Chapter 50: Assessment of The Ear and Hearing Test Bank: Multiple Choice

Chapter 50: Assessment of the Ear and Hearing
Test Bank
MULTIPLE CHOICE
1. The nurse notes that a clients tympanic membrane moves in response to air injected
into the external canal. What is the nurses best action?
a. Notify the health care provider.

b. Document the finding.
c. Prepare to wash the external ear canal.
d. Immediately remove the otoscope.
ANS: B
The healthy ear should have a tympanic membrane that is mobile when air is injected
into the external canal. This normal finding should be documented in the clients chart.
Because the mobile tympanic membrane is an expected finding, the nurse does not
need to remove the otoscope immediately from the clients ear canal. No cerumen is
impacting the ear canal, so irrigation is not appropriate. The physician does not need
to be notified about a normal finding.
DIF: Cognitive Level: Application/Applying or higher REF: N/A
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-

Specific Assessments) MSC: Integrated Process: Nursing Process (Assessment)
2. The nurse is performing an ear assessment on an older adult. Which assessment

finding does the nurse document in the clients chart as an expected age-related
change?
a. Coarse hair is seen in the auditory canal.

b. Tympanic membrane is intact and bulging.
c. Impacted cerumen is present in the auditory canal.
d. Small, painless nodules are noted on the helix of the pinna.
ANS: A
Growth of coarse hair in the auditory canal occurs in some older men and women. It
does not interfere with hearing and is considered a normal variation related to aging; it
would be considered abnormal in a younger adult. Bulging tympanic membranes,
impacted cerumen, and pinna nodules are not expected findings in the older adult.
DIF: Cognitive Level: Comprehension/Understanding REF: Chart 50-1, p. 1082

3. Which client is at highest risk for hearing loss?
a. Client with heart failure receiving digoxin (Lanoxin), 0.125 mg orally

daily
b. Client with asthma receiving high-dose methylprednisolone (Solu-
Medrol) therapy
c. Client with osteomyelitis receiving IV gentamicin (Garamycin)
d. Client with hyperkalemia being treated with intravenous glucose and
insulin
ANS: C
Gentamicin is an aminoglycoside that can cause ototoxicity. Assessment of hearing

should be done before and during therapy. Digoxin, methylprednisolone, and insulin
do not put the client at risk for hearing loss.
TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral

TherapiesAdverse Effects/Contraindications/Interactions/Side Effects)
MSC: Integrated Process: Nursing Process (Assessment)

4. The nurse is caring for an older adult client with sensorineural hearing loss. Which
assessment finding does the nurse correlate with the clients health history?
a. History of frequent ear infections

b. Swims frequently
c. Worked in a sawmill for the last 20 years
d. Had a tumor removed from his left eardrum last year
ANS: C
Sensorineural hearing loss is caused by damage to the cochlear hair cells. This
damage may be caused by exposure to loud noises, including noise from machinery in
factories or sawmills. Tumor removal from the eardrum, swimming, and ear infections
do not increase the risk for sensorineural hearing loss because conduction of sound
through the nerves is not affected.

5. The nurse is caring for a client who will undergo electronystagmography testing the
following day. Which instruction does the nurse provide for the client?
a. You should drink only caffeine-free beverages the day of and the day
before the test.
b. Do not chew gum or clean your ears for 24 hours after the test is
completed.
c. You may feel flushed as the contrast dye is injected through your IV for
the test.
d. You will be sedated for the test, so you need someone to drive you home.
ANS: A
Caffeinated drinks may interfere with the test results, so the client should be sure to
drink only decaffeinated beverages during the 24 to 48 hours before the test. Clients
may chew gum or clean their ears after the test, if desired. Neither IV contrast nor
sedation is used for the test.
TOP: Client Needs Category: Physiologic Integrity (Reduction of Risk PotentialDiagnostic

