1. A 42 year old client has been diagnosed with a right sided acoustic neuroma. The tumor is large and has impaired the function of the 7th and 8th cranial nerves. Which of the following nursing actions will be carried out to prevent complications?

a. Keeping a suction machine availableb. Use of an eyepatch or eyeshield on the right eyec. Use only cool water to wash the faced. Advising the client to use only the left eye

the 7th nerve closes the eyelid. Without a patch the cornea is subject to damage. Temperature of water does not matter. A suction machine is n0ot necessary. Analysis

2. A labyrinthectomy can be performed to treat meniere’s syndrome. This procedure resilt in:

a. Anosmiab. Absence of painc. Reduction of cerumend. Permanent irreversible deafness

the labyrinth is the inner ear and consist of vestibule, cochlea, semicircular canals, utricle, saccule, cochlear duct and membranous semicircular canals. A labyrinthectomy is performed to alleviate the symptom of vertigo but results in deafness, because the organ of corti and cochlear nerve are located in the inner ear.

Analysis

3. A client who complains of tinnitus is describing a symptom that is

a. Objectiveb. Subjectivec. Functionald. Prodromal

a subjective symptom such as ringing in the ears can be felt only by the client

Analysis

4. Physiologically, the middle ear, containing the three ossicles serves primarily to:

a. Maintain balanceb. Translate sound waves into nerve impulsesc. Amplify the enrgy of sound waves entering the eard. Communicate with the throat via the eustchian tube

the middle ear contains the 3 ossicles, malleus, incus, and stapes which along with tympanic membrane and oval window form an amplifying system

Analysis

5. An 85 year old client has impaired hearing. When creating the care plan, which of the ff should have the highest priority?

a. Obtaining an amplified telephoneb. Teaching the importance of changing his positionc. Providing reading material with large printd. Checking expiration dates of food packages

the amplified telephone helps with hearing and provides a means for communicating with others. Option2 refers to tactile impairment. Option3 relates to visual impairment and option 4 an olfactory impairment.

Analysis

6. The nurse is assessing for hearing function. What assessment tool is used for testing

a. Stereognosisb. Tuning forkc. Snellen chart

tuning fork is use to assess hearing, stereognosis is for tactile and snellen chart is for visual.

Knowledge

7. The client has been diagnosed to have meniere’s disease. The client should void which of the ff to prevent acute attack of the disease. Select all that apply.

a. Alcoholb. High sodium foodsc. Caffeined. Fruit juicese. Cigarette smokingf. Green salad alcohol, high sodium foods caffeine and cigarette smoking should be avoided to prevent acute attacks of meniere’s disease

Application

8. The client is experiencing vertigo due to meniere’s disaease. Which of the following is the priority nursing diagnosis?

a. High risk for injury related to vertigob. Alteration in comfort related to tinnitusc. Altered body image related to hearing lossd. Altered nutrition related to nausea and vomiting

meniere’s disease is primarily characterized by vertigo. The client is at risk for falls. Safety is a priority.

> Analysis

9. A female client is admitted to a facility for investigation of balance and coordination problems, including possible meniere’s disease . when assessing the client, the nurse expects to note:

a. Vertigo, tinnitus, and hearing lossb. Vertigo, vomiting, and nystagmusc. Vertigo, pain and hearing impairmentd. Vertigo, blurred vision and fever

meniere’s disease, an inner ear disease, is characterized by the smptom triad of vertigo, tinnitus and hearing loss. The combination of vertigo. Vomiting, and nystagmus suggests labyrinthitis. Meniere’s disease rarely cause pain, blurred vision or fever.

Analysis

10. A male client with conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?

a. Lie in the bed with your head elevated, and refrain from blowing your node for 24 hoursb. Try to ambulate independently after about 24 hoursc. Shampoo your hair every day for 10 days to help prevent ear infectiond. Don’t fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself tom

loud sounds for 30 days

for 30 days after a stpedectomy, the client should avoid air travel, sudden movements that mey cause trauma, and exposure to loud sounds and pressure changes

Analysis

11. When performing a physical examination on an infant, the nurse in charge notes abnormally low-set ears. This finding is associated with:

a. Otogenous tetanus b. Tracheoesophageal fistula c. Congenital heart defects d. Renal anomalies

Normally the top of the ear aligns with an imaginary line drawn across the inner and outer canthus of the eye. Ears set below this line are associated with renal anomalies or mental retardation. Low-set ears do not accompany otogenous tetanus, tracheoesophageal fistula, or congenital heart defects.

analysis

12. Nurse Betina is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature?

a. Eustachian tubesb. Nasopharynxc. Tympanic membraned. External ear canal

In a child, Eustachian tubes are short and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media. The nosopharynx, tympanic membrane, external ear canal have no unusual features that would predispose a child to otitis media.

application

13. Nurse Jenny is instilling an otic solution into an adult male client left ear. Nurse Jenny avoidsdoing which of the following as part of the procedure

a. Pulling the auricle backward and upward

b. Warming the solution to room temperature

c. Pacing the tip of the dropper on the edge of ear canal

d. Placing client in side lying position

The dropper should not touch any object or any part of the client’s ear.

