Chapter 14 - Ears Flashcards
The nurse needs to pull the portion of the ear that consists of movable cartilage and skin down and back when administering eardrops. This portion of the ear is called the:
a. Auricle.
b. Concha.
c. Outer meatus.
d. Mastoid process.
a. Auricle.
Rationale: The external ear is called the auricle or pinna and consists of movable cartilage and skin.
The nurse is examining a patient’s ears and notices cerumen in the external canal. Which of these statements about cerumen is correct?
a. Sticky 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.
c. The purpose of cerumen is to protect and lubricate the ear.
Rationale: The ear is lined with glands that secrete cerumen, which is a yellow waxy material that lubricates
and protects the ear.
When examining the ear with an otoscope, the nurse notes that the tympanic membrane should appear:
a. Light pink with a slight bulge.
b. Pearly gray and slightly concave.
c. Pulled in at the base of the cone of light.
d. Whitish with a small fleck of light in the superior portion.
b. Pearly gray and slightly concave.
Rationale: The tympanic membrane is a translucent membrane with a pearly gray color and a prominent
cone of light in the anteroinferior quadrant, which is the reflection of the otoscope light. The tympanic membrane is oval and slightly concave, pulled in at its center by the malleus, which is one of the middle ear ossicles.
The nurse is reviewing the structures of the ear. Which of these statements concerning the eustachian tube is true?
a. The eustachian tube is responsible for the production of cerumen.
b. It remains open except when swallowing or yawning.
c. The eustachian tube allows passage of air between the middle and outer ear.
d. It helps equalize air pressure on both sides of the tympanic membrane.
d. It helps equalize air pressure on both sides of the tympanic membrane.
Rationale: The eustachian tube allows an equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture during, for example, altitude changes in an airplane. The tube is normally closed, but it opens with swallowing or yawning.
A patient with a middle ear infection asks the nurse, What does the middle ear do? The nurse responds by telling the patient that the middle ear functions to:
a. Maintain balance.
b. Interpret sounds as they enter the ear.
c. Conduct vibrations of sounds to the inner ear.
d. Increase amplitude of sound for the inner ear to function.
c. Conduct vibrations of sounds to the inner ear.
Rationale: Among its other functions, the middle ear conducts sound vibrations from the outer ear to the
central hearing apparatus in the inner ear. The other responses are not functions of the middle ear.
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
c. VIII
Rationale: The nerve impulses are conducted by the auditory portion of CN VIII to the brain.
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. Vibrations of the bones in the skull cause air conduction.
c. Amplitude of sound determines the pitch that is heard.
d. Loss of air conduction is called a conductive hearing loss.
a. Air conduction is the normal pathway for hearing.
Rationale: The normal pathway of hearing is air conduction, which starts when sound waves produce
vibrations on the tympanic membrane. Conductive hearing loss results from a mechanical dysfunction of the external or middle ear. The other statements are not true concerning air conduction.
A patient has been shown to have a sensorineural hearing loss. During the assessment, it would be important for the nurse to:
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.
c. Ask the patient what medications he is currently taking.
Rationale: A simple increase in amplitude may not enable the person to understand spoken words. Sensorineural hearing loss may be caused by presbycusis, which is a gradual nerve degeneration that occurs with aging and by ototoxic drugs, which affect the hair cells in the cochlea.
During an interview, the patient states he has the sensation that everything around him is spinning. The nurse recognizes that the portion of the ear responsible for this sensation is the:
a. Cochlea.
b. CN VIII.
c. Organ of Corti.
d. Labyrinth.
d. Labyrinth.
Rationale: If the labyrinth ever becomes inflamed, then it feeds the wrong information to the brain, creating
a staggering gait and a strong, spinning, whirling sensation called vertigo.
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 infants hearing?
a. Rubella may affect the mothers hearing but not the infants.
b. Rubella can damage the infants organ of Corti, which will impair hearing.
c. Rubella is only dangerous to the infant in the second trimester of pregnancy.
d. Rubella can impair the development of CN VIII and thus affect hearing.
b. Rubella can damage the infants organ of Corti, which will impair hearing.
Rationale: If maternal rubella infection occurs during the first trimester, then it can damage the organ of Corti and impair hearing.
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.
d. Your son’s eustachian tube is shorter and wider than yours because of his age, which allows for infections more easily.
d. Your son’s eustachian tube is shorter and wider than yours because of his age, which allows for infections more easily.
Rationale: The infants eustachian tube is relatively shorter and wider than the adults eustachian tube, and its position is more horizontal; consequently, pathogens from the nasopharynx can more easily migrate through to the middle ear. The other responses are not appropriate.
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. The most likely cause of his hearing loss is:
a. Otosclerosis.
b. Presbycusis.
c. Trauma to the bones.
d. Frequent ear infections.
a. Otosclerosis.
Rationale: Otosclerosis is a common cause of conductive hearing loss in young adults between the ages of 20 and 40 years. Presbycusis is a type of hearing loss that occurs with aging. Trauma and frequent ear infections are not a likely cause of his hearing loss.
A 70 year-old patient tells the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says that he cant always tell where the sound is coming from and 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. Scarring of the tympanic membrane.
c. Nerve degeneration in the inner ear.