Tests)
MSC: Integrated Process: Teaching/Learning
6. The nurse is caring for a client who may have an ear infection. Which intervention
is used to prevent spread of the infection to other clients?
a. A new sterile otoscope speculum is used to examine each of the clients

ears.
b. The nurse washes his hands after removing hearing aids from the clients
ears.
c. Hearing aids are cleaned with alcohol before they are re-inserted into the
clients ears.
d. The tuning fork is cleaned with hydrogen peroxide before and after use
with the client.
ANS: B
Washing hands after removal of a hearing aid should prevent any spread of infection
between clients. Hearing aids may harbor infectious microorganisms, especially in
clients who may have an ear infection. The other answers pertain to the possible
spread of infection from one ear to the othernot to other clients.
TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)
MSC: Integrated Process: Nursing Process (Implementation)
7. The nurse is caring for a client who is hard of hearing. Which intervention best
helps the client with communication?
a. Speaking loudly and adding extra inflections to the tone of voice

b. Bending over the client so that he or she can see the nurses lips more
easily
c. Closing the door to the room and making sure that lighting is adequate
d. Asking the clients spouse to answer questions that are not heard by the
client
ANS: C
Environmental noise decreases the hearing-impaired clients ability to hear

conversation. The room should be adequately lit so the client can read supplemental
written notes. Bending down to the client may be seen as condescending or offensive.
Speaking loudly, with extra inflections, can actually make it harder for the client to
understand the nurse. The nurse should not bend over the client and should instead sit
to meet the clients eye level. The clients spouse should be used only as a last resort if
no other means of communication are possible.
DIF: Cognitive Level: Comprehension/Understanding REF: p. 1080
TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)
MSC: Integrated Process: Communication and Documentation
8. Which statement indicates that a client needs additional teaching about protecting
the ears and preventing hearing loss?
a. I will start a smoking cessation program and will take a multivitamin

every day.
b. I will wear earplugs whenever I cut the grass or use my snow blower.
c. I will blow my nose gently, one nostril at a time, whenever I get a cold or
the flu.
d. I will take Motrin (ibuprofen) instead of Tylenol (acetaminophen) for
pain.
ANS: D
Motrin (ibuprofen) can be ototoxic. Its use should be avoided to help prevent
additional hearing loss. Blowing the nose gently can help prevent damage to the
tympanic membrane. Smoking reduces oxygen supply to the cochlea, possibly
increasing damage to the sensory cells, and should be avoided. Clients should use
earplugs whenever they are exposed to loud noises to help prevent cochlear hair cell
damage.
TOP: Client Needs Category: Health Promotion and Maintenance (Health and Wellness)
MSC: Integrated Process: Nursing Process (Evaluation)
9. Which is the best assessment question for the nurse to ask a client with tinnitus?
a. How exactly do you clean your ears?

b. Have you had your hearing checked lately?
c. Do you have ringing in both ears or in only one ear?
d. Does the ringing make it hard for you to sleep at night?
ANS: C
Determining whether the tinnitus is in one or both ears provides valuable information
about the cause of the problem. Tinnitus is not related to how the client cleans his or
her ears. Asking about the last hearing check will not help determine the cause of the
tinnitus. Asking about nighttime tinnitus is helpful but is less important than asking if
the problem is present in one or both ears.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)
10. The nurse notes reddened areas behind both ears. What does the nurse ask the
client?
a. Do you wear eyeglasses?

b. Do you have any allergies?
c. Do you use dandruff shampoo?
d. Have you been around anyone with lice?
ANS: A
The presence of reddened areas behind both ears strongly suggests constant pressure,
such as that incurred from wearing eyeglasses or sunglasses. Dandruff shampoo,
allergies, and lice would not cause reddened areas only behind the ears.

11. Which statement indicates that a client needs additional teaching about ear
hygiene?
a. I will wash my hands before I put in my earplugs at work.

b. I will clean my ears with plain warm water and a washcloth every day.
c. I will use a cotton swab to get the extra water out of my ears after I
swim.
d. I can rinse my ears with half-strength hydrogen peroxide if ear wax
builds up.
ANS: C
Cotton swabs should not be inserted into the ear canal because injury to the tympanic
membrane can result. The cotton swab can push cerumen deeper into the ear canal,
possibly resulting in impaction. Hands should always be washed before earplug
insertion to prevent ear infection. Ears should be cleaned with plain warm water and a
washcloth to prevent irritation of the ear canal. The ears may be safely rinsed with
half-strength hydrogen peroxide to remove excess ear wax within the ear canal.
TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)
12. Several clients come to the emergency department following an accident. Which
client does the nurse assess first?
a. Client with clear watery drainage from the ear canals

b. Client who reports tinnitus and pain in the right ear
c. Client with a deep, 1-inch laceration to the pinna
d. Client who has had severe difficulty hearing since the accident
ANS: A
Clear watery drainage from the ears following trauma suggests a basal skull fracture
and should be assessed immediately. Tinnitus and pain, lacerations, and hearing loss
all may be assessed by the nurse in a timely manner, after the possible skull fracture.

