NU 627 EXAM 4 | ACTUAL QUESTIONS AND ANSWERS | 2026 UPDATED | WITH
COMPLETE SOLUTIONS - HERZING.
Question 1
A 62-year-old who has worked on an assembly line since age 24 begins taking aspirin for
arthritis. The client presents with hearing problems and ringing in the ears. Which of the
following should the nurse suspect?
A) Tinnitus
B) Vertigo
C) Ototoxicity
D) Impacted cerumen
E) Presbyopia
Correct Answer: C) Ototoxicity
Rationale: Aspirin is a known ototoxic drug. Symptoms include hearing loss and tinnitus
(ringing in the ears). While tinnitus is a symptom, the overall "problem" or diagnosis in
this context of medication use is ototoxicity.
Question 2
A new nursing assistant asks the nurse how best to approach a hearing-impaired older adult.
Which of the following approaches should the nurse recommend?
A) Raise the volume of your voice significantly.
B) Leave the radio on to provide background comfort.
C) Lower the tone and pitch of your voice.
D) Use exaggerated lip movements to help the patient read lips.
E) Stand behind the patient while speaking.
Correct Answer: C) Lower the tone and pitch of your voice.
Rationale: Older adults with presbycusis typically lose the ability to hear high-frequency
sounds first. Lowering the tone and pitch of the voice, rather than shouting, makes speech
more intelligible.
Question 3
A nurse is attempting to ascertain the etiology of an older man's new hearing loss. Which of the
following factors should the nurse consider? (Select all that apply / most accurate group)
A) Genetic factors
B) Environmental conditions
C) Fluid and electrolyte imbalances
D) Ototoxic medications
E) Atherosclerosis
Correct Answer: A, B, D (Genetic factors, Environmental conditions, Ototoxic medications)
Rationale: Medications, genetics, and lifelong environmental noise exposure are primary
contributors to hearing loss in the elderly. Electrolyte imbalances and atherosclerosis are
not common direct causes of hearing loss.
, 2
Question 4
What strategy should care providers adopt when communicating with older adults who have
hearing loss?
A) Use simplified, "child-like" language to ensure understanding.
B) Use a high, consistent tone and pitch.
C) Speak at a high volume directly into the less affected ear.
D) Make eye contact before and during the conversation.
E) Avoid using any hand gestures.
Correct Answer: D) Make eye contact before and during the conversation.
Rationale: Eye contact facilitates communication by allowing the patient to see facial
expressions and lip movements. Shouting or using "elderspeak" (simplifying concepts
inappropriately) is ineffective and demeaning.
Question 5
Communication interventions for the hearing impaired should aim at clarity of words. This is
best accomplished by:
A) Increasing the speed of speech to keep the patient engaged.
B) Eliminating environmental noise and distractions.
C) Speaking in a whisper to avoid startling the patient.
D) Using only written communication.
E) Using a very high-pitched voice.
Correct Answer: B) Eliminating environmental noise and distractions.
Rationale: Clarity is improved by slowing the rate of speech and removing background
noise, which can compete with the speaker's voice and confuse the listener.
Question 6
Which physiological change of aging is primarily responsible for presbycusis?
A) Thickening of the tympanic membrane.
B) Calcification of the ossicles.
C) Degeneration of the organ of Corti.
D) Narrowing of the external auditory canal.
E) Increased production of thin cerumen.
Correct Answer: C) Degeneration of the organ of Corti.
Rationale: Presbycusis is a sensorineural hearing loss resulting from age-related changes in
the inner ear, specifically the degeneration of the hair cells in the organ of Corti.
Question 7
An older patient is prescribed Gentamicin. The nurse should monitor for which adverse effect
related to sensory perception?
A) Blurred vision
B) Loss of taste
, 3
C) Hearing loss and dizziness
D) Peripheral neuropathy
E) Anosmia
Correct Answer: C) Hearing loss and dizziness
Rationale: Aminoglycoside antibiotics like Gentamicin are highly ototoxic and can cause
permanent damage to both the auditory and vestibular systems.
Question 8
Which of the following is a common barrier to the use of hearing aids in the older adult
population?
A) They increase the risk of ear infections.
B) The high cost and lack of insurance coverage.
C) They cause permanent damage to the eardrum.
D) They are only effective for children.
E) They require surgical implantation in all cases.
Correct Answer: B) The high cost and lack of insurance coverage.
Rationale: Hearing aids are expensive, and many insurance plans (including basic
Medicare) do not cover the full cost, making them inaccessible for many seniors.
Question 9
When assessing an older adult for hearing loss, which behavioral cue is most significant?
A) The patient leans forward and tilts their head.
B) The patient maintains perfect eye contact.
C) The patient answers questions quickly.
D) The patient prefers quiet rooms.
E) The patient asks no questions during the exam.
Correct Answer: A) The patient leans forward and tilts their head.
Rationale: Leaning forward or tilting the head to "aim" the better ear toward the speaker
is a classic compensatory behavior for hearing loss.
Question 10
The nurse is performing a Weber test on an older adult. If the sound lateralizes to the right ear,
this suggests:
A) Normal hearing in both ears.
B) Sensorineural loss in the right ear or conductive loss in the left.
C) Conductive loss in the right ear or sensorineural loss in the left.
D) Bilateral hearing loss.
E) Total deafness in the right ear.
Correct Answer: C) Conductive loss in the right ear or sensorineural loss in the left.
