TERM 2-MY NOTES HEALTH ASSESSMENT JARVIS CH.15 "EARS" Flashcards Preview

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1

MIDDLE EAR

.

2

The middle ear is a tiny air-filled cavity inside the temporal bone. It contains tiny ear bones, or auditory ossicles: the malleus, incus, and stapes. The middle ear has several openings. Its opening to the outer ear is covered by the tympanic membrane.
A)true
B)false

A

3

The________ ear is a tiny air-filled cavity inside the temporal bone. It contains tiny ear bones, or auditory ossicles: the malleus, incus, and stapes. The_______ ear has several openings. Its opening to the outer ear is covered by the tympanic membrane.
A)external
B)middle

B

4

It contains tiny ear bones, or auditory ossicles: the malleus, incus, and stapes
A)middle
B)external
C)inner

A

5

The openings to the ____--- ear are the oval window at the end of the stapes and the round window. Another opening is the eustachian tube, which connects the middle ear with the nasopharyrLx and allows passage of air. The tube is normally closed, but it opens with swallowing or yawning.
A)middle
B)inner
C)external

A

6

Another opening is the eustachian tube, which connects the middle ear with the
A)nasopharyrLx and allows passage of air. The tube is normally closed, but it opens with swallowing or yawning.
B)pharynx and tracheal

A

7

The tube is normally closed, but it opens with swallowing or yawning.
A) Eustachian tube
B) external tube

A

8

The middle ear has three functions:
(l) it conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear;
(2) it protects the inner ear by reducing the amplitude of loud sounds; and
(3) its eustachian tube allows equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture (e.g., during altitude changes in an airplane).
A)true
B)false

A

9

The________ ear has three functions:
(l) it conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear;
(2) it protects the inner ear by reducing the amplitude of loud sounds; and
(3) its eustachian tube allows equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture (e.g., during altitude changes in an airplane).
A)external
B)middle
C)inner

B

10

INNER EAR

.

11

The_______ ear is embedded in bone. It contains the bony labyrinth, which holds the sensory organs for equilibrium and hearing. Within the bony labyrinth, the vestibule and the semicircular canals compose the vestibular apparatus and the cochlea (Latin for "snail shell") contains the central hearing apparatus. Although the ______ ear is not accessible to direct examination, you can assess its functions
A)inner
B)middle

A

12

Within the bony labyrinth, the vestibule and the semicircular canals compose the vestibular apparatus and the cochlea (Latin for "snail shell") contains the central hearing apparatus.
A)true,inner ear
B)false,fase inner ear

A

13

HEARING

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14

The function of hearing involves the auditory system at three levels:
A)peripheral, brainstem, and cerebral cortex.
B)cortex, meddullla oblongata,cerebellum

A

15

At the __________ level, the ear transmits sound and converts its vibrations into electrical impulses, which can be analyzed by the brain. For example, you hear an alarm bell ringing in the hall. Its sound waves travel instantly to your ears. The amplitude is how loud the alarm is; its frequency is the pitch (in this case, high) or the number of cycles per second. The sound waves produce vibrations on your tympanic membrane. These vibrations are carried by the middle ear ossicles to your oval window. Then the sound waves travel through your cochlea, which is coiled like a snail's shell, and are dissipated against the round window.Along the way, the basilar membrane vibrates at a point specific to the frequency of the sound. In this case, the alarm's high frequency stimulates the basilar membrane at its base near the stapes.
A)peripheral
B)cortex
B)brain

A

16

The numerous fibers along the basilar membrane are the receptor hair cells of the ____________, the sensory organ of hearing.
A)lacrimal
B)organ of Corti

B

17

As the hair cells bend, they mediate the vibrations into electric impulses. The electrical impulses are conducted by the auditory portion of cranial nerve VIII to the brainstem.
A)organ of corti
B)false, cranial nerve 5

A

18

As the hair cells bend, they mediate the vibrations into electric impulses. The electrical impulses are conducted by the auditory portion of cranial nerve_____ to the brainstem.
A)VIII
B)VI
C)both a and b

A

19

The function at the___________ level is binaural interaction, which permits locating the direction of a sound in space as well as identifying the sound. How does this work? Each ear is actually one half of the total sensory organ. The ears are located on each side of a movable head. The cranial nerve VIII from each ear sends signals to both sides of the brainstem. Areas in the brainstem are sensitive to differences in intensity and timing of the messages from the two ears, depending on the way the head is turned.
A)brainstem
B)cortex

A

20

Ears

.

21

STRUCTURE AND FUNCTION

.

22

The ear is the sensory organ for hearing and maintaining equilibrium
A)true
B)false

A

23

The ear has three parts:
A)the external ear, the middle ear, and the inner ear.
B)inner,outer, and external

A

24

The external ear is called the
A)auricle
B)pinna
C)both a and b

C

25

The external ear is called the ______ or ______ and consists of movable cartilage and skin
A)auricle
B)pinna
C)both a and b

C

26

The ________________, the bony prominence behind the lobule, is not part of the ear but
is an important landmark.
A)mastoid process
B)ancilie

A

27

EXTERNAL EAR

.

28

The external ear has a characteristic shape and serves to funnel sound waves into its opening, the external auditory canal (Fig. 15-2). The canal is a cul-de-sac 2.5 to 3 cm long in the adult and terminates at the eardrum, or tympanic membrane.
A)true
B)false

A

29

The __________ has a characteristic shape and serves to funnel sound waves into its opening, the external auditory canal. The canal is a cul-de-sac 2.5 to 3 cm long in the adult and terminates at the eardrum, or tympanic membrane.
A)external ear
B)internal ear

A

30

The canal is a cul-de-sac 2.5 to 3 cm long in the adult and terminates at the eardrum, or tympanic membrane.
A)external auditory canal
B)inner canal

A

31

The canal is lined with glands that secrete cerumen, a yellow, waxy material that lubricates and protects the ear. The wax forms a sticky barrier that helps keep foreign bodies from entering and reaching the sensitive tympanic membrane. Cerumen migrates out to the meatus by the movements of chewing and talking.
A)external auditory canal
B)inner canal

A

32

The wax forms a sticky barrier that helps keep foreign bodies from entering and reaching the sensitive tympanic membrane.
A)true
B)false

A

33

Cerumen migrates out to the meatus by the movements of
A)chewing
B)talking
C)both a and b

C

34

The outer one third of the canal is cartilage; the inner two thirds consists of bone covered by thin, sensitive skin.
A)ear canal
B)false

A

35

The canal has a slight S-curve in the adult. The outer one third curves up and toward the back of the head, whereas the inner two thirds angles down and forward toward the nose.
A)true
B)fase

A

36

The ________________, separates the external and the middle ear and is tilted obliquely to the ear canal, facing downward and somewhat forward. It 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.
A)tympanic membrane
B)ear drum
C)both a and b

C

37

The drum is oval and slightly concave, pulled in at its center by one of the middle ear ossicles, the malleus.
A)true
B)false

A

38

The parts of the malleus show through the translucent drum; these are the
A)umbo, the manubrium (handle), and the short process.
B)false, there is no umbo but ossciles

A

39

The small, slack, superior section of the tympanic membrane is called the
A)pars flaccida
B)eardrum
C)slackness duct

A

40

The remainder of the drum, which is thicker and more taut, is the
A)pars tensa
b)annulus

A

41

The______ is the outer fibrous rim of the drum.
A)annulus
B)pinna

A

42

Lymphatic drainage of the external ear flows to the parotid, mastoid, and superficial cervical nodes.
A)true
B)false

A

43

Lymphatic drainage of the external ear flows to the
A)parotid
B)mastoid
C)superficial cervical nodes
D)all the above

D

44

The cranial nerve VIII from each ear sends signals to both sides of the brainstem. Areas in the brainstem are sensitive to differences in intensity and timing of the messages from the two ears, depending on the way the head is turned.
A)true
B)false

A

45

Finally, the function of the_______ is to interpret the meaning of the sound and begin the appropriate response.
A)cortex
B)brainstem

A

46

_________. The normal pathway of hearing is air conduction (AC), described earlier; it is the most efficient. An alternate route of hearing is by bone conduction (BC). Here, the bones of the skull vibrate. These vibrations are transmitted directly to the inner ear and to cranial nerve VIII.
A)Pathways of Hearing
B)there are 2 more paths

A

47

___________. Anything that obstructs the transmission of sound impairs hearing. A conductive hearing loss involves a mechanical dysfunction of the external or middle ear. It is a partial loss because the person is able to hear if the sound amplitude is increased enough to reach normal nerve elements in the inner ear. Conductive hearing loss may be caused by impacted cerumen, foreign bodies, a perforated tympanic membrane, pus or serum in the middle ear, and otosclerosis (a decrease in mobility of the ossicles).
A)Hearing Loss
B)hearing gain

A

48

A conductive hearing loss involves a mechanical dysfunction of the external or middle ear. The nurse that
A)It is a partial loss because the person is able to hear if the sound amplitude is increased enough to reach normal nerve elements in the inner ear.
B)false patient is fine

A

49

Conductive hearing loss may be caused by?select all that a apply
A)impacted cerumen
B) foreign bodies
C)a perforated tympanic membrane, pus or serum in the middle ear
D )otosclerosis (a decrease in mobility of the ossicles).

