Chapter 64

1. The clinic nurse is assessing a child who has been brought to the clinic with
signs and symptoms that are suggestive of otitis externa. What assessment
finding is characteristic of otitis externa?
A) Tophi on the pinna and ear lobe
B) Dark yellow cerumen in the external auditory canal
C) Pain on manipulation of the auricle
D) Air bubbles visible in the middle ear
Ans: C
Feedback:
Pain when the nurse pulls gently on the auricle in preparation for an otoscopic
examination of the ear canal is a characteristic finding in patients with otitis
externa. Tophi are deposits of generally painless uric acid crystals; they are a
common physical assessment finding in patients diagnosed with gout.
Cerumen is a normal finding during assessment of the ear canal. Its presence
does not necessarily indicate that inflammation is present. Air bubbles in the
middle ear may be visualized with the otoscope; however, these do not
indicate a problem involving the ear canal.
2. While reviewing the health history of an older adult experiencing hearing loss
the nurse notes the patient has had no trauma or loss of balance. What aspect
of this patients health history is most likely to be linked to the patients
hearing deficit?
A) Recent completion of radiation therapy for treatment of thyroid cancer
B) Routine use of quinine for management of leg cramps
C) Allergy to hair coloring and hair spray
D) Previous perforation of the eardrum
Ans: B
Feedback:
 Long-term, regular use of quinine for management of leg cramps is associated
with loss of hearing acuity. Radiation therapy for cancer should not affect
hearing; however, hearing can be significantly compromised by chemotherapy.
Allergy to hair products may be associated with otitis externa; however, it is
not linked to hearing loss. An ear drum that perforates spontaneously due to
the sudden drop in altitude associated with a high dive usually heals well and
is not likely to become infected. Recurrent otitis media with perforation can
affect hearing as a result of chronic inflammation of the ossicles in the middle
ear.
3. A nurse is planning preoperative teaching for a patient with hearing loss due to
otosclerosis. The patient is scheduled for a stapedectomy with insertion of a
prosthesis. What information is most crucial to include in the patients
preoperative teaching?
A) The procedure is an effective, time-tested treatment for sensory hearing
loss.
B) The patient is likely to experience resolution of conductive hearing loss
after the procedure.
C) Several months of post-procedure rehabilitation will be needed to
maximize benefits.
D) The procedure is experimental, but early indications suggest great
therapeutic benefits.
Ans: B
Feedback:
Stapedectomy is a very successful time-tested procedure, resulting in the
restoration of conductive hearing loss. Lengthy rehabilitation is not normally
required.
4. Which of the following nursing interventions would most likely facilitate
effective communication with a hearing-impaired patient?
A) Ask the patient to repeat what was said in order to evaluate
understanding.
B) Stand directly in front of the patient to facilitate lip reading.
C) Reduce environmental noise and distractions before communicating.
D) Raise the voice to project sound at a higher frequency.
Ans: C
Feedback:
Communication with the hearing impaired can be facilitated by talking in a
quiet space free of competing noise stimuli and other distractions. Asking the
patient to repeat what was said is likely to provoke frustration in the patient. A
more effective strategy would be to repeat the question or statement, choosing
different words. Raising the voice to project sound at higher frequency would
make understanding more difficult. The nurse cannot assume that the patient
reads lips. If the patient does read lips, on average he or she will understand
only 50% of words accurately.
5. The nurse is providing discharge education for a patient with a new diagnosis
of Mnires disease. What food should the patient be instructed to limit or
avoid?
A) Sweet pickles
B) Frozen yogurt
C) Shellfish
D) Red meat
Ans: A
Feedback:
The patient with Mnires disease should avoid foods high in salt and/or
sugar; sweet pickles are high in both. Milk products are not contraindicated.
Any type of meat, fish, or poultry is permitted, with the exception of canned or
pickled varieties. In general, the patient with Mnires disease should avoid
or limit canned and processed foods.