Rationale: In the Weber test, sound lateralizes to the ear with conductive loss or away from
the ear with sensorineural loss.
COMPLETE SOLUTIONS - HERZING.
Question 1
A 62-year-old who has worked on an assembly line since age 24 begins taking aspirin for
arthritis. The client presents with hearing problems and ringing in the ears. Which of the
following should the nurse suspect?
A) Tinnitus
B) Vertigo
C) Ototoxicity
D) Impacted cerumen
E) Presbyopia
Correct Answer: C) Ototoxicity
Rationale: Aspirin is a known ototoxic drug. Symptoms include hearing loss and tinnitus
(ringing in the ears). While tinnitus is a symptom, the overall "problem" or diagnosis in
this context of medication use is ototoxicity.
Question 2
A new nursing assistant asks the nurse how best to approach a hearing-impaired older adult.
Which of the following approaches should the nurse recommend?
A) Raise the volume of your voice significantly.
B) Leave the radio on to provide background comfort.
C) Lower the tone and pitch of your voice.
D) Use exaggerated lip movements to help the patient read lips.
E) Stand behind the patient while speaking.
Correct Answer: C) Lower the tone and pitch of your voice.
Rationale: Older adults with presbycusis typically lose the ability to hear high-frequency
sounds first. Lowering the tone and pitch of the voice, rather than shouting, makes speech
more intelligible.
Question 3
A nurse is attempting to ascertain the etiology of an older man's new hearing loss. Which of the
following factors should the nurse consider? (Select all that apply / most accurate group)
A) Genetic factors
B) Environmental conditions
C) Fluid and electrolyte imbalances
D) Ototoxic medications
E) Atherosclerosis
Correct Answer: A, B, D (Genetic factors, Environmental conditions, Ototoxic medications)
Rationale: Medications, genetics, and lifelong environmental noise exposure are primary
contributors to hearing loss in the elderly. Electrolyte imbalances and atherosclerosis are
not common direct causes of hearing loss.
, 2
Question 4
What strategy should care providers adopt when communicating with older adults who have
hearing loss?
A) Use simplified, "child-like" language to ensure understanding.
B) Use a high, consistent tone and pitch.
C) Speak at a high volume directly into the less affected ear.
D) Make eye contact before and during the conversation.
E) Avoid using any hand gestures.
Correct Answer: D) Make eye contact before and during the conversation.
Rationale: Eye contact facilitates communication by allowing the patient to see facial
expressions and lip movements. Shouting or using "elderspeak" (simplifying concepts
inappropriately) is ineffective and demeaning.
Question 5
Communication interventions for the hearing impaired should aim at clarity of words. This is
best accomplished by:
A) Increasing the speed of speech to keep the patient engaged.
B) Eliminating environmental noise and distractions.
C) Speaking in a whisper to avoid startling the patient.
D) Using only written communication.
E) Using a very high-pitched voice.
Correct Answer: B) Eliminating environmental noise and distractions.
Rationale: Clarity is improved by slowing the rate of speech and removing background
noise, which can compete with the speaker's voice and confuse the listener.
Question 6
Which physiological change of aging is primarily responsible for presbycusis?
A) Thickening of the tympanic membrane.
B) Calcification of the ossicles.
C) Degeneration of the organ of Corti.
D) Narrowing of the external auditory canal.
E) Increased production of thin cerumen.
Correct Answer: C) Degeneration of the organ of Corti.
Rationale: Presbycusis is a sensorineural hearing loss resulting from age-related changes in
the inner ear, specifically the degeneration of the hair cells in the organ of Corti.
Question 7
An older patient is prescribed Gentamicin. The nurse should monitor for which adverse effect
related to sensory perception?
A) Blurred vision
B) Loss of taste
, 3
C) Hearing loss and dizziness
D) Peripheral neuropathy
E) Anosmia
Correct Answer: C) Hearing loss and dizziness
Rationale: Aminoglycoside antibiotics like Gentamicin are highly ototoxic and can cause
permanent damage to both the auditory and vestibular systems.
Question 8
Which of the following is a common barrier to the use of hearing aids in the older adult
population?
A) They increase the risk of ear infections.
B) The high cost and lack of insurance coverage.
C) They cause permanent damage to the eardrum.
D) They are only effective for children.
E) They require surgical implantation in all cases.
Correct Answer: B) The high cost and lack of insurance coverage.
Rationale: Hearing aids are expensive, and many insurance plans (including basic
Medicare) do not cover the full cost, making them inaccessible for many seniors.
Question 9
When assessing an older adult for hearing loss, which behavioral cue is most significant?
A) The patient leans forward and tilts their head.
B) The patient maintains perfect eye contact.
C) The patient answers questions quickly.
D) The patient prefers quiet rooms.
E) The patient asks no questions during the exam.
Correct Answer: A) The patient leans forward and tilts their head.
Rationale: Leaning forward or tilting the head to "aim" the better ear toward the speaker
is a classic compensatory behavior for hearing loss.
Question 10
The nurse is performing a Weber test on an older adult. If the sound lateralizes to the right ear,
this suggests:
A) Normal hearing in both ears.
B) Sensorineural loss in the right ear or conductive loss in the left.
C) Conductive loss in the right ear or sensorineural loss in the left.
D) Bilateral hearing loss.
E) Total deafness in the right ear.
Correct Answer: C) Conductive loss in the right ear or sensorineural loss in the left.
Rationale: In the Weber test, sound lateralizes to the ear with conductive loss or away from
the ear with sensorineural loss.
