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 available

b. Use of an eyepatch or eyeshield on the right eye
c. Use only cool water to wash the face
d. 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. Anosmia
b. Absence of pain
c. Reduction of cerumen
d. 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. Objective
b. Subjective
c. Functional
d. 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 balance
b. Translate sound waves into nerve impulses
c. Amplify the enrgy of sound waves entering the ear
d. 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 telephone
b. Teaching the importance of changing his position
c. Providing reading material with large print
d. 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. Stereognosis
b. Tuning fork
c. 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. Alcohol
b. High sodium foods
c. Caffeine
d. Fruit juices
e. Cigarette smoking
f. 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 vertigo

b. Alteration in comfort related to tinnitus
c. Altered body image related to hearing loss
d. 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 loss

b. Vertigo, vomiting, and nystagmus
c. Vertigo, pain and hearing impairment
d. 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 hours
b. Try to ambulate independently after about 24 hours
c. Shampoo your hair every day for 10 days to help prevent ear infection
d. 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 tubes
b. Nasopharynx
c. Tympanic membrane
d. 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 back

b. Pull the ear straight out
c. Pull the ear up and back
d. 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 environment

b. The client has difficulty understanding women’s voice
c. The client Weber’s test indicates that vibration of tuning fork is perceived better in the poor ear
d. 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 drum

b. Use cold water
c. Warm solution at 98 degree f
d. 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. Olfactory
b. Facial
c. Occulomotor
d. Trochlear
Facial nerve is commonly affected by acoustic neuroma.
Intellectualization

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

a. Earache
b. Discharge from the ear
c. Hearing loss
d. 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 isolation
b. IV 5 % dextrose in 0.45 normal saline solution at 35ml/hr
c. Tylenol 120 mg PO q4h
d. 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. Utricle
 b. Cochlea
c. Middle ear
d. 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 era
b. Outer ear
c. Middle ear
d. 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 nerve
b. Cochlear nerve
c. Trigeminal nerve
d. 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 hearing
c. The client is usually unable to hear bass tones
d. 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 test
b. Rinne test
c. Weber test
d. 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 conduction

b. Air conduction is audible longer than bone conduction in affected ear
c. Air conduction is audible longer than bone conduction in unaffected ear
d. 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 position
b. Otoscope should be held in the examiner’s left hand, in a dart-like hold position
c. Otoscope should be held in the examiner’s right hand, in a pencil-like hold position
d. 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 test
b. Weber’s test
c. Rinne’s test
d. 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 ear
C. Instill an antibiotic ointment in the affected ear
D. 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 outward

B. Pull the pinna downward and inward
C. Pull the pinna inside and out
D. 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
impaired?

A. Speaks in a raised voice

B. Speaks slowly
C. 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 V

B. Eight cranial nerve VIII
C. Second cranial nerve II
D. 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 diet

B. Eliminate environmental noise
C. Preserve the remaining hearing
D. 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 interventions
include 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 feet
C. Bone conduction is heard twice as long as air conduction with the Rinne Test
D. 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
appearance 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 days

B. I will make sure that I will clean my hair and face to prevent infection
C. I will use straw for drinking
D. 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, Circulation
B. Love and Belongingness
C. Food, Diet and Nutrition
D. Safety

Although A is priority according to maslow, it is not specific in clients with menieres

disease. The client has an attack of incapacitating vertigo and client is high risk for injury
due to falls. The client will perceive the environment moving due to disruption of the
vestibular 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 intake

b. Encourage the client to avoid sudden head movements
c. Instruct the client to cut down on cigarette smoking
d. 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 aid
c. Withdrawal from social activities
d. Reluctance to answer the telephone
Answer. 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 back

b. Wear gloves
c. Hold the child in a sitting position
d. 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 temperature

b. Placing the client in a side-lying position with the ear facing up
c. 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 ear

b. Complaints f severe pain in the affected ear
c. Complaints of burning in the ear
d. 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 membrane

b. A pearly colored tympanic membrane
c. A mobile tympanic membrane
d. 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. Analysis
42. 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 F

b. Positions the client with the affected side up following the irrigation
c. Directs a slow steady stream of irrigation solution toward the eardrum
d. 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, olfactory

b. Cranial nerve IV, trochlear
c. Cranial nerve III, oculomotor
d. 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 diet
b. Low-sodium diet
c. Low-cholesterol diet
d. 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 diet

b. Avoid sudden head movements
c. 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 hair

b. I can resume my tennis lessons starting next week
c. I will take stool softeners as prescribed by my doctor
d. 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 aging
b. Nystagmus that occurs with aging
c. A conductive hearing loss that occurs with aging
d. 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 ear

b. Instillation of diluted alcohol
c. Instillation of antibiotic ear drops
d. 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 loudly
b. Speak frequently
c. Speak at a normal volume
d. 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 membrane

b.A pearly colored tympanic membrane
c.A transparent and clear tympanic membrane
d.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.Pruritus
b.Tinnitus
c.Hearing loss
d.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 eye

