GNUR 290 Exam 2 Questions and Answers Fully Solved Graded A+
A 62-year-old who has worked on an assembly line since he was 24 years old began taking aspirin for
arthritis 6 months ago. The client presents to the nurse with hearing problems and ringing in the ears.
Which of the following problems should the nurse suspect? A) Tinnitus B) Vertigo C) Ototoxicity D)
Impacted cerumen - Answers Ans: CThe older adult has symptoms of ototoxicity. Aspirin is a known
ototoxic drug. Tinnitus is the persistent sensation of ringing in the ears, which is one of this client's
symptoms. Vertigo is a sensation of motion, which is not a reported symptom for this client. Although
common, impacted cerumen would not lead to ringing in the ears.
A new nursing assistant asks the nurse how best to approach a hearingimpaired older adult. Which of
the following approaches should the nurse recommend? A) Raise the volume of your voice. B) Leave the
radio on to calm the older adult. C) Lower the tone of your voice. D) Use exaggerated lip movements. -
Answers Ans: C Communication interventions for the hearing impaired should aim at clarity of words.
This is accomplished by slowing the rate of speech and eliminating environmental noise and distractions.
When communicating, lower the tone while speaking in a moderately loud voice
A nurse is teaching a group of hearingimpaired nursing home residents about hearing aids. Which of the
following points should the nurse emphasize? A) It is not necessary to use the hearing aid for one-on-
one conversations. B) The hearing aid should be used only in the dining room or social area. C) While
inserting the hearing aid, make sure the volume is turned off. D) If whistling is heard, the volume of the
hearing aid may need to be increased - Answers Ans: C The hearing aid should be inserted with the
volume off with the canal portion pointing into the ear. A hearing aid should be used for one-on-one
conversation and should not be used in a dining room where there is background noise. If whistling is
heard, the volume should be decreased
A nurse notes that a client who has heart failure could hear well during the last home visit, and is having
difficulty hearing today. Which of the following laboratory findings is most likely associated with
impaired hearing? A) Albumin of 4.1 B) Creatinine of 4.2 C) Potassium of 4.3 D) Sodium of 144 - Answers
Ans: B Older adults with heart failure are at increased risk for hearing loss caused by medications (e.g.,
diuretics) and decreased renal and cardiac perfusion. Normal levels of albumin, potassium, and sodium
are not associated with hearing loss
An 85-year-old woman who lives alone says to the nurse, "There is nothing I can do about my hearing. I
am 85 years old, and I am not really interested in listening to television programs anymore." Which of
the following would be the nurse's best response?A)"You are lucky you still live alone at 85, and I
understand why you don't care about the programs on television."B)"Have you talked with your health
care provider about a hearing evaluation? This would determine the problem and possible solutions to
it."C)"I know a hearing aid dealer who offers free testing. Have you thought about trying a hearing
aid?"D)"Did you know that there are closedcaption television sets that would allow you to enjoy some
shows?" - Answers Ans: B The first step would be to determine what the problem is. Free testing is not
comprehensive in its evaluative scope. Telling the client she is lucky to be living alone at 85 years of age
,is nontherapeutic communication and suggesting that the woman use closedcaption television does not
address the hearing issue.
A 76-year-old adult expresses frustration to the nurse regarding hearing loss despite a lifetime of being
conscientious about avoiding known causes of hearing damage. Which of the following age-related
changes may result in hearing loss? A) Degeneration of the inner ear structures B) Decreased viscosity
and quantity of cerumen C) Plaque formation and occlusion of the Eustachian tubes D) Hypertrophy of
the external ear structures - Answers Ans: A Age-related changes of the inner ear include loss of hair
cells, reduction of blood supply, diminution of endolymph production, decreased basilar membrane
flexibility, degeneration of spiral ganglion cells, and loss of neurons in the cochlear nuclei. These inner
ear changes result in the degenerative hearing impairment termed presbycusis. Cerumen often becomes
more viscous with age, and occlusion of the Eustachian tubes is not a normal, age-related change.
Changes to the external ear structures are not implicated in age-related hearing loss
A nurse who regularly visits an adult daycare center has noted evidence of a hearing deficit in a man
who has no documented history of hearing loss. Which of the following factors should the nurse
consider when attempting to ascertain the etiology of the man's hearing loss? (Select all that apply.) A)
Genetic factors B) Environmental conditions C) Fluid and electrolyte imbalances D) Ototoxic medications
E) Atherosclerosis or thrombotic events - Answers Ans: A, B, D Medications, genetic factors, and
environmental factors are all among the many potential contributors to hearing loss in older adults.