> application

14. The physician has ordered cortisporin ear drops for a 2-year-old. To administer the ear drops, the nurse should:

a. Pull the ear down and backb. Pull the ear straight outc. Pull the ear up and backd. Leave the ear undisturbed

When administering ear drops to a child under 3 years of age, the nurse should pull the ear down and back to straighten the ear canal. Answers B and D are incorrect positions for administering ear drops. Answer C is used for administering ear drops to an adult client.

application

15.Which of the following assessment findings indicates presbycussis?

a. The client has difficulty understanding hearing in quiet environmentb. The client has difficulty understanding women’s voicec. The client Weber’s test indicates that vibration of tuning fork is perceived better in the poor eard. The client hears and understands telephone conversation well

Presbycussis is a sensorineural hearing loss common among elderly males. It is characterized by difficulty understanding high pitched sounds, like women’s voice.Analysis

16. The nurse is to administer ear irrigation as prescribes by the physician which of the following is appropriate nursing action?

a. Direst the low of solution to the ear drumb. Use cold waterc. Warm solution at 98 degree fd. Position the client with the ear to be irrigated facing upward

The solution for ear irrigation should be warmed at body temperature to prevent dizziness.Analysis

17. Which of the following cranial nerves is most frequently affected by acoustic neuroma?

a. Olfactoryb. Facialc. Occulomotord. Trochlear

Facial nerve is commonly affected by acoustic neuroma.Intellectualization

18. The most common complaint of the client with ear disorder is?

a. Earacheb. Discharge from the earc. Hearing lossd. Tinnitus

The most common chief complaint of a client with ear disorder is tinnitus.Analysis

19. A toddler is admitted to the hospital with acute bilateral otitis media, with a temperature of 103 degree f and tremors in arms and legs. In addition to a spinal tap to rule out bacterial meningitis, the doctor orders the following which order should the nurse perform first?

a. Respiratory isolationb. IV 5 % dextrose in 0.45 normal saline solution at 35ml/hrc. Tylenol 120 mg PO q4hd. Seizure precautions

The first priority is protecting the nurse and other clients by observing appropriate infection control measures, in this case, respiratory isolation.Analysis

20. The part of the ear that contains receptors for hearing is the:

a. Utricleb. Cochleac. Middle eard. Tympanic cavity

The dendrites of the cochlear nerve terminate on the hair cells of the organ of corti in the cochlea.Intellectualization

21. The ear bones that transmit vibrations to the oval window of the cochlea are found in the:

a. Inner erab. Outer ear

c. Middle eard. Eustachian tube

The bones in the middle ear transmit and amplify air pressure waves from the tympanic membrane to the oval window of the cochlea, which is in the inner ear. The tympanic membranes separate the outer form the middle ear.Intellectualization

22. Nerve deafness would most likely results from an injury or infection that damaged the:

a. Vagus nerveb. Cochlear nervec. Trigeminal nerved. Vestibular nerve

Because the organ of hearing is the organ of corti, located in the cochlea, nerve deafness would most likely accompany damage to the cochlear nerve.Intellectualization

23. Ostoclerosis is a common cause of conductive hearing loss with such a partial hearing loss:

a. Stapedectomy is the procedure of choice b. Hearing aids usually restore some hearingc. The client is usually unable to hear bass tonesd. Air conduction is more effective than bone conduction

With a partial hearing loss auditory ossicles have not yet become fixed as long as vibrations occur, a hearing aid may be beneficial.Analysis

24. Which of the following ear examination will best indicate for ostoclerosis?

a. Whisper testb. Rinne testc. Weber testd. Typanogram

Otosclerosis is a type of conductive hearing loss, the client hears the sound better in the affected ear.Intellectualization

25. What is the characteristic of sound, when performing rinne’s test with the client with conductive hearing loss?

a. Air conduction is audible longer than bone conductionb. Air conduction is audible longer than bone conduction in affected earc. Air conduction is audible longer than bone conduction in unaffected eard. Sound heard as long or longer in affected ear

Rinne test is useful for distinguishing between conductive and sensorineural hearing loss. A person with conductive hearing loss hears bone-conducted sounds as long as or longer than air-conducted sound.Intellectualization

26. What is the proper technique of holding an otoscope?

a. Otoscope should be held in the examiner’s right hand, in a dart-like hold positionb. Otoscope should be held in the examiner’s left hand, in a dart-like hold positionc. Otoscope should be held in the examiner’s right hand, in a pencil-like hold positiond. Otoscope should be held in the examiner’s left hand, in a pencil-like hold position

The position (pencil-hold, held in the examiner’s right hand) prevents examiner from inserting otoscope too far into the external canal.Intellectualization

27. Which of the following test use in assessing bone conduction of sound?

a. Whisper testb. Weber’s testc. Rinne’s testd. All of the above

Weber’s test uses bone conduction to test lateralization, of sounds. A tuning fork, set in motion by grasping it firmly by its stem and tapping it on the examiners knee or hand, is placed, is placed on the patient’s head or forehead.Analysis

28. The nurse is admitting a client in the ER with foreign body in the ear identified as an insect. Which of the following intervention is a priority for the nurse to perform?

A. Irrigate the affected ear B. Instill diluted alcohol in the affected earC. Instill an antibiotic ointment in the affected earD. Instill cortisone ointment into the affected ear

Insects are killed before they can remove unless a flashlight can coax them out. Mineral oil or diluted alcohol will suffocate the insect so that removal by forceps is possible. If the foreign object is vegetable matter, it is not irrigated because this would cause the object to expand.ANALYSIS 29. How does the nurse correctly straighten the ear canal in preparation to administer eardrops to an adult client?

