Exam 2 V2: NUR 210/ NUR210– Principles of Pharmacology Guide | Galen (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

Exam 2 V2: NUR 210/ NUR210– Principles of Pharmacology Guide | Galen (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A Which of these sequences are NOT matched correctly? SELECT ALL THAT APPLY 1) Upper heart chamber = atrium 2) Lower heart chambers = ventricles 3) Tricuspid valve = separates left atrium and left ventricle 4) Mitral valve = separates right atrium and right ventricle 5) Pulmonic Semilunar valves separates right ventricle from pulmonary artery, aortic semilunar valve separates the left ventricle from the aorta. 4, 5 A nursing student is teaching about systolic vs diastolic pressure, which requires CORRECTION? 1) Systole is when the ventricles contracts. 2) Systole is when blood gets pushed into the aorta from Left ventricle and blood gets pushed into pulmonary arteries from Right ventricle. 3) Diastole is when the atrium contracts. 4) Diastole is when the heart has the opportunity to refill with blood. When the nurse is reviewing the charts of a heart attack patient, one of their electrical nodes is damaged. Which electrical pacemaker of the heart would most likely be damaged first? 1) SA node 2) AV node 3) Bundle of HIS 4) Purkinje fibers 1 Although one of the many pacemakers can be used to keep the heart going, one of them is very sensitive to electrolyte imbalances and is the last line of electrical stimulus for the heart when all else fails. Which node would fit this description? 1) SA node 2) AV node 3) Bundle of HIS 4) Purkinje fibers 4 A nursing student has made an incorrect description for one of the ECG values. Which statement is the one that needs CORRECTION? 1) P wave indicates stimulus in atrium 2) QT interval indicates initial stimulation in atrium 3) QRS complex indicates propagation of stimulus through ventricles 4) ST segment and T wave indicates return of stimulated ventricle to relaxed state 2 A nursing instructor is educating students on the differences between arteries and veins, which of them is not accurate? 1) Arteries are more elastic and strong 2) Veins are unidirectional 3) Arteries are passive vessels 4) Veins are a large storage area of blood to relive stress off the heart 3 For which of these patients would the nurse expect to request extra pillows in their bed or ask to sleep in a chair/chair during their sleep schedule? 1) Patient with general dyspnea 2) Patient with ortho-dyspnea 3) Patient with paroxysmal nocturnal dyspnea 4)Patient with transient syncope 2 The nurse is trying to educate new students about the certain blood pressure changes, which type of condition below causes unconsciousness in patients? 1) Patient with general dyspnea 2) Patient with ortho-dyspnea 3) Patient with paroxysmal nocturnal dyspnea 4) Patient with transient syncope 4 Which of the following objective data points are used to estimate a patients heart size? SELECT ALL THAT APPLY 1) Heaves and lifts 2) Echocardiogram 3) Percussion of heart by hand 4) Apical pulse 5) Pulsations diameter 1, 2, 3 To ensure proper palpitations and auscultation of the apical pulse, the patient should be instructed to.... SELECT ALL THAT APPLY 1) Clench their fists to pool more blood away from extremities 2) Lean forward to the nurse for auscultation 3) Remain seated for the entire auscultation 4) Fold their arms together to create peripheral blood resistance 5) Flex and extend their legs to increase blood flow 2, 3 As your preceptor is checking over your notes, she notices an error in your responses on chest landmarks. Which of the following landmarks is incorrectly labeled? SELECT ALL THAT APPLY 1) Aortic: 2nd intercostal (right hand side), S2 is greater in sound 2) Pulmonic: 3rd intercostal (left hand side), S2 is greater in sound 3) Pulmonic 2: 3rd intercostal (left hand side) S2 = S1 in sound 4) Tricuspid: 5th intercostal (left hand side), S1 is greater in sound 5) Mitral: 5th intercostal mid-clavicular line (left hand side), S1 is greater in sound 2, 4 In the series of abnormal finding of the heart, which following statement are the false statements? SELECT ALL THAT APPLY 1) We will not hear S3 and S4 in kids over the age of 8 yrs old 2) There is almost 5 ml of serous fluid that lubricates the heart against rubbing action inside the pericardium 3) We will hear S3 and S4 in adults that have severe uncontrolled hypertension 4) When listening for S4, the sequence is S1, S2, S3, S4 in that order 5) Ejection fraction is 1-2 liters of blood which accounts for 25-30% of blood in the adult body 4, 5 (S 4 is heard in this sequence: S4, S1, S2, and S3. The ejection fraction is actually 55 at minimum to be considered normal) When finding a heart murmur, what are we looking for when auscultating? 1) Timing and Location 2) Intensity and duration 3) Pattern and Quality 4) all of the above 4 A patients ecg shows chaotic arrangements of P waves and unequally distanced QRS complexes. Which dysrhythmia is this? 1) Atrial fibrillation 2) Ventricular tachycardia 3) Fine ventricular fibrillation 4) Asystole 1 Which aspect of the Older adult heart is FALSE? SELECT ALL THAT APPLY 1) Heart pump capacity increases 2) Left ventricular wall thickens 3) S4 is common in very old adults 4) Cardiac output decreases 10-15% 5) Myocardium is more elastic 1, 4, 5 Which of the older adult ecg is NOT expected to be normal in regards of being age related heart condition? 1) Premature systole 2) Left Ventricular hypertrophy 3) Atrial Fibrillation 4) Tours de pointes 4) Tours de pointes (you will only see this when there is magnesium deficiency and untreated Ventricular tachycardia) Which of the reasons are valid for why we conduct the Allen's test? 1) We are testing for ulnar artery patency 2) To decide if the patient is compatible for hypertensive drugs 3) We are checking if the patient has donated their radial artery for coronary bypass surgery 4) options 1 and 3 4 A new nurse is reviewing certain terms pertaining to the cardiovascular system. Which examination results are mismatched? 1) Pulsus paradoxus test: difference in 10 mg of mercury indicates a positive test 2) Claudication pain: Muscle cramps after sustained exercise due to ischemia of the legs. 3) Jugular venous pressure: Jugular pulse cannot be seen but can be palpated 4) Bruits: use the bell of the stethoscope for the most accurate auscultation experience 3 Which other objective/subjective data set must be collected to enhance a positive Homan's test to indicate deep vein thrombosis and Venous thromboembolism? SELECT ALL THAT APPLY 1) Verify Pain 2) Verify breathlessness 3) Verify Swelling 4) Verify Cardiac pulse patency 5) Verify after pain medication is given (like morphine) 1, 3 Which sequence of Cardiac nodes and bundles/fibers are ordered correctly from most superior to inferior of the heart? 1) SA node = AV node = Bundle of HIS = Purkinje fibers 2) SA node = Bundle of HIS = Purkinje fibers = AV node 3) Purkinje fibers = Bundle of HIS = AV node = SA node 4) AV node = SA node = Bundle of HIS = Purkinje fibers 1 Which of the following complex, segment or interval takes up the largest amount of space on a ECG? 1) PR interval 2) QRS complex 3) ST segment 4) QT interval 4 Which abnormal heart rhythms is matched incorrectly? 1) Sinus bradycardia: Caused by vagal stimulation (carotid massage or bearing down during bowel movements), beta blockers, calcium channel blocker, MI, increased cranial pressure. 