6. Following a motorcycle accident, a 17-year-old man is brought to the ED.
What physical assessment findings related to the ear should be reported by the
nurse immediately?
A) The malleus can be visualized during otoscopic examination.
B) The tympanic membrane is pearly gray.
C) Tenderness is reported by the patient when the mastoid area is palpated.
D) Clear, watery fluid is draining from the patients ear.
Ans: D
Feedback:
For the patient experiencing acute head trauma, immediately report the
presence of clear, watery drainage from the ear. The fluid is likely to be
cerebrospinal fluid associated with skull fracture. The ability to visualize the
malleus is a normal physical assessment finding. The tympanic membrane is
normally pearly gray in color. Tenderness of the mastoid area usually indicates
inflammation. This should be reported, but is not a finding indicating urgent
intervention.
7. A patient has been diagnosed with hearing loss related to damage of the end
organ for hearing or cranial nerve VIII. What term is used to describe this
condition?
A) Exostoses
B) Otalgia
C) Sensorineural hearing loss
D) Presbycusis
Ans: C
Feedback:
Sensorineural hearing loss is loss of hearing related to damage of the end
organ for hearing or cranial nerve VIII. Exostoses refer to small, hard, bony
protrusions in the lower posterior bony portion of the ear canal. Otalgia refers
to a sensation of fullness or pain in the ear. Presbycusis is the term used to
refer to the progressive hearing loss associated with aging. Both middle and
inner ear age-related changes result in hearing loss.
8. A group of high school students is attending a concert, which will be at a
volume of 80 to 90 dB. What is a health consequence of this sound level?
A) Hearing will not be affected by a decibel level in this range.
B) Hearing loss may occur with a decibel level in this range.
C) Sounds in this decibel level are not perceived to be harsh to the ear.
D) Ear plugs will have no effect on these decibel levels.
Ans: B
Feedback:
Sound louder than 80 dB is perceived by the human ear to be harsh and can be
damaging to the inner ear. Ear protection or plugs do help to minimize the
effects of high decibel levels.
9. A patient has undergone diagnostic testing and has been diagnosed with
otosclerosis? What ear structure is primarily affected by this diagnosis?
A) Malleus
B) Stapes
C) Incus
D) Tympanic membrane
Ans: B
Feedback:
Otosclerosis involves the stapes and is thought to result from the formation of
new, abnormal bone, especially around the oval window, with resulting
fixation of the stapes.
10. A patient with otosclerosis has significant hearing loss. What should the nurse
do to best facilitate communication with the patient?
A) Sit or stand in front of the patient when speaking.
B) Use exaggerated lip and mouth movements when talking.
C) Stand in front of a light or window when speaking.
D) Say the patients name loudly before starting to talk.
Ans: A
Feedback:
 Standing directly in front of a hearing-impaired patient allows him or her to
lip-read and see facial expressions that offer clues to what is being said. Using
exaggerated lip and mouth movements can make lip-reading more difficult by
distorting words. Backlighting can create glare, making it difficult for the
patient to lip-read. To get the attention of a hearing-impaired patient, gently
touch the patients shoulder or stand in front of the patient.
11. The nurse in the ED is caring for a 4 year-old brought in by his parents who
state that the child will not stop crying and pulling at his ear. Based on
information collected by the nurse, which of the following statements applies
to a diagnosis of external otitis?
A) External otitis is characterized by aural tenderness.
B) External otitis is usually accompanied by a high fever.
C) External otitis is usually related to an upper respiratory infection.
D) External otitis can be prevented by using cotton-tipped applicators to
clean the ear.
Ans: A
Feedback:
Patients with otitis externa usually exhibit pain, discharge from the external
auditory canal, and aural tenderness. Fever and accompanying upper
respiratory infection occur more commonly in conjunction with otitis media
(infection of the middle ear). Cotton-tipped applicators can actually cause
external otitis so their use should be avoided.
