The nurse is assessing the patient's ear. The correct procedure for straightening the ear canal of an adult is to pull the pinna…
Down and back
Up and back
Down and forward
Straight back
None
None
The Correct Answer is B
A. This option is appropriate for children under the age of 3. Pulling the pinna down and back straightens the ear canal in young children, but it does not align the canal correctly in adults.
B. For an adult, the correct method to straighten the ear canal during examination is to pull the pinna (outer part of the ear) up and back. This maneuver aligns the ear canal for better visualization of the tympanic membrane (eardrum) and inner structures.
C. Pulling the pinna down and forward is incorrect for both adults and children. This action would not provide a clear view of the ear canal and could make examination difficult.
D. Pulling the pinna straight back does not fully straighten the ear canal in adults and may make the examination less effective. The correct technique is up and back for adults to fully straighten the canal and enhance visualization.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The examiner uses bimanual palpitation to evaluate the tail of spence.
This statement is true. The tail of Spence is the extension of breast tissue into the axilla, and it is important to evaluate this area during a breast examination. Bimanual palpation, which involves using both hands to examine the breast tissue, is commonly used to assess the tail of Spence.
B. The axillae are not palpated if the breast tissue is normal.
This statement is false. The axillae should be palpated during a breast examination, even if the breast tissue is normal. Lymph nodes in the axilla can sometimes be the first site of metastasis for breast cancer, so it is important to check for any abnormalities in this area.
C. Nipple discharge in pregnant women is considered abnormal.
This statement is false. Nipple discharge is a common occurrence during pregnancy and is usually considered normal, especially in the later stages of pregnancy. However, any sudden or persistent discharge should be evaluated by a healthcare provider.
D. The breasts are inspected as the client changes positions to detect abnormal symmetry.
This statement is false. The breasts should be inspected in a consistent position, such as with the patient sitting or lying down. Changing positions can alter the appearance of the breasts and make it difficult to detect any changes or abnormalities. However, it is important to inspect both breasts and compare them for any signs of asymmetry or abnormalities.
Correct Answer is A
Explanation
The nurse would describe this as tinnitus, which is a sensation of hearing sound when no external sound is present. Tinnitus is commonly described as ringing in the ears, but can also be perceived as buzzing, humming, hissing, or other sounds. Tinnitus can be caused by a variety of factors, including age-related hearing loss, exposure to loud noises, ear infections, certain medications, and underlying medical conditions such as high blood pressure, thyroid disorders, or head and neck injuries. It is important for the patient to see a healthcare provider to determine the underlying cause and appropriate treatment.
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