2) Sinus tachycardia Caused by: Normal response to exercise, anxiety, fear, or consumed coffee, alcohol, drugs 3) Premature Atrial Contractions (PAC's): very dangerous in patient without heart disease when they mention "my heart skipped a beat" 4) Rate of Sinus rhythms: Bradycardia is lower than 60 beats per min, tachycardia is more than 100 beats per minute 3 Which of the following is NOT a characteristic of Atrial flutter? 1) Atrial rate is 250-400 bpm 2) Saw tooth pattern and the normal P waves have turned into F waves 3) Cardiac output is largely unaffected as stroke volume will always compensate for the flutters without medications needed 4) Patients can live with A-flutter if ventricular rate is normal since blood clots threats can be treated with medications to avoid stroke or pulmonary embolism 3 Which of the following is NOT a characteristic of Atrial Fibrillation? 1) Holiday heart commonly causes atrial fibrillation to continue indefinitely in a patients 2) Atrial rate is 400-600 bpm 3) Chaotic, asynchronous nature with the loss of atrial kick 4) Angina and syncope (loss of consciousness) 1 Week 4 week 4 A nursing students made an error in one of the following statements about premature ventricular contraction (PVC's), which one requires further teaching? A) Patients can have increased Cardiac output (CO) B) It can be treated via limiting intake of the irritable substances C) 3 or more Premature Ventricular Contractions = ventricular tachycardia D) The QRS complexes are abnormal usually wider and have a bizarre appearance A Your patient is in ventricular tachycardia after forgetting to take his amiodarone meds, the nurse knows that one of these following information is false regarding the nature of this condition? A) Starts at beginning of cardiac arrest B) V-tachycardia precedes V-fibrillation and sudden cardiac arrest C) Treatment is AED and high quality CPR D) Ventricular tachycardia can be sustained as long as it does not enter tours de pointe rhythm D A nurse is looking over ECG papers and sees very large ribbon twirl patterns on the readings. Which heart condition could it be? A) V-tachycardia B) Tours de pointe C) V-fibrillation D) Asystole B An older patient arrives to the ER with a myocardial infarction and a younger patient who got shocked by the powerline. Which heart rhythm does the nurses suspect these two patients will have? A) V-Tachycardia B) V-Fibrillation C) Sinus bradycardia D) 1st degree heart block B The nurse is treating a patient with Junctional dysrhythmia, which of the following is true about the nature of this condition? Select all that apply A) The SA node is still active despite any previous damage B) The AV node provides guidance for the heart beats C) The Bundle of HIS can contribute to providing a rhythm D) Their treatment can only be pacemakers E) The p-waves on the ECG will appear normal and not upside down B, C, D Which statement correctly separates 2nd degree type I heart block (mobitz I /wenckebach) from the type II version (mobitz II) A) Mobitz I has increasingly longer PR intervals each time B) Mobitz II has normal QRS complex while mobitz I has the abnormal QRS complex C) Mobitz II has less P-waves compared with Mobitz I D) All of these are true A Your patient has gone into Asystole after their fine V-tachycardia rhythm has not been resolved, which intervention is appropriate for the nurse to carry out? Select all that apply A) Use original defibrillator shock pads B) Provide high quality CPR C) Modify defibrillator to use electric pacing temporarily D) Use epinephrine on the patient E) Administer potassium and magnesium to jumpstart the heart B, C, D Which of the cardiac interventions are temporary placements/placements on the patient? Select all that apply A) Ablation B) Epicardial pacemakers C) A-CID D) Transvenous pacemakers E) S-CID B, D Which of the following is NOT a risk to higher rates of coronary artery disease (CAD)? A) Excess tobacco smoking and alcohol B) BMI over 24 C) Type A personality traits D) Diabetes type I B Which of the following is NOT a non-modifiable aspect of CAD prevention? A) Age B) Genetics C) Healthy equity D) Personal diet D The nurse educator is reviewing the CDC article about the silent killer in the american population, which statement would be questioned? A) CAD starts out with no symptoms like headaches B) Americans should have their cholesterol, checked every 5 years C) LDL should be increased while HDL should be lowered to reduce CAD risk D) Nurses should give statins at night when the liver is most metabolically active in making cholesterol. C Which of the following diagnostic procedures can best objectively identify chronic angina? A) PQRST assessment B) Troponin biomarkers C) Angiogram D) Both B and C D For the nursing trying to optimize myocardial perfusion, which intervention should be used last? A) Ace inhibitors and beta blockers B) Calcium channel blockers C) Flu vaccine D) Diet change C The nurse is reviewing antianginal medication information for a patient experiencing anginal pain, which one of the medications is incorrect? A) Nitrates (vasodilators that decreases spasms) B) aspirin/clopidogrel (anti-platelets to thin blood) C) ACE inhibitors (vasodilation, decrease blood volume) D) Beta blocker (increases heart rate to lower O2 demand of heart) D After the angioplasty, the nurse will assess the patient for all of the following EXCEPT? A) dysrhythmias B) new chest pain C) check extremity for color D) All of the above will be accessed D A bunch of patients have acute coronary syndrome, rank them based on severity and which ones you will treat first and which ones to treat last. 1) Non-ST elevation acute coronary syndrome (NSTEACS) 2) Unstable angina and non-ST segment elevation myocardial infarction (NSTEMI) 3) ST-segment elevation myocardial infarction (STEMI) A) 1, 2, 3 B) 2, 1, 3 C) 3, 2, 1 D) 2, 3, 1 C STEMI is the deadliest one because there is 100 percent occlusion of the vessel. NTEMI is the second priority because there is some occlusion. [You can remember that STEMI's have completely stemmed the flow of blood] In the diagnosis and treatment of Acute coronary syndrome, the nurse will obtain which of the following first? A) ECG results B) Morphine C) Oxygen D) Nitrates A For the nursing care of Acute coronary syndrome, which intervention is used LAST? A) Pain relief B) TPA (tissue plasminogen activator) C) Catheter lab within 90 minutes D) Auscultation for lung crackles B Which of the BP readings indicates stage 1 hypertension? A) 128/88 B) 120/80 C) 150/ 82 D) 138/88 D A nurse educator is researching idiopathic hypertension, which facts about it are true? Select all that apply A) It is referred to as primary hypertension B) It is referred to as secondary hypertension C) It is more prone to hypertensive crisis D) Its causes are easily identifiable and treated E) It is the most common case of hypertension in patients A , E The nurse is trying to educate the patient on changing diet for stage 1 hypertension, which statement is not appropriate or accurate? Select all that apply A) High sodium causes ventricular hypertrophy and fibrosis B) You should try to cook at home and limit eat out in restaurants C) Avoid exceeding 5 grams of salts in the daily diet D) Limit intake of breads and chicken E) Take the diuretic medications close to bed time hours C and E A nurse is attending to a patient with an acute ischemic stroke and another patient with a dissecting aortic aneurysm in an hypertensive crisis (180/120), which detail of the treatment plan is NOT appropriate? A) Give sodium nitroprusside B) Never use PO drugs and resort to IV route C) Slowly bring the blood pressure back to 120/80 D) Withhold doses of