Chapter 54: Ear and Hearing Disorders Nursing School Test Banks

Chapter 54: Ear and Hearing Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A nurse reads in a patients history that the patient has experienced otalgia. How should the nurse interpret this term?
a. Difficulty hearing
b. Buildup of cerumen
c. Ear pain
d. Ringing in the ears
ANS: C
Otic- is the root word for ear, and -algia is the root term for pain of any type.

DIF: Cognitive Level: Knowledge REF: p. 1252 OBJ: 5
TOP: Definitions KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. A nurse is assisting with a caloric test and notes that the specific patient response that indicates a hearing disorder is a problem in the labyrinth. Which response did the nurse witness?
a. Blinking
b. Grimacing
c. Headache
d. Nystagmus
ANS: D
When warm or cold water is introduced into the ear, the appearance of nystagmus is a positive indication that the hearing problem has its cause in the labyrinth.

DIF: Cognitive Level: Comprehension REF: p. 1256 OBJ: 2
TOP: Caloric Test KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. A 75-year-old patient has normal age-related changes in his ear. What change should not be considered a normal change in the aging patient?
a. Dry and wrinkled skin on the auricle
b. Otitis externa
c. Dry cerumen
d. Hair in the ear canal
ANS: B
Otitis externa is an outer ear infection and therefore an exception. The other three options are normal age-related changes.

DIF: Cognitive Level: Comprehension REF: p. 1251 OBJ: 5
TOP: Age-Related Changes KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. When making an initial assessment on a patient with a hearing deficit, the patient reports that he often feels off balance and is dizzy when he stands up. Which diagnosis might explain these symptoms?
a. Sinus infection
b. Rubella
c. Otalgia
d. Presbycusis
ANS: A
A sinus infection can be an acute cause of hearing deficits and can create problems with balance.

DIF: Cognitive Level: Comprehension REF: p. 1252 OBJ: 5
TOP: Hearing Assessment: Medical History
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. A 94-year-old patient is receiving gentamicin sulfate (Garamycin) in a continuous intravenous (IV) infusion. The nurse adds to the nursing care plan the diagnosis Risk for injury. What nursing action should be implemented?
a. Pull side rails in place.
b. Assist with ambulation.
c. Measure intake and output.
d. Provide for a possible seizure.
ANS: C
Reduced urine output would cause the drug to stay in the system rather than being excreted, which could result in a drug saturation. Gentamicin is ototoxic and can cause hearing impairment.

DIF: Cognitive Level: Application REF: p. 1253 OBJ: 7
TOP: Gentamicin KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. A 75-year-old patient reports to a nurse that although she has cleaned her ears with cotton-tipped applicators for weeks, she still cannot hear her television unless the volume is loud, and she misses a great deal of conversations. What should the nurse anticipate when examining her ears?
a. Otitis externa
b. Purulent drainage
c. Dry cerumen across the canal
d. Pearly tympanic membrane
ANS: C
Obstruction of the external canal with cerumen will result in a hearing loss. Cleaning the ears with something such as an applicator will pack the cerumen in the canal.

DIF: Cognitive Level: Comprehension REF: p. 1251 OBJ: 6
TOP: External Auditory Canal KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. A patient reports that her hearing loss has become more severe over the past 3 months. The clinic nurse makes arrangements for an evaluation for a hearing aid. What health care provider should provide this service?
a. Otologist
b. Otolaryngologist
c. Audiometrist
d. Audiologist
ANS: D
Audiologists assess patients for hearing aids. The other specialists treat ear, nose, and throat (ENT) disorders.

DIF: Cognitive Level: Knowledge REF: p. 1253 OBJ: 7
TOP: Audiometry KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. When a patient has a suspected vestibular disorder, the physician orders an electronystagmography test. Which instruction should the nurse include when educating the patient about this test?
a. Use tea or coffee on the morning of test.
b. Electrodes will be placed on the scalp.
c. Air will be blown into the external ear.
d. The patient should have nothing to eat or drink (NPO) 3 hours before the test.
ANS: D
Electronystagmography is used to detect vestibular lesions and requires a 3-hour period of NPO before the test. Coffee and tea should also be avoided before the test.

