Ch14 Ears, Nose, Mouth, And Throat

The correct answer is "palate." The palate refers to the anterior portion of the roof of the mouth that is formed by bones. It separates the oral and nasal cavities and plays a crucial role in speech and swallowing. The palate also helps to direct airflow during breathing and prevents food and liquid from entering the nasal passages.

Presbycusis is the correct answer because it is a type of high-frequency hearing loss that occurs gradually over time, often associated with aging. The other options, paranasal sinuses, uvula, and palate, are not related to hearing loss.

Mastoiditis is the correct answer because it refers to the inflammation of the mastoid, which can occur as a result of an infection in the middle ear or throat. This condition typically causes pain, swelling, and redness behind the ear, and may also lead to fever and drainage from the ear. Prompt medical treatment is necessary to prevent complications such as hearing loss or the spread of infection to surrounding areas. Otitis externa, on the other hand, refers to inflammation of the outer ear canal, while air conduction (AC) and bone conduction (BC) are terms related to hearing tests.

Smooth, pale, benign growths found along the turbinates of the nose are known as nasal polyps. Nasal polyps are noncancerous growths that develop in the lining of the nasal passages or sinuses. They can vary in size and may cause symptoms such as nasal congestion, runny nose, facial pain, and reduced sense of smell. They are often associated with chronic inflammation and can be caused by conditions like allergies, asthma, or recurring infections. Treatment options for nasal polyps include medication to reduce inflammation, nasal sprays, or in some cases, surgical removal.

Focused Interview Questions, Mouth and Throat

Dysphagia is difficulty in swallowing and may be due to a neurologic or gastrointestinal problem, or it may be related to ill-fitting dentures or malocclusion. Gingivitis is inflammation of the gingivae (gums) and not associated with dysphagia. Loss of sense of taste and smell is not related to swallowing difficulties. A sore throat is called pharyngitis and is not related to difficulty in swallowing.

Nursing Process Step: Assessment
Cognitive Level: Application
Client Need: Physiological Integrity

The correct answer is the tympanic membrane. This membrane, also known as the eardrum, is located between the external ear and the middle ear. It plays a crucial role in transmitting sound vibrations from the external ear to the middle ear. When sound waves enter the ear canal, they cause the tympanic membrane to vibrate, which in turn sets the ossicles (tiny bones in the middle ear) into motion. This vibration is then transmitted to the inner ear, specifically the cochlea, where it is converted into electrical signals that can be interpreted by the brain as sound.

Paranasal sinuses are mucous-lined, air-filled cavities that surround the nasal cavity. They are responsible for performing air-processing functions such as filtration, moistening, and warming. These sinuses help to reduce the weight of the skull, improve the resonance of the voice, and provide protection to the nasal cavity.

Tonsillitis is characterized by inflammation of the tonsils, which leads to a red throat and swollen tonsils. The tonsils may also be covered by white or yellow patches or exudate. Additionally, lymph nodes in the cervical chain may become enlarged. Tonsillitis can be accompanied by a high fever.

Otitis externa is the correct answer because it refers to an infection of the outer ear or ear canal, commonly known as swimmer's ear. This condition is caused by bacteria or fungi entering the ear canal, often due to water exposure or damage to the skin lining the ear canal. Symptoms of otitis externa include ear pain, itching, redness, and swelling. If left untreated, it can lead to complications such as mastoiditis, which is an infection of the mastoid bone located behind the ear. Air conduction (AC) and bone conduction (BC) are unrelated terms in audiology and not relevant to the given question.

The external portion of the ear is known as the auricle or pinna. It is the visible part of the ear that is composed of cartilage and covered by skin. The auricle helps to collect sound waves and direct them into the ear canal. It also plays a role in localizing the source of sound. The term "pinna" is often used interchangeably with "auricle" to refer to this external part of the ear.

The correct answer is uvula. The uvula is a fleshy pendulum that hangs from the edge of the soft palate in the back of the mouth. It moves with swallowing, breathing, and phonation.