Fluid and electrolyte imbalances, atherosclerosis, and thrombosis are not commonly implicated in
hearing loss among older adults
The incidence of hearing loss in a longterm care facility is high, especially among white men. What
strategy should care providers adopt when communicating with older adults who have hearing loss?
A)Use less complex concepts when communicating with hearing-impaired older adults.B) Use a high,
consistent tone and pitch when speaking to adults with hearing loss.C)Speak at a high volume directly
into the less affected ear when talking to an older adult with a hearing deficit.D)Make eye contact
before and during a conversation with hearing-impaired adults. - Answers Ans: D Eye contact helps
facilitate communication with individuals who have hearing loss. It is unnecessary, and likely
inappropriate, to simplify the content of conversations, and a low tone is more beneficial than a high
tone. It is not normally necessary to speak directly into the ear of the older adult
As part of a comprehensive physical assessment of an older adult client, a nurse is performing an
otoscopic examination. Which of the following assessment findings most clearly warrants further
assessment and possible intervention? A) There is a small amount of cerumen visible in the ear canal. B)
The epithelial lining is bright red. C) The tympanic membrane is intact. D) The tympanic membrane is a
pearl-gray color - Answers Ans: B Bright red epithelial lining in the ear is an abnormal finding; the lining
should be pinkish white. A small amount of cerumen and an intact, pearl-gray tympanic membrane are
expected findings
A nurse has been caring for an 83-yearold resident of a nursing home for 2 years and has developed a
high level of trust with the resident. Which of thefollowing recent changes in the resident's behavior
, may signal the possibility of hearing loss? A) The resident's statements occasionally suggest that he is
not oriented to time.B)The resident had a recent episode where he became visibly angry at a nursing
assistant. C) The resident's attention span is short and he is easily distracted. D) The resident has
become increasingly disagreeable and terse in his demeanor - Answers Ans: CShort attention span and
easy distractibility are indicators of hearing loss. Aggression and agitation more often suggest alternative
etiologies, such as neurologic health problems
A gerontological nurse presents at a local conference regarding recent findings in age-related hearing
loss. Which age-related changes indicated in hearing loss and speech perception should the nurse
include? A) Changes to the external auditory canal and pinna B) Degenerative changes to the auditory
brainstem C) Growth of longer and thicker hair in the ear canal D) Thickening of the tympanic membrane
- Answers Ans: B Studies suggest that central auditory structures (e.g., primary auditory cortex and
auditory brainstem) account for a significant component of hearing loss in older adults, particularly with
regard to speech perception. The external ear changes that occur with normal aging are not directly
related to hearing loss (including hair growth in men). The tympanic membrane thins and stiffens with
age
The Functional Consequences Theory approach to hearing loss identifies health promotion interventions
for promoting hearing wellness. Which of the following interventions will most directly affect auditory
health of the older adult? A) Avoidance of medications B) Regular colonics C) Smoking cessation D) Ear
muff use in winter - Answers Ans: C Reviews of studies identified the following risk factors for hearing
impairment: male gender, increased age, genetic predisposition, exposure to noise, impacted cerumen,
smoking, exposure to secondhand smoke, use of ototoxic medications, education level less than or equal
to high school diploma, and certain medical conditions. Colonic use and ear coverage for warmth have
not been identified as risk factors to hearing loss
A nurse teaches an older adult about risks related to ototoxic medications. Which of the following
medications should the adult minimize or avoid? A) Nonsteroidal anti-inflammatory agents B) Osmotic
stool softeners C) Over-the-counter sleep aids D) Penicillin-type antibiotics - Answers Ans: A Ototoxic
medications include (but are not limited to) aminoglycosides, macrolides, quinolones, and some
antifungals (not penicillins), aspirin and other salicylates, as well as nonsteroidal anti-inflammatory
drugs. Neither sleep aids nor stool softeners have been implicated in ototoxicity
After an older adult has had irrigation for removing impacted cerumen, which of the following
interventions would be helpful for preventing a recurrence? (Select all that apply.) A) Ceruminolytic
drops as indicated B) Cotton-tipped swabs daily C) Ear candling monthly D) Home oral jet irrigator
bimonthly E) Examination by the health care provider every 6 to 12 months - Answers Ans: A, E
Prophylactic use of ceruminolytic agents can reduce the risk of impacted cerumen. Those at high risk for
impaction should get an examination by qualified health care provider every 6 to 12 months. Teach all
older adults to avoid putting anything smaller than their elbow in their ear: this includes candles, oral
jets, and swabs. All of these are potentially harmful to the ear
A 62-year-old who has worked on an assembly line since he was 24 years old began taking aspirin for
arthritis 6 months ago. The client presents to the nurse with hearing problems and ringing in the ears.