13. A client asks the nurse why there is waxy yellow stuff on the cotton swab when he
cleans his ears. Which is the nurses best response?
a. The yellow ear wax helps transmit sound to your middle ear.
b. The yellow ear wax indicates that you have an infection in your ears.
c. The yellow ear wax helps protect and lubricate the inside of your ear
canal.
d. The yellow ear wax builds up when you dont clean your ears often
enough.
ANS: C
The ear canal is lined with ear wax (cerumen), which offers protection and
lubrication. Ear wax does not help with sound transmission and does not indicate ear
infection or buildup because of infrequent cleaning.
TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)
14. A client is scheduled for a caloric test to evaluate the vestibular portion of the
inner ear. Which statement by the client leads the nurse to conclude that more
teaching is necessary?
a. I can eat a hearty breakfast before the procedure.

b. I will have to stay in bed after the procedure to prevent nausea.
c. Warm water will be infused into my affected ear.
d. I may experience dizziness after the water is inserted.
ANS: A
The client usually is asked to fast for several hours before the caloric test. A hearty
breakfast is not a good idea because nausea and vomiting is a common reaction
following the test. Fasting will lower the risk of aspiration. The other responses
demonstrate adequate knowledge of this procedure and its follow-up care.
TOP: Client Needs Category: Physiologic Integrity (Reduction of Risk PotentialDiagnostic

Tests)
MULTIPLE RESPONSE
1. The nurse is caring for an older client who presents with dizziness and difficulty
hearing. Which of the nurses assessment findings will require collaboration with the
clients primary health care provider? (Select all that apply.)
a. Tympanic membrane is retracted, with multiple air bubbles.

b. The client reports inability to hear high-frequency voices and sounds.
c. Clear watery drainage is present in the ear canal and is positive for
glucose.
d. Tympanic membrane is shiny and translucent, with light reflex noted.
e. Hearing test indicates positive Rinne test, with AC > BC noted
bilaterally.
f. The client reports dizziness after taking naproxen (Aleve) for arthritis
pain.
ANS: A, C, F
Aleve can cause ototoxicity, which can present as dizziness. Retraction of the
tympanic membrane with air bubbles indicates an ear infection, which may be treated
with antibiotics. Clear, watery, glucose-positive drainage from the ear canal suggests a
basal skull fracture. An inability to hear high-frequency voices and sounds are
commonly found in older adults as normal age-related changes. A shiny, translucent,
tympanic membrane with a light reflex is a normal assessment finding, as is a positive
Rinne test with AC > BC noted bilaterally.

2. Which statements by a client alert the nurse that the client may have some
psychosocial issues with impaired hearing? (Select all that apply.)
a. I get so angry when I cannot hear what my daughter says.

b. When I use my hearing aids, I hear the choir so clearly.
c. I dont mind sitting in my chair all day long and not playing bingo.
d. My family never seems to visit anymore because their voices all seem so
distant.
e. No one asks my opinion because I cannot hear their question.
f. My grandchildren do not think that I am funny anymore because I cannot
hear their jokes.
ANS: A, C, D, E, F
The client may become angry, frustrated, and depressed by an inability to hear and
may respond appropriately. The inability to hear often isolates the client from the
world, as depicted by sitting in a chair all day long, the perception of the family being
distant, and no one asking for an opinion or joking around. The nurse must be
sensitive to the depression resulting from the sensory isolation of hearing loss. If
hearing aids are working so that the client can clearly hear a choir, psychosocial issues
may be less of a problem.
TOP: Client Needs Category: Psychosocial Integrity (Grief and Loss)
OTHER
1. A client is being taught how to safely irrigate ears to remove cerumen. What is the
correct order of self-ear irrigation? (Separate letters by a comma and space as
follows: a, b, c, d.)
a. Fill the syringe with lukewarm water.
b. Hold the head at a 30-degree angle.
c. Insert the tip of the syringe carefully into the ear canal and aim toward the canal
roof.
d. Tilt the head at a 90-degree angle to remove excess fluid.
e. Use one hand to hold the syringe and the other to push the plunger.
f. Repeat the procedure on the opposite ear.
g. Continue the procedure until at least a cup of fluid has flowed into and out of the
ear.
h. The ear should fill with fluid and the water will flow out with cerumen.
ANS:
a, c, b, e, g, h, d, f
Safe irrigation of the ear promotes cerumen removal without the use of penetrating
objects. Warm water through the irrigating syringe will soften the cerumen, and the
angle of the head will allow the cerumen to flow out of the ear. The order of the
irrigation is important for safe removal of cerumen.