heparin or warfarin from possible encephalopathy, intracranial or subarachnoid hemorrhage C (our goal is to quickly bring down blood pressure before further damage is done to the blood vessels downstream of the aneurysm) In teaching heart failure to new nursing students, which statement requires further teaching? A) Normal cardiac ejection fraction for adults is 70-90% B) HFrEF = defect in ventricular systole C) HFpEF = defect in ventricular diastole D) Main causes of heart failure are valve disorders, hypertension, coronary artery disease A Which of the following is NOT an recognized effective compensatory system for hypertension? A) RAAS system activates to promote sodium and water retention to supply kidney with enough blood volume B) Ventricles become bigger and more elastic overtime C) The ACE system retain more bradykinins to trap more CO2 D) Ventricles become thicker and more muscular which need more O2 as demanded C A nurse is attending to 4 different Acute decompensated heart failure patients, which clinical manifestations will require your attention as a priority due to their high mortality rate? A) Dry and warm B) Dry and cold C) Wet and warm D) Wet and cold D A nurse is attending to 4 different Acute decompensated heart failure patients, which clinical manifestations will require your least attention as a priority due to lower mortality rate? A) Dry and warm B) Dry and cold C) Wet and warm D) Wet and cold A Which of the following symptoms are commonly related with RIGHT-sided heart failure? A) Ascites and enlarged liver/spleen B) Nocturia C) Orthopnea and Dyspnea D) Syncope A Which of the following symptoms are commonly related with LEFT-sided heart failure? A) Distended jugular veins B) Pulmonary congestion (crackles/wheeze) C) Dependent edema D) GI disturbances B Week 5 Week 5 Which of the following statements about the BMP test is NOT true? Select all that apply A) the value correlates with degree of heart failure. B) Acute heart failures can reach 1000's -4000's in value. C) Higher BMP = Lesser symptoms of heart failure D) It is both a prognostic lab value and also diagnostic value E) The less stress placed on ventricles leads to more BMP. C, E Which statements by the following patient requires re-education? A) Acute heart failure patients says they are expecting morphine and diuretics/vasodilators B) Chronic heart failure patient says that they are expecting ACE inhibitors as their medication C) Most the heart patients say that they are allowed to take NSAIDS for chest pain management D) A patient with a ventricular assist device acknowledges that the device is a temporary solution and is not long term. C Which lung symptoms are incorrectly assigned to the disorder? A) Air Trapping is common lung sounds with emphysema B) Cheyne-Stokes is mostly seen in dying patients). C) Ataxic breaths are usually seen in CNS issues D) Stridor is most common in COPD adult patients D (stridor is mostly seen in kids that chocked on small foreign objects and will not be seen in COPD patients) Which palpation result for the lung is ABNORMAL for any patient? A) Thoracic chest expansion test: The examiner's thumbs move apart equally after the patient inhales. B) Tactile fremitus test: the number "99" is muffled. C) Crepitus test: crackles are heard on palpation D) Trachea test: midline alignment result C Which of these lung sound macthes are abnormal? A) Resonance sounds = Normal lung B) Flat = friction rub C) Dullness = pulmonary edema, atelectasis, pneumonia D) Hyperresonance = COPD, emphysema patients B (flatness is mostly heard over bones) Which of these expected lung sounds match with their correct landmarks? A) Tracheal/bronchial = superior to manubrium bone B) Bronchovesicular = middle medial aspect of chest C) Vesicular = all normal lung tissues away from the upper medial aspect of lungs D) All of these are correct D Which of these lung sounds are described as deep rumbling and can be cleared up with a cough? A) Rhonchi B) Wheezes C) Stridor D) Friction rub A Which of these lung sounds is a high pitched musical sound and is common in asthma? A) Rhonchi B) Wheezes C) Stridor D) Friction rub B Which of these lung sounds are high pitched piercing sound and common in kids that swallow foreign objects that are dislodged in the airway? A) Rhonchi B) Wheezes C) Stridor D) Friction rub C Which of these lung sounds are grating dry sounds? A) Rhonchi B) Wheezes C) Stridor D) Friction rub D The nurse is conducting lung tests, which one is the normal finding/expected finding in healthy patients? A) Bronchophony = muffled clarity and loudness. B) Egophony = ask the patient to say E, but it sounds like an A. C) Pectoriloquy = bronchophony where a whisper can be heard clearly through a stethoscope. D) All of the above. C A patient comes in with confusion, a BUN level of 21, respiratory rate of 32, blood pressure 110/80 and it is their 60th birthday. Based off of the CURB65 score guideline, how many points did this patient score to necessitate hospitalization for their pulmonary status? A) 3/5 B) 2/5 C) 1/5 D) 4/5 A Older patients with hospital acquired pneumonia will NOT have which common symptom found in the adult patients? A) Confusion B) Stupor C) Jaundice D) Hypothermia C Select all the potential complications with pneumonia= A) Acute renal failure B) Pneumothorax C) Empyema D) Lung tumor E) Chest barrel A, B, C The case of covid pneumonia will NOT have which of the following common signs? A) Broken glass imaging X-ray results B) Acute respiratory distress C) Fluid filled lungs D) Hemothorax D Which group of people will likely show delayed signs tuberculosis? A) Elderly/old patients B) Young teen patients C) HIV positive patients D) Pediatric patients (kids) E) Transplant patients A, C, E Which of the following reasons contributes to patients not adhering to the Tuberculosis (TB) drug regimen? A) All of the above B) Drug regimen can cause blindness C) Drug regimen can cause liver damage D) Drug regimen can go up to 16 pills per day on the first phase A Which of the following thoracic impairments is NOT a medical emergency in terms of time constraints on the nurse? A) Tension pneumothorax B) Flail chest (fractured ribs) C) Spontaneous pneumothorax D) Thoracentesis D (this procedure can be routine in some patients before they need TALC treatment) On the Pleura VAC device, which action/line of thought by the nurse needs correction regarding the 3 chambers system? Select all that apply A) It is common to have 20 cm of water in the suction for most agencies B) The suction chamber (1st one) will slowly evaporate water and must be replaced by only regular tap water C) The water seal chamber (2nd one) should not be bubbling and should only have constant tidals. D) The collection chambers (3rd one) should be emptied and reused to save money E) The Pleura VAC device is an open drainage system B, D, E (we must use sterile water in the chamber, not tap water, the collection chambers are one use only because the pleura VAC is a closed system for drainage (not intended to be open) A patient with recurrent pulmonary effusion will require which nursing intervention and planning? A) thoracentesis B) chest tube procedure C) TALC injections D) diuretic medications C (the TALC injections will form a complex that takes up the usual space where fluid accumulate in the pleural space kinda like how cement occupies a crack in the sidewalk) Which is the GOLD standard for pulmonary embolism diagnosis? A) Spiral CAT scan B) D-dimer test C) Tactile fremitus D) Crepitus A Core pulmonale is the enlarged right ventricle