Bone conduction (BC) refers to the transmission of sound through the bones of the skull to the cochlea and auditory nerve. This means that sound vibrations bypass the outer and middle ear and directly stimulate the inner ear. Otitis externa and mastoiditis are both conditions affecting the outer ear and would not impact bone conduction. Air conduction (AC) refers to the transmission of sound through the air and the normal pathway of sound conduction through the ear. Therefore, the correct answer is bone conduction (BC).

Epistaxis is the medical term for a nosebleed. It can occur as a result of trauma, such as a blow to the nose, or it may be associated with other health conditions like rhinitis, hypertension, or a blood coagulation disorder. The answer provided correctly identifies epistaxis as the term for a nosebleed.

Sinusitis is the correct answer because it matches the symptoms described in the question. Sinusitis is the inflammation of the sinuses, often occurring after an upper respiratory infection. It causes facial pain, inflammation, and discharge. The symptoms mentioned in the question, such as fever, chills, frontal headache, and pain in the cheeks or teeth, are commonly associated with sinusitis.

When the client begins to gag while the examiner is inspecting their throat with a tongue blade, it indicates that the client has a functioning response. Gagging is a protective reflex that occurs when the back of the throat is stimulated, such as by the presence of a foreign object. This reflex helps to prevent choking and aspiration of the object into the airway. Therefore, the client's gag reflex is working properly in this situation.

The eustachian tube is the correct answer because it is the bony and cartilaginous auditory tube that connects the middle ear with the nasopharynx. This tube helps to equalize the air pressure on both sides of the tympanic membrane, which is the eardrum. The ossicles are the three small bones in the middle ear that transmit sound vibrations to the inner ear. The cochlea is the spiral-shaped structure in the inner ear that is responsible for converting sound vibrations into electrical signals that can be interpreted by the brain.

The cochlea is a spiraling chamber in the inner ear that contains the receptors for hearing. It is responsible for converting sound vibrations into electrical signals that can be interpreted by the brain. The other options listed, such as the tympanic membrane, ossicles, and eustachian tube, are all structures involved in the process of hearing, but they do not specifically contain the receptors for hearing like the cochlea does.

Anatomy and Physiology Review, Nasal Sinuses, Figure 14.5

The paranasal sinuses are mucous-lined, air-filled cavities that surround the nasal cavity and perform the functions of filtration, moistening, and warming. They are named for the bones of the skill in which they are contained. The columella is the cartilaginous structure located between the nares. The inferior turbinate is the lowest bony projection within the nose and is covered with mucosa.

Nursing Process Step: Assessment
Cognitive Level: Application
Client Need: Physiological Integrity

Abnormal Findings, Mouth and Throat

Ankyloglossia is a fixation of the tip of the tongue to the floor of the mouth due to a shortened lingual frenulum. The condition is usually congenital and may be corrected with surgery. Enlargement of the tongue is not related to ankyloglossia. Aphthous ulcers (canker sores) are lesions on the oral mucosa and not associated with this condition. Nose bleeds (epistaxis) are also not related to ankyloglossia.

Nursing Process Step: Implementation
Cognitive Level: Application
Client Need: Physiological Integrity

The correct answer is "ossicles" because the question is asking about the bones of the middle ear, and the malleus, incus, and stapes are the three small bones that make up the ossicles. These bones are important for transmitting sound vibrations from the eardrum to the inner ear.

Techniques and Normal Findings, Ear

The pinna should be pulled up and back in an adult client to straighten the canal and allow visualization of the tympanic membrane. The otoscope should not be inserted deep into the canal because the inner two-thirds of the ear canal is very sensitive. The client should tilt the head away from the side to be examined, toward the opposite shoulder. Insertion of the otoscope should not be painful.

Nursing Process Step: Assessment
Cognitive Level: Application
Client Need: Physiological Integrity

Focused Interview Questions, General Questions

Hearing loss can be hereditary. Telling the client that hearing loss is not hereditary or that they will likely have hearing problems are not true statements. Obtaining information about medications and specifically ototoxic medications is important, but is not specifically related to the client's statements at this time.