A. Pull the pinna upward and outwardB. Pull the pinna downward and inwardC. Pull the pinna inside and outD. All of the above

The nurse must pull the pinna upward and outward to straighten the ear canal to administer eardrops in the adult client.APPLICATION

30. The nurse implements which of the following in the plan of care for a client who is hearing im-paired?

A. Speaks in a raised voiceB. Speaks slowlyC. Uses exagerrated facial expression D. Has the light behind the nurse

Speak in normal tone of voice to the client with impaired hearing. Avoid rasing the voice because this does not improve communication.APPLICATION

31. A client has been receiving streptomycin and develop tinnitus, a disturbance in equilibrium, and hearing loss. The nurse reports this as a result of damage to which cranial nerve?

A. Fifth cranial nerve VB. Eight cranial nerve VIIIC. Second cranial nerve IID. Fourth cranial nerve IV

Eight cranial nerve is the acoustic nerve that is responsible for hearing. Damage to this cranial nerve results in hearing loss. Streptomycin is an aminoglycoside anti-infective that may be ototoxic to the eight cranial nerve.APPLICATION

32. The nurse correctly tells a client that the priority goal in the treatment for Menierie's disease:

A. Maintain a Sodium free dietB. Eliminate environmental noiseC. Preserve the remaining hearingD. Promote a quiet environment

Meniere's Disease is an inner ear disease with an unknown etiology that results in vertigo, tinnitus, and sen-sorineural hearing loss. The goal of treatment is to preserve the remaining hearing. Nusing interventions in-clude eliminating environmental noise, promoting a quiet environment and restricting caffeine, nicotine and alcohol.ANALYSIS

33. The nurse is reviewing the normal limits of a hearing assessment for a client who presents with decrease hearing. Which of the following findings would indicate the need for addititional investigation.

A. Sound heard equally in both ears with Weber's test.B. Whispered words are repeated at two feetC. Bone conduction is heard twice as long as air conduction with the Rinne TestD. Pearly gray tympanic membrane observed with etoscope.

In the rinne test, the client should hear air conduction twice as long as bone conduction. It is normal for sound to be heard equally in both ears with the Webers. The tympanic membrane should have a pearly gray appear-ance with the otoscope. It is also normal to be able to hear whispered words at two feet.ANALYSIS

34. Following an ear surgery, which statement if heard by Nurse from the patient indicates a correct understanding of the post operative instructions?

A. Activities are resumed within 5 daysB. I will make sure that I will clean my hair and face to prevent infectionC. I will use straw for drinkingD. I should avoid air travel for a while

After ear surgery, Air travel is halted for a while. There is no need to restrict activities. The client is not allowed to shower for 7 days, Patient can clean himself using a sponge bath but avoids to shampoo or wet the face and hair. Straws are not used after ear surgery because sips increases pressure in the ear.COMPREHENSION

35. Nurse is developing a plan of care for a patient with Menieres disease. What is the priority nursing intervention in the plan of care for this particular patient?

A. Air, Breathing, CirculationB. Love and BelongingnessC. Food, Diet and NutritionD. Safety

Although A is priority according to maslow, it is not specific in clients with menieresdisease. The client has an attack of incapacitating vertigo and client is high risk for injurydue to falls. The client will perceive the environment moving due to disruption of thevestibular system of the ear's normal function.APPLICATION

36. A home care nurse is prepaing a plan of care for a client with Meniere’s Disease who is experiencing severe vertigo. Which nursing intervention would the nurse include in the plan of care to assist the client in controlling the vertigo?

a. Encourage the client to increase daily fluid intakeb. Encourage the client to avoid sudden head movementsc. Instruct the client to cut down on cigarette smokingd. Instruct the client to increase sodium in the diet

Answer. B. the nurse instructs the client to make slow head movements to prevent worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce the amount of endlymphatic fluid are sometime prescribed. Clients are advised to stop smoking because of its vasoconstrictive effects.

Application

37. A nurse is assessing a client to determine adjustment to presbycusis. Which of the following indicates successful adaptation to this problem?a. Denial of a hearing impairment b. Proper use of hearing aidc. Withdrawal from social activitiesd. Reluctance to answer the telephoneAnswer. B. Presbycusis occurs as part of the aging process and is a progressive sensorineural hearing loss. Some clients may not adapt well to the impairment, denying its presence. Others withdraw from social interactions and contact with others , embarrassed by the problem and the need to wear a hearing aid. Clients show adewuate adaptation by obtaining and regularly using a hearing aid. Analysis

38. The nurse prepares a teaching plan about the administration of ear drops for the parents of a 6 year old child. The nurse tells the parents that when administering the drops, they should:

a. Pull the ear up and backb. Wear glovesc. Hold the child in a sitting positiond. Position the child so that the affected ear is facing downward

Answer. A. To administer ear drops in a child older than 3 years of age, the ear is pulled upward and back. The ear is pulled down and back in children younger than 3 years of age. Glove do not need to be worn by the parents, but handwashing before and after the procedure needs to be performed. The child needs to be in a side-lying position with the affected ear facing upward to facilitate the flow of medication down the ear canal by gravity. Application

39. A nurse is instilling an otic solution into the adult client’s left ear. The nurse avoids doing which of the following as part of this procedure?

a. Warming the solution to room temperatureb. Placing the client in a side-lying position with the ear facing upc. Pulling the auricle backward and upward d. Placing the tip of the dropper on the edge of the ear canal

Answer. D. The dropper is not allowed to touch any object or any part of the client’s skin. The solution is warmed before use. The client is placed on the side with the affected ear upward. The nurse pulls the auricle backward and upward and instills the medication by holding the dropper about 1cm above the ear canal. Application

40. A nurse is reviewing the record of a client with a disorder involving the inner ear. Which of the following would the nurse most likely expect to note documented as an assessment finding in this client?

