MSN NCLEX Exam for Care of the Clients with Ear Disorder

1. The nurse is performing a voice test to assess hearing. Which of the following describes the accurate procedure for performing this test?

  1. Stand 4 feet away from the client to ensure that the client can hear at this distance.
  2. Whisper a statement and ask the client to repeat it.
  3. Whisper a statement with the examiners back facing the client
  4. Whisper a statement while the client blocks both ears.

2. During a hearing assessment, the nurse notes that the sound lateralizes to the clients left ear with the Weber test. The nurse analyzes this result as:

  1. A normal finding
  2. A conductive hearing loss in the right ear
  3. A sensorineural or conductive loss
  4. The presence of nystagmus

3. The nurse is caring for a client that is hearing impaired. Which of the following approaches will facilitate communication?

  1. Speak frequently
  2. Speak loudly
  3. Speak directly into the impaired ear
  4. Speak in a normal tone

4. The nurse has conducted discharge teaching for a client who had a fenestration procedure for the treatment of otosclerosis. Which of the following, if stated by the client, would indicate that teaching was effective?

  1. “I should drink liquids through a straw for the next 2-3 weeks.”
  2. “It’s ok to take a shower and wash my hair.”
  3. “I will take stool softeners as prescribed by my doctor.”
  4. “I can resume my penis lessons starting next week.”

5. 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?

  1. Irrigation of the ear
  2. Instillation of diluted alcohol
  3. Instillation of antibiotic ear drops
  4. Instillation of corticosteroids ear drops

6. The nurse has notes that the physician has a diagnosis of presbycusis on the client’s chart. The nurse plans care knowing the condition is:

  1. A sensorineural hearing loss that occurs with aging
  2. A conductive hearing loss that occurs with aging.
  3. Tinnitus that occurs with aging
  4. Nystagmus that occurs with aging

7.  A client with Meniere’s disease is experiencing severe vertigo. Which instruction would the nurse give to the client to assist in controlling the vertigo?

  1. Increase fluid intake to 3000 ml a day
  2. Avoid sudden head movements
  3. Lie still and watch the television
  4. Increase sodium in the diet

8. The nurse is reviewing the physician’s orders for a client with Meniere’s disease. Which diet will most likely be prescribed?

  1. Low-cholesterol diet
  2. Low-sodium diet
  3. Low-carbohydrate diet
  4. Low-fat diet

9.  A client is diagnosed with a disorder involving the inner ear. Which of the following is the most common client complaint associated with a disorder in this part of the ear?

  1. Hearing loss
  2. Pruritus
  3. Tinnitus
  4. Burning of the ear

10. A nurse would question an order to irrigate the ear canal in which of the following circumstances?

  1. Ear pain
  2. Hearing loss
  3. Otitis externa
  4. Perforated tympanic membrane

11. Which of the following interventions is essential when instilling Cortisporin suspension, 2 gtt right ear?

  1. Verifying the proper client and route
  2. Warming the solution to prevent dizziness
  3. Holding an emesis basin under the client’s ear
  4. Positioning the client in the semi-fowlers position

12.  When teaching the client about Meniere’s disease, which of the following instructions would a nurse give about vertigo?

  1. Report dizziness at once
  2. Drive in daylight hours only
  3. Get up slowly, turning the entire body
  4. Change your position using the logroll method

13. The part of the ear that contains the receptors for hearing is the:

  1. Utricle
  2. Cochlea
  3. Middle ear
  4. Tympanic cavity

14. The ear bones that transmit vibrations to the oval window of the cochlea are found in the:

  1. Inner ear
  2. Outer ear
  3. Middle ear
  4. Eustachian tube

15.  Nerve deafness would most likely result from an injury or infection that damaged the:

  1. Vagus nerve
  2. Cochlear nerve
  3. Vestibular nerve
  4. Trigeminal nerve

16. A labyrinthectomy can be preformed to treat Meniere’s syndrome. This procedure results in:

  1. Anosmia
  2. Absence of pain
  3. Reduction in cerumen
  4. Permanent irreversible deafness

17.  Otosclerosis is a common cause of conductive hearing loss. Which such a partial hearing loss:

  1. Stapedectomy is the procedure of choice
  2. Hearing aids usually restore some hearing
  3. The client is usually unable to hear bass tones
  4. Air conduction is more effective than bone conduction

18. A client who is complaining of tinnitus is describing a symptom that is:

  1. Objective
  2. Subjective
  3. Functional
  4. Prodromal

19. Physiologically, the middle ear, containing the three ossicles, serves primarily to:

  1. Maintain balance
  2. Translate sound waves into nerve impulses
  3. Amplify the energy of sound waves entering the ear
  4. Communicate with the throat via the Eustachian tube.
Answers and Rationales
  1. B. The examiner stands 1-2 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.
  2. C. In the Weber tuning fork test the nurse places the vibrating tuning fork in the middle of the client’s head, at the midline of the forehead, or above the upper lip over the teeth. Normally, the sound is heard in equally in both ears by bone conduction. If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear. If the client has a conductive hearing loss in one ear, the sound is heard in that ear.
  3. D. 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.
  4. C. Following ear surgery, the client needs to avoid straining while having a bowel movement. The client needs to be instructed to avoid drinking through a straw for 2-3 weeks, air travel, and coughing excessively. The client needs to avoid getting his or her hair wet, washing hair, showering for 1 week, and rapidly moving the head, bouncing, and bending over for 3 weeks.
  5. 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 by using forceps. When the foreign object is vegetable matter, irrigation is not used because this material expands with hydration and the impaction becomes worse.
  6. A. 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.
  7. 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 endolymphatic fluid sometimes are prescribed. Lying still and watching television will not control vertigo.
  8. B. Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid sometimes are prescribed.
  9. C. Tinnitus is the most common complaint of clients with otological 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.
  10. D. Irrigation of the ear canal is contraindicated with perforation of the tympanic membrane because the solution entering the inner ear may cause dizziness, nausea, vomiting, and infection.
  11. A. When giving medications, a nurse follows the five R’s of medication administration. The drops may be warmed to prevent pain or dizziness, but this action is not essential. An emesis basin would be used for irrigation of the ear. Put the client in the lateral position to prevent the drops from draining out for 5 minutes, not semi-fowlers position.
  12. C. Turning the entire body, not the head, will prevent vertigo. Dizziness is expected but can be prevented. The client shouldn’t drive as he may reflexively turn the wheel to correct vertigo. Turning the client in bed slowly and smoothly will be helpful; logrolling isn’t needed.
  13. B. The dendrites of the cochlear nerve terminate on the hair cells of the organ of Corti in the cochlea.
  14. C. 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 the inner ear. The tympanic membrane separates the other from the middle ear.
  15. B. 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.
  16. D. The labyrinth is the inner ear and consists of the vestibule, cochlea, semicircular canals, utricle, saccule, cochlear duct, and membraneous semicircular canals. A labrinthectomy is preformed to alleviate the symptoms of vertigo but results in deafness, because the organ of Corti and cochlear nerve are located in the inner ear.
  17. B. With a partial hearing loss that auditory ossicles have not yet become fixed; as long as vibrations occur, a hearing aid may be beneficial.
  18. B. A subjective symptom such as ringing in the ears can be felt only by the client.
  19. C. The middle ear contains the three ossicles—malleus, incus, and stapes—which, along with the tympanic membrane and oval window, form an amplifying system.