12. A patient diagnosed with arthritis has been taking aspirin and now reports
experiencing tinnitus and hearing loss. What should the nurse teach this
patient?
A) The hearing loss will likely resolve with time after the drug is
discontinued.
B) The patients hearing loss and tinnitus are irreversible at this point.
C) The patients tinnitus is likely multifactorial, and not directly related to
aspirin use.
D) The patients tinnitus will abate as tolerance to aspirin develops.
Ans: A
Feedback:
Tinnitus and hearing loss are signs of ototoxicity, which is associated with
aspirin use. In most cases, this will resolve upon discontinuing the aspirin.
Many other drugs cause irreversible ototoxicity.
13. A patient is postoperative day 6 following tympanoplasty and mastoidectomy.
The patient has phoned the surgical unit and states that she is experiencing
occasional sharp, shooting pains in her affected ear. How should the nurse best
interpret this patients complaint?
A) These pains are an expected finding during the first few weeks of
recovery.
B) The patients complaints are suggestive of a postoperative infection.
C) The patient may have experienced a spontaneous rupture of the tympanic
membrane.
D) The patients surgery may have been unsuccessful.
Ans: A
Feedback:
For 2 to 3 weeks after surgery, the patient may experience sharp, shooting
pains intermittently as the eustachian tube opens and allows air to enter the
middle ear. Constant, throbbing pain accompanied by fever may indicate
infection and should be reported to the primary care provider. The patients
pain does not suggest tympanic perforation or unsuccessful surgery.
14. The nurse is discussing the results of a patients diagnostic testing with the
nurse practitioner. What Weber test result would indicate the presence of a
sensorineural loss?
A) The sound is heard better in the ear in which hearing is better.
B) The sound is heard equally in both ears.
C) The sound is heard better in the ear in which hearing is poorer.
D) The sound is heard longer in the ear in which hearing is better.
Ans: A
 Feedback:
A patient with sensorineural hearing loss hears the sound better in the ear in
which hearing is better. The Weber test assesses bone conduction of sound and
is used for assessing unilateral hearing loss. A tuning fork is used. A patient
with normal hearing hears the sound equally in both ears or describes the
sound as centered in the middle of the head. A patient whose hearing loss is
conductive hears the sound better in the affected ear.
15. The advanced practice nurse is attempting to examine the patients ear with an
otoscope. Because of impacted cerumen, the tympanic membrane cannot be
visualized. The nurse irrigates the patients ear with a solution of hydrogen
peroxide and water to remove the impacted cerumen. What nursing
intervention is most important to minimize nausea and vertigo during the
procedure?
A) Maintain the irrigation fluid at a warm temperature.
B) Instill short, sharp bursts of fluid into the ear canal.
C) Follow the procedure with insertion of a cerumen curette to extract
missed ear wax.
D) Have the patient stand during the procedure.
Ans: A
Feedback:
Warm water (never cold or hot) and gentle, not forceful, irrigation should be
used to remove cerumen. Too forceful irrigation can cause perforation of the
tympanic membrane, and ice water causes vomiting. Cerumen curettes should
not be routinely used by the nurse. Special training is required to use a curette
safely. It is unnecessary to have the patient stand during the procedure.
16. A patient is scheduled to have an electronystagmography as part of a
diagnostic workup for Mnires disease. What question is it most important
for the nurse to ask the patient in preparation for this test?
A) Have you ever experienced claustrophobia or feelings of anxiety while in
enclosed spaces?
B) Do you currently take any tranquilizers or stimulants on a regular basis?
C) Do you have a history of falls or problems with loss of balance?
D) Do you have a history of either high or low blood pressure?
Ans: B
Feedback:
Electronystagmography measures changes in electrical potentials created by
eye movements during induced nystagmus. Medications such as tranquilizers,
stimulants, or antivertigo agents are withheld for 5 days before the test.