Which of the following problems should the nurse suspect? A) Tinnitus B) Vertigo C) Ototoxicity D)
Impacted cerumen - Answers Ans: CThe older adult has symptoms of ototoxicity. Aspirin is a known
ototoxic drug. Tinnitus is the persistent sensation of ringing in the ears, which is one of this client's
symptoms. Vertigo is a sensation of motion, which is not a reported symptom for this client. Although
common, impacted cerumen would not lead to ringing in the ears.
A new nursing assistant asks the nurse how best to approach a hearingimpaired older adult. Which of
the following approaches should the nurse recommend? A) Raise the volume of your voice. B) Leave the
radio on to calm the older adult. C) Lower the tone of your voice. D) Use exaggerated lip movements. -
Answers Ans: C Communication interventions for the hearing impaired should aim at clarity of words.
This is accomplished by slowing the rate of speech and eliminating environmental noise and distractions.
When communicating, lower the tone while speaking in a moderately loud voice
A nurse is teaching a group of hearingimpaired nursing home residents about hearing aids. Which of the
following points should the nurse emphasize? A) It is not necessary to use the hearing aid for one-on-
one conversations. B) The hearing aid should be used only in the dining room or social area. C) While
inserting the hearing aid, make sure the volume is turned off. D) If whistling is heard, the volume of the
hearing aid may need to be increased - Answers Ans: C The hearing aid should be inserted with the
volume off with the canal portion pointing into the ear. A hearing aid should be used for one-on-one
conversation and should not be used in a dining room where there is background noise. If whistling is
heard, the volume should be decreased
A nurse notes that a client who has heart failure could hear well during the last home visit, and is having
difficulty hearing today. Which of the following laboratory findings is most likely associated with
impaired hearing? A) Albumin of 4.1 B) Creatinine of 4.2 C) Potassium of 4.3 D) Sodium of 144 - Answers
Ans: B Older adults with heart failure are at increased risk for hearing loss caused by medications (e.g.,
diuretics) and decreased renal and cardiac perfusion. Normal levels of albumin, potassium, and sodium
are not associated with hearing loss
An 85-year-old woman who lives alone says to the nurse, "There is nothing I can do about my hearing. I
am 85 years old, and I am not really interested in listening to television programs anymore." Which of
the following would be the nurse's best response?A)"You are lucky you still live alone at 85, and I
understand why you don't care about the programs on television."B)"Have you talked with your health
care provider about a hearing evaluation? This would determine the problem and possible solutions to
it."C)"I know a hearing aid dealer who offers free testing. Have you thought about trying a hearing
aid?"D)"Did you know that there are closedcaption television sets that would allow you to enjoy some
shows?" - Answers Ans: B The first step would be to determine what the problem is. Free testing is not
comprehensive in its evaluative scope. Telling the client she is lucky to be living alone at 85 years of age
,is nontherapeutic communication and suggesting that the woman use closedcaption television does not
address the hearing issue.
A 76-year-old adult expresses frustration to the nurse regarding hearing loss despite a lifetime of being
conscientious about avoiding known causes of hearing damage. Which of the following age-related
changes may result in hearing loss? A) Degeneration of the inner ear structures B) Decreased viscosity
and quantity of cerumen C) Plaque formation and occlusion of the Eustachian tubes D) Hypertrophy of
the external ear structures - Answers Ans: A Age-related changes of the inner ear include loss of hair
cells, reduction of blood supply, diminution of endolymph production, decreased basilar membrane
flexibility, degeneration of spiral ganglion cells, and loss of neurons in the cochlear nuclei. These inner
ear changes result in the degenerative hearing impairment termed presbycusis. Cerumen often becomes
more viscous with age, and occlusion of the Eustachian tubes is not a normal, age-related change.
Changes to the external ear structures are not implicated in age-related hearing loss
A nurse who regularly visits an adult daycare center has noted evidence of a hearing deficit in a man
who has no documented history of hearing loss. Which of the following factors should the nurse
consider when attempting to ascertain the etiology of the man's hearing loss? (Select all that apply.) A)
Genetic factors B) Environmental conditions C) Fluid and electrolyte imbalances D) Ototoxic medications
E) Atherosclerosis or thrombotic events - Answers Ans: A, B, D Medications, genetic factors, and
environmental factors are all among the many potential contributors to hearing loss in older adults.
