Chapter 16: Ears
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. The nurse is examining a patient’s ears and notices cerumen in the external canal. Which of
these statements about cerumen is correct?
a.
Wet, honey-colored cerumen is a sign of infection.
b.
The presence of cerumen is indicative of poor hygiene.
c.
The purpose of cerumen is to protect and lubricate the ear.
d.
Cerumen is necessary for transmitting sound through the auditory canal.
2. When examining the ear with an otoscope, how should the tympanic membrane look?
a.
Light pink with a slight bulge
b.
Pearly gray and slightly concave
c.
Whitish with black flecks or dots
d.
Pulled in at the base of the cone of light
3. A patient with a middle ear infection asks the nurse, “What does the middle ear do?” Which is
the best response by the nurse?
a.
It helps maintain balance.
b.
It interprets sounds as they enter the ear.
c.
It conducts vibrations of sounds to the inner ear.
d.
It increases the amplitude of sound for the inner ear to function.
4. The nurse is reviewing the function of the cranial nerves (CNs). Which CN is responsible for
conducting nerve impulses to the brain from the organ of Corti?
a.
I
b.
III
c.
VIII
d.
XI
5. The nurse is assessing a patient who may have hearing loss. Which of these statements is true
concerning air conduction?
a.
Air conduction is the normal pathway for hearing.
b.
Amplitude of sound determines the pitch that is heard.
c.
Vibrations of the bones in the skull cause air conduction.
d.
Loss of air conduction is called a conductive hearing loss.
6. A patient has been identified as having a sensorineural hearing loss. What would be important
for the nurse to do during the assessment of this patient?
a.
Speak loudly so the patient can hear the questions.
b.
Assess for middle ear infection as a possible cause.
c.
Ask the patient what medications he is currently taking.
d.
Look for the source of the obstruction in the external ear.
7. During an interview, the patient states he has the sensation that “everything around him is
spinning.” What part of the ear should the nurse recognize is responsible for this sensation?
a.
Cochlea
b.
CN VIII
c.
Labyrinth
d.
Organ of Corti
8. A patient in her first trimester of pregnancy is diagnosed with rubella. Which of these
statements is correct regarding the significance of this in relation to the infant’s hearing?
a.
Rubella may affect the mother’s hearing but not the infant’s.
b.
Rubella can damage the infant’s organ of Corti, which will impair hearing.
c.
Rubella can impair the development of cranial nerve VIII and thus affect hearing.
d.
Rubella is especially dangerous to the infant’s hearing in the second trimester of
pregnancy.
9. The mother of a 2-year-old is concerned because her son has had three ear infections in the
past year. What would be an appropriate response by the nurse?
a.
“It is unusual for a small child to have frequent ear infections unless something
else is wrong.”
b.
“We need to check the immune system of your son to determine why he is having
so many ear infections.”
c.
“Ear infections are not uncommon in infants and toddlers because they tend to
have more cerumen in the external ear.”
d.
“Your son’s eustachian tube is shorter and wider than yours because of his age,
which allows for infections to develop more easily.”
10. A 31-year-old patient tells the nurse that he has noticed a progressive loss in his hearing. He
says that it does seem to help when people speak louder or if he turns up the volume of a
television or radio. What is the most likely cause of this hearing loss?
a.
Presbycusis
b.
Otosclerosis
c.
Trauma to the bones
d.
Frequent ear infections
11. A 70-year-old patient tells the nurse that he has noticed that he is having trouble hearing,
especially in large groups. He says “I can’t always tell where the sound is coming from” and
that the words often sound “mixed up.” What might the nurse suspect as the cause for this
change?
a.
Atrophy of the apocrine glands
b.
Cilia becoming coarse and stiff
c.
Nerve degeneration in the inner ear
d.
Scar tissue in the tympanic membrane
12. During an assessment of a 20-year-old Asian patient, the nurse notices that he has dry, flaky,
white cerumen in his canal. What is the significance of this finding?
a.
It represents poor hygiene.
b.
It is probably the result of lesions from eczema in his ear.
c.
It is a normal finding, and no further follow-up is necessary.
d.
It could be indicative of change in cilia; the nurse should assess for hearing loss.
13. The nurse is taking the history of a patient who may have a perforated eardrum. What would
be an important question in this situation?
a.
“Do you ever notice ringing or crackling in your ears?”
b.
“When was the last time you had your hearing checked?”
c.
“Have you ever been told that you have any type of hearing loss?”
d.