Claustrophobia is not a significant concern associated with this test; rather, it
is most often a concern for patients undergoing magnetic resonance imaging
(MRI). Balance is impaired by Mnires disease; therefore, a patient history
of balance problems is important, but is not relevant to test preparation.
Hypertension or hypotension, while important health problems, should not be
affected by this test.
17. The nurse is planning the care of a patient who is adapting to the use of a
hearing aid for the first time. What is the most significant challenge
experienced by a patient with hearing loss who is adapting to using a hearing
aid for the first time?
A) Regulating the tone and volume
B) Learning to cope with amplification of background noise
C) Constant irritation of the external auditory canal
D) Challenges in keeping the hearing aid clean while minimizing exposure
to moisture
Ans: B
Feedback:
Each of the answers represents a common problem experienced by patients
using a hearing aid for the first time. However, amplification of background
noise is a difficult problem to manage and is the major reason why patients
stop using their hearing aid. All patients learning to use a hearing aid require
support and coaching by the nurse and other members of the health care team.
Patients should be encouraged to discuss their adaptation to the hearing aid
with their audiologist.
18. A patient with mastoiditis is admitted to the post-surgical unit after undergoing
a radical mastoidectomy. The nurse should identify what priority of
postoperative care?
A) Assessing for mouth droop and decreased lateral eye gaze
B) Assessing for increased middle ear pressure and perforated ear drum
C) Assessing for gradual onset of conductive hearing loss and nystagmus
D) Assessing for scar tissue and cerumen obstructing the auditory canal
Ans: A
Feedback:
The facial nerve runs through the middle ear and the mastoid; therefore, there
is risk of injuring this nerve during a mastoidectomy. When injury occurs, the
patient may display mouth droop and decreased lateral gaze on the operative
side. Scar tissue is a long-term complication of tympanoplasty and therefore
would not be evident during the immediate postoperative period. Tympanic
perforation is not a common complication of this surgery.
19. The nurse is assessing a patient with multiple sclerosis who is demonstrating
involuntary, rhythmic eye movements. What term will the nurse use when
documenting these eye movements?
A) Vertigo
B) Tinnitus
C) Nystagmus
D) Astigmatism
Ans: C
Feedback:
Vertigo is an illusion of movement where the individual or the surroundings
are sensed as moving. Tinnitus refers to a subjective perception of sound with
internal origin. Nystagmus refers to involuntary rhythmic eye movement.
Astigmatism is a defect is visual acuity.
20. The nurse is planning the care of a patient with a diagnosis of vertigo. What
nursing diagnosis risk should the nurse prioritize in this patients care?
A) Risk for disturbed sensory perception
B) Risk for unilateral neglect
C) Risk for falls
D) Risk for ineffective health maintenance
Ans: C
Feedback:
Vertigo is defined as the misperception or illusion of motion, either of the
person or the surroundings. A patient suffering from vertigo will be at an
increased risk of falls. For most patients, this is likely to exceed the patients
risk for neglect, ineffective health maintenance, or disturbed sensation.
21. A patient has been diagnosed with serous otitis media for the third time in the
past year. How should the nurse best interpret this patients health status?
A) For some patients, these recurrent infections constitute an age-related
physiologic change.
B) The patient would benefit from a temporary mobility restriction to
facilitate healing.
C) The patient needs to be assessed for nasopharyngeal cancer.
D) Blood cultures should be drawn to rule out a systemic infection.
Ans: C
Feedback:
A carcinoma (e.g., nasopharyngeal cancer) obstructing the eustachian tube
should be ruled out in adults with persistent unilateral serous otitis media. This
phenomenon is not an age-related change and does not indicate a systemic
infection. Mobility limitations are unnecessary.
22. A patient with a sudden onset of hearing loss tells the nurse that he would like
to begin using hearing aids. The nurse understands that the health professional
dispensing hearing aids would have what responsibility?
A) Test the patients hearing promptly.