A B C D

50

__________ signifies pathology of the inner ear, cranial nerve VIII, or the auditory areas of the cerebral cortex. A simple increase in amplitude may not enable the person to understand words. Sensorineural hearing loss may be caused by presbycusis, a gradual nerve degeneration that occurs with aging, and by ototoxic drugs, which affect the hair cells in the cochlea. A mixed loss is a combination of conductive and sensorineural types in the same ear.
A)Sensorineural (or perceptive) loss
B)cortex

A

51

Sensorineural hearing loss may be caused by______________, a gradual nerve degeneration that occurs with aging, and by ototoxic drugs, which affect the hair cells in the cochlea. A mixed loss is a combination of conductive and sensorineural types in the same ear.
A)presbycusis
B)presbyopia

A

52

________. The labyrinth in the inner ear constantly feeds information to your brain about your body's position in space. It works like a plumb line to determine verticality or depth. The ear's plumb lines register the angle of your head in relation to gravity. If the labyrinth ever becomes inflamed, it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo.
A)Equilibrium
B)inner ear

A

53

________in the inner ear constantly feeds information to your brain about your body's position in space. It works like a plumb line to determine verticality or depth. The ear's plumb lines register the angle of your head in relation to gravity. If the ______ ever becomes inflamed, it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo.
A)labyrinth
B)jugular

A

54

If the_______ ever becomes inflamed, it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo.
A)external ear
B)labyrinth

B

55

DEVELOPMENTAL COMPETENCE
Infants and Children

.

56

The inner ear starts to develop early in the fifth week of gestation.
A)true
B)false

A

57

In early development, the ear is posteriorly rotated and low set; later it ascends to its normal placement around eye level.
A)infant and children
B)false

A

58

If maternal rubella infection occurs during the first trimester, it can damage the organ of Corti and impair hearing.
A)infant and children
B)false

A

59

If maternal rubella infection occurs during the first trimester, it can damage the
A)organ of Corti
B)impair hearing
C)both a and b

C

60

The infant's eustachian tube is relatively shorter and wider and its position is more horizontal than the adult's, so it is easier for pathogens from the nasopharynx to migrate through to the middle ear.
A)true
B)false

A

61

The________ eustachian tube is relatively shorter and wider and its position is more horizontal than the adult's, so it is easier for pathogens from the nasopharynx to migrate through to the middle ear.
A)infant's
B)adults

A

62

The lumen is surrounded by lymphoid tissue, which increases during childhood; thus the lumen is easily occluded .. These factors place the infant at greater risk for middle ear infections than the adult.
A)true
B)fase

A

63

These factors place the infant at greater risk for middle ear infections than the adult.
A)The lumen is surrounded by lymphoid tissue, which increases during childhood; thus the lumen is easily occluded ..
B)false adults at risk

A

64

The infant's and the young child's ear canal is shorter and has a slope opposite to that of the adult's.
A)true
B)false

A

65

DEVELOPMENTAL COMPETENCE
THE ADULT

.

66

Otosclerosis is a common cause of conductive hearing loss in young adults between the ages of 20 and 40 years. It is a gradual hardening that causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound and causing progressive deafness.
A) the adult
B)aging adult

A

67

_________is a common cause of conductive hearing loss in young adults between the ages of 20 and 40 years. It is a gradual hardening that causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound and causing progressive deafness
A)Otosclerosis
B)glaucoma

A

68

is a common cause of conductive hearing loss in young adults between the ages of 20 and 40 years.
A)otosclerosis
b)atherosclerosis

A

69

It is a gradual hardening that causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound and causing progressive deafness
A)the adult,otosclerosis
B)the aging adult

A

70

DEVELOPMENTAL COMPETENCE
The Aging Adult

.

71

In the _______ person, cilia lining the ear canal become coarse and stiff. This may cause cerumen to accumulate and oxidize, which greatly reduces hearing. The cerumen itself is drier because of atrophy of the apocrine glands. Also, a life history of frequent ear infections may result in scarring on the drum.
A)aging
B)adult

A

72

The cerumen itself is drier because of atrophy of the apocrine glands.
A)aging adult
B)adult

A

73

Impacted cerumen is common in aging adults (up to 57%) and in other at-risk groups (e.g., institutionalized and mentally disabled) who may underreport the associated hearing loss.
A)true
B)false

A

74

,who may underreport the associated hearing loss.
A)institutionalized
B)mentally disabled
C)both a and b

C

75

Cerumen impaction also blocks conduction in those wearing hearing aids and accounts for 70% of the malfunction in hearing aids returned to the manufacturer.
A)true
B)false

A

76

accounts for 70% of the malfunction in hearing aids returned to the manufacturer.
A)impacted cerumen
B)batteries died

A

77

________are wax-softening agents that expedite removal with electric or manual irrigators. After removal, those persons with hearing loss have shown improvement by 5 to 36 dB.
A)Ceruminolytics
B)false,

A

78

A person living in a noise-polluted area (e.g., near an airport or a busy highway) has a greater risk for hearing loss.
A)true
B)false

A

79

________is a type of hearing loss that occurs with 60% of those older than 65 years, even in people living in a quiet environment. It is a gradual sensorineural loss caused by nerve degeneration in the inner ear that slowly progresses after the fifth decade.
The person first notices a high-frequency tone loss; it is harder to hear consonants than vowels. Much speech information is lost, and words sound garbled.
A)presbycusis
B)glaucoma

A

80

occurs with 60% of those older than 65 years, even in people living in a quiet environment. It is a gradual sensorineural loss caused by nerve degeneration in the inner ear that slowly progresses after the fifth decade.
The person first notices a high-frequency tone loss; it is harder to hear consonants than vowels. Much speech information is lost, and words sound garbled.
A)presbycusis
B)glaucoma

A

81

It is a gradual sensorineural loss caused by nerve degeneration in the inner ear that slowly progresses after the fifth decade.
The person first notices a high-frequency tone loss; it is harder to hear consonants than vowels. Much speech information is lost, and words sound garbled.
A)presbycusis
B)glaucoma

A

82

The person first notices a high-frequency tone loss; it is harder to hear consonants than vowels. Much speech information is lost, and words sound garbled.
A)presbycusis
B)glaucoma

A

83

The ability to localize sound is impaired also. This communication dysfunction is accentuated when unfavorable background noise is present (e.g., with music, with dishes
clattering, or at a large, noisy party). Associated with
A)glaucoma
B)presbycusis

B

84

CULTURE AND GENETICS

,

85

_______ occurs because of obstruction of the eustachian tube or passage of nasopharyngeal secretions into the middle ear.
A)presbycusis
B)Otitis media, or OM (middle ear infection),

B

86

Otitis media is one of the most common illnesses in children.
A)true
B)false

A

87

Otitis media is one of the most common illnesses in________.
A)adults
B)children

B

88

It is so common that 90% of all children younger than 2 years have had at least one episode of OM.
A)true
B)false

A

89

The incidence and severity are increased in indigenous children from North America, Australia, New Zealand, and Northern Europe, although genetic factors have not been determined. Rather, the most important cause is environmental; children in high-risk groups usually have multiple pathogens, and the total bacterial load is high
A)true
B)false

A

90

The incidence and severity are increased in indigenous children from
A)North America
B)Australia, New Zealand
C)Northern Europe
D)all the above

D

91

Predisposing factors for OM include ? Select all that apply
A)absence of breastfeeding in the first 3 months of age
B) exposure to tobacco smoke
C) daycare attendance
D)male gender
E)pacifier use
F)seasonality (fall and winter),
G)underlying diseases.