“Is there any relationship between the ear pain and the discharge you mentioned?”
14. A 31-year-old patient tells the nurse that he has noticed pain in his left ear when people speak
loudly to him. What does this finding indicate?
a.
A cerumen impaction
b.
Normal for people of his age
c.
Possible middle ear infection
d.
A characteristic of recruitment
15. While discussing the history of a 6-month-old infant, the mother tells the nurse that she took a
significant amount of aspirin while she was pregnant. What question would the nurse want to
include in the history?
a.
“Does your baby seem to startle with loud noises?”
b.
“Has your baby had any surgeries on her ears?”
c.
“Have you noticed any drainage from her ears?”
d.
“How many ear infections has your baby had since birth?”
16. The nurse is performing an otoscopic examination on an adult. Which of these actions is
correct?
a.
Tilt the person’s head forward during the examination.
b.
Once the speculum is in the ear, releasing the traction.
c.
Pulling the pinna up and back before inserting the speculum.
d.
Using the smallest speculum to decrease the amount of discomfort.
17. The nurse is assessing a 16-year-old patient who has suffered head injuries from a recent
motor vehicle accident. Which of these statements indicates the most important reason for
assessing for any drainage from the ear canal?
a.
The auditory canal may be occluded from increased cerumen.
b.
If the drum has ruptured, then purulent drainage will result.
c.
Bloody or clear watery drainage can indicate a basal skull fracture.
d.
Foreign bodies from the accident may cause occlusion of the ear canal.
18. In performing a voice test to assess hearing, which of these actions would the nurse perform?
a.
Shield the lips so that the sound is muffled.
b.
Whisper a set of random numbers and letters, and then ask the patient to repeat
them.
c.
Ask the patient to place his or her finger in their ear to occlude outside noise.
d.
Stand approximately 4 feet away to ensure that the patient can really hear at this
distance.
19. How should the nurse perform an examination of a 2-year-old child with a suspected ear
infection?
a.
Pull the ear up and back before inserting the speculum.
b.
Omit the otoscopic examination if the child has a fever.
c.
Ask the mother to leave the room while examining the child.
d.
Perform the otoscopic examination at the end of the assessment.
20. The nurse is preparing to perform an otoscopic examination of a newborn infant. Which
statement is true regarding this examination?
a.
An injected membrane may indicate an infection.
b.
The eardrum will appear in the oblique position.
c.
The normal membrane may appear thick and opaque.
d.
The appearance of the membrane is identical to that of an adult.
21. The nurse assesses the hearing of a 7-month-old by clapping hands. What is the expected
response?
a.
The infant shows no obvious response to the noise.
b.
The infant shows a startle and acoustic blink reflex.
c.
The infant turns his or her head to localize the sound.
d.
The infant stops any movement, and appears to listen for the sound.
22. The nurse is performing an ear examination of an 80-year-old patient. Which of these findings
would be considered normal?
a.
High-tone frequency loss
b.
Thin, translucent membrane
c.
Shiny, pink tympanic membrane
d.
Increased elasticity of the pinna
23. An assessment of a 23-year-old patient reveals the following: an auricle that is tender and
reddish-blue in color with small vesicles. The nurse would need to know additional
information that includes which of these?
a.
Any change in ability to hear
b.
Any recent drainage from the ear
c.
Recent history of trauma to the ear
d.
Any prolonged exposure to extreme cold
24. While performing the otoscopic examination of a 3-year-old boy who has been pulling on his
left ear, the nurse finds that his left tympanic membrane is bright red and that the light reflex
is not visible. What do these findings indicate?
a.
Cholesteatoma
b.
A fungal infection
c.
An acute otitis media
d.
A perforation of the eardrum
25. The mother of a 2-year-old toddler is concerned about the upcoming placement of
tympanostomy tubes in her son’s ears. The nurse would include which of these statements in
the teaching plan?
a.
The tubes are placed in the inner ear.
b.
The tubes are used in children with sensorineural loss.
c.
The tubes are permanently inserted during a surgical procedure.
d.
The purpose of the tubes is to decrease the pressure and allow for drainage.
26. In an individual with otitis externa, which of these signs would the nurse expect to find on
assessment?
a.
Rhinorrhea
b.
Periorbital edema
c.
Pain over the maxillary sinuses
d.
Enlarged superficial cervical nodes
27. When performing an otoscopic examination of a 5-year-old child with a history of chronic ear
infections, the nurse sees that his right tympanic membrane is amber-yellow in color and that
air bubbles are visible behind the tympanic membrane. The child reports occasional hearing
loss and a popping sound with swallowing. Based on this data, what does the nurse conclude?
a.
