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 B

Explanation

A. Palm: The palm of the hand is not ideal for palpating lymph nodes because it does not provide the fine sensitivity needed to detect subtle differences in size, texture, and tenderness.

B. Pads of fingers: The pads of the fingers are the best part of the hand to use when examining lymph nodes. This part allows for precise and gentle palpation, helping the nurse assess the size, consistency, and mobility of the lymph nodes effectively.

C. Base of hand: The base of the hand is less sensitive and not suitable for palpating lymph nodes as it provides less sensitivity compared to the pads of the fingers. The base of the hand is better suited for applying pressure during broader palpation techniques It does not provide the necessary tactile feedback for a thorough examination.

D. Ulnar surface: The ulnar surface of the hand is not typically used for palpation of lymph nodes. It is less sensitive compared to the pads of the fingers and is not appropriate for this examination.

A. Whisper a set of random numbers and letters, and then ask the patient to repeat them. B. Shield the lips so that the sound is muffled. C. Stand approximately 6 feet away to ensure that the patient can really hear at this distance. D. Ask the patient to place his or her finger in their ears to occlude outside noise.

Correct Answer is A

Explanation

A. Whisper a set of random numbers and letters, and then ask the patient to repeat them: The whispered voice test is a simple and reliable screening method for hearing loss. The nurse stands about 2 feet behind the patient, whispers a series of random numbers or letters, and asks the patient to repeat them. This helps assess high-frequency hearing loss.

B. Shield the lips so that the sound is muffled: While the test is performed without the patient seeing the nurse’s lips to prevent lip reading, deliberately muffling the sound is unnecessary and may alter the accuracy of the assessment.

C. Stand approximately 6 feet away to ensure that the patient can really hear at this distance: The whispered voice test is conducted at a standard distance of about 2 feet, not 6 feet. Increasing the distance may make the test unreliable.

D. Ask the patient to place his or her finger in their ears to occlude outside noise: The test should be performed in a quiet environment, but instructing the patient to occlude their ears is unnecessary. Instead, the nurse tests one ear at a time by covering the opposite ear.

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Naxlex Comprehensive Predictor Exams

A 33 year old patient presents with complaints of enlarged lymph nodes in their neck. The nurse will use which part of the hand to examine the lymph node size?

Correct Answer is B

Explanation

In performing a voice test to assess hearing, which of these actions would the nurse perform?

Correct Answer is A

Explanation

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