A B C D E F G

92

Feeding by bottle in the________ position increases risk because the effects of gravity and sucking draw the nasopharyngeal contents directly into the middle ear.
A)supine
B)semi fowlers
C)high fowlers

A

93

Urge parents to breastfeed whenever possible.
A)true, to fight against OM
B)false

A

94

But when bottle-feeding, do not prop the bottle or let the baby take a bottle to bed.
A)true to fight against OM
B)false

A

95

The most important side effect of acute otitis media is the
A)persistence of fluid in the middle ear after treatment.
B)false

A

96

The most important side effect of acute otitis media is the persistence of fluid in the middle ear after treatment. This middle ear effusion can impair hearing, placing the child at risk for delayed cognitive development.
A)true
B)false

A

97

The most important side effect of acute otitis media is the persistence of fluid in the middle ear after treatment. This middle ear effusion can impair hearing, placing the child at risk for
A)delayed cognitive development
B)happiness
C)jaundice
D)MS

A

98

Genetic variations. Cerumen is genetically determined to be of two major types:
(l) dry cerumen, which is gray and flaky and frequently forms a thin mass in the ear canal; and
(2) wet cerumen, which is honey brown to dark brown and moist. Chromosome 16 holds one gene trait determining the wet or dry phenotype.
(3)The wet cerumen phenotype occurs more often in Caucasians and African Americans, whereas
(4)the dry cerumen is more frequent in Asians and American Indians.
A)true
B)false

A

99

_________, which is gray and flaky and frequently forms a thin mass in the ear canal;
A)dry cerumen
B)wet cerumen

A

100

___________, which is honey brown to dark brown and moist.
A)dry cerumen
B)wet cerumen

B

101

Chromosome ____holds one gene trait determining the wet or dry phenotype.
A)12
B)16
C)5

B

102

The wet cerumen phenotype occurs more often in
A)Caucasians
B)African American
C)both a and b

C

103

the dry cerumen is more frequent in
A)Asians
B)American Indians
C)both a and b

C

104

The presence and composition of cerumen are not related to poor hygiene. Take caution to avoid mistaking the flaky, dry cerumen for eczematous lesions.
A)true
B)false

A

105

SUBJECTIVE DATA

,

106

Earaches
Infections
Discharge
Hearing loss
Environmental noise
Tinnitus
Vertigo
Self-care behaviors
A)objective data
B)subjective data

B

107

INFANT
A)Horizontal eustachian tube
B)S curve

A

108

ADULT
A)Sloped eustachian tube
B)no curve

A

109

Earache. Any earache or other pain in ears?
A)Otalgia may be directly due to ear disease or may be referred pain from a problem in teeth or oropharynx.
B)tinnitus

A

110

_______may be directly due to ear disease or may be referred pain from a problem in teeth or oropharynx.
A)Otalgia
B)dyspepsia

A

111

Any accompanying cold symptoms or sore throat? Any problems with sinuses or teeth?
A)Virus/bacteria from upper respiratory infection may migrate up the eustachian tube to involve the middle ear.
B)HIV

A

112

Ever been hit on the ear or on the side of the head or had any sport injury? Ever had any trauma from a foreign body?
A)Trauma may rupture the tympanic membrane (TM)
B)Assess effect of coping strategies.

A

113

What have you tried to relieve pain?
A)Assess effect of coping strategies.
B)A history of chronic ear problems suggests possible sequelae

A

114

Infections. Any ear infections? As an adult, or in childhood? • How frequent were they? How were they treated?
A)A history of chronic ear problems suggests possible sequelae
B)Otorrhea suggests infected canal or perforated eardrum, such as:

A

115

Otorrhea suggests infected canal or perforated eardrum.
A)true
B)false

A

116

Discharge. Any discharge from your ears?
A)Otorrhea suggests infected canal or perforated eardrum,
B)OM

A

117

________-purulent, sanguineous, or watery discharge.
A) External otitis
B) Acute otitis

A

118

_______ with perforation purulent discharge
A)Acute otitis media
B)chronic

A

119

Any odor to the discharge?
A)Cholesteatoma-dirty yellow/gray discharge, foul odor.
B)Cholesteatoma-bloody

A

120

_______-dirty yellow/gray discharge, foul odor.
A) Cholesteatoma
B) OM

A

121

Any relationship between the discharge and the ear pain?
A)Typically witll perforation-ear pain occurs first, stops witll a popping sensation, tllen drainage occurs.
B)false

A

122

Hearing loss. Ever had any trouble hearing? • Onset-did the loss come on slowly or all at once?
A)Presbycusis is gradual onset over years, whereas a trauma bearing loss is often sudden. Refer any sudden loss in one or both ears not associated with upper respiratory infection (URI)
B)glaucoma

A

123

______is gradual onset over years, whereas a trauma bearing loss is often sudden. Refer any sudden loss in one or both ears not associated with upper respiratory infection (URI)
A)Presbycusis
B)galcoms

A

124

In what situations do you notice the loss: conversations, using the telephone, listening to TV, at a party?
A)Loss shows witll competition from background noise, as at a party.
B)Recruitment-a marked loss when speech is at low intensity, but sound actually becomes painful when speaker repeats in a loud voice.

A

125

__________-a marked loss when speech is at low intensity, but sound actually becomes painful when speaker repeats in a loud voice.
A)Recruitment
B)OM

A

126

Do people seem to shout at you?
A)Recruitment-a marked loss when speech is at low intensity, but sound actually becomes painful when speaker repeats in a loud voice.
B)glaucoma

A

127

Do ordinary sounds seem hollow, as if you are hearing in a barrel or under water
A)Character of hearing loss when cerumen expands and becomes impacted, as after swimming or showering.
B)barrel hearing

A

128

Recently traveled by airplane? Any family history of hearing loss?
A)true
B)false

True

129

Hearing loss can cause social isolation and lessen pleasure of leisure activities.
A)true
B)false

A

130

Note to examiner-during history, note these clues from normal conversation tllat indicate possible hearing loss:

,

131

l. Person lip reading or watching your face and lips closely rather than your eyes
2. Frowning or straining forward to hear
3. Posturing of head to catch sounds with better ear
4. Misunderstands your questions or frequently asks you to repeat
5. Acts irritable or shows startle reflex when you raise your voice (recruitment)
6. Person's speech sounds garbled, possibly vowel sounds distorted
7. Inappropriately loud voice
8. Flat, monotonous tone of voice
A)true,Note to examiner-during history, note these clues from normal conversation tllat indicate possible hearing loss
B)false,do not Note to examiner-during history, note these clues from normal conversation tllat indicate possible hearing loss

A read again

132

CONTD.. SUBJECT DATA

,

133

Environmental noise. Any loud noises at home or on the job? For example, do you live in a noise-polluted area, near an airport or busy traffic area? Now or in tile past?
A)Old trauma to hearing initially goes unnoticed but results in furtl1er decibel loss in later years.
B)false

A

134

Are you near other noises such as heavy machinery, loud persistent music, gunshots while hunting?
A)can cause hearing loss
B)doesn't matter

A

135

Tinnitus. Ever felt ringing, crackling, or buzzing in your ears? When did this occur?
A)Tinnitus originates within the person; it accompanies some hearing or ear disorders
B)false

A

136

Tinnitus.Seem louder at night?
A)Tinnitus seems louder with no competition from environment noise
B)false

A

137

Are you taking any medications?
A)Many medications have ototoxic sequelae: aspirin, aminoglycosides (streptomycin, gentamicin, kanamycin, neomycin), ethacrynic acid, furosemide, indomethacin, naproxen, quinine, vancomycin
B)false

A

138

Vertigo. Ever felt vertigo; that is, the room spinning around or yourself spinning? (Vertigo is a true twirling motion.)
A)Objective vertigo-feels like room spins. Subjective vertigo-person feels like he or she spins
B)Distinguish true vertigo from dizziness or light-headedness.
C)both a and b

C

139

__________ vertigo-feels like room spins.
A)objective data
B)subjective data

A

140

______ vertigo-person feels like he or she spins
A)objective data
B)subjective data

B

141

Self-care behaviors. How do you clean your ears?
A)Assess potential trauma from invasive instruments. Cotton-tipped applicators can impact cerumen, causing hearing loss
B)false

A

142

Additional History for Infants and Children

,

143

Ear infections. At what age was the child's first episode? How many ear infections in the past 6 months? How many total? How were these treated?
A)A first episode that occurs within 3 months of life increases risk for recurrent OM. Recurrent OM is 3 episodes in past 3 months or 4 within past year.
B)false

A

144

A first episode that occurs within 3 months of life increases risk for recurrent OM. Recurrent OM is 3 episodes in past 3 months or 4 within past year.
A)true
B)false

A

145

Does anyone in the home smoke cigarettes?
A)Passive and gestational smoke are risk factors for OM
B)fase

A

146

Passive and gestational smoke are risk factors for
A)OM
B)ear cysts

A

147

Does your child receive childcare outside your home? In a daycare center or someone else's home? How many children in the group care?
A)Daycare attendance and bottle-feeding (as opposed to breastfeeding) are risk factors for OM.
B)false

A

148

Have you noticed that the infant startles with loud noise? Did the infant babble around 6 months? Does he or she talk? At what age did talking start? Was the speech intelligible?
A)Children at risk for hearing deficit include those exposed to maternal rubella or to maternal ototoxic drugs in utero; premature infants; low-birth-weight infants; trauma or hypoxia at birth; and infants with congenital liver or kidney disease.
B)false

A

149

Children at risk for hearing deficit include those ? select all that apply
A)exposed to maternal rubella or to maternal ototoxic drugs in utero;
B)premature infants; low-birth-weight infants; C)trauma or hypoxia at birth;
D)infants with congenital liver or kidney disease.