b. I will place the patch on both eyes
c. I will place the patch on the left eye
d. 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: A
Rationale: 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: B
Rationale: 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: C
Rationale: 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: D
Rationale:  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:  A
Rationale:  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:  D
Rationale: 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 child
has otitis media. On examination, the nurse would recognize which of the following findings
as 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 cervical
lymph gland enlargement, rhinorrhea, vomiting, diarrhea, loss of appetite, and red tympanic
membrane. 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 infection
may 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 vomiting

b. Altered body image related to hearing loss
c. High risk for injury
d. 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 impulse
b. Stereognosis
c. Romberg test
d. 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 moving

b. Encourage the patient to close the eyes
c. 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 migraine
b. Motion sickness
c. Meniere’s disease
d. 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. conductive
b. sensorineural
c. 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. nystagmus
 b. Presence of otalgia
c. Otorrhoea
d. tinnitus
e. 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 week
b. store the hearing aid in a warm place
c. 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-ear
b. in-the-ear
c. half shell
d. completely-in-the-canal

ANSWER: A
RATIONALE:
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 drainage
b. cerumen with blood or mucus
c. blood

  ANSWER: B
RATIONALE:
            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 test
b. Weber test
c. Rinne test
 d. All of the above

Answer: B
Rationale: 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 ears

b. Sound heard best in affected ear
c. Sound heard as long as or longer in affected ear
d. Air conduction is audible longer then bone conduction in affected ear.

Answer: C
Rationale: 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 position
b. Otoscope should be held in the examiner’s left hand, in a dart-like hold position
c. Otoscpoe should be held in the examiner’s right hand, in a pencil-hold position
d. Otoscope should be held in the examiner’s left hand, in a pencil-hold position

Answer: C
Rationale: 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 ear
c. Electrodes place in forehead

Answer: A
Rationale: 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 B

B.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 loss

B. 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.Otalgia
B.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 prohibited

b) swimming in lake water needs to be avoided
c) she will place earplugs in the child's ears during baths and showers
d) she will be sure to give her child soft tissues to blow his nose
Answer: 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 voice

b) speak slowly in a loud voice
c) speak slowly and try to overemphasize words
d) speak slowly and directly in front of the client
Answer: 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 ear

b) place the vibrating tuning fork in the middle of the head
c) place the vibrating tuning fork behind the ear
d) irrigate the ear with cold water and observe movement of the eyes
Answer 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 diet

b) limit salt intake
c) limit fats in the diet
d) drink a lot of fluids
Answer: 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. Cholesteatoma
b. Otitis media
c. Osteoclerosis
d. 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 III

b. Cranial nerve X
c. Cranial nerve VII
d. 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. Otoscopy
b. X-ray
c. CT scan
d. 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 sign

b. The patient manifests chovtek’s sign
c. The patient presents a facial nerve paresis
d. 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 removal
b. Administration of antibiotics
c. Use of hearing aids
d. 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 repetition
b. Patient speaks softly
c. Patient speaks loudly and reports no difficulty hearing grandchildren talking
d. Patient has trouble hearing in a noisy environment
e. Patient reports hearing difficulty only at noisy gatherings, such as a wedding
 
ANSWER: A
Patient 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 orientation
b. sensorineural loss
c. aural rehabilitation
 
ANSWER: C
RATIONALE:
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
stapedectomy sugery is;

a. The removal of eardrum, bony ear canal wall, middle ear mucosa and ossicles
b. drainage of endolymph that fills the membranous labyrinth of the inner ear
c. removal of diseased stapes
d. a connection made between stapes and malleus in order to improve ossicular conduction of
sound.
 
ANSWER: C
RATIONALE:
                  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 loss
b. conductive hearing loss
c. cochlea hearing loss
 
ANSWER: B
RATIONALE:
            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. nystagmus
b. Presence of otalgia
c. Otorrhoea
d. tinnitus
e. 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.
 94. Which of the following is the threshold limit for normal hearing?
a. 10 dB HL
b. 20 dB HL
c. 30 dB HL
d. 40 dB HL
 
ANSWER: B
RATIONALE:
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 drainage
b. cerumen with blood or mucus
c. blood
 
ANSWER: B
RATIONALE:
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 used
b. Patient will most likely have better communication with binaural hearing aids
c. The ear with the hearing aid will reorganize so that the other ear can never be successfully
aided
d. Patient will hear sounds at a softer level
 
ANSWER: B
RATIONALE:
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. Cochlea
b. Inner canal
c. Malleus
 
ANSWER: A
RATIONALE:
            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/itracochlear)
a. electrode design
b. analog or pulsatile
c. 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 week

B. store the hearing aid in a warm place
C. 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.

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

A. Maintain a Sodium free diet

B. Eliminate environmental noise
C. Preserve the remaining hearing
D. 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
interventions include eliminating environmental noise, promoting a quiet environment and restricting
caffeine, nicotine and alcohol.
ANALYSIS