a. Complaints of itching in the affected earb. Complaints f severe pain in the affected earc. Complaints of burning in the eard. Complaints of tinnitus

Answer. D. Tinnitus is the most common complaint of clients with ear disorders, especially disorders involving the inner ear. Symptoms of tinnitus can range from mild ringing in the ear that can go unnoticed during the day to a loud roaring in the ear that can interfere with the client’s thinking process and attention span. Analysis

41. A nurse is performing an ostoscopic examination on a client with a suspected diagnosis of mastoiditis. The nurse would expect to note which of the following if this disorder was present?

a. A thick and immobile tympanic membraneb. A pearly colored tympanic membranec. A mobile tympanic membraned. A transparent tympanic membrane

Answer. A. Otoscopic examination in a client with mastoiditis reveals a red, dull, thick and immobile tympanic

membrane with or without perforation. Analysis42. Ear drops are prescribed for an infant with otitis media. The most appropriate method to

administer the ear drops to the infant is to

a. Pull up and back on the pinna and direct the solution onto the eardrum.b. Pull down and back on the pinna and direct the solution onto the eardrum.c. Pull down and back on the pinna and direct the solution toward the wall of the canal.d. Pull up and back on the ear lobe and direct the solution toward the wall of the canal.

Answer. C. In a child younger than 3 years, the pinna is pulled down and straight back. The infant should be turned on the side with the affected ear uppermost. With the nondominant hand, the pinna is pulled down and back. The medication is administered by aiming it at the wall of the canal rather than directly onto the eardrum. The infant should remain with the affected ear uppermost for 10 to 15 minutes to retain the solution. In the adult or a child older than 3 years, the pinna is pulled up and back to straighten the auditory canal. Application

43. The nurse prepares the client for ear irrigation as prescribed by the physician. In performing the procedure the nurse

a. Warms the irrigating solution to 98 degrees Fb. Positions the client with the affected side up following the irrigationc. Directs a slow steady stream of irrigation solution toward the eardrumd. Assists the client to turn his or her head so that the ear to be irrigated is facing upward

Answer. A. Irrigation solutions that are not close to the client’s body temperature can be uncomfortable and may cause injury, nausea and vertigo. The client is positioned so that the ear to be irrigated is facing downward, because this allows gravity to assist in the removal of the ear wax and solution. Following the irrigation, the client is to lie on the affected side to finish draining the irrigating solution. A slow steady stream of solution should be directed toward the upper wall of the ear canal and not toward the eardrum. Too much force could cause the tympanic membrane to rupture. Application

44. The nurse is caring for a client following craniotomy for removal of an acoustic neuroma. Assessment of which of the following cranial nerves would identify a complication specifically associated with this surgery?

a. Cranial nerve I, olfactoryb. Cranial nerve IV, trochlearc. Cranial nerve III, oculomotord. Cranial nerve VII, facial nerve

Answer. D. Treatment for acoustic neuroma is surgical removal via a craniotomy. Extreme care is taken to preserve remaining hearing and preserve the function of the facial nerve. Acoustic neuromas rarely recur following surgical removal. Analysis.

45. The nurse is reviewing the physician’s orders for a client with Meniere’s disease. Which diet most likely would be prescribed for the client?

a. Low-fat dietb. Low-sodium dietc. Low-cholesterol dietd. Low-carbohydrate diet

Answer. B. Dietary changes such as salt and fluid restrictions that reduce the amount of endolympahtic fluid are sometimes prescribed. Options 1, 3, and 4 are not specific to the client with Meniere’s disease. Analysis

46. A client with Menieres disease is experiencing severe vertigo. Which instruction should the nurse give to the client to assist in controlling the vertigo?

a. Increase sodium in the dietb. Avoid sudden head movementsc. Lie still and watch the television

d. Increase fluid intake to 3000 ml a day

Answer. B. The nurse instructs the client to make slow head movements to prevent worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce the amount of endlymphatic fluid restrictions that reduce the amount of endolymphatic fluid are sometimes prescribed. Lying still and watching television will not control vertigo. Application

47. The nurse has conducted discharge teaching for a client who has has a fenestration procedure for the treatment of otosclerosis. Which of the following, if stated by the client, would indicate that teaching was effective?

a. It is okay to take shower and wash my hairb. I can resume my tennis lessons starting next weekc. I will take stool softeners as prescribed by my doctord. I should drink liquids through a straw for the next 2 to 3 weeks

Answer. C. Following ear surgery, the client needs to avoid straining when having a bowel movement. The client needs to be instructed to avoid drinking with a straw for 2 to 3 weeks, air travel and coughing excessively. The client needs to avoid getting his or her head wet, washing hair, showering for 1 week and rapidly moving the head, bouncing and bending over for 3 weeks. Analysis

48. The nurse notes that the physician has documented a diagnosis of presbycusis on the client’s chart. The nurse plans care knowing that the condition is:

a. Tinnitus that occurs with agingb. Nystagmus that occurs with agingc. A conductive hearing loss that occurs with agingd. A sensorineural hearing loss that occurs with aging

Answer. D. Presbycusis is a type of hearing loss that occurs with aging. Presbycusis is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve. Comprehension

49. A client arrives at the emergency room with a foreign body in the left ear that has been determined to be an insect. Which intervention would the nurse anticipate to be prescribed initially?

a. Irrigation of the earb. Instillation of diluted alcoholc. Instillation of antibiotic ear dropsd. Instillation of corticosteroid ointment