A B C D

150

It is important to catch any problem early, because a child with hearing loss is at risk for delayed speech and social development and learning deficit.)
A)true
B)false

A

151

In children, the incidence of meningitis, measles, mumps, otitis media, and any illness with persistent high fever may increase risk for A)hearing deficit.
B)cardiac deficit

A

152

Does the child tend to put objects in the ears? Is the older child or adolescent active in contact sports?
A)These children are at increased risk for trauma.
B)false

A

153

OBJECTIVE DATA

,

154

Position the adult sitting up straight with his or her head at your eye level.
A)true
B)false

A

155

If the eardrum is intact and no current infection is present, a preferred method of cleaning the adult canal is to soften the cerumen with a warmed solution of mineral oil and hydrogen peroxide. Then the canal is irrigated with warm water (body temperature) with a bulb syringe or a low-pulsatile dental irrigator (WaterPik). Direct fluid to the posterior wall. Leave space around the irrigator tip for water to escape. Do not irrigate if the history or the examination suggests perforation or infection.
A)true
B)false

A

156

EQUIPMENT NEEDED

,

157

Otoscope with bright light (fresh batteries give off white-not yellow- light).
Pneumatic bulb attachment, sometimes used with infant or young child.
A)true
B)false

A

158

Otoscope with bright light (fresh batteries give off white-not yellow- light).the nurse would use a ____________, sometimes used with infant or young child.
A)Pneumatic bulb attachment
B)applicator swab

A

159

INSPECT AND PALPATE THE EXTERNAL EAR

,

160

________-ears smaller than 4 m vertically;
A)microtia
B)macrotia

A

161

________-ears larger than 10 cm. Edema with infection or trauma
A)microtia
B)macrotia

B

162

The skin color is consistent with the person's facial skin color. The skin is intact, with no lumps or lesions. On some people you may note Darwin's tubercle, a small, painless nodule at the helix. This is a congenital variation and is not significant
A)true
B)false

A

163

. On some people you may note ___________, a small, painless nodule at the helix. This is a congenital variation and is not significant.
A)Darwin's tubercle
B)OM

A

164

______ is a congenital ear condition which often presents as a thickening on the helix at the junction of the upper and middle thirds
A)Darwin's tubercle
B)Darwin's cysts

A

165

Reddened, excessively warm skin with inflammation.
A)abnormal finding
B)normal finding

A

166

Crusts and scaling occur with otitis externa, eczema, contact dermatitis, seborrhea. Enlarged, tender lymph nodes in the region indicate inflammation of the pinna or mastoid process.
A)abnormal findings
B)normal findings

A

167

Crusts and scaling occur with
A)otitis externa, eczema
B) contact dermatitis, seborrhea
C)both a and b

C

168

Enlarged, tender lymph nodes in the region indicate
A)inflammation of the pinna or mastoid process
B)fase

A

169

Red-blue discoloration with frostbite.
A)true
B)false

A

170

Tophi, sebaceous cyst, chondrodermatitis, keloid, carcinoma.
A)abnormal findings
B)normal findings

A

171

Move the pinna and push on the tragus. They should feel firm, and movement should produce no pain. Palpating the mastoid process should also produce no pain
A)abnormal finding
B)normal finding

B

172

Pain with movement occurs with
A)otitis externa
B)furuncle
C)both a and b

C

173

Pain at the mastoid process may indicate A)mastoiditis
B)enlarged posterior auricular node
C)both a and b

C

174

A sticky, yellow discharge accompanies otitis extema or may indicate otitis media if the drum has ruptured.
A)abnormal finding
B)normal finding

A

175

: Infection of the skin covering the outer ear canal that leads in to the ear drum, usually due to bacteria such as streptococcus, staphylococcus, or pseudomonas. Swimmer's ear is usually caused by excessive water exposure
A)Otitis externa
B)Otitis media

A

176

Some cerumen is usually present. The color varies from gray-yellow to light brown and black, and the texture varies from moist and waxy to dry and desiccated.
A)true
B)false

A

177

A large amount of cerumen obscures visualization of the canal and drum.
A)true
B)false

A

178

Impacted cerumen is a common cause of A)conductive hearing loss
B)increaseing hearing that was lost

A

179

INSPECT WITH THE OTOSCOPE

,

180

As you inspect the external ear, note the size of the auditory meatus. Then choose the largest speculum that will fit comfortably in the ear canal and attach it to the otoscope. Tilt the person's head slightly away from you toward the opposite shoulder. This method brings the obliquely sloping eardrum into better view.
A)true,inspecting with an otoscope
B)false

A

181

Pull the pinna up and back on an______ or older child; this helps straighten the S-shape of the canal.Hold the pinna gently but firmly.
A)adult
B)infant

A

182

Pull the pinna down on an infant and a child younger than 3 years.hold firm but gentle.
A)true
B)false

A

183

Pull the pinna down on an _______ and a ______ younger than 3 years.hold firm but gentle.
A)infant, child
B)adult

A

184

Pull the pinna down on an infant and a child younger than _____ years.hold firm but gentle.
A)4
B)3
C)8

B

185

Do not release traction on the ear until you have finished the examination and the otoscope is removed.
A)true
B)false

A

186

Hold the otoscope "upside down" along your fingers and have the dorsa (back) of your hand along the person's cheek braced to steady the otoscope .
A)true
B)false

A

187

This position feels awkward to you only at first. It soon will feel natural, and you will find it useful to prevent forceful insertion. Also, your stabilizing hand acts as a protecting lever if the person suddenly moves the head.
A)holding the otoscope upside down
B)false

A

188

Insert the speculum slowly and carefully along the axis of the canal. Watch the insertion; then put your eye up to the otoscope. Avoid touching the inner "bony" section of the canal wall, which is covered by a thin epithelial layer and is sensitive to pain. Sometimes you cannot see anything but canal wall. If so, try to reposition the person's head, apply more traction on the pinna, and re-angle the otoscope to look forward toward the person's nose.
A)inspecting with an otoscope
B)inspecting with an othalmascope

A

189

Last, perform the otoscopic examination before you test hearing; ear canals with impacted cerumen give the erroneous impression of pathologic hearing loss.
A)true
B)false

A

190

Last, perform the otoscopic examination________ you test hearing; ear canals with impacted cerumen give the erroneous impression of pathologic hearing loss.
A)before
B)after

A

191

The External Canal
Inspecting with a otoscope

,

192

Note any redness and swelling, lesions, foreign bodies, or discharge. If any discharge is present, note the color and odor. (Also, clean any discharge from the speculum before examining the other ear to avoid contamination with possibly infectious material.) For a person with a hearing aid, note any irritation on the canal wall from poorly fitting ear molds.
A)inspecting the external canal with a otoscope
B)inspecting the TM

A

193

For a person with a hearing aid, note any irritation on the canal wall from poorly fitting ear molds.
A) external canal
B)inner ear

A

194

Redness and swelling occur with otitis externa; canal may be completely closed with swelling
A)true
B)false

A

195

Purulent otorrhea suggests
A)otitis externa
B)otitis media if the drum has ruptured
C)both a and b

C

196

Frank blood or clear, watery drainage (cerebrospinal fluid [CSF]) after trauma suggests basal skull fracture and warrants immediate referral. CSF feels oily and is positive for glucose on TesTape.
A)true,external canal
B)false,external canal

A

197

Frank blood or clear, watery drainage (cerebrospinal fluid [CSF]) after trauma suggests
A)basal skull fracture and warrants immediate referral.
B)false, no referral