Chapter 51: Care of Patients with Ear and Hearing Problems
Test Bank
MULTIPLE CHOICE
1. The nurse is caring for a client with external otitis. Which assessment finding
indicates to the nurse that the clients infection has worsened?
a. The client now reports tinnitus and vertigo at night.

b. The client now has a positive Rinne test, with AC > BC.
c. The tympanic membrane is pearly gray with white patches.
d. The auricular lymph nodes have increased in size over the last 24 hours.
ANS: D
Enlargement of the auricular lymph nodes indicates that the clients external otitis is
becoming more widespread and that current therapy is insufficient. Tinnitus, vertigo,
and a positive Rinne test all indicate middle to inner ear problems not related to
external otitis media. The tympanic membrane is normally pearly gray in color. White
patches on the tympanic membrane are called tympanosclerosis and generally have no
clinical importance.
2. The nurse is caring for a client with a furuncle on the pinna at the opening of the ear
canal. The nurse is reviewing home care instructions with the client. Which statement
by the client indicates that additional teaching is needed?
a. I will put the bacitracin ointment on the sore three times a day.
b. I will gently squeeze the sore to drain the liquid out once a day.
c. I will take Tylenol (acetaminophen) if my ear starts to hurt a lot.
d. I will put a warm compress on the sore for 15 minutes three times a day.
ANS: B
Compressing or squeezing the furuncle can traumatize tissues and can force infective
material deeper into the tissue layers, spreading the infection. Tylenol may be taken to
reduce pain, and a warm compress will facilitate drainage and healing of the furuncle.
Bacitracin ointment is an anti-infective and will help clear the infection.
TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness

Management) MSC: Integrated Process: Nursing Process (Evaluation)
3. The nurse is caring for a client with otitis media. The client reports that the pain was
severe during the night but was gone upon awakening in the morning. Which finding
does the nurse expect to observe during the clients physical assessment?
a. The tympanic membrane is bluish-gray.

b. Purulent fluid is present in the ear canal.
c. The pinna and the tragus are reddened and swollen.
d. Sounds are lateralized toward the affected ear.
ANS: B
Spontaneous perforation of the tympanic membrane during acute otitis media relieves
the pressure on middle ear structures and results in a sudden decrease in or elimination
of pain. Purulent drainage is often present in the ear canal as the fluid drains away
from the tympanic membrane. Bluish-gray coloring of the tympanic membrane
indicates blood behind the eardrum. A reddened pinna and tragus indicate otitis
externa. Lateralization of sounds toward the affected ear would not be expected.

4. The nurse is caring for a client with otitis media and notes purulent drainage in the
ear canal during the physical assessment. Which is the nurses priority intervention?
a. Obtain a specimen of the drainage for culture.

b. Irrigate the ear canal with sterile normal saline.
c. Gently examine the clients ear with an otoscope.
d. Place a cotton ball in the ear canal to absorb the drainage.
ANS: C
The nurse should use an otoscope to determine whether the clients tympanic
membrane has ruptured. Until the tympanic membrane is examined and is found to be
intact, syringing is not performed. A specimen is obtained only if the infection has
failed to respond to standard antibiotic therapy. A cotton ball should not be placed in
the ear canal to absorb the drainage.

Management) MSC: Integrated Process: Nursing Process (Assessment)
5. A client with a ruptured tympanic membrane asks the nurse whether hearing will be
affected permanently. Which is the nurses best response?
a. Possibly. The eardrum usually heals in 1 to 2 weeks. Any persistent

hearing problem should be evaluated.
b. No. Antibiotics will help resolve the infection and cure your hearing
impairment.
c. Yes. It will be important for you to be fitted with a hearing aid as soon as
possible.
d. Yes. Any time the eardrum is ruptured it will form a scar, which will
cause some degree of permanent hearing loss.
ANS: A
An uncomplicated rupture of the tympanic membrane usually heals spontaneously

within 1 to 2 weeks and does not result in a permanent hearing impairment.
Antibiotics may not be effective in restoring hearing fully. Hearing aids may be
prescribed for the client only if hearing loss is determined to be permanent.
Alterations in Body Systems) MSC: Integrated Process: Teaching/Learning
6. The nurse is caring for a client with Mnires disease. The client asks the nurse how
to prevent another acute episode from occurring. Which is the nurses best response?
a. Stop or reduce cigarette smoking.

b. Use aspirin rather than acetaminophen (Tylenol) for pain.
c. Reduce the quantity of saturated fats in your diet.
d. Avoid crowds and people with upper respiratory infection.
ANS: A
The vasoconstrictive effects of cigarette smoking promote acute episodes of Mnires

disease. Aspirin and other NSAIDs can be ototoxic and should be avoided. Avoiding
saturated fats and people with upper respiratory infection will not help prevent a
recurrence of Mnires disease. A hydrops diet may stabilize body fluid levels to
prevent excess endolymph accumulation.

