The nurse is performing a middle ear assessment on a 15-year-old patient who has had a history of chronic ear infections. When examining the right tympanic membrane, the nurse sees the presence of dense white patches. The tympanic membrane is otherwise unremarkable. It is pearly, with the light reflex at 5 o'clock and landmarks visible. What should the nurse do?

Be concerned about a genetic abnormality on the tympanic membrane.

Refer the patient for the possibility of a fungal infection.

Recognize that these are scars caused from frequent ear infections.

Consider that these findings may represent the presence of blood in the middle ear.

Answer and Explanation

The Correct Answer is C

A. Be concerned about a genetic abnormality on the tympanic membrane: Genetic abnormalities affecting the tympanic membrane, such as congenital cholesteatomas, typically present with other structural changes or masses rather than dense white patches. The described findings are more indicative of scarring from previous infections rather than a genetic disorder.

B. Refer the patient for the possibility of a fungal infection: Fungal infections (otomycosis) usually present with fluffy white, black, or yellow debris in the ear canal rather than dense white patches on the tympanic membrane. Additionally, fungal infections often cause symptoms such as itching or discomfort, which are not mentioned in this case.

C. Recognize that these are scars caused from frequent ear infections: Dense white patches on the tympanic membrane are typically tympanosclerosis, a benign condition caused by repeated episodes of otitis media. This scarring does not usually affect hearing significantly unless it involves the ossicles. Given the patient’s history of chronic ear infections, tympanosclerosis is the most likely explanation.

D. Consider that these findings may represent the presence of blood in the middle ear: Blood in the middle ear, as seen in hemotympanum, appears as a dark red or bluish discoloration rather than dense white patches. The presence of an otherwise normal tympanic membrane, with a visible light reflex and landmarks, further suggests that the findings are not due to blood accumulation.

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Correct Answer is C

Explanation

A. Behind with the nurse's hands placed firmly around his neck: This approach may be perceived as threatening or invasive, potentially increasing the patient's apprehension and discomfort. It is important to maintain a respectful and gentle approach, especially when working with a patient who may already feel uneasy.

B. Behind with hands placed on throat: Similar to option A, examining from behind and placing hands on the throat may cause anxiety and discomfort for the patient, particularly if they are not familiar with the procedure. This method does not provide a clear line of sight or reassurance for the patient.

C. The front with the nurse's thumbs placed on either side of his trachea and his head tilted forward: This technique is the most appropriate approach for examining the thyroid gland. Positioning the patient in front allows for better communication and visibility. Placing the thumbs on either side of the trachea is a standard method for palpating the thyroid, and having the patient tilt their head forward can help relax the neck muscles, making the examination more comfortable. Additionally, this approach allows the nurse to explain the procedure more easily, even with language barriers.

D. Have the patient perform the exam: While patient involvement in their care can be empowering, asking the patient to perform the exam may not be appropriate for a thyroid examination, as the nurse must assess the gland's size, consistency, and any potential nodules. This approach may also lead to further anxiety for the patient, who may not know how to perform the exam correctly.

A. Thyroid B. Parathyroid C. Adrenal D. Parotid

Correct Answer is A

Explanation

A. Thyroid: The thyroid gland produces thyroxine (T4) and triiodothyronine (T3), which are essential hormones that regulate metabolism, growth, and development. An elevated T4 level typically indicates hyperthyroidism or other thyroid disorders, making it necessary to assess the function and health of the thyroid gland.

B. Parathyroid: The parathyroid glands regulate calcium levels in the blood through the secretion of parathyroid hormone (PTH). They do not produce T4 or directly influence thyroid hormone levels, so assessing the parathyroid glands would not be relevant in the context of elevated T4.

C. Adrenal: The adrenal glands produce hormones such as cortisol, aldosterone, and adrenaline. While adrenal function can impact overall hormonal balance in the body, they are not directly involved in the production of thyroxine (T4), making them unrelated to the assessment for elevated T4 levels.

D. Parotid: The parotid glands are major salivary glands that secrete saliva. They do not play a role in thyroid hormone production or regulation, so assessing the parotid glands would not be appropriate when investigating elevated T4 levels.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A visitor from Poland who does not speak English seems to be somewhat apprehensive about the nurse examining his neck. How should the nurse proceed that would allow the patient to feel more comfortable with the nurse examining his thyroid gland?

Correct Answer is C

Explanation

A patient's laboratory data reveal an elevated thyroxine (T4) level. What gland should the nurse assess?

Correct Answer is A

Explanation

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