle. The Weber's test uses bone conduction to test lateralization of sound.

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.