ENT Chapter

Question 0

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 purpose of cerumen is to protect and lubricate the ear.
C. The presence of cerumen is indicative of poor hygiene.
D. Cerumen is necessary for transmitting sound through the auditory canal.

Answer 0

B. The purpose of cerumen is to protect the ear

Question 1

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 a characteristic of recruitment.
B. may indicate a middle ear infection.
C. is normal for people of that age.
D. indicates that the patient has a cerumen impaction.

Answer 1

A. Characteristic of recruitment

Question 2

A colleague is assessing an 80-year-old patient who has ear pain and asks him to hold his nose and swallow. The nurse knows that which of the following is true concerning this technique?

A. This is especially useful in assessing a patient with an upper respiratory infection.
B. This should not be used in an 80-year-old patient.
C. This technique is helpful in assessing for otitis media.
D. This will cause the eardrum to bulge slightly and make landmarks more visible.

Answer 2

B. This should not be used in an 80 year old

Question 3

The projections in the nasal cavity that increase the surface area are called the:

A. septum.
B. meatus.
C. Kiesselbach plexus.
D. turbinates.

Answer 3

D. Turbinates

Question 4

The nurse is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale, gray, and swollen. What would be the most appropriate question to ask the patient?

A. “Have you been having frequent nosebleeds?”
B. “Do you have an elevated temperature?”
C. “Have you had any symptoms of a cold?”
D. “Are you aware of having any allegies?”

Answer 4

D. Are you aware of having any allergies

Question 5

When assessing the tongue of an adult, the nurse knows that an abnormal finding would be:

A. a thin white coating over the tongue.
B. visible venous patterns on the ventral surface.
C. a smooth glossy dorsal surface.
D. raised papillae on the dorsal surface.

Answer 5

C. Smooth glossy tongue

Question 6

Which of these techniques best describes the test the nurse should use to assess the function of cranial nerve X?

A. Assess movement of the hard palate and uvula with the gag reflex.
B. Ask the patient to say “ahhh” and watch for movement of the soft palate and uvula.
C. Have the patient stick out the tongue and observe for tremors or pulling to one side.
D. Observe the patient’s ability to articulate specific words.

Answer 6

B. Ask the patient to say Ahh

Question 7

The nurse is performing a middle ear assessment on a 15-year-old patient who has 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. The nurse should:

A. consider that these findings may represent the presence of blood in the middle ear.
B. know that these are scars caused from frequent ear infections.
C. refer the patient for the possibility of a fungal infection.
D. be concerned about the ability to hear because of this abnormality on the tympanic membrane.

Answer 7

B. Know that these scars are caused by frequent ear infections

Question 8

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:

A. the cochlea.
B. cranial nerve VIII.
C. the labyrinth.
D. the organ of Corti.

Answer 8

C. The labyrinth

Question 9

The nurse is assessing an 80-year-old patient. Which of these findings would be expected for this patient?

A. An increased production of saliva
B. Finer and less prominent nasal hair
C. A decreased ability to identify odors
D. Hypertrophy of the gums

Answer 9

C. A decreased ability to identify odors

Question 9

When assessing the tongue of an adult, the nurse knows that an abnormal finding would be:

A. visible venous patterns on the ventral surface.
B. a smooth glossy dorsal surface.
C. raised papillae on the dorsal surface.
D. a thin white coating over the tongue.

Answer 9

B. a smooth glossy dorsal surface..

Question 10

What is the most common cause of conductive hearing loss in adults between the ages if 20-40 years of age?

Answer 10

Otosclerosis

Question 11

Wet cerumen

Answer 11

Wet cerumen is honey brown to dark brown and moist. Occurs in Caucasians and African Americans.

Question 12

Any discharge from your ears?

Answer 12

Ask patient if their is any relationship between the discharge and the ear pain?

Question 13

dry Cerumen

Answer 13

Dry cerumen is gray, flaky, and frequently found in Asians and American Indians

Question 14

What is presbycusis?

Answer 14

A gradual onset over the years, whereas a trauma sudden loss is often sudden. REFER any SUDDEN loss in one or both ears NOT associated with upper respiratory infection (URI)

Question 15

What is tinnitus?

Answer 15

Tinnitus is ringing, crackling,or buzzing in your ears.