Management) MSC: Integrated Process: Teaching/Learning
7. When performing a clients physical assessment, the nurse notes that the client has
conductive hearing loss. Which finding does the nurse expect to see in the clients
medical history?
a. History of diabetes with peripheral neuropathy

b. Frequent episodes of otitis media during childhood
c. History of frequent impactions of cerumen in the ear canals
d. History of osteomyelitis treated with IV gentamicin (Garamycin)
ANS: B
Chronic middle ear infections can thicken the tympanic membrane, leading to
conductive hearing loss. Gentamicin and diabetes mellitus damage the eighth cranial
nerve and cause sensorineural hearing loss. Cerumen impaction results in temporary
conduction hearing loss.
8. The nurse is caring for a client with Mnires disease. What does the nurse
recommend to the client to reduce the symptoms of vertigo?
a. Take salt and potassium supplements daily.

b. Drink at least eight glasses of water every day.
c. Blow your nose hard when dizziness first begins.
d. When dizziness begins, lie down and keep your head still.
ANS: D
Vertigo is a sense of whirling or turning in space, disturbing the sense of balance and
inducing nausea and/or vomiting. Restricting head motions can help reduce the
disturbances induced by vertigo. Excessive endolymph fluid can cause symptoms of
Mnires disease, so the nurse should not encourage extra fluid intake. Sodium will
encourage water retention, which can exacerbate symptoms. The client should not
blow his or her nose forcefully because this can cause damage to the ear.

Management) MSC: Integrated Process: Teaching/Learning
9. A client is being started on scopolamine (Transderm Scop) for vertigo. What does
the nurse tell the client regarding this medication?
a. You may drive your car while taking this medication.

b. Concentration on your college courses will not be affected.
c. It is recommended that you limit activities requiring a detailed focus.
d. You should be able to continue your job as a crane operator.
ANS: C
With scopolamine (Transderm Scop), drowsiness can be a problematic side effect.

Clients are encouraged not to operate machinery or drive while taking this medication.
Therefore driving a car or operating a crane could be dangerous. College coursework
may be challenging because of tiredness experienced by the client.

TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)
10. The nurse is providing discharge instructions for a client who will be going home
following tympanoplasty surgery. Which statement by the client indicates that
additional teaching is needed?
a. I will wear earplugs whenever I am in noisy areas.
b. I will occlude only one nostril when I blow my nose.
c. I will wait 3 weeks before I resume my aerobics workouts.
d. I will use a cotton swab to clean drainage from inside my ear.
ANS: D
Cotton swabs should not be used to clean drainage from the ear canal, especially after
ear surgery. The client should be careful to avoid pressure extremes that could damage
the tympanic membrane, including jumping or blowing the nose forcefully. Occluding
only one nostril when blowing the nose reduces pressure within the ear and minimizes
the chance of injury to the ear.

Management) MSC: Integrated Process: Nursing Process (Evaluation)
11. The nurse is assessing several clients with hearing loss. Which client does the
nurse recommend should investigate hearing aids?
a. Client who has smoked two packs of cigarettes a day for 30 years
b. Client who had chronic middle ear infections during childhood
c. Client with constant tinnitus that becomes worse at night
d. Client who worked as a security guard at rock concerts for 10 years
ANS: B
Hearing aids are most effective for clients with conductive hearing loss, rather than
sensorineural hearing loss caused by smoking or loud noises. Tinnitus is associated
with sensorineural rather than conductive hearing loss. Chronic ear infections are a
significant risk factor for conductive hearing loss.