secondary to COPD, which sign is not a common symptom that the nurse will find? A) edema B) weight gain C) distended veins D) shrunken liver D A nurse is teaching new students about asthma, which statement needs to be REVISED? A) Women are more likely to have asthma than man adjusted for population B) Minor Asthma includes chest tightness, shortness of breath C) Major Asthma includes accessory muscle usage D) Wheezing is a good accurate indicator for the severity of the asthma patient D Status Asthmaticus is a life threatening condition that must be treated immediately, which drug classes will you NOT use due to inefficiency in patient response? A) IV Magnesium B) Analgesic drugs C) Sedation drugs D) Corticosteroids E) Bronchodilators D, E COPD is the 3rd leading cause of death in the US, which of the following classifications is incorrect? A) Blue bloaters are patients with chronic bronchitis B) Pink puffers are patients with emphysema C) Chronic cough is the most common first sign D) Forced exhaled volume test is the standard to determine if a patient needs portable O2 tanks after discharge. D Rationale, the walk test is the standard to determine if a patient needs home O2 tanks, oxygen saturation must be 88% or less to qualify. After treating a COPD patient with first line agents of bronchodilators and IV corticosteroid, the patient will receive all of the following interventions/teaching EXCEPT? A) Oxygen therapy B) Pursed lip breathing C) Huff coughing (say huff when coughing) D) Encourage accessory muscle breathing first before diaphragmatic breathing D A cystic fibrosis patient is asking you about their lung condition, what is NOT accurate for the nurse to say to this patient? A) You will likely live into you 60's without difficulty B) We diagnosed you as an infant with the sweat test C) We can give you mucus buster drugs (mucolytics) D) You have muscous obstruction of your lungs but also pancreas and intestines A Rationale: most CF patients won't make it past the age of 30s A patient with Bronchiectasis comes in to the clinic for a second visit, what common signs would the nurse NOT expect to find? A) Permanent dilation of bronchial walls B) Persistent thick and tenacious purulent sputum C) Personality changes from agitation of coughs D) hemoptysis (coughing blood tinged mucus) C A nurse educator is instructing on how to treat obstructive sleep apnea, which statement needs re-assessment? A) Obstructive sleep apnea is most common on obese patients or patients with thicker neck folds B) Patients can have atherosclerosis, hypoxia/hypoxemia as clinical manifestations C) We will provide them with the continuous positive airway pressure machines to use at night time. D) We educate patients that they should sleep on their back side for optimal relaxation of accessory muscles D Rationale: we want patients with obstructive sleep apnea to sleep on their SIDES A patient is being assessed for range-of-joint movement. The nurse asks him to move his arm in toward the center of his body. This movement is called: a. Flexion. b. Abduction. c. Adduction. d. Extension. C A patient tells the nurse that she is having a hard time bringing her hand to her mouth when she eats or tries to brush her teeth. The nurse knows that for her to move her hand to her mouth, she must perform which movement? a. Flexion b. Abduction c. Adduction d. Extension A 3. The functional units of the musculoskeletal system are the: a. Joints. b. Bones. c. Muscles. d. Tendons. A Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called: a. Bursa. b. Tendons. c. Cartilage. d. Ligaments. D The nurse notices that a woman in an exercise class is unable to jump rope. The nurse is aware that to jump rope, one's shoulder has to be capable of: a. Inversion. b. Supination. c. Protraction. d. Circumduction. D The articulation of the mandible and the temporal bone is known as the: a. Intervertebral foramen. b. Condyle of the mandible. c. Temporomandibular joint. d. Zygomatic arch of the temporal bone. C The nurse is explaining to a patient that there are shock absorbers in his back to cushion the spine and to help it move. The nurse is referring to his: a. Vertebral column. b. Nucleus pulposus. c. Vertebral foramen. d. Intervertebral disks. D The nurse is checking the range of motion in a patient's knee and knows that the knee is capable of which movement(s)? a. Flexion and extension b. Supination and pronation c. Circumduction d. Inversion and eversion A A patient is visiting the clinic for an evaluation of a swollen, painful knuckle. The nurse notices that the knuckle above his ring on the left hand is swollen and that he is unable to remove his wedding ring. This joint is called the _________ joint. a. Interphalangeal b. Tarsometatarsal c. Metacarpophalangeal d. Tibiotalar C An 85-year-old patient comments during his annual physical examination that he seems to be getting shorter as he ages. The nurse should explain that decreased height occurs with aging because: a. Long bones tend to shorten with age. b. The vertebral column shortens. c. A significant loss of subcutaneous fat occurs. d. A thickening of the intervertebral disks develops. B A patient has been diagnosed with osteoporosis and asks the nurse, "What is osteoporosis?" The nurse explains that osteoporosis is defined as: a. Increased bone matrix. b. Loss of bone density. c. New, weaker bone growth. d. Increased phagocytic activity. B The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women. Which of these actions is the best way to prevent or delay bone loss in this group? a. Taking calcium and vitamin D supplements b. Taking medications to prevent osteoporosis c. Performing physical activity, such as fast walking d. Assessing bone density annually C A patient is complaining of pain in his joints that is worse in the morning, better after he moves around for a while, and then gets worse again if he sits for long periods. The nurse should assess for other signs of what problem? a. Tendinitis b. Osteoarthritis c. Rheumatoid arthritis d. Intermittent claudication C A patient states, "I can hear a crunching or grating sound when I kneel." She also states that "it is very difficult to get out of bed in the morning because of stiffness and pain in my joints." The nurse should assess for signs of what problem? a. Crepitation b. Bone spur c. Loose tendon d. Fluid in the knee joint A A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasms. The nurse should suspect: a. Crepitation. b. Rotator cuff lesions. c. Dislocated shoulder. d. Rheumatoid arthritis. B A professional tennis player comes into the clinic complaining of a sore elbow. The nurse will assess for tenderness at the: a. Olecranon bursa. b. Annular ligament. c. Base of the radius. d. Medial and lateral epicondyle. D The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen test. To perform this test, the nurse should instruct the patient to: a. Dorsiflex the foot. b. Plantarflex the foot. c. Hold both hands back to back while flexing the wrists 90 degrees for 60 seconds. d. Hyperextend the wrists with the palmar surface of both hands touching, and wait for 60 seconds. C An 80-year-old woman is visiting the clinic for a checkup. She states, "I can't walk as much as I used to." The nurse is observing for motor dysfunction in her hip and should ask her to: a. Internally rotate her hip while she is sitting. b. Abduct her hip while she is lying on her back. c. Adduct her hip while she is lying on her back. d. Externally rotate her hip while she is standing. B During an examination, the nurse asks a patient to bend