B) Perform an otoscopy.
C) Measure the width of the patients ear canal.
D) Refer the patient to his primary care physician.
Ans: D
Feedback:
Health care professionals who dispense hearing aids are required to refer
prospective users to a physician if the patient has sudden or rapidly
progressive hearing loss. This would be a health priority over other forms of
assessment, due to the possible presence of a pathologic process.
23. The nurse is providing care for a patient who has benefited from a cochlear
implant. The nurse should understand that this patients health history likely
includes which of the following? Select all that apply.
A) The patient was diagnosed with sensorineural hearing loss.
B) The patients hearing did not improve appreciably with the use of
hearing aids.
C) The patient has deficits in peripheral nervous function.
D) The patients hearing deficit is likely accompanied by a cognitive deficit.
E) The patient is unable to lip-read.
Ans: A, B
Feedback:
A cochlear implant is an auditory prosthesis used for people with profound
sensorineural hearing loss bilaterally who do not benefit from conventional
hearing aids. The need for a cochlear implant is not associated with deficits in
peripheral nervous function, cognitive deficits, or an inability to lip-read.
24. A patient presents to the ED complaining of a sudden onset of incapacitating
vertigo, with nausea and vomiting and tinnitus. The patient mentions to the
nurse that she suddenly cannot hear very well. What would the nurse suspect
the patients diagnosis will be?
A) Ossiculitis
B) Mnires disease
C) Ototoxicity
D) Labyrinthitis
Ans: D
Feedback:
Labyrinthitis is characterized by a sudden onset of incapacitating vertigo,
usually with nausea and vomiting, various degrees of hearing loss, and
possibly tinnitus. None of the other listed diagnosis is characterized by a rapid
onset of symptoms.
25. Which of the following nurses actions carries the greatest potential to prevent
hearing loss due to ototoxicity?
A) Ensure that patients understand the differences between sensory hearing
loss and conductive hearing loss.
B) Educate patients about expected age-related changes in hearing
perception.
C) Educate patients about the risks associated with prolonged exposure to
environmental noise.
D) Be aware of patients medication regimens and collaborate with other
professionals accordingly.
Ans: D
Feedback:
A variety of medications may have adverse effects on the cochlea, vestibular
apparatus, or cranial nerve VIII. All but a few, such as aspirin and quinine,
cause irreversible hearing loss. Ototoxicity is not related to age-related
changes, noise exposure, or the differences between types of hearing loss.
26. A child goes to the school nurse and complains of not being able to hear the
teacher. What test could the school nurse perform that would preliminarily
indicate hearing loss?
A) Audiometry
B) Rinne test
C) Whisper test
D) Weber test
Ans: C
Feedback:
A general estimate of hearing can be made by assessing the patients ability to
hear a whispered phrase or a ticking watch, testing one ear at a time. The
Rinne and Weber tests distinguish sensorineural from conductive hearing loss.
These tests, as well as audiometry, are not usually performed by a registered
nurse in a general practice setting.
27. A nurse is teaching preventative measures for otitis externa to a group of older
adults. What action should the nurse encourage?
A) Rinsing the ears with normal saline after swimming
B) Avoiding loud environmental noises
C) Instilling antibiotic ointments on a regular basis
D) Avoiding the use of cotton swabs
Ans: D
Feedback:
Nurses should instruct patients not to clean the external auditory canal with
cotton-tipped applicators and to avoid events that traumatize the external canal
such as scratching the canal with the fingernail or other objects. Environmental
noise should be avoided, but this does not address the risk for ear infection.
Routine use of antibiotics is not encouraged and rinsing the ears after
swimming is not recommended.
28. The nurse is reviewing the health history of a newly admitted patient and reads
that the patient has been previously diagnosed with exostoses. How should the
nurse accommodate this fact into the patients plan of care?
A) The nurse should perform the Rinne and Weber tests.
B) The nurse should arrange for audiometry testing as soon as possible.