TOP: Client Needs Category: Health Promotion and Maintenance (Health and Wellness)
12. The nurse is caring for a newly deaf client who is learning to read lips. Which
client statement indicates that additional teaching is needed?
a. After I practice lip reading for a while, I wont need to worry about using
sign language anymore.
b. I will have a harder time lip reading when I am not familiar with the
topic of the conversation.
c. Focusing so much on lip reading will make me tired, so I will try to keep
conversations short.
d. I may not be able to lip read very well when the other person has a beard
or when light in the room is inadequate.
ANS: A
Usually, experienced lip readers cannot understand more than half of what is being
said by the other person, so the client should not abandon sign language as a means of
communication. The client will find it easier to lip read for short conversations at first.
Poor lighting and facial hair make lip reading difficult.
TOP: Client Needs Category: Psychosocial Integrity (Sensory/Perceptual Alterations)
13. A client is being discharged after a tympanoplasty. Which instruction about

cephalexin (Keflex) does the nurse provide to this client?
a. Be sure to finish all the Keflex pills, even if you feel fine.
b. The Keflex may turn your urine an orange color while you are taking it.
c. Take the Keflex on an empty stomach and stay upright for 30 minutes
afterward.
d. Use sunscreen and avoid exposure to sunlight while you are taking
Keflex.
ANS: A
Keflex is an antibiotic. Clients should be sure to take the entire course of therapy to
prevent the development of infection with resistant microorganisms. Keflex will not
turn the urine orange and may be taken on an empty stomach. Keflex will not cause
sun sensitivity. The client does not need to stay in an upright position after taking
Keflex.

TherapiesMedication Administration) MSC: Integrated Process: Teaching/Learning
14. A client tells the nurse, Bumps have developed in my ear canals from my hearing
aid. Which is the nurses best recommendation for the client?
a. Clean your hearing aid with rubbing alcohol every evening and let it dry
overnight.
b. Apply a small amount of benzoyl peroxide cream to the inside of your
ear canals before you insert your hearing aid.
c. Clean your hearing aid with mild soap and water and make sure that it is
completely dry before inserting it in your ears.
d. Clean your ears with half-strength hydrogen peroxide twice a day before
you put in your hearing aid and after you take it out.
ANS: C
Keeping the hearing aid clean and making sure that it is dry before insertion into the
ear will minimize plugging of the sebaceous glands, resulting in bumps. Rubbing
alcohol should never be used to clean the hearing aid. Benzoyl peroxide should not be
applied to the inside of the ear canals, although carbamide peroxide (Debrox) may be
used to facilitate excessive ear wax removal.
15. The nurse teaches a clients wife how to administer eardrops to the client. Which
statement by the clients wife indicates that additional teaching is needed?
a. I will make sure that the eardrops are at room temperature before using
them.
b. I will wash my hands before and after giving my husband the eardrops.
c. After I put the drops in, I will gently tug on the outer ear to make sure
that they go into the ear canal.
d. I will have my husband lay on his back with his chin up when I give him
the eardrops.
ANS: D
The client should be positioned on his side for administration of eardrops. Hands
should be washed before and after administration of eardrops. Cold eardrops may
cause vertigo and nystagmus. The client or his wife may give a gentle tug on the outer
ear to ensure that the drop has gone into the ear canal.
ControlHome Safety) MSC: Integrated Process: Teaching/Learning
16. Which recommendation does the nurse provide for the client with Mnires disease
who has periodic spells of vertigo?
a. Avoid wearing high-heeled shoes.

b. Put brightly colored rugs on the floor for visibility.
c. Step on a sturdy chair to get items from high shelves.
d. Wait to drive a car until after you have taken your Benadryl.
ANS: A
Clients with vertigo should wear low-heeled shoes with nonskid soles and tied laces to
prevent injury. Brightly colored rugs would not help with safety concerns, especially
if the rugs were throw rugs. Clients should use a stepstool with arms to reach items
from high shelves, not just a sturdy chair. Diphenhydramine hydrochloride (Benadryl)
may cause drowsiness, and clients should not drive after taking it.
ControlHome Safety) MSC: Integrated Process: Teaching/Learning
17. Which is the best approach for the nurse to use to obtain a history from a client
with sudden hearing loss?
a. Question the clients family.

b. Write out the questions for the client to answer.
c. Obtain the information from the clients old chart.
d. Check with the clients primary health care provider.
ANS: B
The nurse should communicate with the client directly, using written questions if the
client cannot hear. The nurse can use old charts or information from the clients family
or primary health care provider only if the client is unable to answer the questions.