Question 16

Tinnitus

Answer 16

Many medications have ototoxic sequale so be sure to ask if they are taking any medications.

Question 17

What is recruitment?

Answer 17

A marked loss when speech is at low intensity, but sound actually becomes PAINFUL when the speaker repeats in a loud voice.

Question 18

Vertigo

Answer 18

Ever felt vertigo; that is, the room spinning around or yourself spinning? (Vertigo is a true twirling motion)

Question 19

Objective vertigo

Answer 19

Feels like the room spins

Question 20

Subjective vertigo

Answer 20

Person feels like he or she spins

Distinguish true vertigo from dizziness or light headed ness

Question 21

Inspect and palpate the external ear

Answer 21

The ears are equal bilaterally with no swelling or thickening.

Ears of unusual size and shape may be normal due to family trait and not of any clinical significance.

Question 22

Skin condition

Answer 22

The skin color should be consistent with the face. The skin should be intact with no lumps or lesions.

Question 23

Darwin’s tubercle

Answer 23

A small, painless nodule at the helix. This is NOT significant!

Question 24

Tenderness of the ear

Answer 24

Pinna and trays should feel firm and free of pain. Palpate the mastoid process and that should be pain free.

Question 25

The external auditory meatus

Answer 25

Note the size or the opening to direct your choice or speculum for otoscope. No swelling, redness, or discharge should be present. Some cerumen is typically present

Question 26

Impacted cerumen

Answer 26

Is a common cause of conductive hearing loss

Question 27

The nurse needs to pull the portion of the ear that consists of moveable cartlidge and skin down  and back when administering ear drops. This portion of the ear is called:
A. Outer meatus
B. Auricle
C.concha
D. Mastoid process

Answer 27

B. Auricle

Question 28

A patient with a middle ear Infection asks the nurse,”what does the middle ear do”? The nurse responds by telling:

A. Interpret sounds as they enter the ear
B. Conduct vibrations of sounds to the inner ear
C. Maintain balance
D. Increase amplitude or sound for the inner ear to function

Answer 28

B. Conduct vibrations of sounds to the inner ear

Question 29

Inspect with the otoscope

Answer 29

Choose the largest speculum to fit comfortably in the ear canal and attach it to an otoscope. Tilt the person’s head slightly away from you toward the opposite shoulder. Pull the pinna up and back. Hold the pinna firmly but gently. Do not release traction until you’ve finished the exam.

Question 30

A 70 yr old patient tell the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says he can't always tell where the sound in coming from  and the words often sound mixed up. What might the nurse suspect as the cause for this change?
A. Cilia becoming course and stiff
B. Nerve degeneration
C. Scarring of the tympanic membrane
D. Atrophy of the apocrine glands

Answer 30

B. Nerve degeneration

Question 31

The primary purpose of the ciliates mucous membrane in the nose is to:
A. Filter course particles from inhaled air
B. Warm the inhaled air
C. Filter out dust and bacteria
D. Facilitate movement of air through the nares

Answer 31

C. Filter out dust and bacteria

Question 34

The nurse is using an otoscope to assess the nasal cavity. Which of these is correct?
A. Avoid touching the nasal septum with the speculum
B. Gently displace the nose to the side that is being examined
C.insert the speculum tip medial to avoid touching the

Answer 34

A. Avoid touching the nasal septum with the speculum

Question 35

allows passage of air; cloed until sallowing or yawning

Answer 35

eustachian tube

Question 36

The tympanic membrane is a translucent membrane with a _____ color and a _____.

Answer 36

pearly gray

prominent cone of light in the anteroinferior quadrant

Question 37

the inner ear is embedded in ___. you can assess the function of the inner ear but is ____ in the examination.

Answer 37

bone

not accessible

Question 38

air conduction is ___ than bone conduction

Answer 38

greater

Question 39

cranial nerve ___ from each ear send signals to both sides of the brainstem

Answer 39

VIII

Question 40

a _____ hearing loss involves a mechanical dysfunction of external or middle ear.

Answer 40

conductive

Question 41

a decrease in mobility of the ossicles

Answer 41

otosclerosis

Question 42

____hear loss signifies pathology of the inner ear, cranial nerve VIII, or the auditory areas of the cerebral cortex.

Answer 42

sensorineural (or perceptive)

Question 43

a gradual nerve degeneration that occurs with aging

Answer 43

presbycusis

Question 44

a ___ hearing loss is a combination of conductive and sensorineural types in the SAME ear.