Answer. B. Insects are killed before removal unless they can be coaxed out by a flashlight or a humming noise. Mineral oil or diluted alcohol is instilled into the ear to suffocate the insect, which then is removed using ear forceps. When the foreign object is vegetable matter, irrigation is not used, because this material expands with hydration and the impaction becomes worse. Analysis

50. The nurse is caring for a hearing-impaired client. Which of the following approaches will facilitate communication?

a. Speak loudlyb. Speak frequentlyc. Speak at a normal volumed. Speak directly into the impaired ear

Answer. C. Speaking in a normal tone to the client with impaired hearing and not shouting are important. The nurse should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said, the nurse should express it differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse should avoid talking directly into the impaired ear. Application

51. The nurse is performing an otoscopic examination on a client with mastoiditis. On examination of the tympanic membrane, which of the following would he nurse expect to observe?

a.A pink-colored tympanic membraneb.A pearly colored tympanic membranec.A transparent and clear tympanic membraned.A red, dull, thick and immobile tympanic membrane

Answer. D. Otoscopic examination in a client with mastoiditis reveals a red, dull, thick and immobile tympanic membrane, with or without perforation. Post auricular lymph nodes are tender and enlarged. Clients also have a low-grade fever, malaise, anorexia, swelling behind the ear, and pain with minimal movement of the head. Analysis

52. The client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder involving this part of the ear?

a.Pruritusb.Tinnitusc.Hearing lossd.Burning in the ear

Answer. B. Tinnitus is the most common complaint of clients with ontological disorders, especially disorders involving the inner ear. Symptoms of tinnitus range from mild ringing in the ear, which can go unnoticed during the day, to a loud roaring in the ear, which can interfere with the client’s thinking process and attention span. Analysis

53. The nurse is performing a voice test to assess hearing. Which of the following describes the accurate procedure for performing this test?

a. Whisper a statement while the client blocks both ears.b. Whisper a statement with the examiner’s back facing the client.c. Whisper a statement and ask the client to repeat it while blocking one ear.d. Stand 4 feet away from the client to ensure that the client can hear at this distance.

Answer. C. In the voice test, the examiner stands 1 to 2 feet away from the client and asks the client to block one external ear canal. The nurse whispers a statement and asks the client to repeat it. Each ear is tested separately. Application

54. A nurse is providing instructions to the mother of a child with a diagnosis of strabismus of the left eye, and the nurse reviews the procedure for patching the child. The nurse determines that the mother understands the procedure if the mother makes which statement?

a. I will place the patch on the right eyeb. I will place the patch on both eyesc. I will place the patch on the left eyed. I will alternate the patch from the right to the left eye every hour

Answer. A. Patching may be used in the treatment of strabismus to strengthen the weak eye. In this treatment, the good eye is most successful when done during the preschool years. The schedule for patching is individualized and prescribed by the ophthalmologist. Analysis

55. Which referral would be most important for the client with permanent hearing loss?

a. Aural rehabilitation.b. Speech therapist.c. Social worker.d. Vocational rehabilitation.

Answer: ARationale: The purpose of aural rehabilitation is to maximize the communication skills of the client who is hearing impaired. It includes auditory training, speech reading, speech training, and the use of hearing aids andhearing guide dogs.

knowledge

56. The client is two (2) hours postoperative right-ear mastoidectomy. Which assessment data should be reported to the health-care provider?

a. Complaints of aural fullness.b. Hearing loss in the affected ear.c. No vertigo.d. Facial drooping

Answer: BRationale: Viral conjunctivitis is a highly contagious eye infection. It is easily spread from one person to another; therefore the client should not share personal items.Comprehension

57. The client comes to the clinic and is diagnosed with otitis media. Which intervention should the clinic nurse include in the discharge teaching?

a. Instruct the client not to take any over-the-counter pain medication.b. Encourage the client to apply cold packs to the affected ear.c. Tell the client to call the HCP if an abrupt relief of ear pain occurs.d. Wear a protective earplug in the affected ear.Answer: CRationale: Pain that subsides abruptly may indicate spontaneous perforation of the tympanic membrane within the middle ear and should be reported to the HCP.Knowledge

58. The client is scheduled for ear surgery. Which statement indicates the client needs more preoperative teaching concerning the surgery?

a. “If I have to sneeze or blow my nose, I will do it with my mouth open.”b “I may get dizzy after the surgery, so I must be careful when walking.”c. “I will probably have some hearing loss after surgery, but hearing will return.”d. “I can shampoo my hair the day after surgery as long as I am careful.”

Answer: DRationale:  Shampooing, showering, and immersing the head in water are avoided to prevent contamination of the ear canal; therefore, this comment indicates the client does not understand the preoperative teaching.Comprehension

59. The client has undergone a bilateral stapedectomy. Which action by the client would warrant immediate intervention by the nurse?

a. The client is ambulating without assistance.b. The client is blowing the nose with the mouth open.c. There is some slight serosanguineous drainage.d. The client reports hearing popping in the affected ear.

Answer:  ARationale:  Balance disturbance, or true vertigo, rarely occurs with other middle-ear surgical procedures, but it does occur for a short time after a stapedectomy. Safety is an important issue, and ambulating without assistance would require intervention by the nurse.Knowledge

60. Which signs/symptoms should the nurse expect to find when assessing the client with an acoustic neuroma?a. Incapacitating vertigo and otorrhea.b. Nystagmus and complaints of dizziness.c. Nausea and vomiting.d. Unilateral hearing loss and tinnitus.