Specific Assessments) MSC: Integrated Process: Communication and Documentation
18. The nurse is caring for a client who has just been diagnosed with profound hearing
loss. The client tells the nurse, The doctors must have made a mistake. Theres no way
I can be deaf! Which is the nurses best response?
a. Why do you think that the doctors made a mistake?

b. I can tell that you are anxious and scared about your hearing.
c. Lots of people lead productive lives after losing their hearing.
d. The doctors did extensive tests to make sure that the diagnosis was
correct.
ANS: B
The nurse should acknowledge the clients feelings rather than trying to convince the
client of the physicians correct diagnosis. Reflective techniques can help the client
clarify feelings and share concerns with the nurse. The nurse should not belittle the
clients concerns with generalizations. Why questions can seem probing and often put
the client on the defensive. Merely reassuring the client that all pertinent tests were
conducted will not help the client resolve feelings about deafness.
TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)
19. The client requires a hearing aid but tells the nurse that he cannot afford to pay for
it right now. What is the nurses best response?
a. Your insurance company should pay some of the cost.

b. The hospital can set up a payment plan for the new hearing aid.
c. Ill ask the social worker about organizations that help pay for hearing
aids.
d. You can check around to see who has the lowest price.
ANS: C
Local organizations may be able to help the client pay for the hearing aid. The social
worker should be contacted as soon as possible. The client should not shop around for
the best price for a hearing aid because discount providers may not be able to offer
required diagnostic tests or follow-up care.
TOP: Client Needs Category: Psychosocial Integrity (Support Systems)
20. The nurse is caring for an older client whose ear canals are impacted with hard
cerumen. Which action by the nurse is best to remove the cerumen?
a. Instruct the client to put a few drops of mineral oil into each ear every
evening and to schedule the irrigation for 3 days later.
b. Aim the irrigation fluid directly at the center of the cerumen to facilitate
dissolving the impaction.
c. Administer 10 mg of prochlorperazine (Compazine) to prevent nausea
during irrigation of the ears.
d. Irrigate the ears with 35 to 40 mL of sterile normal saline and repeat as
needed until the cerumen is cleared.
ANS: A
Softening hard cerumen with mineral oil for 3 days before irrigation will facilitate
removal from the ear canal. Irrigation fluid should be aimed at the side of the
impacted cerumen to facilitate removal. Administration of prochlorperazine before
irrigation is not recommended. Normal saline need not be sterile for ear irrigation.
TOP: Client Needs Category: Physiological Integrity (Basic Care and ComfortPersonal Hygiene)

MULTIPLE RESPONSE
1. Which of the nurses assessment findings will require collaboration with the clients
primary health care provider? (Select all that apply.)
a. Purulent drainage from the ear canal

b. Hearing loss with nausea and vertigo
c. Ringing in the ears after attending a loud rock concert
d. Presence of cerumen blocking 50% of the ear canal
e. Increasing hearing loss since starting furosemide (Lasix)
f. Temperature of 101.7 F following a stapedectomy 3 days ago
ANS: A, B, E, F
Purulent drainage in the ear canal indicates a middle ear infection with a ruptured
tympanic membrane. Hearing loss with vertigo and nausea indicates labyrinthitis.
Furosemide is ototoxic. Fever following stapedectomy is most likely caused by
infection inside the ear. Ringing in the ears following exposure to loud noise is a
common symptom, which should resolve spontaneously. Nonimpacted cerumen may
be left alone if it is not impairing the clients hearing.
TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationAlterations in

Body Systems) MSC: Integrated Process: Nursing Process (Assessment)
2. Which client statement indicates that the client understands teaching about
stapedectomy surgery? (Select all that apply.)
a. My hearing will get worse before it gets better.

b. I will have to miss 6 weeks of swim team practice.
c. I will see the doctor 1 week after surgery to have my stitches removed.
d. Foods may taste funny for a short time after surgery.
e. I may get dizzy and feel like the room is spinning after surgery.
f. I can blow my nose to relieve the feeling of fullness in my ear after
surgery.
ANS: A, B, D, E
Postoperative swelling and packing in the ear will result in reduced hearing ability for
the first few weeks after surgery. When the swelling subsides and the packing is
removed, hearing will improve. The client should not get water in the ear for the first
6 weeks after surgery. Damage to or swelling of the facial nerve may result in
postoperative loss of taste sensation. Vertigo is common after stapedectomy because
of close proximity to inner ear structures. Blowing the nose should be avoided to
prevent increased pressure within the ear.
Complications from Surgical Procedures and Health Alterations)
3. A client has mastoiditis. The nurse assesses most carefully for which
manifestations? (Select all that apply.)
a. Red and bulging eardrum

b. A crackling sound upon yawning
c. Enlarged lymph nodes behind the ear
d. Low-grade fever and malaise
e. Diminished hearing
f. Loss of appetite
ANS: C, D, E, F
Common signs and symptoms of mastoiditis include enlarged lymph nodes behind the
ear, low-grade fever, malaise, loss of hearing, and loss of appetite. When the eardrum
is red and bulging and a crackling sound is heard upon yawning, the client is usually
diagnosed with otitis media.