A

198

CSF feels oily and is positive for glucose on TesTape.
A)true,external canal
B)false,external canal

A

199

The Tympanic Membrane
Inspecting with a otoscope

,

200

The normal eardrum is shiny and translucent, with a pearl gray color. The cone-shaped light reflex is prominent in the anteroinferior quadrant (at the 5 o'clock position in the right drum and the 7 o'clock position in the left drum). This is the reflection of your otoscope light. Sections of the malleus are visible through the translucent drum: the umbo, manubrium, and short process.
A)inspecting the TM with a otoscope
B) false

A

201

The normal eardrum is shiny and translucent, with a pearl gray color.
A)true
B)false

A

202

The cone-shaped light reflex is prominent in the anteroinferior quadrant (at the 5 o'clock position in the right drum and the 7 o'clock position in the left drum). This is the reflection of your otoscope light.
A)true
B)false

A

203

Sections of the malleus are visible through the translucent drum: the umbo, manubrium, and short process.
A)inspecting the TM with an otoscope
B)false

A

204

Infrequently, you also may see the incus behind the drum; it shows as a whitish haze in the upper posterior area.) At the periphery, the annulus looks whiter and denser.
A)inspecting the TM with an otoscope
B)false

A

205

Yellow-amber drum color occurs with otitis media with effusion (serous).
A)abnormal finding of TM
B) normal finding of TM

A

206

Red color with acute otitis media.Absent or distorted landmarks
A)abnormal finding of TM
B)normal finding of TM

A

207

Air/fluid level or air bubbles behind drum indicate otitis media with effusion .
A)abnormal finding of TM
B)normal finding of TM

A

208

Position. The eardrum is flat, slightly pulled in at the center, and flutters when the person performs the Valsalva maneuver or holds the nose and swallows (insufflation). You may elicit these maneuvers to assess drum mobility. Avoid them with an aging person because they may disrupt equilibrium. Also avoid middle ear insufflation in a person with upper respiratory infection because it could propel infectious matter into the middle ear.
A)true
B)false

A

209

Position. The eardrum is flat, slightly pulled in at the center, and flutters when the person performs the ____________ or holds the nose and swallows (insufflation). You may elicit these maneuvers to assess drum mobility. Avoid them with an aging person because they may disrupt equilibrium.
A)Valsalva maneuver
B)false

A

210

Also avoid middle ear insufflation in a person with upper respiratory infection because it could propel infectious matter into the middle ear.
A)true
B)false

A

211

Retracted drum from vacuum in middle ear with obstructed eustachian tube.
A)abnormal
B)normal

A

212

Bulging drum from increased pressure in otitis media.
A)normal
B)abnormal

B

213

Drum hypomobility is an early sign of
A)otitis media.
B)otitis externa

A

214

Integrity of Membrane. Inspect the eardrum and the entire circumference of the annulus for perforations. The normal tympanic membrane is intact.
A)normal,true
B)abnormal,true

A

215

Some adults may show scarring, which is a dense white patch on the drum. This is a sequela of repeated ear infections.
A)true
B) false

A

216

Perforation shows as a
A)dark oval area or as a larger opening on the drum.
B)yellow oval area

A

217

TEST HEARING ACUITY

,

218

Also, ask the person directly if he or she thinks there is a hearing difficulty. If the answer is yes, perform audiometric testing or refer for audiometric testing. If the answer is no, screen using the whispered voice test described below.
A)true
B)false

A

219

If the answer is yes, for a hearing acuity test?
A)perform audiometric testing or refer for audiometric testing.
B)If the answer is no, screen using the whispered voice test described below.

A

220

If the answer is no, for visual acuity test
A)screen using the whispered voice test described below.
B)perform audiometric testing or refer for audiometric testing.

A

221

A pure tone audiometer gives a precise quantitative measure of hearing by assessing the person's ability to hear sounds of varying frequency. This is a battery-powered, lightweight, handheld instrument that is available in most outpatient settings
A)true
B)false

A

222

Each tone is on for 1.5 seconds and off for 1.5 seconds. Test each ear separately and record the results. An audiometer gives a precise quan titative measure of hearing by assessing the person's ability to hear sounds of varying frequency.
A)true
B)false

A

223

Whispered Voice Test

,

224

Test one ear at a time while masking hearing in the other ear to prevent sound transmission around the head. This is done by placing one finger on the tragus and rapidly pushing it in and out of the auditory meatus. Shield your lips so the person cannot compensate for a hearing loss (consciously or unconsciously) by lip reading or using the "good" ear. With your head 30 to 60 cm ( 1 to 2 ft) from the person's ear, exhale and whisper slowly a set of 3 random numbers and letters, such as "5, B, 6." Normally, the person repeats each number/letter correctly after you say it. If the response is not correct, repeat the whispered test using a different combination of 3 numbers and letters. A passing score is correct repeating of at least 3 out of a possible 6 numbers/letters. Assess the other ear using yet another set of whispered items.
A)whispered voice test
B)none

A

225

With your head 30 to 60 cm ( 1 to 2 ft) from the person's ear, exhale and whisper slowly a set of 3 random numbers and letters, such as "5, B, 6." Normally, the person repeats each number/letter correctly after you say it. If the response is not correct, repeat the whispered test using a different combination of 3 numbers and letters. A passing score is correct repeating of at least 3 out of a possible 6 numbers/letters.
A)whispered voice test
B)false

A

226

The person is unable to hear whispered items. A whisper is a high-frequency sound and is used to detect high-tone loss.
A)abnormal finding for whispered voice test
B)normal finding

A

227

Tuning Fork Tests

,

228

____________ measure hearing by air conduction (AC) or by bone conduction (BC), in which the sound vibrates through lhe cranial bones to the inner ear. The AC route through the ear canal and middle ear is usually the more sensitive route. Traditionally, these tests have been taught for physical examination; yet evidence shows that both the Weber and the ___________ are inaccurate and do not yield precise or reliable data.Thus these tests should not be used for general screening.
A)Tuning fork tests (rinne tuning fork tests)
B)none

A

229

THE VESTIBULAR APPARATUS

,

230

__________ assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance. Because the __________ also assesses intactness of the cerebellum and proprioception
A)The Romberg test
B)rinne test

A

231

DEVELOPMENTAL COMPETENCE
Infants and Young Children

,

232

The top of the pinna should match an imaginary line extending from the corner of the eye to the occiput. Also, the ear should be positioned within 10 degrees of vertical
A)true
B)false

A

233

Low-set ears are found with trisomy 13, 18, and 21. Large prominent ears, misshapen ears, and creases on earlobes are nonspecific but occur with certain syndromes and with underlying ear structure abnormalities. Pre-auricular skin tags may occur alone or with other facial anomalies.
A)true
B)false

A

234

Low-set ears are found with trisomy 13, 18, and 21. Large prominent ears, misshapen ears, and creases on earlobes are nonspecific but occur with certain syndromes and with underlying ear structure abnormalities.
A)abnormal finding of infant and children
B) normal finding

A

235

Low-set ears and deviation in alignment . >10 is a
A)abnormal findings in infant and children
B) normal finding in infant and children

A

236

In addition to its place in the complete examination, eardrum assessment is mandatory for any infant or child requiring care for illness or fever.
A)true
B)false

A

237

A child or infant is sick what is mandatory for the nurse to assess?
A)eardrum
B)feet
C)both a and b

A

238

For the infant or young child, the timing of the otoscopic examination is best toward the end of the complete examination.
A)true
B)false

A

239

Many young children protest vigorously during this procedure no matter how well you prepare, and it is difficult to re-establish cooperation afterward. Save the otoscopic examination until last
A)true
B)false

A

240

Ear pain and ear rubbing are associated with acute OM, as are a cloudy, bulging eardrum and a distinctly red eardrum
A)infant and child
B)pregnant woman

A

241

Ear pain and ear rubbing are associated with A)acute OM, as are a cloudy
B)bulging eardrum
C)a distinctly red eardrum
D)all the above

D

242

To help prepare the child, let him or her hold your funny-looking "flashlight." You may wish to have the child look in the parent's ear as you hold the otoscope.
A)children and infants
B)adults

A

243

Avoid harsh restraint, but you must protect the eardrum from injury in case of sudden head movement. Enlist the aid of a cooperative parent. Prop an infant upright against the parent's chest or shoulder, with the parent's arm around the upper part of the head
A)true for otoscope examination
B)false for otoscope examination