Answer:  DRationale: An acoustic neuroma is a slow-growing, benign tumor of cranial nerve VII. It usually arises from the Schwann cells of the vestibular portion of the nerve and results in unilateral hearing loss and tinnitus, with or

without vertigo.Knowledge

61. A 1 yr old has brought pediatric clinic because she is concerned that the childhas otitis media. On examination, the nurse would recognize which of the following findingsas the most common positive sign of otitis media?

A. Correct Temperature of 39° C and loss of appetite.B. Feeling of “fullness” in the ear and a popping sensation during swallowing.C. Pearly gray tympanic membrane and rhinorrhea.D. I Pain on pressure on the tragus and edema within the canal.

Answer:A Rationale: Common signs of otitis media include fever (as high as 40° C), postauricular and cervicallymph gland enlargement, rhinorrhea, vomiting, diarrhea, loss of appetite, and red tympanicmembrane. Infants become irritable, hold their ears, and roll their head from side to side.Young children verbally complain of pain. A concurrent respiratory or pharyngeal infectionmay also be present.Comprehension

62. The client is experiencing vertigo. As a nurse which of the following is the priority nursing diagnosis?

a. Altered nutrition related to nausea and vomitingb. Altered body image related to hearing lossc. High risk for injuryd. Alteration in comfort related to tinnitus

Ans. C, the client is at risk for falls since he feel dizzy and out of balance. Safety is a priority.

63. As a nurse you know that useful tools in evaluating vestibular function includes: except

a. Head impulseb. Stereognosisc. Romberg testd. Dix-hallpike manoeuvre

Ans. B, head impulse, Romberg teast, Dix-hallpike maneuver are clinical tests useful in Evaluating vestibular function. Stereognosis is used in tactile function.

64. What is the appropriate nursing intervention when the patient is attacked by vertigo?

a. Let the patient to keep on movingb. Encourage the patient to close the eyesc. Let the patient to keep eyes open and stare straight ahead when lying down

Ans. C, sensation of vertigo decreases and motion decelerates if eyes are kept in a fixed position.

65. As a nurse you know that the most common cause of vertigo is:

a. Vestibular migraineb. Motion sicknessc. Meniere’s diseased. Benign paroxysmal positional vertigo

Ans. D, Benign paroxysmal positional vertigo occurs 0.6of the population in early, with 10 % having an attack during their lifetime

66. What is the major problem in hearing aid?

a. conductiveb. sensorineuralc. feedback

  ANSWER: C Feedback is a major problem in hearing aid. It happens when the amplification from the microphone to the receiver is greater than the attenuation of sound leaking from the output back to the input.

67. The following should always be assessed in using hearing aid except;

a. nystagmusb. Presence of otalgiac. Otorrhoead. tinnituse. headache

ANSWER: E

RATIONALE: In relation to hearing loss, the presence of any otalgia (earache), otorrhoea, (aural discharge) and tinnitus also aid diagnosis. Observing for nystagmus is also important; the eye moves slowly away from the affected side and then rapidly flicks back (horizontal nystagmus). This is common in inner ear disease. Headaches are not associated with this disorder.

68. Which instruction should be given to the client who is fitted for a behind-the-ear hearing aid?a. remove the mold and clean every weekb. store the hearing aid in a warm placec. clean the batteries weekly

ANSWER: B

RATIONALE:The hearing aid should be stored in a warm, dry place. It should be cleaned daily but should not be moldy, so answer A is incorrect. A toothpick is inappropriate to use to clean the aid; the toothpick might break off in the hearing aide, making answer C incorrect. Changing the batteries weekly, as in answer D, is not necessary.

69. Which one of the following hearing aid style is most appropriate for someone with severe hearing loss and dexterity problems?

a. behind-the-earb. in-the-earc. half shelld. completely-in-the-canal

ANSWER: ARATIONALE:

The behind-the-ear model fits over the ear and directs sound into the ear canal through a tube and ear mold. The ear mold is a custom-fitted piece, but the behind-the-ear portion is standard size. This style has the greatest number of circuit and feature options, and it is easy for most people to handle.

70. Which of the following is not considered as infectious agent?

a. ear drainageb. cerumen with blood or mucusc. blood

  ANSWER: BRATIONALE:

            Cerumen is not considered an infectious agent unless it is contaminated with blood or mucus. However, due to its color and viscosity, visual detection of blood or ear drainage contaminants cannot be made with predictable accuracy and, therefore, cerumen should be treated as if it is a potentially infectious agent.

71. Under the gross auditory acuity, which of the following test in assessing bone conduction of sounds?

a. Whisper testb. Weber testc. Rinne testd. All of the above

Answer: BRationale: Weber test uses bone conduction to test lateralization of sound. A tuning folk set in motion by grasping it firmly by its stem and tapping it on the examiner’s knee or hand, is placed on the patient’s head or forehead.

72. Upon assessment of the client what should be the characteristic of the sound when using Rinne test?

a. Sound is heard equally in both earsb. Sound heard best in affected earc. Sound heard as long as or longer in affected eard. Air conduction is audible longer then bone conduction in affected ear.

Answer: CRationale: otosclerosis manifest as a progressive conductive or mixed hearing loss. Rinne test is useful for distinguishing between conductive and sensorineural hearing loss. In conductive hearing loss the client should heard the sound as long as or longer in affected ear.