forward from the waist and notices that the patient has lateral tilting. When his leg is raised straight up, the patient complains of a pain going down his buttock into his leg. The nurse suspects: a. Scoliosis. b. Meniscus tear. c. Herniated nucleus pulposus. d. Spasm of paravertebral muscles. C A 40-year-old man has come into the clinic with complaints of extreme pain in his toes. The nurse notices that his toes are slightly swollen, reddened, and warm to the touch. His complaints would suggest: a. Osteoporosis. b. Acute gout. c. Ankylosing spondylitis. d. Degenerative joint disease. B A 68-year-old woman has come in for an assessment of her rheumatoid arthritis, and the nurse notices raised, firm, nontender nodules at the olecranon bursa and along the ulna. These nodules are most commonly diagnosed as: a. Epicondylitis. b. Gouty arthritis. c. Olecranon bursitis. d. Subcutaneous nodules. D A woman who has had rheumatoid arthritis for years is starting to notice that her fingers are drifting to the side. The nurse knows that this condition is commonly referred to as: a. Radial drift. b. Ulnar deviation. c. Swan-neck deformity. d. Dupuytren contracture. B A patient who has had rheumatoid arthritis for years comes to the clinic to ask about changes in her fingers. The nurse will assess for signs of what problems? a. Heberden nodes b. Bouchard nodules c. Swan-neck deformities d. Dupuytren contractures C A patient's annual physical examination reveals a lateral curvature of the thoracic and lumbar segments of his spine; however, this curvature disappears with forward bending. The nurse knows that this abnormality of the spine is called: a. Structural scoliosis. b. Functional scoliosis. c. Herniated nucleus pulposus. d. Dislocated hip. B When assessing muscle strength, the nurse observes that a patient has complete range of motion against gravity with full resistance. What grade of muscle strength should the nurse record using a 0- to 5-point scale? a. 2 b. 3 c. 4 d. 5 D The nurse should use which test to check for large amounts of fluid around the patella? a. Ballottement b. Tinel sign c. Phalen test d. McMurray test A A patient tells the nurse that, "All my life I've been called 'knock knees'." The nurse knows that another term for knock knees is: a. Genu varum. b. Genu valgum. c. Pes planus. d. Metatarsus adductus. B A man who has had gout for several years comes to the clinic with a problem with his toe. On examination, the nurse notices the presence of hard, painless nodules over the great toe; one has burst open with a chalky discharge. This finding is known as: a. Callus. b. Plantar wart. c. Bunion. d. Tophi. D The nurse is assessing the joints of a woman who has stated, "I have a long family history of arthritis, and my joints hurt." The nurse suspects that she has osteoarthritis. Which of these are symptoms of osteoarthritis? Select all that apply. (3) a. Symmetric joint involvement b. Asymmetric joint involvement c. Pain with motion of affected joints d. Affected joints are swollen with hard, bony protuberances e. Affected joints may have heat, redness, and swelling B, C, D The nurse needs to pull the portion of the ear that consists of movable cartilage and skin down and back when administering eardrops. This portion of the ear is called the: a. Auricle. b. Concha. c. Outer meatus. d. Mastoid process. A. auricle The external ear is called the auricle or pinna and consists of movable cartilage and skin. The nurse is examining a patient's ears and notices cerumen in the external canal. Which of these statements about cerumen is correct? a. Sticky honey-colored cerumen is a sign of infection. b. The presence of cerumen is indicative of poor hygiene. c. The purpose of cerumen is to protect and lubricate the ear. d. Cerumen is necessary for transmitting sound through the auditory canal. C. the purpose of cerumen is to protect and lubricate the ear The ear is lined with glands that secrete cerumen, which is a yellow waxy material that lubricates and protects the ear. When examining the ear with an otoscope, the nurse notes that the tympanic membrane should appear: a. Light pink with a slight bulge. b. Pearly gray and slightly concave. c. Pulled in at the base of the cone of light. d. Whitish with a small fleck of light in the superior portion. B. Pearly gray and slightly concave. The tympanic membrane is a translucent membrane with a pearly gray color and a prominent cone of light in the anteroinferior quadrant, which is the reflection of the otoscope light. The tympanic membrane is oval and slightly concave, pulled in at its center by the malleus, which is one of the middle ear ossicles. The nurse is reviewing the structures of the ear. Which of these statements concerning the eustachian tube is true? a. The eustachian tube is responsible for the production of cerumen. b. It remains open except when swallowing or yawning. c. The eustachian tube allows passage of air between the middle and outer ear. d. It helps equalize air pressure on both sides of the tympanic membrane. D. It helps equalize air pressure on both sides of the tympanic membrane. The eustachian tube allows an equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture during, for example, altitude changes in an airplane. The tube is normally closed, but it opens with swallowing or yawning. A patient with a middle ear infection asks the nurse, "What does the middle ear do?" The nurse responds by telling the patient that the middle ear functions to: a. Maintain balance. b. Interpret sounds as they enter the ear. c. Conduct vibrations of sounds to the inner ear. d. Increase amplitude of sound for the inner ear to function. C. Conduct vibrations of sounds to the inner ear. Among its other functions, the middle ear conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear. The other responses are not functions of the middle The nurse is reviewing the function of the cranial nerves (CNs). Which CN is responsible for conducting nerve impulses to the brain from the organ of Corti? a. I b. III c. VIII d. XI C. VIII The nerve impulses are conducted by the auditory portion of CN VIII to the brain. The nurse is assessing a patient who may have hearing loss. Which of these statements is true concerning air conduction? a. Air conduction is the normal pathway for hearing. b. Vibrations of the bones in the skull cause air conduction. c. Amplitude of sound determines the pitch that is heard. d. Loss of air conduction is called a conductive hearing loss. A. Air conduction is the normal pathway for hearing. The normal pathway of hearing is air conduction, which starts when sound waves produce vibrations on the tympanic membrane. Conductive hearing loss results from a mechanical dysfunction of the external or middle ear. The other statements are not true concerning air conduction. A patient has been shown to have a sensorineural hearing loss. During the assessment, it would be important for the nurse to: a. Speak loudly so the patient can hear the questions. b. Assess for middle ear infection as a possible cause. c. Ask the patient what medications he is currently taking. d. Look for the source of the obstruction in the external ear. C. Ask the patient what medications he is currently taking. A simple increase in amplitude may not enable the person to understand spoken words. Sensorineural hearing loss may be caused by presbycusis, which is a gradual nerve degeneration that occurs with aging and by ototoxic drugs, which affect the hair cells in the During an interview, the patient states he has the sensation that "everything around