Fluid and electrolyte imbalances, atherosclerosis, and thrombosis are not commonly implicated in
hearing loss among older adults
The incidence of hearing loss in a longterm care facility is high, especially among white men. What
strategy should care providers adopt when communicating with older adults who have hearing loss?
A)Use less complex concepts when communicating with hearing-impaired older adults.B) Use a high,
consistent tone and pitch when speaking to adults with hearing loss.C)Speak at a high volume directly
into the less affected ear when talking to an older adult with a hearing deficit.D)Make eye contact
before and during a conversation with hearing-impaired adults. - Answers Ans: D Eye contact helps
facilitate communication with individuals who have hearing loss. It is unnecessary, and likely
inappropriate, to simplify the content of conversations, and a low tone is more beneficial than a high
tone. It is not normally necessary to speak directly into the ear of the older adult
As part of a comprehensive physical assessment of an older adult client, a nurse is performing an
otoscopic examination. Which of the following assessment findings most clearly warrants further
assessment and possible intervention? A) There is a small amount of cerumen visible in the ear canal. B)
The epithelial lining is bright red. C) The tympanic membrane is intact. D) The tympanic membrane is a
pearl-gray color - Answers Ans: B Bright red epithelial lining in the ear is an abnormal finding; the lining
should be pinkish white. A small amount of cerumen and an intact, pearl-gray tympanic membrane are
expected findings
A nurse has been caring for an 83-yearold resident of a nursing home for 2 years and has developed a
high level of trust with the resident. Which of thefollowing recent changes in the resident's behavior
, may signal the possibility of hearing loss? A) The resident's statements occasionally suggest that he is
not oriented to time.B)The resident had a recent episode where he became visibly angry at a nursing
assistant. C) The resident's attention span is short and he is easily distracted. D) The resident has
become increasingly disagreeable and terse in his demeanor - Answers Ans: CShort attention span and
easy distractibility are indicators of hearing loss. Aggression and agitation more often suggest alternative
etiologies, such as neurologic health problems
A gerontological nurse presents at a local conference regarding recent findings in age-related hearing
loss. Which age-related changes indicated in hearing loss and speech perception should the nurse
include? A) Changes to the external auditory canal and pinna B) Degenerative changes to the auditory
brainstem C) Growth of longer and thicker hair in the ear canal D) Thickening of the tympanic membrane
- Answers Ans: B Studies suggest that central auditory structures (e.g., primary auditory cortex and
auditory brainstem) account for a significant component of hearing loss in older adults, particularly with
regard to speech perception. The external ear changes that occur with normal aging are not directly
related to hearing loss (including hair growth in men). The tympanic membrane thins and stiffens with
age
The Functional Consequences Theory approach to hearing loss identifies health promotion interventions
for promoting hearing wellness. Which of the following interventions will most directly affect auditory
health of the older adult? A) Avoidance of medications B) Regular colonics C) Smoking cessation D) Ear
muff use in winter - Answers Ans: C Reviews of studies identified the following risk factors for hearing
impairment: male gender, increased age, genetic predisposition, exposure to noise, impacted cerumen,
smoking, exposure to secondhand smoke, use of ototoxic medications, education level less than or equal
to high school diploma, and certain medical conditions. Colonic use and ear coverage for warmth have
not been identified as risk factors to hearing loss
A nurse teaches an older adult about risks related to ototoxic medications. Which of the following
medications should the adult minimize or avoid? A) Nonsteroidal anti-inflammatory agents B) Osmotic
stool softeners C) Over-the-counter sleep aids D) Penicillin-type antibiotics - Answers Ans: A Ototoxic
medications include (but are not limited to) aminoglycosides, macrolides, quinolones, and some
antifungals (not penicillins), aspirin and other salicylates, as well as nonsteroidal anti-inflammatory
drugs. Neither sleep aids nor stool softeners have been implicated in ototoxicity
After an older adult has had irrigation for removing impacted cerumen, which of the following
interventions would be helpful for preventing a recurrence? (Select all that apply.) A) Ceruminolytic
drops as indicated B) Cotton-tipped swabs daily C) Ear candling monthly D) Home oral jet irrigator
bimonthly E) Examination by the health care provider every 6 to 12 months - Answers Ans: A, E
Prophylactic use of ceruminolytic agents can reduce the risk of impacted cerumen. Those at high risk for
impaction should get an examination by qualified health care provider every 6 to 12 months. Teach all
older adults to avoid putting anything smaller than their elbow in their ear: this includes candles, oral
jets, and swabs. All of these are potentially harmful to the ear