OTHER
1. The nurse is instilling eardrops into a clients ear. Place the following in order
according to best practice. (Separate letters by a comma and space as follows: a, b, c,
d.)
a. Ask the client to move the head gently back and forth five times.
b. Wash your hands.
c. Wear gloves to remove any packing from the ear.
d. Perform an otoscopic examination to see if the eardrum is intact.
e. Irrigate the ear if needed to remove cerumen.
f. Tilt the clients head in the opposite direction of the affected ear and place the drops
in the affected ear.
g. Warm the bottle of eardrops in a bowl of warm water for 5 minutes.
h. Wash your hands again.
i. Insert a ball of cotton in the ear as packing.
ANS:
c, b, d, e, g, f, a, i, h
The correct sequence for performing this action is as follows: Remove any existing
packing from the clients ear while wearing gloves, wash your hands, check the
eardrum with an otoscope to ensure that it is intact, irrigate the ear if needed, warm
the eardrops, tilt the clients head opposite the affected ear and instill the drops, ask the
client to move his or her head back and forth five times, insert a cotton ball in the ear,
and finally wash your hands again.
DIF: Cognitive Level: Comprehension/Understanding REF: Chart 51-1, p. 1089

TherapiesMedication Administration) MSC: Integrated Process: Nursing Process (Intervention)
COMPLETION
1. The nurse is caring for a 132-lb client with an ear infection who is to receive
amoxicillin, 40 mg/kg/day in divided doses every 8 hours. The nurse will administer
____ mg/dose of amoxicillin to the client.
ANS:
800
132 lb (1 kg/2.2 lb) = 60 kg
60 kg (40 mg/day) = 2400 mg/day)/3 = 800 mg/dose

TherapiesDosage Calculation)

Chapter 50: Assessment of The Ear and Hearing Test Bank: Multiple Choice

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Chapter 50: Assessment of The Ear and Hearing Test Bank: Multiple Choice

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Chapter 50: Assessment of the Ear and Hearing

a. Notify the health care provider.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-

2. The nurse is performing an ear assessment on an older adult. Which assessment

a. Coarse hair is seen in the auditory canal.

DIF: Cognitive Level: Comprehension/Understanding REF: Chart 50-1, p. 1082

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-

3. Which client is at highest risk for hearing loss?

a. Client with heart failure receiving digoxin (Lanoxin), 0.125 mg orally

Gentamicin is an aminoglycoside that can cause ototoxicity. Assessment of hearing

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral

MSC: Integrated Process: Nursing Process (Assessment)

a. History of frequent ear infections

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiologic Integrity (Reduction of Risk PotentialDiagnostic

MSC: Integrated Process: Teaching/Learning

a. A new sterile otoscope speculum is used to examine each of the clients

DIF: Cognitive Level: Application/Applying or higher REF: N/A

a. Speaking loudly and adding extra inflections to the tone of voice

Environmental noise decreases the hearing-impaired clients ability to hear

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1080

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC: Integrated Process: Communication and Documentation

a. I will start a smoking cessation program and will take a multivitamin

DIF: Cognitive Level: Application/Applying or higher REF: N/A

MSC: Integrated Process: Nursing Process (Evaluation)

a. How exactly do you clean your ears?

a. Do you wear eyeglasses?

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-

a. I will wash my hands before I put in my earplugs at work.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

a. Client with clear watery drainage from the ear canals

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialSystem-

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1078

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Teaching/Learning

a. I can eat a hearty breakfast before the procedure.

TOP: Client Needs Category: Physiologic Integrity (Reduction of Risk PotentialDiagnostic

MSC: Integrated Process: Nursing Process (Evaluation)

a. Tympanic membrane is retracted, with multiple air bubbles.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

a. I get so angry when I cannot hear what my daughter says.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Grief and Loss)

MSC: Integrated Process: Nursing Process (Assessment)

a. Fill the syringe with lukewarm water.

b. Hold the head at a 30-degree angle.

d. Tilt the head at a 90-degree angle to remove excess fluid.

f. Repeat the procedure on the opposite ear.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

a. The client now reports tinnitus and vertigo at night.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)