C) The nurse should collaborate with the pharmacist to assess for potential
ototoxic medications.
D) No specific assessments or interventions are necessary to addressing
exostoses.
Ans: D
Feedback:
Exostoses are small, hard, bony protrusions found in the lower posterior bony
portion of the ear canal; they usually occur bilaterally. They do not normally
impact hearing and no treatments or nursing actions are usually necessary.
29. The nurse is caring for a patient who has undergone a mastoidectomy. In an
effort to prevent postoperative infection, what intervention should the nurse
implement?
A) Teach the patient about the risks of ototoxic medications.
B) Instruct the patient to protect the ear from water for several weeks.
C) Teach the patient to remove cerumen safely at least once per week.
D) Instruct the patient to protect the ear from temperature extremes until
healing is complete.
Ans: B
Feedback:
To prevent infection, the patient is instructed to prevent water from entering
the external auditory canal for 6 weeks. Ototoxic medications and temperature
extremes do not present a risk for infection. Removal of cerumen during the
healing process should be avoided due to the possibility of trauma.
30. A patient is being discharged home after mastoid surgery. What topic should
the nurse address in the patients discharge education?
A) Expected changes in facial nerve function
B) The need for audiometry testing every 6 months following recovery
C) Safe use of analgesics and antivertiginous agents
D) Appropriate use of OTC ear drops
Ans: C
 Feedback:
Patients require instruction about medication therapy, such as analgesics and
antivertiginous agents (e.g., antihistamines) prescribed for balance
disturbance. OTC ear drops are not recommended and changes in facial nerve
function are signs of a complication that needs to be addressed promptly.
There is no need for serial audiometry testing.
31. After mastoid surgery, an 81-year-old patient has been identified as needing
assistance in her home. What would be a primary focus of this patients home
care?
A) Preparation of nutritious meals and avoidance of contraindicated foods
B) Ensuring the patient receives adequate rest each day
C) Helping the patient adapt to temporary hearing loss
D) Assisting the patient with ambulation as needed to avoid falling
Ans: D
Feedback:
The caregiver and patient are cautioned that the patient may experience some
vertigo and will therefore require help with ambulation to avoid falling. The
patient should not be expected to experience hearing loss and no foods are
contraindicated. Adequate rest is needed, but this is not a primary focus of
home care.
32. A hearing-impaired patient is scheduled to have an MRI. What would be
important for the nurse to remember when caring for this patient?
A) Patient is likely unable to hear the nurse during test.
B) A person adept in sign language must be present during test.
C) Lip reading will be the method of communication that is necessary.
D) The nurse should interact with the patient like any other patient.
Ans: A
Feedback:
 During health care and screening procedures, the practitioner (e.g., dentist,
physician, nurse) must be aware that patients who are deaf or hearing-impaired
are unable to read lips, see a signer, or read written materials in the dark rooms
required during some diagnostic tests. The same situation exists if the
practitioner is wearing a mask or not in sight (e.g., x-ray studies, MRI,
colonoscopy).
33. The nurse and a colleague are performing the Epley maneuver with a patient
who has a diagnosis of benign paroxysmal positional vertigo. The nurses
should begin this maneuver by performing what action?
A) Placing the patient in a prone position
B) Assisting the patient into a sitting position
C) Instilling 15 mL of warm normal saline into one of the patients ears
D) Assessing the patients baseline hearing by performing the whisper test
Ans: B
Feedback:
The Epley maneuver is performed by placing the patient in a sitting position,
turning the head to a 45-degree angle on the affected side, and then quickly
moving the patient to the supine position. Saline is not instilled into the ears
and there is no need to assess hearing before the test.
34. A 6-month-old infant is brought to the ED by his parents for inconsolable
crying and pulling at his right ear. When assessing this infant, the advanced
practice nurse is aware that the tympanic membrane should be what color in a
healthy ear?
