The advanced practice nurse (APRN) is performing the Weber test on a 22 year old patient with a right otitis media with perforated ear drum. The APRN expects what findings?
Sound will lateralize to the patient's ears equally
Sound will lateralize to the patient's unaffected ear
Sound will lateralize to the patient's affected ear
The patient will not hear the tuning fork at all
The Correct Answer is C
A. Sound will lateralize to the patient's ears equally is incorrect because in unilateral conductive hearing loss, the Weber test does not produce equal perception. Equal hearing occurs in patients with normal hearing or symmetric sensorineural hearing loss.
B. Sound will lateralize to the patient's unaffected ear is incorrect because in conductive hearing loss, such as otitis media with a perforated eardrum, sound is perceived louder in the affected ear, not the unaffected ear. Lateralization to the unaffected ear occurs in sensorineural hearing loss.
C. Sound will lateralize to the patient's affected ear is correct because conductive hearing loss (caused by fluid, infection, or perforation) increases the perception of bone-conducted sound in the affected ear. The impaired external or middle ear reduces ambient noise interference, making the sound from the tuning fork appear louder in the affected ear during the Weber test.
D. The patient will not hear the tuning fork at all is incorrect because even with a perforated eardrum, bone conduction is still possible, and the patient will perceive the tuning fork sound during the Weber test.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Pulmonary hypertension is incorrect because it may produce a loud pulmonic component of S2 (P2) or possibly a murmur of pulmonic regurgitation, but it is not typically described as a classic blowing diastolic murmur best heard along the left sternal border.
B. Right sided heart failure is incorrect because it is a clinical syndrome, not a direct cause of a specific murmur. While it may be associated with murmurs such as tricuspid regurgitation, those are typically holosystolic, not diastolic.
C. Left sided heart failure is incorrect because, like right-sided failure, it is a condition rather than a specific valvular lesion. It may be associated with murmurs, but it does not directly produce a blowing diastolic murmur.
D. Aortic regurgitation is correct because it classically presents as a blowing, decrescendo diastolic murmur best heard along the left sternal border (2nd to 4th intercostal spaces). This murmur occurs due to backflow of blood from the aorta into the left ventricle during diastole, and is commonly seen in older adults due to degenerative valve changes.
Correct Answer is A
Explanation
A. Abnormal: indicating elevated right atrial pressure (central venous pressure) is correct because the normal JVP is ≤3–4 cm above the sternal angle when the patient is at a 30–45° incline. A measurement greater than 5 cm above the sternal angle indicates elevated central venous pressure (CVP), which reflects increased right atrial pressure. Causes may include right-sided heart failure, fluid overload, tricuspid regurgitation, or constrictive pericarditis.
B. Normal: Indicating normal left atrial pressure is incorrect because JVP reflects right atrial pressure, not left atrial pressure. Left atrial pressure is assessed indirectly via pulmonary capillary wedge pressure, not by JVP.
C. Normal: Indicating normal right atrial pressure is incorrect because a JVP >5 cm is above the normal range. Normal right atrial pressure corresponds to a JVP ≤3–4 cm above the sternal angle.
D. Abnormal: indicating decreased right atrial pressure (central venous pressure) is incorrect because elevated JVP indicates increased, not decreased, right atrial pressure. A decreased JVP would be observed as flattened or nearly invisible jugular veins, which is the opposite finding.
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