1|Page
# TEST BANK FOR PRIMARY CARE: THE ART
AND SCIENCE OF ADVANCED PRACTICE
NURSING
## CHAPTER 23: INFLAMMATORY AND INFECTIOUS
DISORDERS OF THE EAR
SECTION I: ANATOMY AND ASSESSMENT OF THE EAR (Questions
1-5)
**1. A nurse practitioner palpates a patient's ear and finds that the tragus
is exquisitely tender. This finding is most consistent with which
condition?**
A) Acute otitis media
B) Otitis externa
C) Mastoiditis
D) Ruptured tympanic membrane
**Correct Answer: B**
**Rationale:** Tragal tenderness (pain on manipulation of the tragus or
pinna) is the hallmark physical examination finding of otitis externa
(OE). This occurs because the external auditory canal becomes
edematous and inflamed. In contrast, acute otitis media typically
presents with pain that is relieved by tragal traction, while mastoiditis
,2|Page
presents with tenderness behind the ear over the mastoid process. A
ruptured tympanic membrane may present with sudden pain relief
followed by otorrhea.
---
**2. During a Weber tuning fork test, the patient reports that the sound
lateralizes to the left ear. The Rinne test demonstrates air conduction
greater than bone conduction bilaterally (AC > BC). This pattern
indicates:**
A) Right sensorineural hearing loss
B) Left sensorineural hearing loss
C) Right conductive hearing loss
D) Left conductive hearing loss
**Correct Answer: B**
**Rationale:** In the Weber test, sound lateralizes to the ear with
sensorineural loss (the "good" ear hears better) OR to the ear with
conductive loss (the "bad" ear hears better due to less environmental
noise interference). However, bilateral AC > BC on Rinne indicates
normal or sensorineural function. When Weber lateralizes to the left and
Rinne is normal bilaterally, this indicates left sensorineural hearing loss.
,3|Page
Conductive loss would show BC > AC (Rinne negative) on the affected
side.
---
**3. A 45-year-old patient presents with complaints of progressive
hearing loss,耳鸣, and occasional dizziness. Otoscopic examination
reveals a normal-appearing tympanic membrane. The nurse practitioner
suspects otosclerosis. Which tuning fork finding is most characteristic of
this condition?**
A) Weber lateralizes to affected ear; Rinne shows BC > AC in affected
ear
B) Weber lateralizes to unaffected ear; Rinne shows AC > BC in both
ears
C) Weber midline; Rinne shows AC > BC in both ears
D) Weber lateralizes to affected ear; Rinne shows AC > BC in affected
ear
**Correct Answer: A**
**Rationale:** Otosclerosis causes conductive hearing loss due to
fixation of the stapes bone. In conductive hearing loss, the Weber test
lateralizes to the affected (worse) ear because bone conduction is
perceived as louder when ambient noise is blocked. The Rinne test
, 4|Page
shows bone conduction greater than air conduction (BC > AC) on the
affected side, indicating a negative Rinne. The unaffected ear will have
normal AC > BC findings.
---
**4. A nurse practitioner performs pneumatic otoscopy on a child with
suspected middle ear effusion. Which finding would be most consistent
with this diagnosis?**
A) Tympanic membrane is pearly gray with brisk mobility
B) Tympanic membrane is erythematous, bulging, with absent mobility
C) Tympanic membrane is retracted with visible fluid level and
decreased mobility
D) Tympanic membrane is perforated with purulent drainage
**Correct Answer: C**
**Rationale:** Otitis media with effusion (OME) presents with a
retracted tympanic membrane, visible air-fluid level or bubbles behind
the TM, and decreased mobility on pneumatic otoscopy. The membrane
is typically not erythematous or bulging (those findings suggest AOM).
Normal TM is pearly gray with brisk mobility. Perforation suggests
acute or chronic suppurative otitis media.
# TEST BANK FOR PRIMARY CARE: THE ART
AND SCIENCE OF ADVANCED PRACTICE
NURSING
## CHAPTER 23: INFLAMMATORY AND INFECTIOUS
DISORDERS OF THE EAR
SECTION I: ANATOMY AND ASSESSMENT OF THE EAR (Questions
1-5)
**1. A nurse practitioner palpates a patient's ear and finds that the tragus
is exquisitely tender. This finding is most consistent with which
condition?**
A) Acute otitis media
B) Otitis externa
C) Mastoiditis
D) Ruptured tympanic membrane
**Correct Answer: B**
**Rationale:** Tragal tenderness (pain on manipulation of the tragus or
pinna) is the hallmark physical examination finding of otitis externa
(OE). This occurs because the external auditory canal becomes
edematous and inflamed. In contrast, acute otitis media typically
presents with pain that is relieved by tragal traction, while mastoiditis
,2|Page
presents with tenderness behind the ear over the mastoid process. A
ruptured tympanic membrane may present with sudden pain relief
followed by otorrhea.
---
**2. During a Weber tuning fork test, the patient reports that the sound
lateralizes to the left ear. The Rinne test demonstrates air conduction
greater than bone conduction bilaterally (AC > BC). This pattern
indicates:**
A) Right sensorineural hearing loss
B) Left sensorineural hearing loss
C) Right conductive hearing loss
D) Left conductive hearing loss
**Correct Answer: B**
**Rationale:** In the Weber test, sound lateralizes to the ear with
sensorineural loss (the "good" ear hears better) OR to the ear with
conductive loss (the "bad" ear hears better due to less environmental
noise interference). However, bilateral AC > BC on Rinne indicates
normal or sensorineural function. When Weber lateralizes to the left and
Rinne is normal bilaterally, this indicates left sensorineural hearing loss.
,3|Page
Conductive loss would show BC > AC (Rinne negative) on the affected
side.
---
**3. A 45-year-old patient presents with complaints of progressive
hearing loss,耳鸣, and occasional dizziness. Otoscopic examination
reveals a normal-appearing tympanic membrane. The nurse practitioner
suspects otosclerosis. Which tuning fork finding is most characteristic of
this condition?**
A) Weber lateralizes to affected ear; Rinne shows BC > AC in affected
ear
B) Weber lateralizes to unaffected ear; Rinne shows AC > BC in both
ears
C) Weber midline; Rinne shows AC > BC in both ears
D) Weber lateralizes to affected ear; Rinne shows AC > BC in affected
ear
**Correct Answer: A**
**Rationale:** Otosclerosis causes conductive hearing loss due to
fixation of the stapes bone. In conductive hearing loss, the Weber test
lateralizes to the affected (worse) ear because bone conduction is
perceived as louder when ambient noise is blocked. The Rinne test
, 4|Page
shows bone conduction greater than air conduction (BC > AC) on the
affected side, indicating a negative Rinne. The unaffected ear will have
normal AC > BC findings.
---
**4. A nurse practitioner performs pneumatic otoscopy on a child with
suspected middle ear effusion. Which finding would be most consistent
with this diagnosis?**
A) Tympanic membrane is pearly gray with brisk mobility
B) Tympanic membrane is erythematous, bulging, with absent mobility
C) Tympanic membrane is retracted with visible fluid level and
decreased mobility
D) Tympanic membrane is perforated with purulent drainage
**Correct Answer: C**
**Rationale:** Otitis media with effusion (OME) presents with a
retracted tympanic membrane, visible air-fluid level or bubbles behind
the TM, and decreased mobility on pneumatic otoscopy. The membrane
is typically not erythematous or bulging (those findings suggest AOM).
Normal TM is pearly gray with brisk mobility. Perforation suggests
acute or chronic suppurative otitis media.