DIF: Cognitive Level: Comprehension REF: p. 1255 OBJ: 3
TOP: Testing for Ear Disorders KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. A nurse assessing the results of a Rinne test sees the notation of BC > AC. How should the nurse translate this result?
a. Conductive hearing loss
b. Sensorineural hearing loss
c. Normal hearing
d. Cochlear defect
ANS: A
When the bone conduction (BC) is greater than the air conduction (AC), the results of the Rinne test will read, BC > AC, which means the patient has a conductive hearing loss. The normal finding for the Rinne test is that AC is greater than BC (AC > BC).

DIF: Cognitive Level: Analysis REF: p. 1255 OBJ: 2
TOP: Rinne Test KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. A patient undergoing a Weber test says that the sound is louder in her left ear. What should this result indicate?
a. Normal hearing
b. Nerve damage from listening to loud music
c. Blocked ear canal in the right ear
d. Conductive hearing loss in the left ear
ANS: D
With the Weber test, a conductive hearing loss is determined by the sound being heard loudest in the affected ear.

DIF: Cognitive Level: Comprehension REF: p. 1256 OBJ: 2
TOP: Weber Test KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

11. Which instruction should a nurse include when providing patient teaching information for a patient who will be self-administering ear drops for an ear infection?
a. Tip the affected ear up and keep it in that position for several minutes after instilling the medication.
b. Keep the medication in the refrigerator to preserve it. Instill the medication with the affected ear tilted upward.
c. Touch the dropper to the opening of the ear canal to ensure that the drops are correctly instilled.
d. Warm the ear drops and then tilt the head downward.
ANS: A
The head is kept in an upward position to ensure that the drops penetrate deep into the external ear.

DIF: Cognitive Level: Application REF: p. 1256-1257
OBJ: 4 TOP: Ear Drops KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

12. What nursing action should be implemented when irrigating a patients ear?
a. Straighten the ear canal and irrigate with a large-tipped bulb syringe.
b. Direct the solution to the middle of the canal to avoid damaging the ear.
c. Use a body temperature solution and have the patient hold a basin under the ear while directing the solution toward the top of the canal.
d. Repeat the irrigation with hotter water.
ANS: C
The irrigation is done with warm water using a small-tipped syringe. The flow is directed upward. If the cerumen does not wash out, the procedure can be repeated but with the same water temperature.

DIF: Cognitive Level: Application REF: p. 1257 OBJ: 3
TOP: Irrigation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

13. A nursing report on a newly admitted patient who is profoundly deaf says that the patient is confused and difficult to assess because she does not appropriately respond to questions or sometimes fails to respond at all. What should be the first action of the oncoming nurse?
a. Consider asking the physician to assess the patient for dementia.
b. Assess the patient to determine whether her hearing aids are in.
c. Report to the physician that the patient is exhibiting signs of the sundown syndrome.
d. Assess the patients medications to check for an overdose.
ANS: B
Profoundly deaf persons can be mistakenly assessed as being confused or disoriented when not wearing their hearing aids.

DIF: Cognitive Level: Application REF: p. 1258 OBJ: 5
TOP: Hearing Aids KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

14. Which nursing diagnosis is most appropriate for a patient having ear surgery?
a. Disturbed body image
b. Risk for injury
c. Acute confusion
d. Ineffective protection
ANS: B
Patients who have had ear surgery are at risk for vertigo, fluid accumulation, or pressure in the operative ear. Because of the surgery and potential postoperative conditions, the patient may be at risk for a fall.

DIF: Cognitive Level: Application REF: p. 1259-1260
OBJ: 7 TOP: Care Planning for Ear Surgery
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

15. What significant instruction should a nurse include to a patient being discharged after ear surgery?
a. Use stool softeners with caution.
b. Assume your usual activities.
c. Avoid blowing your nose.
d. Shampoo your hair with baby shampoo.
ANS: C
The patient should avoid blowing the nose to prevent back pressure in the eustachian tube. The patient should take stool softeners, limit activity until balance returns, and delay shampooing.