A

244

A toddler can be held in the parent's lap with his or her arms gently secured. As you pull down on the pinna, gently push in on the child's tragus as a lead-in to inserting the speculum tip. This sometimes helps avoid the startling poke of the speculum tip.
A)true for otoscope examination
B)false for otoscope examination

A

245

Remember to pull the pinna straight down on an infant or a child younger than 3 years. This method will match the slope of the ear canal.
A)true
B)false

A

246

Adult- pull pinna up and back
A)true
B)false

A

247

lnfanT and child under 3-pull pinna straight down
A)true
B)false

A

248

At birth, the patency of the ear canal is determined but the otoscopic examination is not performed because the canal is filled with amniotic fluid and vernix caseosa.
A)true
B)fase

A

249

Atresia-
A)absence or closure of the ear canal.
B)ear infection

A

250

After a few days, the TM is examined. During the first few days, the TM often looks thickened and opaque. It may look "injected" and have a mild redness from increased vascularity. The eardrum also looks injected in infants after crying.
A)true
B)false

A

251

The position of the eardrum is more horizontal in the neonate, making it more difficult to see completely and harder to differentiate from the canal wall.
A)true
B)false

A

252

Difficulty to see which eardrum age group
A)neonate
B) infant
C)child
D)toddler

A

253

By 1 month of age, the drum is in the oblique (more vertical) position as in the older child and examination is a bit easier.
A)true
B)fase

A

254

When examining an infant or young child, a pneumatic bulb attachment enables you to direct a light puff of air toward the drum to assess vibratility.
A)true
B)false

A

255

For a secure seal, choose the largest speculum that will fit in the ear canal without causing pain. A rubber tip on the end of the speculum gives a better seal. Give a small pump to the bulb (positive pressure), then release the bulb (negative pressure). Normally the tympanic membrane moves inward with a slight puff and outward with a slight release.
A)true
B)false

A

256

For a secure seal, choose the largest speculum that will fit in the ear canal without causing pain. A rubber tip on the end of the speculum gives a better seal. Give a small pump to the bulb (positive pressure), then release the bulb (negative pressure). Normally the tympanic membrane moves inward with a slight puff and outward with a slight release
A)testing for vibratility
B)testing for circulation

A

257

An abnormal response is no movement. Drum hypomobility indicates effusion or a high vacuum in the middle ear. For the newborn's first 6 weeks, drum immobility is the best indicator of middle ear infection.
A)true for the vibratility test
B)false

A

258

Drum hypomobility indicates
A)effusion
B)a high vacuum in the middle ear.
C)both a and b

C

259

For the newborn's first 6 weeks, drum immobility is the best indicator of
A)middle ear infection.
B)none

A

260

Normally the TM is intact.
A)true
B)false

A

261

In a child being treated for chronic otitis media, you may note the presence of a tympanostomy tube in the central part of the eardrum. This is inserted surgically to equalize pressure and drain secretions.
A)true
B)false

A

262

Finally, although the condition is not normal, it is not uncommon to note a foreign body in a child's canal, such as a small stone or a bead
A)true
B)false

A

263

In a child being treated for chronic otitis media, you may note the presence of a_________ tube in the central part of the eardrum. This is inserted surgically to equalize pressure and drain secretions.
A)tympanostomy
B)tympoectomy

A

264

Chronic OM relieved by
A)tympanostomy tubes
B)tympanrectomy tubes

A

265

Test Hearing Acuity
Infant and children

,

266

The room should be silent and the baby contented. Make a loud, sudden noise (hand clap or squeeze toy) out of the baby's peripheral range of vision of about 30 cm (12 in). You may need to repeat a few times, but you should note these responses.
A)true
B) false

A

267

-Newborn-startle (Moro) reflex, acoustic blink reflex
-3 to 4 months-acoustic blink reflex, infant stops movement and appears to "listen," halts sucking, quiets if crying, cries if quiet
• 6 to 8 months- infant turns head to localize sound, responds to own name
-Preschool and school-age child-child must be screened with audiometry
A)hearing test diagram
B)visual acuity

A

268

-Newborn-startle (Moro) reflex, acoustic blink reflex
A)true
B)false

A

269

-3 to 4 months-acoustic blink reflex, infant stops movement and appears to "listen," halts sucking, quiets if crying, cries if quiet
A)true
B)false

A

270

• 6 to 8 months- infant turns head to localize sound, responds to own name
A)true
B)false

A

271

-Preschool and school-age child-child must be screened with audiometry
A)true
B)false

True

272

Absence of alerting behavior may indicate A)congenital deafness
B)false no indications

A

273

Failure to localize sound.
A)abnormal finding in infant and children
B)normal finding

A

274

No intelligible speech by age 2 years.
A)abnormal finding of hearing problems of deaf of an infant or child
B)false, typically normal

A

275

Note that a young child may be unaware of a hearing loss because the child does not know how one "ought" to hear. Note these behavioral manifestations of hearing loss:

,

276

1. The child is inattentive in casual conversation.
2. The child reacts more to movement and facial expression than to sound.
3. The child's facial expression is strained or puzzled.
4. The child frequently asks to have statements repeated.
5. The child confuses words that sound alike. 6. The child has an accompanying speech problem: speech is monotonous or garbled; the child mispronounces or omits sounds.
7. The child appears shy and withdrawn and "lives in a world of his or her own."
8. The child frequently complains of earaches. 9. The child hears better at times when the environment is more conducive

Read again

277

DEVELOPMENTAL COMPETENCE
The Aging Adult

,

278

An aging adult may have pendulous earlobes with linear wrinkling because of loss of elasticity of the pinna.
A)true
B)false

A

279

Coarse, wiry hairs may be present at the opening of the ear canal.
A)aging adult
B)chid

A

280

During otoscopy, the eardrum normally may be whiter in color and more opaque, duller than in the younger adult. lt also may look thickened.
A)aging adult
B)infant
C)pregnant woman

A

281

A high-tone frequency hearing loss is apparent for those affected with presbycusis, the hearing loss that occurs with aging.
A)aging adult
B)child

A

282

This condition is revealed in difficulty hearing whispered words in the voice test and in difficulty hearing consonants during conversational speech.
A)presbycusis
B)glaucoma

A

283

The aging adult feels that "people are mumbling" and feels isolated in family or friendship groups.
A)presbycusis
B)glaucoma

A

284

PROMOTING A HEAL THY LIFESTYLE Earbuds and the Increasing Prevalence of Hearing Loss in Adolescents

,

285

Today, there is a growing body of evidence that suggests users of portable media players (PMP) and earbuds are at risk for noise-induced hearing loss (NIHL)
A)true
B)false

A

286

The 60-60 rule recommends that individuals use their digital music players and earbuds for no more than 60 minutes a day at levels below 60% of maximum volume.
A)true
B)false

A

287

Normal conversation takes place around 60 dB, whereas a chainsaw typically records at 100 dB and a rock concert at 120 dB
A)true
B)false

A

288

ABNORMAL FINDINGS

,

289

Abnormalities of the External Ear

,

290

Reddish blue discoloration and swelling of auricle after exposure to extreme cold. Vesicles or bullae may develop, the person feels pain and tenderness, and ear necrosis may ensue
A)Frostbite
B)Branchial Remnant and Ear Deformity

A

291

An infection of the outer ear, with severe painful movement of the pinna and tragus, redness and swelling of pinna and canal, scanty purulent discharge, scaling, itching, fever, and enlarged tender regional lymph nodes. Hearing is normal or slightly diminished. More common in hot, humid weather. Swimming causes canal to become waterlogged and swell; skinfolds are set up for infection. Prevent by using rubbing alcohol or 2% acetic acid eardrops after every swim.
A)Otitis Externa (Swimmer's Ear)
B)Branchial Remnant and Ear Deformity

A

292

A facial remnant or leftover of the embryologic branchial arch usually appears as a skin tag; in this case, one containing cartilage. They occur most often in the preauricular area, in front of the tragus. When bilateral, there is increased risk for renal anomalies
A)Cellulitis
B)Branchial Remnant and Ear Deformity

B

293

Inflammation of loose, subcutaneous connective tissue. Shows as thickening and induration of auricle with distorted contours.
A)Sebaceous Cyst .
B)Cellulitis

B

294

Lumps and Lesions on the Ear

,

295

Location is commonly behind lobule, in the postauricular fold. A nodule with central black punctum indicates blocked sebaceous gland. It is filled with waxy sebaceous material and is painful if it becomes infected. Often are multiple.
A)Sebaceous Cyst
B)tophi

