Chapter 13: Ears, Nose, Throat

Question 1

1. Mr. Sprat is a 21-year-old patient who complains of nasal congestion. He admits to using recreational drugs. On examination, you have noted a septal perforation. Which of the following recreational drugs is commonly associated with nasal septum perforation?
   a. Heroin
   b. Cocaine
   c. PCP
   d. Ecstasy

Answer 1

b. Cocaine

Question 2

2. A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness, you should palpate over the
   a. sphenoid and frontal sinuses.
   b. maxillary and frontal sinuses.
   c. maxillary sinuses only.
   d. sphenoid sinuses only.

Answer 2

c. maxillary sinuses only.

Question 3

3. Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize
   the otoscope against the head while using the other hand to
   a. pull the auricle down and back.
   b. hold the speculum in the canal.
   c. distract the infant.
   d. stabilize the chest.

Answer 3

a. pull the auricle down and back.

Question 4

4. Mrs. Donaldson is a 31-year-old patient who is pregnant. In providing Mrs. Donaldson with healthcare information, you will explain that she can expect to experience
   a. more nasal stuffiness.
   b. a sensitive sense of smell.
   c. drooling.
   d. enhanced hearing.

Answer 4

a. more nasal stuffiness.

Question 5

5. You are performing hearing screening tests. Who would be expected to find difficulty in hearing the highest frequencies?
   a. A 7-year-old
   b. An 18-year-old
   c. A 30-year-old
   d. A 50-year-old

Answer 5

d. A 50-year-old

Question 6

6. Mr. Spencer presents with the complaint of hearing loss. You specifically inquire about current medications. Which medications, if listed, are likely to contribute to his hearing loss?
   a. Chlorothiazide
   b. Acetaminophen
   c. Salicylates
   d. Cephalosporins

Answer 6

c. Salicylates

Question 7

7. To approximate vocal frequencies, which tuning fork should be used to assess hearing?
   a. 100 to 300 Hz
   b. 200 to 400 Hz
   c. 500 to 1000 Hz
   d. 1500 to 2000 Hz

Answer 7

c. 500 to 1000 Hz

Question 8

8. You are using a pneumatic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to
   a. remove all cerumen from the canal.
   b. change to a larger speculum.
   c. squeeze the bulb with more force.
   d. insert the speculum to a depth of 2 cm.

Answer 8

b. change to a larger speculum.

Question 9

9. When conducting an adult otoscopic examination, you should
   a. position the patient’s head leaning toward you.
   b. grasp the handle of the otoscope as you would a baseball bat.
   c. select the largest speculum that will fit in the canal.
   d. ask the patient to keep his or her eyes closed.

Answer 9

c. select the largest speculum that will fit in the canal.

Question 10

10. Bulging of an amber tympanic membrane without mobility is usually associated with
    a. middle ear effusion.
    b. healed tympanic membrane perforation.
    c. impacted cerumen in the canal.
    d. repeated and prolonged crying cycles.

Answer 10

a. middle ear effusion.

Question 11

11. When hearing is evaluated, which cranial nerve is being tested?
    a. III
    b. IV
    c. VIII
    d. XII

Answer 11

c. VIII

Question 12

12. Speech with a monotonous tone and erratic volume may indicate
    a. otitis externa.
    b. hearing loss
    c. serous otitis media. d. sinusitis.

Answer 12

b. hearing loss

Question 13

13. You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, air conduction-to-bone conduction ratio is less than 2:1. You interpret these findings as suggestive of
    a. a defect in the inner ear.
    b. a defect in the middle ear.
    c. otitis externa.
    d. impacted cerumen.

Answer 13

a. a defect in the inner ear.

Question 14

14. Nasal symptoms that imply an allergic response include
    a. purulent nasal drainage.
    b. bluish gray turbinates.
    c. small, atrophied nasal membranes.
    d. firm consistency of turbinates.

Answer 14

b. bluish gray turbinates.

Question 15

15. You are interviewing a parent whose child has a fever, is pulling at her right ear, and is irritable. You ask the parent about the child’s appetite and find that the child has a decreased appetite. This additional finding is more suggestive of
    a. acute otitis media.
    b. otitis externa.
    c. serous otitis media.
    d. middle ear effusion.

Answer 15

a. acute otitis media.

Question 16

16. A hairy tongue with yellowish brown to black elongated papillae on the dorsum
    a. is indicative of oral cancer.
    b. is sometimes seen following antibiotic therapy.
    c. usually indicates vitamin deficiency.
    d. usually indicates anemia.

Answer 16

b. is sometimes seen following antibiotic therapy.

Question 17

17. To inspect the lateral borders of the tongue, you should
    a. ask the patient to extend the tongue outward.
    b. insert the tongue blade obliquely against the tongue.
    c. lift the tongue upward with gloved fingers.
    d. pull the gauze-wrapped tongue to each side.

Answer 17

d. pull the gauze-wrapped tongue to each side.

Question 18

18. For best results, an otoscopic and oral examination in a child should be
    a. conducted at the beginning of the assessment.
    b. done after inspection.
    c. performed at the end of the examination.
    d. performed before palpation.

Answer 18

c. performed at the end of the examination.

Question 19

1. Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss. Which are changes in hearing that occur in older adults? (Select all that apply.)
   a. Results from cranial nerve VII
   b. Slow progression
   c. Loss of high frequency
   d. Bone conduction heard longer than air conduction
   e. Sounds may be garbled, difficult to localize
   f. Unable to hear in a crowded room

Answer 19

b. Slow progression
c. Loss of high frequency
e. Sounds may be garbled, difficult to localize
f. Unable to hear in a crowded room

Question 20

2. Which signs and symptoms occur with a sensorineural hearing loss? (Select all that apply.)
   a. Air conduction shorter than bone conduction
   b. Lateralization to the affected ear
   c. Loss of high-frequency sounds
   d. Speaks more loudly
   e. Disorder of the inner ear
   f. Air conduction longer than bone conduction

Answer 20

c. Loss of high-frequency sounds
d. Speaks more loudly
e. Disorder of the inner ear
f. Air conduction longer than bone conduction