Rationale: Presbycusis is a type of hearing loss that occurs in 60% of those older than 65 years of age, even
in those living in a quiet environment. This sensorineural loss is gradual and caused by nerve degeneration in the inner ear. Words sound garbled, and the ability to localize sound is also impaired. This communication dysfunction is accentuated when background noise is present.
During an assessment of a 20 year-old Asian patient, the nurse notices that he has dry, flaky cerumen in his canal. What is the significance of this finding? This finding:
a. Is probably the result of lesions from eczema in his ear.
b. Represents poor hygiene.
c. Is a normal finding, and no further follow-up is necessary.
d. Could be indicative of change in cilia; the nurse should assess for hearing loss.
c. Is a normal finding, and no further follow-up is necessary.
Rationale: Asians and Native Americans are more likely to have dry cerumen, whereas Blacks and Whites usually have wet cerumen.
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?
d. Is there any relationship between the ear pain and the discharge you mentioned?
Rationale: Typically with perforation, ear pain occurs first, stopping with a popping sensation, and then drainage occurs.
A 31 year-old patient tells the nurse that he has noticed pain in his left ear when people speak loudly to him. The nurse knows that this finding:
a. Is normal for people of his age.
b. Is a characteristic of recruitment.
c. May indicate a middle ear infection.
d. Indicates that the patient has a cerumen impaction.
b. Is a characteristic of recruitment.
Rationale: Recruitment is significant hearing loss occurring when speech is at low intensity, but sound
actually becomes painful when the speaker repeats at a louder volume. The other responses are not correct.
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?
a. Does your baby seem to startle with loud noises?
Rationale: Children at risk for a hearing deficit include those exposed in utero to a variety of conditions, such as maternal rubella or to maternal ototoxic drugs.
The nurse is performing an otoscopic examination on an adult. Which of these actions is correct?
a. Tilting the persons 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.
c. Pulling the pinna up and back before inserting the speculum.
Rationale: The pinna is pulled up and back on an adult or older child, which helps straighten the S-shape of the canal. Traction should not be released on the ear until the examination is completed and the otoscope is removed.
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. If the drum has ruptured, then purulent drainage will result.
b. Bloody or clear watery drainage can indicate a basal skull fracture.
c. The auditory canal many be occluded from increased cerumen.
d. Foreign bodies from the accident may cause occlusion of the canal.
b. Bloody or clear watery drainage can indicate a basal skull fracture.
Rationale: Frank blood or clear watery drainage (cerebrospinal leak) after a trauma suggests a basal skull
fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media.
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 finger in his ear to occlude outside noise.
d. Stand approximately 4 feet away to ensure that the patient can really hear at this distance.
b. Whisper a set of random numbers and letters, and then ask the patient to repeat them.
Rationale: With the head 30 to 60 cm (1 to 2 feet) from the patients ear, the examiner exhales and slowly
whispers a set of random numbers and letters, such as 5, B, 6. Normally, the patient is asked to repeat each number and letter correctly after hearing the examiner say them.
In performing an examination of a 3 year-old child with a suspected ear infection, the nurse would:
a. Omit the otoscopic examination if the child has a fever.
b. Pull the ear up and back before inserting the speculum.
c. Ask the mother to leave the room while examining the child.
d. Perform the otoscopic examination at the end of the assessment.
d. Perform the otoscopic examination at the end of the assessment.
Rationale: In addition to its place in the complete examination, eardrum assessment is mandatory for any
infant or child requiring care for an illness or fever. For the infant or young child, the timing of the otoscopic examination is best toward the end of the complete examination.
The nurse is preparing to perform an otoscopic examination of a newborn infant. Which statement is true regarding this examination?
a. Immobility of the drum is a normal finding.
b. An injected membrane would indicate an infection.
c. The normal membrane may appear thick and opaque.
d. The appearance of the membrane is identical to that of an adult.
c. The normal membrane may appear thick and opaque.
Rationale: During the first few days after the birth, the tympanic membrane of a newborn often appears
thickened and opaque. It may look injected and have a mild redness from increased vascularity. The other statements are not correct.
The nurse assesses the hearing of a 7 month-old by clapping hands. What is the expected response? The infant:
a. Turns his or her head to localize the sound.
b. Shows no obvious response to the noise.
c. Shows a startle and acoustic blink reflex.
d. Stops any movement, and appears to listen for the sound.
a. Turns his or her head to localize the sound.
Rationale: With a loud sudden noise, the nurse should notice the infant turning his or her head to localize the sound and to respond to his or her own name. A startle reflex and acoustic blink reflex is expected in newborns; at age 3 to 4 months, the infant stops any movement and appears to listen.
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. Increased elasticity of the pinna
c. Thin, translucent membrane
d. Shiny, pink tympanic membrane
a. High-tone frequency loss
Rationale: A high-tone frequency hearing loss is apparent for those affected with presbycusis, the hearing
loss that occurs with aging. The pinna loses elasticity, causing earlobes to be pendulous. The eardrum may be whiter in color and more opaque and duller in the older person than in the younger adult.
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 the 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.
d. Any prolonged exposure to extreme cold.
Rationale: Frostbite causes reddish-blue discoloration and swelling of the auricle after exposure to extreme
cold. Vesicles or bullae may develop, and the person feels pain and tenderness.