An acute purulent otitis externa
b.
Most likely a serous otitis media
c.
Evidence of a resolving cholesteatoma
d.
Experiencing the early stages of perforation
28. The nurse is performing an assessment on a 65-year-old man. He reports a crusty nodule
behind the pinna. It intermittently bleeds and has not healed over the past 6 months. On
physical assessment, the nurse finds an ulcerated crusted nodule with an indurated base. Based
on these findings, what does the nurse suspect?
a.
Most likely a keloid
b.
Probably a benign sebaceous cyst
c.
Could be a potential carcinoma, and the patient should be referred for a biopsy
d.
A tophus, which is common in the older adult and is a sign of gout
29. The nurse suspects that a patient has otitis media. Early signs of otitis media include which of
these findings of the tympanic membrane?
a.
Hypomobility
b.
Fiery red and bulging of entire eardrum
c.
Retraction with landmarks clearly visible
d.
Flat, slightly pulled in at the center, and moves with insufflation
30. The nurse is performing a middle ear assessment on a 15-year-old patient who has had a
history of chronic ear infections. When examining the right tympanic membrane, the nurse
sees the presence of dense white patches. The tympanic membrane is otherwise unremarkable.
It is pearly, with the light reflex at 5 o’clock and landmarks visible. What should the nurse do?
a.
Refer the patient for the possibility of a fungal infection.
b.
Recognize that these are scars caused from frequent ear infections.
c.
Consider that these findings may represent the presence of blood in the middle ear.
d.
Be concerned about the ability to hear because of this abnormality on the tympanic
membrane.
31. The nurse is preparing to do an otoscopic examination on a 2-year-old child. Which one of
these reflects the correct procedure?
a.
Pulling the pinna down
b.
Pulling the pinna up and back
c.
Slightly tilting the child’s head toward the examiner
d.
Instructing the child to touch their chin to their chest
32. The nurse is conducting a child safety class for new mothers. Which factor places young
children at risk for ear infections?
a.
Family history
b.
Air conditioning
c.
Excessive cerumen
d.
Passive cigarette smoke
33. During an otoscopic examination, the nurse notices an area of black and white dots on the
tympanic membrane and the ear canal wall. What does this finding suggest?
a.
Malignancy
b.
Viral infection
c.
Blood in the middle ear
d.
Yeast or fungal infection
34. A 17-year-old student is a swimmer on her high school’s swim team. She has had three bouts
of otitis externa this season and wants to know what to do to prevent it. What should the nurse
include in the instructions?
a.
Use a cotton-tipped swab to dry ear canals thoroughly after each swim.
b.
Use rubbing alcohol or 2% acetic acid eardrops after every swim.
c.
Irrigate the ears with warm water and a bulb syringe after each swim.
d.
Rinse the ears with a warmed solution of mineral oil and hydrogen peroxide.
35. During an examination, the patient states he is hearing a buzzing sound and says that it is
“driving me crazy!” What does this indicate?
a.
Vertigo
b.
Pruritus
c.
Tinnitus
d.
Cholesteatoma
36. During an examination, the nurse notices that the patient stumbles a little while walking, and,
when she sits down, she holds on to the sides of the chair. The patient states, “It feels like the
room is spinning!” What do this signs and symptoms indicate?
a.
Tinnitus
b.
Dizziness
c.
Objective vertigo
d.
Subjective vertigo
37. A patient has been admitted after an accident at work. During the assessment, the patient is
having trouble hearing and states, “I don’t know what is the matter. All of a sudden I can’t
hear you out of my left ear!” What should the nurse do next?
a.
Irrigate the ear with rubbing alcohol.
b.
Notify the patient’s health care provider.
c.
Prepare to remove cerumen from the patient’s ear.
d.
Make note of this finding for the report to the next shift.
MULTIPLE RESPONSE
1. The nurse is testing the hearing of a 78-year-old man and is reminded of the changes in
hearing that occur with aging that include which of the following? (Select all that apply.)
a.
Progression of hearing loss is slow.
b.
The aging person has low-frequency tone loss.
c.
Sounds may be garbled and difficult to localize.
d.
Hearing loss r/t aging begins in the mid-40s.
e.
Hearing loss reflects nerve degeneration of the middle ear.
f.
The aging person may find it harder to hear consonants than vowels.