Review Practice Exercise 1

Middle and Inner Ear Disorders > Adult Health

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Practice Exercise 1

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Total Questions : 5

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Question 1:

What characteristics describe the care of a patient with chronic otitis media? Select all that apply

A. It is most commonly treated with antibiotics. B. It is an infection in the inner ear that may lead to headaches. C. Impairment of the eustachian tube is most commonly associated with effusion. D. Formation of an acoustic neuroma may destroy the structures of the middle ear or invade the dura of the brain. E. The patient who has had a myringotomy with placement of a tympanostomy tube should be instructed to avoid getting water in the ear.

Answer and Explanation

Choice A:

It is most commonly treated with antibiotics: Chronic otitis media typically requires surgical management or long-term strategies rather than repeated antibiotic therapy, which is more applicable to acute otitis media.

Choice B:

It is an infection in the inner ear that may lead to headaches: Chronic otitis media affects the middle ear, not the inner ear; inner ear infections (labyrinthitis) are distinct and present differently.

Choice C:

Impairment of the eustachian tube is most commonly associated with effusion: Chronic otitis media is often related to poor eustachian tube function, which leads to accumulation of fluid and recurrent infections.

Choice D:

Formation of an acoustic neuroma may destroy the structures of the middle ear or invade the dura of the brain: Acoustic neuromas are benign tumors of the vestibulocochlear nerve, unrelated to chronic otitis media.

Choice E:

The patient who has had a myringotomy with placement of a tympanostomy tube should be instructed to avoid getting water in the ear: Water entry can introduce pathogens into the middle ear, increasing risk of infection; ear protection is essential.

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Question 2:

While caring for a patient with otosclerosis, which finding would the nurse expect in the patient’s history and physical?

A. A strong family history of the disease B. Symptoms of sensorineural hearing loss C. A positive Rinne test and lateralization to the good or better ear on Weber testing D. An immediate and consistent improvement in hearing at the time of surgical treatment

Answer and Explanation

Choice A:

A strong family history of the disease: Otosclerosis often follows an autosomal dominant inheritance pattern, making family history a key expected finding in a patient’s history.

Choice B:

Symptoms of sensorineural hearing loss: Otosclerosis primarily causes conductive hearing loss due to stapes fixation, not sensorineural hearing loss.

Choice C:

A positive Rinne test and lateralization to the good or better ear on Weber testing: In conductive hearing loss (otosclerosis), Rinne is typically negative (bone conduction > air conduction), and Weber lateralizes to the affected ear, not the good ear.

Choice D:

An immediate and consistent improvement in hearing at the time of surgical treatment: Postoperative results vary; while many patients experience hearing improvement, it is not always immediate or guaranteed.

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Question 3:

What characteristics of hearing loss are associated with conductive loss? Select all that apply

A. Presbycusis B. Speaks softly C. Related to otitis media D. Result of ototoxic drugs E. Hears best in noisy environment F. May be caused by impacted cerumen

Answer and Explanation

Choice A:

Presbycusis: This is age-related, progressive sensorineural hearing loss, not conductive.

Choice B:

Speaks softly: Patients with sensorineural hearing loss often speak loudly because they cannot hear themselves clearly; conductive loss patients usually speak at a normal level.

Choice C:

Related to otitis media: Middle ear infections interfere with sound conduction, making otitis media a common cause of conductive hearing loss.

Choice D:

Result of ototoxic drugs: Ototoxicity damages the cochlea or auditory nerve, leading to sensorineural hearing loss, not conductive loss.

Choice E:

Hears best in noisy environment: People with conductive hearing loss often hear better in noisy surroundings because the loss is mechanical rather than neural, so background noise may enhance speech perception.

Choice F:

May be caused by impacted cerumen: Blockage of the ear canal by wax prevents sound waves from reaching the tympanic membrane, leading to conductive loss.

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Question 4:

The nurse suspects a patient has presbycusis when she says she has

A. ringing in the ears. B. a sensation of fullness in the ears. C. difficulty understanding the meaning of words. D. a decrease in the ability to hear high-pitched sounds

Answer and Explanation

Choice A:

Ringing in the ears: This refers to tinnitus, which can accompany presbycusis but is not the defining feature. Many other conditions such as noise exposure, medications, or vascular problems can also cause tinnitus, so it is not specific to age-related hearing loss.

Choice B:

A sensation of fullness in the ears: This is more typical of conductive hearing problems, such as otitis media or cerumen impaction. In presbycusis, there is no obstruction in the outer or middle ear, so fullness is not an expected finding.

Choice C:

Difficulty understanding the meaning of words: This symptom reflects reduced speech discrimination, which may occur in advanced presbycusis. However, it develops later in the condition rather than being the earliest or primary characteristic.

Choice D:

A decrease in the ability to hear high-pitched sounds: This is the hallmark of presbycusis. It occurs because the high-frequency hair cells in the cochlea are most susceptible to age-related degeneration. Patients may initially report trouble hearing doorbells, telephones, or voices of women and children.

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Question 5:

A client receives a prescription for sodium fluoride for otosclerosis and asks a nurse what the medication will do for his ears. Which response by the nurse is correct?

A. “The medication prevents the breakdown of bone cells and hardens the bone in the ear.” B. “The medication causes the breakdown of bone cells and softens the bone in the ear.” C. “The medication blocks the effect of histamine and dries the fluid in the ear.” D. “The medication causes the production of histamine and increases the fluid in the ear.”

Answer and Explanation

Choice A:

“The medication prevents the breakdown of bone cells and hardens the bone in the ear.”: Sodium fluoride helps to inhibit further bone resorption and promotes calcification, which can stabilize the abnormal growth. This effect may slow the progression of otosclerosis, although it does not reverse existing hearing loss.

Choice B:

“The medication causes the breakdown of bone cells and softens the bone in the ear.”: Sodium fluoride does not cause breakdown of bone cells or softening; in fact, its role is the opposite—slowing bone remodeling and hardening the abnormal bone. Softening of bone would worsen hearing rather than improve it.

Choice C:

“The medication blocks the effect of histamine and dries the fluid in the ear.”: Antihistamines act in this way, but sodium fluoride is not an antihistamine and does not affect fluid balance in the ear. This choice confuses otosclerosis with inner ear conditions like Ménière’s disease.

Choice D:

“The medication causes the production of histamine and increases the fluid in the ear.”: Sodium fluoride has no relation to histamine production or fluid accumulation. An increase in inner ear fluid would worsen hearing symptoms, not improve them.

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Practice Exercise 1

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