Chapter 12: Ears, Nose, and Throat Test Bank—Nursing (100% Correct solution) | with Rationales

Chapter 12: Ears, Nose, and Throat Test Bank—Nursing MULTIPLE CHOICE 1. The middle ear contains the: a. cerumen and sebaceous glands. b. umbo and malleus. c. vestibule and cochlea. d. p ars tensa and semicircular canals. ANS: B The middle ear contains the ossicles, three small bones—the malleus (umbo is part of the malleus), the incus, and the stapes. Cerumen and sebaceous glands lie outside the middle ear. The vestibule and the cochlea lie in the inner ear. The tympanic membrane separates the external ear from the middle ear and is composed of the pars tensa, and the semicircular canals lie in the inner ear. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. The middle ear is normally filled with: a. air. b. blood. c. serous fluid. d. cerebrospinal fluid. ANS: A The middle ear normally is an air-filled cavity in the temporal bone. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The hair cells of Corti and membrane of Corti: a. produce a waxy lubricant. b. protect the ear from foreign particles. c. stimulate the eighth cranial nerve. d. transmit vibrations to the ossicles. ANS: C Vibrations from the tympanic membrane cause the delicate hair cells of the organ of Corti to strike against the membrane of Corti, stimulating impulses in the sensory endings of the auditory division of the eighth cranial nerve. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 4. The organ of Corti is a coiled structure located inside the: a. cochlea in the inner ear. b. pars flaccida in the tympanic membrane. c. eustachian tube. d. lateral aspect of the pinna. ANS: A The cochlea is a coiled structure within the inner ear that contains the organ of Corti. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 5. Mrs. Kinder is a 39-year-old patient who presents to the office with complaints of an earache. In explaining to the patient about the function of her ears, which ear structure would you tell her is responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning? a. Eustachian tube b. Inner ear c. Pars flaccida d. Triangular fossa ANS: A The eustachian tube is a cartilaginous and bony passageway between the nasopharynx and middle ear that opens briefly to equalize the middle ear pressure with that of the atmospheric pressure when swallowing, yawning, or sneezing. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 6. Mr. Sprat is a 21-year-old patient who complains of nasal congestion. He admits to using recreational drugs. On examination, you have noted a septal perforation. Which of the following recreational drugs is commonly associated with nasal septum perforation? a. Heroin b. Cocaine c. PCP d. Ecstasy ANS: B Long-term cocaine snorting causes ischemic necrosis of the septal cartilage and leads to perforation of the nasal septum. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 243 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 7. A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness, you should palpate over the: a. sphenoid and frontal sinuses. b. maxillary and frontal sinuses. c. maxillary sinuses only. d. sphenoid sinuses only. ANS: C Only the maxillary and the frontal sinuses are accessible for physical examination; however, the young child does not develop frontal sinuses until 7 to 8 years of age. DIF: Cognitive Level: Applying (Application) REF: p. 233 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 8. An infant’s auditory canal, compared with an adult’s, is: a. short, narrow, and straight. b. short and curved upward. c. long, narrow, and curved forward. d. short and curved downward. ANS: B Compared with the adult’s, the infant’s auditory canal is shorter and has an upward curve, which is why pulling the pinna down straightens the canal. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 9. Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to: a. pull the auricle down and back. b. hold the speculum in the canal. c. distract the infant. d. stabilize the chest. ANS: A The nurse should use the other hand to pull the auricle down and back in an effort to straighten the upward curvature of the canal. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 249 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 10. The eruption of permanent teeth usually begins with: a. upper central incisors. b. upper canines. c. lower central incisors. d. lower canines. ANS: C The central incisors on the lower jaw usually erupt between 6 and 7 years of age as the first permanent teeth. Upper central incisors appear at 7 to 8 years of age. Upper canines appear at 11 to 12 years of age. Lower canines appear at 9 to 10 years of age. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 11. Mrs. Donaldson is a 31-year-old patient who is pregnant. In providing Mrs. Donaldson with health care information, you will explain that she can expect to experience: a. more nasal stuffiness. b. a sensitive sense of smell. c. drooling. d. enhanced hearing. ANS: A Physiologic changes of pregnancy include nasal stuffiness, a decreased sense of smell, impaired hearing, epistaxis, and a sense of fullness in the ears. DIF: Cognitive Level: Applying (Application) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 12. During which developmental stage are hoarseness, voice cracking, and a persistent cough common findings in females? a. Adolescence b. Infancy c. Menopause d. Pregnancy ANS: D Laryngeal changes in pregnancy include hoarseness, deepening or cracking of the voice, vocal changes, and a persistent cough. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 13. Hearing tends to decline after 50 years of age because of deterioration of: a. hair cells of the organ of Corti. b. the eustachian tube. c. the helix. d. cerumen. ANS: A Hearing declines after 50 years of age because of degeneration of hair cells in the organ of Corti, as well as atrophy of the hair cells in the cochlea. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 14. You are performing hearing screening tests. Who would be expected to find difficulty in hearing the highest frequencies? a. A 7-year-old b. An 18-year-old c. A 30-year-old d. A 50-year-old ANS: D Sensorineural hearing loss begins after 50 years of age, initially with losses of high-frequency sounds and then progressing to tones of lower frequency. DIF: Cognitive Level: Applying (Application) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 15. Mr. Spencer presents with the complaint of hearing loss. You specifically inquire about current medications. Which medications, if listed, are likely to contribute to his hearing loss? a. Chlorothiazide b. Acetaminophen c. Salicylates d. Cephalosporins ANS: C Ototoxic medications include aminoglycoside, salicylates, furosemide, streptomycin, quinine, ethacrynic acid, and cisplatin. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 16. Mr. Williams, age 25 years, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented in which section of his history? a. Age-specific data b. Past medical data c. Past surgical data d. Social history ANS: B Information concerning the patient’s chronic postnasal drip is part of the past medical history. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 238 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 17. A 6-month-old who can hear well can be expected to: a. exhibit the Moro reflex. b. stop breathing in response to sudden noise. c. turn his or her head toward the source of sound. d. imitate simple words. ANS: C Six-month-old infants turn their head toward the source of sound; they start babbling, but they begin imitating speech sounds closer to 10 months of age. The Moro reflex and cessation of breathing in response to noise are lost by 3 months of age. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 250 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 18. Which risk factor is associated with the highest rate of oral cancers? a. Women b. Being younger than 55 years c. excessive caffeine use d. Fanconi anemia ANS: D Risk factors for oral cancer include age older than 55years, male gender, excessive alcohol use, dental lesions, tobacco use, occupational hazards (e.g., textile industry, leather manufacturing), and systemic disease (e.g., pernicious or iron deficiency anemia, HIV infection, lichen planus, previous malignancy). DIF: Cognitive Level: Remembering (Knowledge) REF: p. 247 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 19. To approximate vocal frequencies, which tuning fork should be used to assess hearing? a. 100 to 300 Hz b. 200 to 400 Hz c. 500 to 1000 Hz d. 1500 to 2000 Hz ANS: C Use of a 500- to 1000-Hz tuning fork approximates vocal frequencies. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 238 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 20. You are using a pneumatic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to: a. remove all cerumen from the canal. b. change to a larger speculum. c. squeeze the bulb with more force. d. insert the speculum to a depth of 2 cm. ANS: B To see tympanic movement when using the pneumatic attachment, there should be a seal around the speculum to block outside air. In this manner, the normal tympanic membrane moves as a result of pressure changes from the insufflator bulb. A soft rubber speculum is recommended to establish the seal. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 240 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 21. An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or: a. digestive disorders. b. skeletal anomalies. c. renal disorders. d. heart defects. ANS: C An auricle with a low-set or unusual angle may indicate chromosomal aberrations or renal disorders. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 249 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 22. When conducting an adult otoscopic examination, you should: a. position the patient’s head leaning toward you. b. grasp the handle of the otoscope as you would a baseball bat. c. select the largest speculum that will fit in the canal. d. ask the patient to keep his or her eyes closed. ANS: C When conducting an adult otoscopic examination, select the largest speculum that will comfortably fit in the patient’s ear. When you are conducting an adult otoscopic examination, the patient’s head should be positioned toward the opposite shoulder. Hold the handle of the otoscope between the thumb and index finger, supporting it on the middle finger. There is no reason for the patient to keep her or his eyes shut. DIF: Cognitive Level: Applying (Application) REF: p. 240 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 23. Normal tympanic membrane color is: a. amber. b. chalky white. c. green. d. pearly gray. ANS: D The expected normal tympanic membrane color is pearly gray. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 240 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 24. Bulging of an amber tympanic membrane without mobility is usually associated with: a. middle ear effusion. b. healed tympanic membrane perforation. c. impacted cerumen in the canal. d. repeated and prolonged crying cycles. ANS: A An amber color, with bulging of the tympanic membrane and without mobility or redness, usually indicates the presence of fluid in the middle ear. DIF: Cognitive Level: Applying (Application) REF: p. 241 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 25. Severe vertigo, tinnitus, and progressive hearing loss are characteristic of: a. cholesteatoma. b. Ménière disease. c. otosclerosis. d. cocaine abuse. ANS: B The classic triad of Ménière disease is vertigo, tinnitus, and progressive hearing loss. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 242 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 26. When hearing is evaluated, which cranial nerve is being tested? a. III b. IV c. VIII d. XII ANS: C Cranial nerve VIII, the vestibulocochlear nerve, is associated with hearing. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 240 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 27. Speech with a monotonous tone and erratic volume may indicate: a. otitis externa. b. hearing loss. c. serous otitis media. d. sinusitis. ANS: B Speech with a monotonous tone and erratic volume may indicate hearing loss. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 241 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 28. Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for: a. air conduction of sound. b. bone versus air conduction. c. lateralization of sound. d. mallear auditory ability. ANS: C Placing the fork on the midline vertex of the patient’s head is the Weber test, a test for conductive hearing loss that lateralizes to the affected ear. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 242 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 29. To perform the Rinne test, place the tuning fork on the: a. top of the head. b. mastoid bone. c. forehead. d. preauricular area. ANS: B The fork is initially placed against the mastoid bone for the Rinne test, a test for sensorineural loss. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 242 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 30. You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, air conduction–to–bone conduction ratio is less than 2:1. You interpret these findings as suggestive of: a. a defect in the inner ear. b. a defect in the middle ear. c. otitis externa. d. impacted cerumen. ANS: A These results are consistent with a sensorineural hearing loss, a defect in the inner ear. Otitis externa and impacted cerumen are conditions of the external ear that can cause conductive hearing problems. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 242 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 31. Nasal symptoms that imply an allergic response include: a. purulent nasal drainage. b. bluish gray turbinates. c. small, atrophied nasal membranes. d. firm consistency of turbinates. ANS: B Nasal symptoms that imply an allergic response include bluish gray or pale pink nasal turbinates that are swollen and boggy and a transverse crease at the junction between the cartilage and bone of the nose. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 243 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 32. You are interviewing a parent whose child has a fever, is pulling at her right ear, and is irritable. You ask the parent about the child’s appetite and find that the child has a decreased appetite. This additional finding is more suggestive of: a. acute otitis media. b. otitis externa. c. serous otitis media. d. middle ear effusion. ANS: A Anorexia is an initial symptom of acute otitis media. DIF: Cognitive Level: Analyzing (Analysis) REF: p. 256 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 33. A smooth red tongue with a slick appearance may indicate: a. niacin or vitamin B12 deficiency. b. oral cancer. c. recent use of antibiotics. d. fungal infection. ANS: A A smooth red tongue with a slick appearance may indicate a niacin or vitamin B12 deficiency. Oral cancer involves lesions, recent use of antibiotics can turn the tongue yellow-brown to black and hairy, and fungal infections result in slightly raised white, cream-colored, or yellow spots in the mouth. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 247 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 34. White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are: a. Fordyce spots. b. aphthous ulcers. c. Stensen ducts. d. leukoedema. ANS: B Aphthous ulcers are white, round, or oval lesions surrounded by a red halo that appear on the buccal mucosa. Fordyce spots are ectopic sebaceous glands that appear on the buccal mucosa and lips as numerous small, yellow-white, raised lesions. Stensen ducts are parotid gland outlets and should appear as whitish yellow or whitish pink protrusions in approximate alignment with the second upper molar. Leukoedema appears on the buccal mucosa as a diffuse filmy grayish surface with white streaks, wrinkles, or milky alterations. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 246 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 35. A hairy tongue with yellowish brown to black elongated papillae on the dorsum: a. is indicative of oral cancer. b. is sometimes seen following antibiotic therapy. c. usually indicates vitamin deficiency. d. usually indicates anemia. ANS: B Recent antibiotic use can turn the tongue yellow-brown to black and make it appear hairy. Oral cancer involves lesions. A smooth red tongue with a slick appearance may indicate a niacin or vitamin B12 deficiency. Pallor usually indicates anemia. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 247 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 36. To inspect the lateral borders of the tongue, you should: a. ask the patient to extend the tongue outward. b. insert the tongue blade obliquely against the tongue. c. lift the tongue upward with gloved fingers. d. pull the gauze-wrapped tongue to each side. ANS: D To inspect the lateral borders of the tongue, you should wrap the tongue with a piece of gauze and then pull the tongue to each side for inspection. DIF: Cognitive Level: Applying (Application) REF: p. 247 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 37. A newborn whose serum bilirubin level is greater than 20 mg/100 mL has a risk of later: a. hearing loss. b. sinusitis. c. tooth decay. d. meningitis. ANS: A Risk factors for hearing loss in infants include infection, irradiation, drug abuse, and syphilis in the mother, as well as birth weight less than 1500 g, excessively high bilirubin level, infections (e.g., bacterial meningitis, recurrent otitis media), cleft palate, craniofacial abnormalities, ototoxic antibiotic use, head trauma, and hypoxic episodes in infancy. DIF: Cognitive Level: Applying (Application) REF: p. 238 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 38. Which variation may be an expected finding in the ear examination of a newborn? a. Diffuse light reflex b. Purulent material in the ear canal c. Redness and swelling of the mastoid process d. Small perforations of the tympanic membrane ANS: A The newborn’s tympanic membrane does not become conical for several months; therefore, the light reflex appears diffuse. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 249 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 39. For best results, an otoscopic and oral examination in a child should be: a. conducted at the beginning of the assessment. b. done after inspection. c. performed at the end of the examination. d. performed before palpation. ANS: C Because young children often resist an otoscopic and oral examination, it may be wise to postpone these procedures until the end, after you have gained some trust. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 251 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 40. Which abnormality is common during pregnancy? a. Eruption of additional molars b. Hypertrophy of the gums c. Otitis externa d. Otitis media ANS: B The gums of pregnant women may appear reddened, swollen, and spongy, with the hypertrophy resolving within 2 months of delivery. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 253 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 41. Intense pain with movement of the pinna is most closely associated with: a. otitis media with effusion. b. otitis externa. c. purulent otitis media. d. bacterial otitis media. ANS: B Otitis externa (swimmer’s ear) should be suspected when pulling of the pinna reproduces ear pain. DIF: Cognitive Level: Applying (Application) REF: p. 254 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 42. Expected physical changes associated with older adults include: a. shiny buccal mucosa. b. shorter teeth. c. wetter nasal mucosa. d. bristly hairs in the vestibule. ANS: D With age, the buccal mucosa becomes less shiny, teeth appear longer because of gums receding, nasal mucosa are drier, and more bristly hairs appear in the nose, especially in men. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 253 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation COMPLETION 1. In adults, the length of the external auditory canal is cm. ANS: 2.5 The external ear canal is approximately 2.5 cm long in adults. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 231 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. When you ask the patient to identify smells, you are assessing cranial nerve . ANS: I The first cranial nerve, the olfactory nerve, is tested when you ask a patient to identify different smells. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 244 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 3. The structures that lie along the lateral wall of the nasal cavity near the facial cheek are the sinuses. ANS: maxillary The maxillary sinuses lie along the nasal cavity near the cheek, the ethmoid sinuses lie behind the frontal sinuses near the superior portion of the nasal cavity, and the paranasal sinuses are extensions of the nasal cavities within the skull. DIF: Cognitive Level: Remembering (Knowledge) REF: p. 233 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation MULTIPLE RESPONSE 1. Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss. Which of the following are changes in hearing that occur in older adults? (Select all that apply.) a. Results from cranial nerve VII b. Slow progression c. Loss of high frequency d. Bone conduction heard longer than air conduction e. Sounds may be garbled, difficult to localize f. Unable to hear in a crowded room ANS: C, E, F Age-related hearing loss is associated with degeneration of hair cells in the organ of Corti, loss of cortical and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased vascularity in the cochlea. Sensorineural hearing loss first occurs with high-frequency sounds and then progresses to tones of lower frequency. Loss of high- frequency sounds usually interferes with the understanding of speech and localization of sound. Conductive hearing loss may result from an excess deposition of bone cells along the ossicle chain, causing fixation of the stapes in the oval window, cerumen impaction, or a sclerotic tympanic membrane. DIF: Cognitive Level: Applying (Application) REF: p. 236 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation 2. Which of the following signs and symptoms occur with a sensorineural hearing loss? (Select all that apply.) a. Air conduction shorter than bone conduction b. Lateralization to the affected ear c. Loss of high-frequency sounds d. Speaks more loudly e. Disorder of the inner ear f. Air conduction longer than bone conduction ANS: C, D, E, F The signs and symptoms of sensorineural hearing loss include loss of high-frequency sounds, speaks more loudly, disorder of the inner ear, air conduction longer than bone conduction, and lateralization to the unaffected ear. DIF: Cognitive Level: Applying (Application) REF: p. 256 OBJ: Nursing process—assessment MSC: Physiologic Integrity: Physiologic Adaptation Show Less