Answer 44

mixed

Question 45

strong, spinning, whirling sensation

Answer 45

vertigo

Question 46

____ is common cause of conductive hearing loss in young adults between the ages of 20 and 40 years,

Answer 46

otosclerosis

Question 47

in an aging person, the cilia lining the ear canal becomes ___.

Answer 47

coarse and stiff

Question 48

the wet cerumen phenotype occurs more often in _____whereas dry cerumen is more frequent in ____.

Answer 48

caucasians and african american

asians and american indians.

Question 49

___ may be directly due to ear diease or may be referred pain from a problem in the teeth or oropharynx.

Answer 49

otalgia

Question 50

infected canal or perforated eardrum

Answer 50

otorrhea which can be external otitis, acute otitis media, cholestratoma

Question 51

purulent, sanguineous or watery discharge

Answer 51

external otitis

Question 52

purulent discharge

Answer 52

acute otitis media with perforation

Question 53

dirty yellow/ gray discharge foul odor.

Answer 53

cholesteatoma

Question 54

hold the otoscope ___ along your fingers and have the ___ along the persons cheek braced to steady the otoscope.

Answer 54

upside down

dorsa of your hand

Question 55

the cone-shaped light reflex is prominent in the anteroinferior quadrant ( at the ____ in the right drum & the ____ in the left drum)

Answer 55

5 o’clock position

7 o’clock position

Question 56

the ____ assess the ability of the vestibular apparatus in the inner ear to help maintain standiing balance.

Answer 56

romberg test

Question 57

the aging adult, during otoscopy, the eardrum normally may be ___ in color and more ___, __ than in the younger adults. it also may looked ____.

Answer 57

whiter
opaque
duller
thickened

Question 58

reddish blue discoloration and swelling of auricle after exposure to extreme cold.

Answer 58

frostbite

Question 59

inflammation of loose, subcutaneous connective tissue. shows as thickening and induration of auricle with distorted contours.

Answer 59

cellulitis

Question 60

location is commonly behind lobule, in the postauricular fold. a nodule with central black panctum indicated blocked sabeceous gland.

Answer 60

sebaceous cyst

Question 61

small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric accid crystals

Answer 61

tophi

Question 62

sign of gout

Answer 62

tophi

Question 63

painful nodules that develop on the rim of the helix as a result of repetitive mechanical pressure or enviromental trauma. they are small, indurated, dull red, poorly defind, and very painful

Answer 63

chondrodermiatitis nodularis helicus

Question 64

ulcerated , crusted nodule with indurated base that fails to heal. bleeds intermittently. usually occurs on the superior rim of pinna, which has the most sun exposure. may occur also in ear canal and show chronic discharge that is either serosanguineous or bloody.

Answer 64

carcinoma

Question 65

Perforation

Answer 65

Typically with perforation of the ear drum, pain occurs first , stops with a popping sensation, then drainage occurs. A

Question 66

Hearing loss

Answer 66

Can cause social isolation and lessen pleasure or leisure activities.

Question 67

Environmental noise

Answer 67

Ask about any loud noises at home, work, or for pleasure.

Old trauma to hearing initially goes unnoticed but results in further decibel loss in years later.

Question 68

Self care behaviors

Answer 68

Ask about self care behaviors. For example: do you clean your ears with q tips? How often? Do you have your hearing checked? If so, how often?

Question 69

Aging adults ears

Answer 69

Coarse, wiry hairs may be present at the opening of the ear canal. The ear drum may be whiter in color and more opaque, duller than the younger adult.

Question 70

Presbycusis

Answer 70

High tone frequency hearing loss is apparent in older adults. Condition is revealed during the whispered voice test.

Question 71

Tophi

Answer 71

Small, whitish, yellow, hard, nontender nodules in or near helix or anti helix; contain greasy, chalky material of Uric acid crystals and are a sign of gout

Question 72

Xerostomia (dry mouth)

Answer 72

A side effect of many drugs: antidepressants, anticholinergics, antispasmodics, anti hypertensives. Antipsychotics, etc. so make sure you ask what medications are you taking!