him is spinning." The nurse recognizes that the portion of the ear responsible for this sensation is the: a. Cochlea. b. CN VIII. c. Organ of Corti. d. Labyrinth. D. Labyrinth. If the labyrinth ever becomes inflamed, then it feeds the wrong information to the brain, creating a staggering gait and a strong, spinning, whirling sensation called vertigo. A patient in her first trimester of pregnancy is diagnosed with rubella. Which of these statements is correct regarding the significance of this in relation to the infant's hearing? a. Rubella may affect the mother's hearing but not the infant's. b. Rubella can damage the infant's organ of Corti, which will impair hearing. c. Rubella is only dangerous to the infant in the second trimester of pregnancy. d. Rubella can impair the development of CN VIII and thus affect hearing. B. Rubella can damage the infant's organ of Corti, which will impair hearing. If maternal rubella infection occurs during the first trimester, then it can damage the organ of The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. What would be an appropriate response by the nurse? a. "It is unusual for a small child to have frequent ear infections unless something else is wrong." b. "We need to check the immune system of your son to determine why he is having so many ear infections." c. "Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear." d. "Your son's eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily." D. "Your son's eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily." The infant's eustachian tube is relatively shorter and wider than the adult's eustachian tube, and its position is more horizontal; consequently, pathogens from the nasopharynx can more easily migrate through to the middle ear. The other responses are not appropriate. A 31-year-old patient tells the nurse that he has noticed a progressive loss in his hearing. He says that it does seem to help when people speak louder or if he turns up the volume of a television or radio. The most likely cause of his hearing loss is: a. Otosclerosis. b. Presbycusis. c. Trauma to the bones. d. Frequent ear infections. A. Otosclerosis. Otosclerosis is a common cause of conductive hearing loss in young adults between the ages of 20 and 40 years. Presbycusis is a type of hearing loss that occurs with aging. Trauma and frequent ear infections are not a likely cause of his hearing loss A 70-year-old patient tells the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says that he "can't always tell where the sound is coming from" and the words often sound "mixed up." What might the nurse suspect as the cause for this change? a. Atrophy of the apocrine glands b. Cilia becoming coarse and stiff c. Nerve degeneration in the inner ear d. Scarring of the tympanic membrane C. Nerve degeneration in the inner ear Presbycusis is a type of hearing loss that occurs in 60% of those older than 65 years of age, even in those living in a quiet environment. This sensorineural loss is gradual and caused by nerve degeneration in the inner ear. Words sound garbled, and the ability to localize sound is also impaired. This communication dysfunction is accentuated when background noise is present. During an assessment of a 20-year-old Asian patient, the nurse notices that he has dry, flaky cerumen in his canal. What is the significance of this finding? This finding: a. Is probably the result of lesions from eczema in his ear. b. Represents poor hygiene. c. Is a normal finding, and no further follow-up is necessary. d. Could be indicative of change in cilia; the nurse should assess for hearing loss C. Is a normal finding, and no further follow-up is necessary. Asians and Native Americans are more likely to have dry cerumen, whereas Blacks and Whites usually have wet cerumen. The nurse is taking the history of a patient who may have a perforated eardrum. What would be an important question in this situation? a. "Do you ever notice ringing or crackling in your ears?" b. "When was the last time you had your hearing checked?" c. "Have you ever been told that you have any type of hearing loss?" d. Is a normal finding, and no further follow-up is necessary. D. Is a normal finding, and no further follow-up is necessary. Typically with perforation, ear pain occurs first, stopping with a popping sensation, and then drainage occurs. A 31-year-old patient tells the nurse that he has noticed pain in his left ear when people speak loudly to him. The nurse knows that this finding: a. Is normal for people of his age. b. Is a characteristic of recruitment. c. May indicate a middle ear infection. d. Indicates that the patient has a cerumen impaction. B. Is a characteristic of recruitment. Recruitment is significant hearing loss occurring when speech is at low intensity, but sound actually becomes painful when the speaker repeats at a louder volume. The other responses are not correct. While discussing the history of a 6-month-old infant, the mother tells the nurse that she took a significant amount of aspirin while she was pregnant. What question would the nurse want to include in the history? a. "Does your baby seem to startle with loud noises?" b. "Has your baby had any surgeries on her ears?" c. "Have you noticed any drainage from her ears?" d. "How many ear infections has your baby had since birth? A. "Does your baby seem to startle with loud noises?" Children at risk for a hearing deficit include those exposed in utero to a variety of conditions, such as maternal rubella or to maternal ototoxic drugs. The nurse is performing an otoscopic examination on an adult. Which of these actions is correct? a. Tilting the person's head forward during the examination b. Once the speculum is in the ear, releasing the traction c. Pulling the pinna up and back before inserting the speculum d. Using the smallest speculum to decrease the amount of discomfort C. Pulling the pinna up and back before inserting the speculum The pinna is pulled up and back on an adult or older child, which helps straighten the S-shape of the canal. Traction should not be released on the ear until the examination is completed and the otoscope is removed. The nurse is assessing a 16-year-old patient who has suffered head injuries from a recent motor vehicle accident. Which of these statements indicates the most important reason for assessing for any drainage from the ear canal? a. If the drum has ruptured, then purulent drainage will result. b. Bloody or clear watery drainage can indicate a basal skull fracture. c. The auditory canal many be occluded from increased cerumen. d. Foreign bodies from the accident may cause occlusion of the canal. B. Bloody or clear watery drainage can indicate a basal skull fracture. Frank blood or clear watery drainage (cerebrospinal leak) after a trauma suggests a basal skull fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media. In performing a voice test to assess hearing, which of these actions would the nurse perform? a. Shield the lips so that the sound is muffled. b. Whisper a set of random numbers and letters, and then ask the patient to repeat them. c. Ask the patient to place his finger in his ear to occlude outside noise. d. Stand approximately 4 feet away to ensure that the patient can really hear at this distance. B. Whisper a set of random numbers and letters, and then ask the patient to repeat them. With the head 30 to 60 cm (1 to 2 feet) from the patient's ear, the examiner exhales and slowly whispers a set of random numbers and letters, such as "5, B, 6." Normally, the patient is asked to repeat each number and letter