A

296

Small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric acid crystals and are a sign of gout.
A)sebeaous cysts
B)Tophi

B

297

Painful nodules develop on the rim of the helix (where there is no cushioning subcutaneous tissue) as a result of repetitive mechanical pressure or environmental trauma (sunlight). They are small, indurated, dull red, poorly defined, and very painful
A)Chondrodermatitis Nodularis Helicus
B)Keloid

A

298

Overgrowth of scar tissue, which invades original site of trauma. It is more common in dark-skinned people, although it also occurs in whites. In the ear it is most common at lobule at the site of a pierced ear. Overgrowth shown here is unusually large.
A)Keloid
B)Carcinoma

A

299

Ulcerated, crusted nodule with indurated base that fails to heal. Bleeds intermittently. Must refer for biopsy. Usually occurs on the superior rim of the pinna, which has the most sun exposure. May occur also in ear canal and show chronic discharge that is either serosanguineous or bloody.
A)Carcinoma
B)Excessive Cerumen

A

300

ABNORMAL FINDINGS
FOR
ADVANCED PRACTICE
------------------------------------------------------

,

301

Abnormalities in the Ear Canal

,

302

Excessive cerumen is produced or is impacted because of narrow, tortuous canal or poor cleaning method. May show as round ball partially obscuring drum or totally occluding canal. Even when canal is 90% to 95% blocked, hearing stays normal. But when last 5% to 10% is totally occluded (when cerumen expands after swimming or showering), person has ear fullness and sudden hearing loss.
A)Excessive Cerumen
B)keloid

A

303

Severe swelling of canal, inflammation, tenderness. Here, canal lumen is narrowed to one-fourth normal size.
A)Otitis Externa
B)keloid

A

304

Usually it is children who place a foreign body in the ear (here, a toy completely occludes the canal), which is later noted on routine examination. Common objects are beans, corn, breakfast cereals, jewelry beads, small stones, sponge rubber. Cotton is most common in adults and becomes impacted from cotton-tipped applicators. A trapped live insect is uncommon but makes the person especially frantic.
A)Foreign Body
B)excessive cerumen

A

305

Single, stony hard, rounded nodule that obscures the drum; non tender; overlying skin appears normal. Attached to inner third, the bony part, of canal. Benign, but refer for removal.
A)Osteoma
B)Exostosis

A

306

More common than osteoma. Small, bony hard, rounded nodules of hypertrophic bone, covered with normal epithelillln. They arise near the drum but usually do not obstruct the view of the drum. They are usually multiple and bilateral. They may occur more frequently in cold-water swimmers. The condition needs no treatment, although it may cause accumulation of cerumen, which blocks the canal.
A)Polyp
B)Exostosis

B

307

Arises in canal from granulomatous or mucosal tissue; redder than surrounding skin and bleeds easily; bathed in foul, purulent discharge; indicates chronic ear disease. Benign, but refer for excision.
A)Polyp
B)Furuncle

A

308

Exquisitely painful, reddened, infected hair follicle. It may occur on the tragus on the cartilaginous part of ear canal. Regional lymphadenopathy often accompanies a furuncle.
A)Retracted Drum
B)Furuncle

B

309

Abnormal Views Seen on Otoscopy

,

310

Yellow-amber color,Serum or pus suggest
A)Serous otitis media or chronic otitis media
B)none

A

311

Prominent landmarks,Retraction of drum suggest
A)Negative pressure in middle ear from an
obstructed eustachian tube
B)none

A

312

Air/fluid level or air bubbles,Serous fluid suggest
A)Serous otitis media
B)none

A

313

Absent or distorted light reflex,Bulging of eardrum suggest
A)Acute otitis media
B)none

A

314

Bright red color,Infection in middle ear suggest
A)Acute purulent otitis media
B)none

A

315

Blue or dark red color,Blood behind drum suggest
A)Trauma, skull fracture
B)none

A

316

Dark oval areas,Perforation suggest
A)drum rupture
B)none

A

317

White dense areas,scaring suggest
A)Sequelae of infections
B)none

A

318

Diminished or absent landmarks,thickened drum suggest
A)Chronic otitis media
B)none

A

319

Black or white dots on drum or canal,Colony of growth suggest
A)fungal infection
B) none

A

320

Abnormal Tympanic Membranes

,

321

Landmarks look more prominent and well defined. Malleus handle looks shorter and more horizontal than normal. Short process is very prominent. Light reflex is absent or distorted. The drum is dull and lusterless and does not move. These signs indicate negative pressure and middle ear vacuum from obstructed eustachian tube and serous otitis media.
A)Retracted Drum
B)Otitis Media with Effusion (OME)

A

322

An amber-yellow drum suggests serum in middle ear that transudates to relieve negative pressure from the blocked eustachian tube. You may note an air/fluid level with fine black dividing line or air bubbles visible behind drum. Symptoms are feeling of fullness, transient hearing loss, popping sound with swallowing. Also called serous otitis media, glue ear.
A)Acute (Purulent) Otitis Media
B)Otitis Media with Effusion (OME

B

323

This results when the middle ear fluid is infected. An absent light reflex from increasing middle ear pressure is an early sign. Redness and bulging are first noted in superior part of drum (pars flaccida), along with earache and fever. Then fiery red bulging of entire drum occurs along with deep throbbing pain, fever, and transient hearing loss. Pneumatic otoscopy reveals drum hypomobility.
A)Acute (Purulent) Otitis Media
B)Perforation

A

324

If the acute otitis media is not treated, the drum may rupture from increased pressure. Perforations also occur from trauma (e.g., a slap on the ear). Usually the perforation appears as a round or oval darkened area on the drum, but in this photo, the perforation is very large. Central perforations occur in the pars tensa. Marginal perforations occur at the annulus. Marginal perforations are called attic perforations when they occur in the superior part of the drum, the pars flaccida.
A)Perforation
B)keloid

A

325

perforations occur in the pars tensa.
A)Central
B)marginal

A

326

perforations occur at the annulus. ________ perforations are called attic perforations when they occur in the superior part of the drum, the pars flaccida
A)Marginal
B)central

A

327

Polyethylene tubes are inserted surgically into the eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent middle ear infections. Number of acute infections tends to decrease because of improved aeration. Tubes extrude spontaneously in 12 to 18 months.
A)Insertion of Tympanostomy Tubes
B)Cholesteatoma

A

328

An overgrowth of epidermal tissue in the middle ear or temporal bone may result over the years after a marginal TM perforation. It has a pearly white, cheesy appearance. Growth of cholesteatoma can erode bone and produce hearing loss. Early signs include otorrhea, unilateral conductive hearing loss, tinnitus.
A)Scarred .
B)Cholesteatoma

B

329

Dense white patches on the eardrum are sequelae of repeated ear infections. They do not necessarily affect hearing.
A)Blue Drum (Hemotympanum) .
B)Scarred Drum

B

330

This indicates blood in the middle ear, as in trauma resulting in skull fracture.
A)Blue Drum (Hemotympanum)
B)Bullous Myringitis

A

331

Small vesicles containing blood on the drum; accompany mycoplasma pneumonia and virus infections. May have blood-tinged discharge and severe otalgia.
A)Bullous Myringitis
B)Fungal Infection (Otomycosis)

A

332

Colony of black or white dots on drum or canal wall suggests a yeast or fungal infection.
A)scared drum
B)Fungal Infection (Otomycosis)

B

333

Summary Checklist: Ear Examination

,

334

1. Inspect external ear:
-Size and shape of auricle
-Position and aJjgnment on head
-Note skin condition-color, lumps, lesions
-Check movement of auricle and tragus for tenderness
-Evaluate external auditory meatus-note size, swelling, redness, discharge, cerumen,lesions, foreign bodies
2. Otoscopic examination:
-External canal
-Cerwnen, discharge, foreign bodies,lesions
-Redness or swelling of canal wall
3. Inspect tympanic membrane:
-Color and characteristics
-Note position (flat, bulging, retracted)
-Integrity of membrane
4. Test hearing acuity: Note behavioral response to conversational speech Whispered voice test
-

Read again

335

EXTRA INFORMATION

,

336

When formulating a nursing diagnosis, it is important to use critical thinking to cluster data and identify patterns that fit together. The nurse compares these clusters of data with the defining characteristics (abnormal findings) for the diagnosis to ensure the most accurate labeling and appropriate interventions.
A)true
B)false

A

337

When formulating a nursing diagnosis for a patient with a tumor in the middle ear, it is important to cluster data and identify patterns that fit together. The nurse compares the data clusters with the defining characteristics (__________) for the diagnosis.