DIF: Cognitive Level: Application REF: p. 1259-1260
OBJ: 7 TOP: Nursing Diagnosis and Outcome Criteria
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. A patient with diabetes says that he needs a hearing aid because he cannot hear well, and everything sounds garbled and distant. What type of hearing loss should the nurse suspect?
a. Mixed hearing loss
b. Conductive hearing loss
c. Central hearing loss
d. Sensorineural hearing loss
ANS: D
A patient with long-term diabetes may have a sensorineural hearing loss that is not helped by hearing aids.

DIF: Cognitive Level: Comprehension REF: p. 1261 OBJ: 5
TOP: Types of Hearing Loss KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. Which nursing diagnosis should take priority in a nursing care plan for a patient with Mnire disease?
a. Social isolation, related to anxiety
b. Risk for injury, related to falls
c. Risk for deficient fluid intake, related to weakness
d. Nutrition: Less than body requirements, related to fatigue
ANS: B
The nursing diagnosis that should take priority is that of preventing injury to the patient. A patient with Mnire disease is prone to falls because of dizziness.

DIF: Cognitive Level: Application REF: p. 1266 OBJ: 7
TOP: Nursing Care Plan for Mnire Disease
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

18. Which nursing diagnosis is most appropriate when considering the impact of a hearing deficit when planning care for a child who has been diagnosed with a hearing impairment?
a. Risk for injury, related to hearing impairment
b. Risk for social isolation, related to hearing impairment
c. Knowledge deficit, related to hearing impairment
d. Anxiety, related to hearing impairment
ANS: B
The loss of hearing and the mild stigma associated with hearing impairment place the newly diagnosed child at risk for social isolation.

DIF: Cognitive Level: Application REF: p. 1262 OBJ: 7
TOP: Impact of Hearing Impairment KEY: Nursing Process Step: N/A
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

19. What information should a nurse stress when teaching a patient with Mnire disease about managing the disorder?
a. Limiting fluid intake
b. Avoiding the use of alcohol and tobacco
c. Using antiemetic medications sparingly
d. Staying active during the day
ANS: B
The use of alcohol and tobacco products affects the amount of fluid in the middle ear, worsening the symptoms of Mnire disease. The patient with Mnire disease should drink adequate fluid, use antiemetic medications as needed, and conserve energy during the day.

DIF: Cognitive Level: Application REF: p. 1266 OBJ: 7
TOP: Mnire Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

20. An 85-year-old patient has had age-related changes in the cochlea. What is the most appropriate nursing action for the nurse to implement?
a. Speak slowly.
b. Provide assistance with ambulation.
c. Speak in a lower tone.
d. Communicate with the patient in writing.
ANS: B
Assisting the patient when ambulating will diminish the risk of a fall. Changes in the cochlea will cause dizziness and ataxia.

DIF: Cognitive Level: Application REF: p. 1252 OBJ: 5
TOP: Age-Related Changes KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

21. A patient comes to the primary care clinic complaining of a head cold and ear pain with drainage. What should the nurse suspect this patient is experiencing?
a. Otitis externa
b. Hearing loss
c. Acute otitis media
d. Mastoiditis
ANS: C
Acute otitis media is connected with colds and drainage from the ear. A hearing loss may be experienced as well, but the pain and drainage place the need to intervene for the infection first.

DIF: Cognitive Level: Comprehension REF: p. 1264 OBJ: 1
TOP: Middle Ear KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. A young woman being admitted to the clinic service states that all the members of her family have been hard of hearing. She says her hearing loss became more pronounced when she was pregnant. What term explains this type of hearing loss?
a. Otosclerosis
b. Ototoxicity
c. Otalgia
d. Otitis media
ANS: A
Otosclerosis is hereditary, develops in young women, and worsens with pregnancy.

DIF: Cognitive Level: Comprehension REF: p. 1265 OBJ: 5
TOP: Otosclerosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. What should a nurse include when educating a patient with Mnire disease?
a. When you feel dizzy, just stay in bed and take your medications.
b. Decrease your sodium intake and take your diuretic medication between attacks.
c. Vestibular rehabilitation might help, and you can still drink your morning coffee.
d. Your vertigo will get better if you take your medications. You wont need any relaxation techniques.
ANS: B
A low-sodium diet and diuretic medications between attacks will prevent edema, which could cause an attack.