73. What is the proper technique of holding an otoscope?

a. Otoscope should be held in the examiner’s right hand, in a dart-like hold positionb. Otoscope should be held in the examiner’s left hand, in a dart-like hold positionc. Otoscpoe should be held in the examiner’s right hand, in a pencil-hold positiond. Otoscope should be held in the examiner’s left hand, in a pencil-hold position

Answer: CRationale: pencil-hold position prevents examiner from inserting the otoscope too far into the external canal

74. What is the nursing responsibility of performing an inspection of the ear using an otoscope?

a. External auditory canal and tympanic membrane canal should be free of large amounts of cerumen

b. Using force when inserting the otoscope to carefully seen the internal earc. Electrodes place in forehead

Answer: ARationale: cerumen is normally present in the external ear canal, and small amounts should not interfere with otoscope examination. If the tympanic membrane cannot be visualized because of cerumen, the cerumen may be removed by gently irrigating the external canal with warm water.

75. Which of the following patient is at risk of otitis externa?

A. A 5 year old boy recently go for swimming B. A 4 year old girl who accidentally pushes a peanut on her ear.C Both A and B.D.A patient wit history of recent respiratory infection.

Rationale: Answer C, the water and the peanut may cause infection in the ear.

76.A which side of the ear is usually affected during otitis externa?

A.left side C. Both A and BB.right side D.NOTA

Rationale:Answer C. Otitis Externa is usually bilateral.

77.Which statements best describes otitis externa?

A.Inflammation of the outer ear which is lined with the skin.B. Persistent middle ear infection.C. Accumulation of endolymp in the inner ear.D.Dizziness where the patient experience spinning sensation.

Rationale: Answer A. The outer ear is inflamed because of the infection.

78. What is the initial symptom of Otitis Externa?

A. itchyness C. Hearing lossB. mucopurulent discharge D. tinnitus

Rationale:answer A. Otitis Externa is a condition in which the symptoms starts with itching.

79. If the patient said “My ear is painfull what is the medical term for pain in the ear?

A. Vertigo C.OtalgiaB.Tinnitus D.Presbycusis

Rationale: Otalgia means earache or pain in the ear.

80. A nurse provides discharge instructions to the mother of a child after myringotomy with insertion of tympanostomy tubes. The nurse determines that the mother needs additional instructions if the mother states that:

a) swimming in deep water is prohibitedb) swimming in lake water needs to be avoidedc) she will place earplugs in the child's ears during baths and showersd) she will be sure to give her child soft tissues to blow his noseAnswer: D- A myringotomy is the insertion of tympanoplasty tubes into the middle ear to equalize pressure and keep the ear aerated. Parents need to be instructed that the child should not blow his or her nose for 7 to 10 days. Bath and lake water are potential sources of bacterial contamination. Diving and swimming in deep water are prohibited. The child’s ears need to be kept dry. Options A, B, and C are appropriate instructions.

81. Which of the following is an effective technique of communicating with a hearing impaired client?

a) speak slowly in a low tone of voiceb) speak slowly in a loud voicec) speak slowly and try to overemphasize wordsd) speak slowly and directly in front of the clientAnswer: D- speaking slowly allows the client to understand the message. And speaking in fron of the client allows him to read the lip movement of the speaker. Avoid using loud voice pitch. High-pitched voice is more difficult to be understood by hearing-impaired client.

82. Which of the following is done when performing Weber test?

a) place vibrating tuning fork in front of the opening of the earb) place the vibrating tuning fork in the middle of the headc) place the vibrating tuning fork behind the eard) irrigate the ear with cold water and observe movement of the eyesAnswer B.describes weber test, which confirms presence of sensorineural hearing loss like Meniere's disease.83. The client has been diagnosed to have Meniere's disease. Which of the following should be included when giving health teachings?

a) limit carbohydrates and proteins in the dietb) limit salt intakec) limit fats in the dietd) drink a lot of fluidsAnswer: B- meniere's disease is a disorder caused by increased endolymphatic pressure in the inner ear; characterized by vertigo, tinnitus, gradual hearing loss. Low sodium diet is indicated to prevent further accumulation of endolymphatic fluids.

84. Another term for masses in the middle ear:

a. Cholesteatomab. Otitis mediac. Osteoclerosisd. Middle ear mass

Answer: A. Cholesteatoma aka middle ear mass which is a painless otorrhea, either unremitting or frequently recurrent.

85. A neuroma is a tumor found in which cranial nerve?

a. Cranial nerve IIIb. Cranial nerve Xc. Cranial nerve VIId. Cranial nerve VIII

Answer: C. Neuroma is a facial nerve tumor found in Cranial nerve VII.86. If a patient has neuroma, what diagnostic examination is needed?

a. Otoscopyb. X-ray c. CT scand. MRI

Answer: B. An x-ray evaluation is necessary to determine the site of the tumor along the facial nerve. These types of tumors are usually not visible on otoscopic examination.

87. What is the common sign if a patient has a facial nerve neuroma?

a. The patient presents kernig’s signb. The patient manifests chovtek’s signc. The patient presents a facial nerve paresisd. It is not visible

Answer: C. When the patient presents a facial nerve paresis, this signifies neuroma.

88. What is the common medical management for middle ear masses?a. Surgical removalb. Administration of antibioticsc. Use of hearing aidsd. Removal of obstruction in the middle ear

Answer: A. Surgical removal is the only management for middle ear masses

89. Which of the following symptoms indicates that patient may have hearing loss?

a. Patient turns the television volume louder and asks for repetitionb. Patient speaks softlyc. Patient speaks loudly and reports no difficulty hearing grandchildren talkingd. Patient has trouble hearing in a noisy environmente. Patient reports hearing difficulty only at noisy gatherings, such as a wedding ANSWER: APatient turns the television volume louder and asks for repetition because of difficulty understanding what people are saying, especially when there are competing voices or background noise.