A)abnormal finding
B)normal findings

A

338

When assessing the tympanic membrane, where would the nurse expect to see a cone of light?
Choose one of the following
A)Anterior quadrant
B)Outer rim
C)Pars tensa
D)Pars flaccida

A

339

What interventions might the staff educator at a long-term care facility suggest to improve the status of patients with hearing loss? Select all that apply.
Select all that apply:
A)Turn off the television and radio when communicating
B)Teach affected patients and staff a modified sign language
C)Close the door if the hallway noise is loud
D)Provide visual aids for detailed discussions
E)Provide hearing aids for affected patients

A C D

340

A registered nurse is working with an APRN at a local walk-in clinic. The APRN needs to perform an objective assessment of a patient's left ear. What equipment would the RN make sure is in the room? Select all that apply.
Select all that apply:
A)Litmus tape
B)High-pitched tuning fork
C)Flashlight
D)Audioscope
E)Otoscope

B E

341

The RN rarely uses an otoscope to inspect the ear.
A)true
B)false

A

342

The tympanic membrane is considered part of the external ear.
Choose one of the following
A)True
B)False

A

343

When assessing the tympanic membrane, a variation of normal is a tympanic membrane with what?

Choose one of the following
A
Yellow areas
B
Sclerosis
C
Pink color
D
Prominent stapes

B

344

The clinic nurse is assessing an 85-year-old woman who fell. The nurse asks if the patient ever feels dizzy or has problems with balance. For what is the nurse assessing?
Choose one of the following
A)Vertigo
B)Tinnitus
C)Otalgia
D)Otorrhea

A

345

When assessing the ears of older adults, it is necessary to remember that physiologic changes take place as people age. What is a physiologic change that takes place in the ear of an older adult?
Choose one of the following
A)Soft hair bristles grow in the ear canal
B)Tympanic membrane is more opaque
C)The external canal enlarges as people age
D)The light cone of the tympanic membrane is brighter

B

346

The nurse is documenting an objective assessment of the patient's ears. Which of the following would be the most appropriate documentation?
Choose one of the following
A)Hearing intact bilaterally on whisper test
B)Hearing intact on right and left with Rinne test
C)Patient states that she has experienced no decrease in hearing
DNo decrease in hearing evident on Weber test

A

347

A nurse has been asked to give an educational presentation for low-income mothers at the local community health care office. The community is culturally diverse. When talking about otitis media, the nurse would be sure to emphasize that incidence of otitis media is higher in which pediatric populations? Select all that apply.
Select all that apply:
A)Native American
B)Indigenous Australian
C)Alaskan Eskimo
D)Asian
E)Caucasian

A B C

348

The nurse is presenting an educational event for gardeners. When discussing the ears, what would be an important topic to cover?
Choose one of the following
A)Skin cancer prevention
B)Sound control
C)Tinnitus
D)Otalgia

A

349

An advanced practice nurse is assessing a patient in the ED following a motor vehicle accident. The patient complains of ear pain. The APRN is performing an otoscopic examination. What would demonstrate the correct technique for using the otoscope? Select all that apply.
Select all that apply:
A)Visualizing portions of the stapes
B)Pulling the patient's ear down and back
C)Rotating the otoscope slightly
D)Holding the otoscope so that the thumb is by the window
E)Holding the patient's ear at the helix

C D E

350

Based on a thorough risk assessment of the ears, the most significant topic for patient teaching is general hearing loss.
Choose one of the following
A)True
B)False

True

351

A 27-year-old farm worker presents at the ED after falling out of a hay loft. The patient states that he fell approximately 4 hours ago and did not lose consciousness. He adds that he is experiencing only a mild headache. When asked why he came to the ED, the patient states that he had a clear discharge from the right ear ever since the accident. What should this finding indicate to the nurse?
Choose one of the following
A)Possible otitis media
B)Possible mass in the ear
C)Possible basilar skull fracture
D)Possible otitis externa

C

352

What are the openings to the middle ear? Select all that apply.
Select all that apply:
A)The oval window
B)The round window
C)The square window
D)The eustachian tube
E)The tympanic membrane

A B D E

353

Most of the tympanic membrane, pars tensa, is stretched tightly and easy to see through.
A)true
B)false

A

354

Pars flaccida, a small portion of the tympanic membrane above the short process of the malleus, is more relaxed and opaque.
A)true
B)false

A

355

When conducting the whisper test on a patient, the nurse is assessing for loss of low-frequency sounds.
Choose one of the following
A)True
B)False

False

356

The nurse is assessing a 5-month-old Asian American infant whose mother has brought him to the clinic with reports that the baby is pulling at the ear and is sleepless and crying at night. When assessing the infant's ears, what color cerumen would the nurse expect to find?
Choose one of the following
A)Gold
B)Light yellow
C)Gray
D)Dark brown

C

357

a method of distinguishing conductive from sensorineural hearing loss. The base of a vibrating tuning fork is placed against the patient's mastoid bone
A)rinne's test
B)whispered test

A

358

congenital absence or closure of ear canal
A)atresia
B)incus

A

359

inflammation of the outer ear and ear canal
A)otitis externa
B)atresia

A

360

inflammation of the middle ear and tympanic membrane
A)otitis media
B)otorrhea

A

361

discharge from the ear
A)otorrhea
B)pas flaccida

A

362

small, slack, superior section of tympanic membrane
A)pars flaccida
B)pars tensa

A

363

thick, taut, centra!Jinferior section of tympanic membrane
A)pars tensa
B)pinna

A

364

auricle, or outer ear
A)pinna
B)stapes

A

365

A _______________ involves a mechanical dysfunction of the external or middle ear, and is considered a partial loss because the person is able to hear if the sound amplitude is increased enough to reach the nerve elements in the inner ear. Common causes are impacted cerumen, foreign bodies in the ear canal, perforated tympanic membrane, and otosclerosis.
A)conductive hearing loss
B)none

A

366

• A ________ hearing loss indicates pathology of the inner ear, cranial nerve VIII, or the auditory areas of the brain. A simple increase in amplitude may not enable the person to hear. Common causes are ototoxic drugs and presbycusis, a gradual nerve degeneration that occurs with aging.
A)sensorineural (or perceptive)
B)none

A

367

_________is a common cause of conductive hearing loss in young adults between ages 20 and 40. It is a gradual hardening that causes the foot plate of the stapes to become fixed in the oval window, thus impeding the transmission of sound. The result is progressive deafness.
A)presbycusis
B)Otosclerosis

B

368

__________is a type of hearing loss that occurs with aging, and is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve. Its onset usually occurs around age 50, and then slowly progresses. Early on, the person notices loss of high-frequency tone; it is harder to hear consonants than vowels. The presence of background noise makes the ability to localize sounds more difficult.
A)Presbycusis
B)otosclerosis

A

369

A pearly gray color of the eardrum is a normal finding.
A)true
B)false

A

370

"stirrup," inner of the 3 ossicles of the middle ear
A)stapes
B)pinna

A

371

binaural interaction at the level of the brain stem permits
A)identification and location of the direction of the sound
B)interpretation of sound

A

372

which of the following behaviors demonstrated by an individual maybe indicative of hearing loss
A)frequently asking for the question to be repeated
B)talking in a high pitched voice

A

373

which of the following children is at risk of recurrent OM
A)an 18-month-old infant who has three episodes of ear infection in a month period
B)auricle

A

374

the external structure of the ear is identified as the
A)auricle
B)atrium
C)auriga

A

375

the labyrinth of the inner ear is responsible for maintaining the body's
A)equilibrium
B)air conduction

A

376

the normal pathway of hearing is air conduction
A)true
B)false

A

377

when an otoscope examination is performed on an older adult client, the tympanic membrane may be
A)whiter than that of a younger adult
B)thinner than that of a younger adult

A

378

which of the following test provides a precise quantitative measure of hearing
A)audiometer test
B)whispered voice test
C)romberg test

A

379

the ______ assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance
A)whispered test
B)romberg test

B

380

the tympanic membrane of a child with acute OM would be
A)flat sightly pulled in at the center
B)bulging with a distinct red color

B

381

if the tympanic membrane has white dense areas, the examiner suspects
A)scarring from recurrent ear infections
B)a fungal infection

A

382

Expiratory effort when the mouth is closed and the nostrils are pinched shut, which forces air into the eustachian tubes and increases pressure on the inside of the eardrum.
A)valsalva maneuver
B)pendulous

A

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