DIF: Cognitive Level: Application REF: p. 1267 OBJ: 7
TOP: Inner Ear KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

24. A 75-year-old patient reports having difficulty hearing in crowds but can hear just fine at home with his wife. What hearing disorder should the nurse suspect?
a. Otitis media
b. Presbycusis
c. Ototoxicity
d. Central deafness
ANS: B
Presbycusis is a conductive hearing loss associated with normal aging and is caused by changes in the cochlea.

DIF: Cognitive Level: Comprehension REF: p. 1269 OBJ: 5
TOP: Presbycusis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25. During an intake physical examination, a patient reports that he has been taking 10 aspirin tablets a day for his arthritis. What question should the nurse ask based on this information?
a. Can you hear high-pitched sounds?
b. Have you noticed deafness in just one ear?
c. Do you have ringing in your ears?
d. Do you experience dizziness when you stand?
ANS: C
A ringing in the ears (tinnitus) is an indication of aspirin toxicity. The patient should be advised to stop taking aspirin.

DIF: Cognitive Level: Application REF: p. 1252-1253
OBJ: 5 TOP: ASA Toxicity
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

26. Which patient behaviors should alert a nurse to a possible hearing deficit? (Select all that apply.)
a. Watches the speakers mouth
b. Gives inappropriate answers to questions
c. Pulls at the ears
d. Fails to respond when spoken to
e. Turns the good ear to the speaker
ANS: A, B, D, E
Pulling at the ear is not a signal for hearing loss; all of the other options are.

DIF: Cognitive Level: Comprehension REF: p. 1261 OBJ: 1
TOP: Behavioral Cues to Hearing Deficit
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

27. Which common characteristics might a patient with conductive hearing loss display? (Select all that apply.)
a. Hears adequately in noisy settings
b. Hears sounds but has difficulty understanding speech
c. Has improved hearing with hearing aids
d. Has a history of diabetes mellitus
e. Speaks in a normal volume
ANS: A, C, E
Persons with conductive hearing loss can hear in a noisy setting and can have improved hearing with the use of hearing aids. Persons with conductive hearing loss speak at a normal or soft volume because they can hear themselves. Muffled sounds and a history of diabetes would be associated with sensorineural hearing loss.

DIF: Cognitive Level: Comprehension REF: p. 1260-1261
OBJ: 5 TOP: Common Characteristics in Persons with Conductive Hearing Loss
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. A patient complains that his hearing aid is not working. What actions should a nurse implement to assess the device? (Select all that apply.)
a. Check to see if the device is turned on.
b. Clean the earpiece and remove cerumen clogged in the vent.
c. Open the earpiece to see if the microphone wire is connected.
d. Examine the interior of the earpiece for water.
e. Validate that the battery is correctly placed.
ANS: A, B, E
Cleaning the earpiece to remove clogged cerumen and checking the device to see if it is turned on and if the battery is placed correctly are all good options. The earpiece should not be opened. If the hearing aid is still not working, it should be evaluated by the dealer.

DIF: Cognitive Level: Application REF: p. 1258 OBJ: 4
TOP: Hearing Aids KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

COMPLETION

29. When planning care for a patient who cannot perceive or interpret sounds, a nurse takes into consideration that the patient may have a(n) _____ hearing loss.

ANS:
central
The inability to perceive or interpret sounds is referred to as a central hearing loss.

DIF: Cognitive Level: Comprehension REF: p. 1261 OBJ: 5
TOP: Central Hearing Loss KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

OTHER

30. A nurse uses a diagram to show the physiologic sequence of hearing. After entering the external ear, the sound is then conducted through the (Arrange the options in sequence. Separate letters by a comma and space as follows: A, B, C, D.)
A. tympanic membrane
B. sensory receptors
C. oval window
D. acoustic nerve to the brain
E. malleus, incus, and stapes

ANS:
A, E, C, B, D
The sound impulse, after entering the external ear, is conducted through the tympanic membrane; into the malleus, incus, and stapes; through the oval window; into the sensory receptors in the inner ear; and then through the acoustic nerve to the brain.

DIF: Cognitive Level: Comprehension REF: p. 1252 OBJ: 1
TOP: Physiology of Hearing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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