correctly after hearing the examiner say them. In performing an examination of a 3-year-old child with a suspected ear infection, the nurse would: a. Omit the otoscopic examination if the child has a fever. b. Pull the ear up and back before inserting the speculum. c. Ask the mother to leave the room while examining the child. d. Perform the otoscopic examination at the end of the assessment D. Perform the otoscopic examination at the end of the assessment In addition to its place in the complete examination, eardrum assessment is mandatory for any infant or child requiring care for an illness or fever. For the infant or young child, the timing of the otoscopic examination is best toward the end of the complete examination. The nurse is preparing to perform an otoscopic examination of a newborn infant. Which statement is true regarding this examination? a. Immobility of the drum is a normal finding. b. An injected membrane would indicate an infection. c. The normal membrane may appear thick and opaque. d. The appearance of the membrane is identical to that of an adult. C. The normal membrane may appear thick and opaque. During the first few days after the birth, the tympanic membrane of a newborn often appears thickened and opaque. It may look injected and have a mild redness from increased vascularity. The other statements are not correct. The nurse assesses the hearing of a 7-month-old by clapping hands. What is the expected response? The infant: a. Turns his or her head to localize the sound. b. Shows no obvious response to the noise. c. Shows a startle and acoustic blink reflex. d. Stops any movement, and appears to listen for the sound. A. Turns his or her head to localize the sound. With a loud sudden noise, the nurse should notice the infant turning his or her head to localize the sound and to respond to his or her own name. A startle reflex and acoustic blink reflex is expected in newborns; at age 3 to 4 months, the infant stops any movement and appears to listen. The nurse is performing an ear examination of an 80-year-old patient. Which of these findings would be considered normal? a. High-tone frequency loss b. Increased elasticity of the pinna c. Thin, translucent membrane d. Shiny, pink tympanic membrane A. High-tone frequency loss A high-tone frequency hearing loss is apparent for those affected with presbycusis, the hearing loss that occurs with aging. The pinna loses elasticity, causing earlobes to be pendulous. The eardrum may be whiter in color and more opaque and duller in the older person than in the younger adult. An assessment of a 23-year-old patient reveals the following: an auricle that is tender and reddish-blue in color with small vesicles. The nurse would need to know additional information that includes which of these? a. Any change in the ability to hear b. Any recent drainage from the ear c. Recent history of trauma to the ear d. Any prolonged exposure to extreme cold D. Any prolonged exposure to extreme cold Frostbite causes reddish-blue discoloration and swelling of the auricle after exposure to extreme cold. Vesicles or bullae may develop, and the person feels pain and tenderness. While performing the otoscopic examination of a 3-year-old boy who has been pulling on his left ear, the nurse finds that his left tympanic membrane is bright red and that the light reflex is not visible. The nurse interprets these findings to indicate a(n): a. Fungal infection. b. Acute otitis media. c. Perforation of the eardrum. d. Cholesteatoma. B. Acute otitis media. Absent or distorted light reflex and a bright red color of the eardrum are indicative of acute otitis media. (See Table 15-5 for descriptions of the other conditions.) The mother of a 2-year-old toddler is concerned about the upcoming placement of tympanostomy tubes in her son's ears. The nurse would include which of these statements in the teaching plan? a. The tubes are placed in the inner ear. b. The tubes are used in children with sensorineural loss. c. The tubes are permanently inserted during a surgical procedure. d. The purpose of the tubes is to decrease the pressure and allow for drainage. D. The purpose of the tubes is to decrease the pressure and allow for drainage. Polyethylene tubes are surgically inserted into the eardrum to relieve middle ear pressure and to promote drainage of chronic or recurrent middle ear infections. Tubes spontaneously extrude in 6 months to 1 year. In an individual with otitis externa, which of these signs would the nurse expect to find on assessment? a. Rhinorrhea b. Periorbital edema c. Pain over the maxillary sinuses d. Enlarged superficial cervical nodes D. Enlarged superficial cervical nodes The lymphatic drainage of the external ear flows to the parotid, mastoid, and superficial cervical nodes. The signs are severe swelling of the canal, inflammation, and tenderness. Rhinorrhea, periorbital edema, and pain over the maxillary sinuses do not occur with otitis externa. When performing an otoscopic examination of a 5-year-old child with a history of chronic ear infections, the nurse sees that his right tympanic membrane is amber-yellow in color and that air bubbles are visible behind the tympanic membrane. The child reports occasional hearing loss and a popping sound with swallowing. The preliminary analysis based on this information is that the child: a. Most likely has serous otitis media. b. Has an acute purulent otitis media. c. Has evidence of a resolving cholesteatoma. d. Is experiencing the early stages of perforation. A. Most likely has serous otitis media. An amber-yellow color to the tympanic membrane suggests serum or pus in the middle ear. Air or fluid or bubbles behind the tympanic membrane are often visible. The patient may have feelings of fullness, transient hearing loss, and a popping sound with swallowing. These findings most likely suggest that the child has serous otitis media. The other responses are not correct. The nurse is performing an assessment on a 65-year-old man. He reports a crusty nodule behind the pinna. It intermittently bleeds and has not healed over the past 6 months. On physical assessment, the nurse finds an ulcerated crusted nodule with an indurated base. The preliminary analysis in this situation is that this: a. Is most likely a benign sebaceous cyst. b. Is most likely a keloid. c. Could be a potential carcinoma, and the patient should be referred for a biopsy. d. Is a tophus, which is common in the older adult and is a sign of gout. C. Could be a potential carcinoma, and the patient should be referred for a biopsy. An ulcerated crusted nodule with an indurated base that fails to heal is characteristic of a carcinoma. These lesions fail to heal and intermittently bleed. Individuals with such symptoms should be referred for a biopsy (see Table 15-2). The other responses are not correct. The nurse suspects that a patient has otitis media. Early signs of otitis media include which of these findings of the tympanic membrane? a. Red and bulging b. Hypomobility c. Retraction with landmarks clearly visible d. Flat, slightly pulled in at the center, and moves with insufflation B. Hypomobility An early sign of otitis media is hypomobility of the tympanic membrane. As pressure increases, the tympanic membrane begins to bulge. 