 

90. Is the process of identifying and diagnosing hearing loss, providing different types of therapies to clients who are hearing impaired, and implementing different amplification devices to aid the client’s hearing ability?

a. hearing aid orientationb. sensorineural lossc. aural rehabilitation ANSWER: CRATIONALE:

Aural rehabilitation is frequently used as an integral component in the overall management of individuals with hearing loss,

 

91. Mrs. S Undergone to a right-sided stapedectomy because of previous vehicle accident, the stapedec-tomy sugery is;

a. The removal of eardrum, bony ear canal wall, middle ear mucosa and ossiclesb. drainage of endolymph that fills the membranous labyrinth of the inner earc. removal of diseased stapesd. a connection made between stapes and malleus in order to improve ossicular conduction of

sound. ANSWER: CRATIONALE:                  Stapedectomy is a window in the footplate of the stapes is made, and the diseased stapes is removed. A prosthesis is inserted which is mobile, to allow for the vibration and conduction of sound. (choises) letter a is Radical Mastoidectomy, letter b is a Soccus Decompression, and letter d is Ossiculoplasty sugery

 

92. If a problem is identified within the external or middle ear, any hearing loss is termed?a. sensorineural hearing lossb. conductive hearing lossc. cochlea hearing loss 

ANSWER: BRATIONALE:            By a process of air conduction, sound waves pass through the ear canal to the ossicular chain. Bone conduction enables wave transmission to reach the inner ear, wear sound energy is transformed into neural ernegy and interpreted by the brain.

93.   The following should always be assessed except;

a. nystagmusb. Presence of otalgiac. Otorrhoead. tinnituse. headache 

ANSWER: ERATIONALE:            In relation to hearing loss, the presence of any otalgia (earache), otorrhoea, (aural discharge) and tinnitus also aid diagnosis. Observing for nystagmus is also important; the eye moves slowly away from the affected side and then rapidly flicks back (horizontal nystagmus). This is common in inner ear disease. Headaches are not associated with this disorder.

94. Which of the following is the threshold limit for normal hearing?a. 10 dB HLb. 20 dB HLc. 30 dB HLd. 40 dB HL

 ANSWER: BRATIONALE:

Normal hearing levels (HLs) at all frequencies, the sensitivity thresholds would be 20 dB HL or better.

 

95. Which of the following is not considered as infectious agent?a. ear drainageb. cerumen with blood or mucusc. blood

 ANSWER: BRATIONALE:

Cerumen is not considered an infectious agent unless it is contaminated with blood or mucus. However, due to its color and viscosity, visual detection of blood or ear drainage contaminants cannot be made with predictable accuracy and, therefore, cerumen should be treated as if it is a potentially infectious agent.

 

96. Which one of the following is true regarding binaural hearing aids for a patient with hearing loss in both ears?

a. Patient will develop more hearing loss in the unaided ear if only one hearing aid is usedb. Patient will most likely have better communication with binaural hearing aidsc. The ear with the hearing aid will reorganize so that the other ear can never be successfully aidedd. Patient will hear sounds at a softer level

 ANSWER: BRATIONALE:

Binaural hearing aids are typically recommended for bilateral hearing loss because patients hear substantially better with binaural hearing aids.7 Even if there is bilateral asymmetry in hearing, both ears should be aided when possible. One hearing aid may suffice if hearing needs are minimal or if caring for 2 hearing aids is difficult. If finances are a concern, 2 basic hearing aids may provide a better outcome than 1 sophisticated hearing aid.

 

97. This is one of the mechanisms used by our auditory system for encoding frequencies:

a. Cochleab. Inner canalc. Malleus ANSWER: ARATIONALE:

            The traveling wave of the basilar membrane in the cochlea vibrates with maximum amplitude at a place along the cochlea that is dependent on the frequency of stimulation. The corresponding hair cells bent by the displacement in the membrane stimulate adjacent nerve fibers, which are organized according to the frequency at which they are most sensitive. Each place or location in the cochlea is therefore responding "best" to a particular frequency.

 

98. Type of cochlear implant design to placed near the round window of cochlea (extracochlear/itra-cochlear)

a. electrode designb. analog or pulsatilec. signal processing ANSWER: A

RATIONALE:            Electrodes may be placed near the round window of the cochlea (extracochlear), or in the scala tympani (intracochlear) or on the surface of the cochlear nucleus. This electrode placement is preferred because it preserves the "place" mechanism used in a normal cochlea for coding frequencies.

 

99. Which instruction should be given to the client who is fitted for a behind-the-ear hearing aid?

A. remove the mold and clean every weekB. store the hearing aid in a warm placeC. clean the batteries weekly ANSWER: BRATIONALE:

            The hearing aid should be stored in a warm, dry place. It should be cleaned daily but should not be moldy, so answer A is incorrect. A toothpick is inappropriate to use to clean the aid; the toothpick might break off in the hearing aide, making answer C incorrect. Changing the batteries weekly, as in answer D, is not necessary.

100. The nurse correctly tells a client that the priority goal in the treatment for Menierie's disease:

A. Maintain a Sodium free dietB. Eliminate environmental noiseC. Preserve the remaining hearingD. Promote a quiet environment

Meniere's Disease is an inner ear disease with an unknown etiology that results in vertigo, tinnitus, and sensorineural hearing loss. The goal of treatment is to preserve the remaining hearing. Nusing interven-tions include eliminating environmental noise, promoting a quiet environment and restricting caffeine, nicotine and alcohol.

ANALYSIS