Review Practice Exercise 2

Middle and Inner Ear Disorders > Adult Health

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Practice Exercise 2

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Total Questions : 5

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Question 1:

What makes up the triad of symptoms that occur with inner ear problems? Select all that apply

A. Vertigo B. Nausea C. Tinnitus D. Sensorineural hearing loss E. Inflammation of the ear canal

Answer and Explanation

Choice A:

Vertigo: Inner ear problems, especially Ménière’s disease, commonly cause spinning sensations due to disturbances in the vestibular system. This vertigo is often sudden, severe, and disabling, lasting from minutes to hours.

Choice B:

Nausea: While nausea and vomiting often accompany vertigo, they are secondary effects of the balance disturbance rather than a core part of the triad. They are common symptoms but not diagnostic criteria.

Choice C:

Tinnitus: A hallmark symptom of inner ear disorders is tinnitus, or ringing in the ears. This occurs because of abnormal stimulation or damage to the cochlear hair cells, leading to perception of sound without external input.

Choice D:

Sensorineural hearing loss: Inner ear damage affects the cochlea or auditory nerve, leading to sensorineural loss. In Ménière’s disease, hearing loss often begins intermittently but may progress to permanent loss over time.

Choice E:

Inflammation of the ear canal: This describes otitis externa (swimmer’s ear), which affects the outer ear, not the inner ear. It causes localized pain, swelling, and discharge but not the triad associated with inner ear disorders.

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Question 2:

An appropriate nursing intervention for the patient during an acute attack of Meniere disease includes providing

A. frequent repositioning. B. a quiet, darkened room. C. a television for diversion. D. padded side rails on the bed.

Answer and Explanation

Choice A:

Frequent repositioning: Moving the patient frequently will worsen vertigo and increase nausea. The patient should be kept as still as possible until symptoms subside.

Choice B:

A quiet, darkened room: Patients with acute Ménière attacks are extremely sensitive to motion, light, and noise, which can worsen vertigo and nausea. A quiet, darkened environment helps reduce sensory input and allows the vestibular system to stabilize.

Choice C:

A television for diversion: Visual stimulation, such as watching television, can aggravate dizziness and nausea during an acute attack, making it inappropriate.

Choice D:

Padded side rails on the bed: While useful for seizure precautions, side rails do not address the underlying issue of vertigo in Ménière disease. The priority intervention is reducing environmental stimuli.

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Question 3:

What knowledge guides the nurse in providing care for a patient with an acoustic neuroma?

A. Widespread metastasis usually occurs before symptoms of the tumor are noticed. B. Facial nerve function will be sacrificed during surgical treatment to preserve hearing. C. Early diagnosis and treatment of the tumor can preserve hearing and vestibular function. D. Treatment is usually delayed until hearing loss is significant because a neuroma is a benign tumor.

Answer and Explanation

Choice A:

Widespread metastasis usually occurs before symptoms of the tumor are noticed: Acoustic neuromas are benign, non-metastatic tumors. The symptoms result from local compression, not spread to other body sites.

Choice B:

Facial nerve function will be sacrificed during surgical treatment to preserve hearing: The goal of surgery is to remove the tumor while preserving both hearing and facial nerve function. Sacrificing the facial nerve is not an expected or planned outcome.

Choice C:

Early diagnosis and treatment of the tumor can preserve hearing and vestibular function: Detecting the neuroma in its early stages allows for treatment before significant nerve compression occurs. This can prevent permanent sensorineural hearing loss and reduce the risk of balance disturbances.

Choice D:

Treatment is usually delayed until hearing loss is significant because a neuroma is a benign tumor: Even though the tumor is benign, delaying treatment risks irreversible hearing loss, facial nerve damage, or brainstem compression. Early intervention improves prognosis.

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Question 4:

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

A. Hearing aid is helpful B. Related to otitis media C. Caused by noise trauma D. Linked with otosclerosis E. Associated with Meniere disease

Answer and Explanation

Choice A:

Hearing aid is helpful: While hearing aids can amplify sounds, they cannot correct distortion caused by nerve or cochlear damage. They are more effective in conductive loss, though some benefit may still occur in mild-to-moderate sensorineural loss.

Choice B:

Related to otitis media: Otitis media is a middle ear infection that interferes with sound conduction, causing conductive hearing loss, not sensorineural. Once treated, hearing usually improves unless chronic damage occurs.

Choice C:

Caused by noise trauma: Prolonged exposure to loud sounds damages the delicate hair cells in the cochlea, leading to permanent sensorineural hearing loss. This is a common preventable cause of hearing loss in younger and working-age adults.

Choice D:

Linked with otosclerosis: Otosclerosis involves abnormal bone growth in the middle ear that immobilizes the stapes. This results in conductive hearing loss, though in rare advanced cases it can extend to the cochlea (mixed hearing loss).

Choice E:

Associated with Ménière disease: Ménière disease is an inner ear disorder caused by abnormal fluid buildup that damages cochlear and vestibular structures. Over time, this leads to progressive sensorineural hearing loss, tinnitus, and vertigo.

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Question 5:

What indicates sensorineural hearing loss? Select all that apply

A. Positive Rinne test B. Negative Rinne test C. Weber lateralization to impaired ear D. Weber lateralization to good ear E. External or middle ear pathology F. Inner ear or nerve pathway pathology

Answer and Explanation

Choice A:

Positive Rinne test: In sensorineural loss, air conduction remains better than bone conduction because the pathway through the outer and middle ear is intact. This results in a positive Rinne test, even though overall hearing is reduced.

Choice B:

Negative Rinne test: A negative Rinne (bone conduction > air conduction) indicates conductive hearing loss, not sensorineural. It reflects impaired sound transmission through the outer or middle ear.

Choice C:

Weber lateralization to impaired ear: Lateralization to the impaired ear occurs in conductive loss, where background noise is reduced, making the vibration more noticeable. It does not occur in sensorineural loss.

Choice D:

Weber lateralization to good ear: In Weber testing, sound localizes to the unaffected ear because the damaged inner ear cannot perceive the vibration as well. This helps differentiate sensorineural loss from conductive loss, which lateralizes to the impaired ear.

Choice E:

External or middle ear pathology: Pathology in the outer or middle ear causes conductive loss, not sensorineural. Sensorineural loss always involves the inner ear or auditory nerve.

Choice F:

Inner ear or nerve pathway pathology: Sensorineural hearing loss originates from damage to the cochlea, auditory nerve, or central auditory pathways. Causes include presbycusis, noise trauma, Ménière disease, and ototoxic drugs.

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