A) Yellowish-white
B) Pink
C) Gray
D) Bluish-white
Ans: C
Feedback:
 The healthy tympanic membrane appears pearly gray and is positioned
obliquely at the base of the ear canal. Any other color is suggestive of a
pathological process.
35. A child has been experiencing recurrent episodes of acute otitis media (AOM).
The nurse should anticipate that what intervention is likely to be ordered?
A) Ossiculoplasty
B) Insertion of a cochlear implant
C) Stapedectomy
D) Insertion of a ventilation tube
Ans: D
Feedback:
If AOM recurs and there is no contraindication, a ventilating, or pressure-
equalizing, tube may be inserted. The ventilating tube, which temporarily
takes the place of the eustachian tube in equalizing pressure, is retained for 6
to 18 months. Ossiculoplasty is not used to treat AOM and stapedectomy is
performed to treat otosclerosis. Cochlear implants are used to treat
sensorineural hearing loss.
36. An older adult with a recent history of mixed hearing loss has been diagnosed
with a cholesteatoma. What should this patient be taught about this diagnosis?
Select all that apply
A) Cholesteatomas are benign and self-limiting, and hearing loss will
resolve spontaneously.
B) Cholesteatomas are usually the result of metastasis from a distant tumor
site.
C) Cholesteatomas are often the result of chronic otitis media.
D) Cholesteatomas, if left untreated, result in intractable neuropathic pain.
E) Cholesteatomas usually must be removed surgically.
Ans: C, E
Feedback:
 Cholesteatoma is a tumor of the external layer of the eardrum into the middle
ear, often resulting from chronic otitis media. They usually do not cause pain;
however, if treatment or surgery is delayed, they may burst or destroy the
mastoid bone. They are not normally the result of metastasis and are not self-
limiting.
37. The nurse is admitting a patient to the unit who is scheduled to have an
ossiculoplasty. What postoperative assessment will best determine whether the
procedure has been successful?
A) Otoscopy
B) Audiometry
C) Balance testing
D) Culture and sensitivity testing of ear discharge
Ans: B
Feedback:
Ossiculoplasty is the surgical reconstruction of the middle ear bones to restore
hearing. Consequently, results are assessed by testing hearing, not by
visualizing the ear, testing balance, or culturing ear discharge.
38. On otoscopy, a red blemish behind the tympanic membrane is suggestive of
what diagnosis?
A) Acoustic tumor
B) Cholesteatoma
C) Facial nerve neuroma
D) Glomus tympanicum
Ans: D
Feedback:
In the case of glomus tympanicum, a red blemish on or behind the tympanic
membrane is seen on otoscopy. This assessment finding is not associated with
an acoustic tumor, facial nerve neuroma, or cholesteatoma.
39. The nurse is discharging a patient home after mastoid surgery. What should
the nurse include in discharge teaching?
A) Try to induce a sneeze every 4 hours to equalize pressure.

B) Be sure to exercise to reduce fatigue.

C) Avoid sleeping in a side-lying position.

D) Dont blow your nose for 2 to 3 weeks.

Ans: D
Feedback:
The patient is instructed to avoid heavy lifting, straining, exertion, and nose
blowing for 2 to 3 weeks after surgery to prevent dislodging the tympanic
membrane graft or ossicular prosthesis. Side-lying is not contraindicated;
sneezing could cause trauma.
40. An advanced practice nurse has performed a Rinne test on a new patient.
During the test, the patient reports that air-conducted sound is louder than
bone-conducted sound. How should the nurse best interpret this assessment
finding?
A) The patients hearing is likely normal.
B) The patient is at risk for tinnitus.
C) The patient likely has otosclerosis.
D) The patient likely has sensorineural hearing loss.
Ans: A
Feedback:
The Rinne test is useful for distinguishing between conductive and
sensorineural hearing loss. A person with normal hearing reports that air-
conducted sound is louder than bone-conducted sound.