Question 1

During an examination, the patient states he is hearing a buzzing sound and says that it is "driving me crazy!" What does this indicate?

Accepted Answer

Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders. Vertigo is a strong spinning, whirling sensation; pruritus is itching; and cholesteatoma is an overgrowth of epidermal tissue in the middle ear or temporal bone that has a pearly white, cheesy appearance. The buzzing sound this patient is hearing is tinnitus.

Question 2

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?

Accepted Answer

Reddish-blue discoloration and swelling of the auricle are manifestations of frostbite so the nurse should ask about any prolonged exposure to extreme cold rather than changes in ability to hear or drainage or recent trauma to the ear. 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.

Question 3

The nurse suspects that a patient has otitis media. Early signs of otitis media include which of these findings of the tympanic membrane?

Accepted Answer

An early sign of otitis media is hypomobility of the tympanic membrane. As pressure increases, the tympanic membrane begins to bulge. A fiery red color and bulging of the entire eardrum is not an early sign of otitis media but occurs a little later. A retracted tympanic membrane with landmarks clearly visible indicates a blocked eustachian tube which is not an early sign of otitis media. A tympanic membrane that is flat, slightly pulled in at the center, and moves with insufflation is a normal eardrum, not a manifestation of otitis media.

Question 4

The nurse assesses the hearing of a 7-month-old by clapping hands. What is the expected response?

Accepted Answer

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. A 7-month-old infant should respond to noise. With a loud sudden noise, the nurse should notice the infant turning his or her head (not stopping any movement) to localize the sound and to respond to his or her own name.

Question 5

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?

Accepted Answer

An amber-yellow color to the tympanic membrane suggests serum or pus in the middle ear. Air or fluid or bubbles behind the tympanic membrane are often visible. The patient may have feelings of fullness, transient hearing loss, and a popping sound with swallowing. These findings most likely suggest that the child has serous otitis media. The other responses are not correct. The manifestation of otitis externa is a sticky, yellow discharge (not an amber-yellow tympanic membrane). Cholesteatoma is an overgrowth of epidermal tissue in the middle ear or temporal bone that has a pearly white, cheesy appearance (not an amber-yellow color). A perforation typically begins with ear pain and stops with a popping sensation and then drainage occurs. This patient's amber-yellow color to the tympanic membrane suggests serum or pus in the middle ear. Air or fluid or bubbles behind the tympanic membrane are often visible.

Question 6

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?

Accepted Answer

Polyethylene tubes are surgically inserted into the eardrum (not the inner ear) to relieve middle ear pressure and to promote drainage of chronic or recurrent middle ear infections (not for sensorineural hearing loss). The tube is not permanent but spontaneously extrudes in 6 months to 1 year.

Question 7

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?

Accepted Answer

Absent or distorted light reflex and a bright red color of the eardrum are indicative of acute otitis media. Cholesteatoma is an overgrowth of epidermal tissue in the middle ear or temporal bone that has a pearly white, cheesy appearance (not bright red). A fungal infection manifests as a colony of black or white dots on the eardrum or canal walls (not bright red). A perforated eardrum usually appears as a round or oval darkened area on the drum. This patient's absent light reflex and bright red color indicate acute otitis media.

Question 8

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.)

Accepted Answer

Presbycusis is a type of hearing loss that occurs with aging and is found in 60% of those older than 65 years. It is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve, and it slowly progresses after the age of 50 years. The person first notices a high-frequency tone loss; it is harder to hear consonants (high-pitched components of speech) than vowels, which makes words sound garbled. The ability to localize sound is also impaired.

Question 9

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?

Accepted Answer

Any sudden loss of hearing in one or both ears that is not associated with an upper respiratory infection needs to be reported at once to the patient's health care provider. Hearing loss associated with trauma is often sudden. Irrigating the ear or removing cerumen is not appropriate at this time. This is not a normal finding.

Question 10

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?

Accepted Answer

With otitis externa (swimmer's ear), swimming causes the external canal to become waterlogged and swell; skinfolds are set up for infection. The rubbing alcohol and acetic acid mix with the water in the ear and then evaporate. The use of cotton-tip swabs in the ears is not recommended as cotton can be left in the ear and it can also impact cerumen. Irrigating the ears is done to clean the ears, not prevent otitis externa. Otitis externa can be prevented by using rubbing alcohol or 2% acetic acid eardrops after every swim.

Question 11

In an individual with otitis externa, which of these signs would the nurse expect to find on assessment?

Accepted Answer

The lymphatic drainage of the external ear flows to the parotid, mastoid, and superficial cervical nodes. The signs are severe swelling of the canal, inflammation, and tenderness. Rhinorrhea, periorbital edema, and pain over the maxillary sinuses do not occur with otitis externa.

Question 12

The nurse is preparing to do an otoscopic examination on a 2-year-old child. Which one of these reflects the correct procedure?

Accepted Answer

For an otoscopic examination on an infant or a child under 3 years of age, the pinna is pulled down. The other responses are not part of the correct procedure. The pinna should be pulled up and back for an otoscopic exam of an adult, not a child under 3 years of age. The child's head should be tilted slightly away from the examiner towards the opposite shoulder, not towards the examiner or to their chin. For an otoscopic examination on an infant or on a child under 3 years of age, the pinna is pulled down.

Question 13

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?

Accepted Answer

An ulcerated crusted nodule with an indurated base that fails to heal is characteristic of a carcinoma. These lesions fail to heal and intermittently bleed. Individuals with such symptoms should be referred for a biopsy. The other responses are not correct. A keloid is an overgrowth of scar tissue which in the ear is common at lobule at the site of a pierced ear. A sebaceous cyst is a nodule filled with waxy sebaceous material, is painful if it becomes infected, and is often multiple of them. A tophus is a hard uric acid deposit under the skin. The ulcerated crusted nodule with an indurated base that fails to heal that this patient has is characteristic of a carcinoma.

Question 14

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?

Accepted Answer

A colony of black or white dots on the drum or canal wall suggests a yeast or fungal infection (otomycosis). A colony of black and white dots on the eardrum is not a manifestation of malignancy, a viral infection, of blood in the middle year. Blood in the middle year would cause a blue or dark red appearance of the eardrum.

Question 15

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?

Accepted Answer

With objective vertigo, the patient feels like the room spins; with subjective vertigo, the person feels like he or she is spinning. Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders. Dizziness is not the same as true vertigo; the person who is dizzy may feel unsteady and light-headed. With subjective vertigo, the person feels like he or she is spinning. The symptom this patient has, that the room is spinning, is objective vertigo.

Question 16

The nurse is conducting a child safety class for new mothers. Which factor places young children at risk for ear infections?

Accepted Answer

Exposure to passive and gestational smoke is a risk factor for ear infections in infants and children. A family history of ear infections, air conditioning, or excessive cerumen are at not risk factors for ear infections.

Question 17

The nurse is performing an ear examination of an 80-year-old patient. Which of these findings would be considered normal?

Accepted Answer

A high-tone frequency hearing loss is apparent for those affected with presbycusis, the hearing loss that occurs with aging. The pinna loses elasticity (not increases), causing ear lobes to be pendulous. The eardrum may be whiter in color and more opaque and duller (not translucent or shiny, pink) in the older person than in the younger adult.

Question 18

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?

Accepted Answer

Dense white patches on the tympanic membrane are sequelae of repeated ear infections. They do not necessarily affect hearing. A fungal infection manifests as a colony of black or white dots on the eardrum or canal walls (not dense white patch). Blood behind the tympanic membrane would cause the tympanic membrane to appear blue or dark red.

Quiz 16: Ears