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. The nurse should: a. Refer the patient for the possibility of a fungal infection. b. Know that these are scars caused from frequent ear infections. c. Consider that these findings may represent the presence of blood in the middle ear. d. Be concerned about the ability to hear because of this abnormality on the tympanic membrane. B. Know that these are scars caused from frequent ear infections. Dense white patches on the tympanic membrane are sequelae of repeated ear infections. They do not necessarily affect hearing. The nurse is preparing to do an otoscopic examination on a 2-year-old child. Which one of these reflects the correct procedure? a. Pulling the pinna down b. Pulling the pinna up and back c. Slightly tilting the child's head toward the examiner d. Instructing the child to touch his chin to his chest A. Pulling the pinna down For an otoscopic examination on an infant or on a child under 3 years of age, the pinna is pulled down. The other responses are not part of the correct procedure. The nurse is conducting a child safety class for new mothers. Which factor places young children at risk for ear infections? a. Family history b. Air conditioning c. Excessive cerumen d. Passive cigarette smoke D. Passive cigarette smoke Exposure to passive and gestational smoke is a risk factor for ear infections in infants and children. During an otoscopic examination, the nurse notices an area of black and white dots on the tympanic membrane and the ear canal wall. What does this finding suggest? a. Malignancy b. Viral infection c. Blood in the middle ear d. Yeast or fungal infection D. Yeast or fungal infection A colony of black or white dots on the drum or canal wall suggests a yeast or fungal infection (otomycosis). A 17-year-old student is a swimmer on her high school's swim team. She has had three bouts of otitis externa this season and wants to know what to do to prevent it. The nurse instructs her to: a. Use a cotton-tipped swab to dry the ear canals thoroughly after each swim. b. Use rubbing alcohol or 2% acetic acid eardrops after every swim. c. Irrigate the ears with warm water and a bulb syringe after each swim. d. Rinse the ears with a warmed solution of mineral oil and hydrogen peroxide. B. Use rubbing alcohol or 2% acetic acid eardrops after every swim. With otitis externa (swimmer's ear), swimming causes the external canal to become waterlogged and swell; skinfolds are set up for infection. Otitis externa can be prevented by using rubbing alcohol or 2% acetic acid eardrops after every swim. During an examination, the patient states he is hearing a buzzing sound and says that it is "driving me crazy!" The nurse recognizes that this symptom indicates: a. Vertigo. b. Pruritus. c. Tinnitus. d. Cholesteatoma. C. Tinnitus. Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders During an examination, the nurse notices that the patient stumbles a little while walking, and, when she sits down, she holds on to the sides of the chair. The patient states, "It feels like the room is spinning!" The nurse notices that the patient is experiencing: a. Objective vertigo. b. Subjective vertigo. c. Tinnitus. d. Dizziness. A. Objective vertigo. With objective vertigo, the patient feels like the room spins; with subjective vertigo, the person feels like he or she is spinning. Tinnitus is a sound that comes from within a person; it can be a ringing, crackling, or buzzing sound. It accompanies some hearing or ear disorders. Dizziness is not the same as true vertigo; the person who is dizzy may feel unsteady and lightheaded. A patient has been admitted after an accident at work. During the assessment, the patient is having trouble hearing and states, "I don't know what the matter is. All of a sudden, I can't hear you out of my left ear!" What should the nurse do next? a. Make note of this finding for the report to the next shift. b. Prepare to remove cerumen from the patient's ear. c. Notify the patient's health care provider. d. Irrigate the ear with rubbing alcohol. C. Notify the patient's health care provider. Any sudden loss of hearing in one or both ears that is not associated with an upper respiratory infection needs to be reported at once to the patient's health care provider. Hearing loss associated with trauma is often sudden. Irrigating the ear or removing cerumen is not appropriate at this time. The nurse is testing the hearing of a 78-year-old man and is reminded of the changes in hearing that occur with aging that include which of the following? Select all that apply. a. Hearing loss related to aging begins in the mid 40s. b. Progression of hearing loss is slow. c. The aging person has low-frequency tone loss. d. The aging person may find it harder to hear consonants than vowels. e. Sounds may be garbled and difficult to localize. f. Hearing loss reflects nerve degeneration of the middle ear. B. progression of hearing loss is slow D. the aging person may find it harder to hear consonants than vowels E. sounds may be garbled and difficult to localize Presbycusis is a type of hearing loss that occurs with aging and is found in 60% of those older than 65 years. It is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve, and it slowly progresses after the age of 50 years. The person first notices a high frequency tone loss; it is harder to hear consonants (high-pitched components of speech) than vowels, which makes words sound garbled. The ability to localize sound is also impaired. The primary purpose of the ciliated mucous membrane in the nose is to: a. Warm the inhaled air. b. Filter out dust and bacteria. c. Filter coarse particles from inhaled air. d. Facilitate the movement of air through the nares. ANS: B The nasal hairs filter the coarsest matter from inhaled air, whereas the mucous blanket filters out dust and bacteria. The rich blood supply of the nasal mucosa warms the inhaled air. The projections in the nasal cavity that increase the surface area are called the: a. Meatus. b. Septum. c. Turbinates. d. Kiesselbach plexus. ANS: C The lateral walls of each nasal cavity contain three parallel bony projections: the superior, middle, and inferior turbinates. These increase the surface area, making more blood vessels and mucous membrane available to warm, humidify, and filter the inhaled air. The nurse is reviewing the development of the newborn infant. Regarding the sinuses, which statement is true in relation to a newborn infant? a. Sphenoid sinuses are full size at birth. b. Maxillary sinuses reach full size after puberty. c. Frontal sinuses are fairly well developed at birth. d. Maxillary and ethmoid sinuses are the only sinuses present at birth. ANS: D Only the maxillary and ethmoid sinuses are present at birth. The sphenoid sinuses are minute at birth and develop after puberty. The frontal sinuses are absent at birth, are fairly well developed at age 7 to 8 years, and reach full size after puberty. The tissue that connects the tongue to the floor of the mouth is the: a. Uvula. b. Palate. c. Papillae. d. Frenulum. ANS: D The frenulum is a midline fold of tissue that connects the tongue to the floor of the mouth. The uvula is the free projection hanging down from the middle of the soft palate. The palate is the arching roof of the mouth. Papillae are the rough, bumpy elevations on the tongue's dorsal surface. The salivary gland that is the largest and located in the cheek in front of the ear is the _________ gland. a. Parotid b. Stensen's c. Sublingual d. Submandibular ANS: A The mouth contains three pairs of salivary glands. The largest, the parotid gland, lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. The Stensen's duct (not gland) drains the parotid gland onto the buccal mucosa opposite the second molar. The sublingual gland is located within the floor of the mouth under the tongue. The submandibular gland lies bene