Nursing Process Step: Implementation
Cognitive Level: Application
Category: Physiological Integrity

Otitis externa is the correct answer because it matches the given description. Otitis externa refers to an infection of the outer ear, often known as "swimmer's ear." It causes redness and swelling of the auricle and ear canal, with usually scanty drainage. It may also be accompanied by itching, fever, and enlarged lymph nodes. Hemotympanum, otitis media, perforation of the tympanic membrane, scarred tympanic membrane, and tophi are not relevant to the given description.

Otitis media is the correct answer because the symptoms described in the question, such as a red, bulging eardrum, fever, and hearing loss, are consistent with an infection of the middle ear. The absence of the light reflex during otoscopic examination is also a common finding in otitis media. The explanation also mentions that otitis media is more common in children due to the anatomical differences in their auditory tubes, which makes it easier for infections to ascend from the pharynx.

A perforated septum refers to a hole in the septum, which is the wall that separates the two nostrils. This condition can be caused by chronic infection, trauma, or the use of cocaine. One way to detect a perforated septum is by shining a penlight through the naris (nostril) on the other side. This allows light to pass through the hole and confirms the presence of a perforated septum.

Air conduction (AC) is the correct answer because it refers to the transmission of sound through the tympanic membrane to the cochlea and auditory nerve. AC occurs when sound waves travel through the external ear canal and cause the tympanic membrane to vibrate. These vibrations are then transmitted through the middle ear bones (ossicles) to the cochlea, where they are converted into electrical signals that are sent to the brain via the auditory nerve. This is the normal pathway for sound transmission in the ear.

Rhinitis is the correct answer because it matches the description provided. Rhinitis is a nasal inflammation that is commonly caused by a viral infection or allergy. It is characterized by symptoms such as watery and copious discharge, sneezing, and congestion. Acute rhinitis is caused by a virus, while allergic rhinitis is a result of contact with allergens like pollen and dust.

Ankyloglossia refers to a condition where the tip of the tongue is fixed to the floor of the mouth due to a shortened lingual frenulum. This condition is usually present from birth and can be corrected through surgical intervention.

Gingivitis is the correct answer because it is a condition characterized by inflammation of the gums. It can be caused by poor dental hygiene or a deficiency of vitamin C. If left untreated, gingivitis can progress to periodontal disease and tooth loss.

Tophi are small white nodules that form on the helix or antihelix of the ear. These nodules contain uric acid crystals and are a characteristic sign of gout. Gout is a type of arthritis that occurs when there is a buildup of uric acid in the body, leading to the formation of these nodules. Therefore, the presence of tophi in the ear is indicative of gout.

The given description matches the symptoms and characteristics of herpes simplex. Herpes simplex is a viral infection that commonly causes cold sores or fever blisters, usually appearing on the skin and lip junction. The vesicles (blisters) erupt, crust, and heal within two weeks. It is known to recur, especially after exposure to bright sunlight. Therefore, the correct answer is Herpes Simplex.

Developmental Considerations, The Older Adult

Presbycusis is the term given to the gradual hearing loss that occurs with aging. As individuals age, the individual develops a loss of high-frequency sounds first, then over time may develop a loss of low-frequency sounds as well. The tympanic membrane becomes paler and thicker with age.

Nursing Process Step: Diagnosis
Cognitive Level: Application
Client Need: Physiological Integrity

The tragus is a small projection on the external ear that is positioned in front of the external auditory canal. It is a small, fleshy prominence that helps to protect the ear canal and enhance sound localization. It also plays a role in directing sound waves into the ear. The other options, cerumen, helix, and lobule, do not accurately describe this specific anatomical feature.

Techniques and Normal Findings, Ear

Pain on movement of the pinna and tragus of the ear and drainage in the external canal suggests the presence of otitis externa (infection in the external ear canal). Otitis media is infection or inflammation of the middle ear, which would be seen using an otoscope. Inner ear infections are not visible or palpable. Romberg's test assesses equilibrium. The client stands with feet together, eyes closed for 20 seconds. The normal response is minimal swaying and is documented as "Romberg negative".

Nursing Process Step: Assessment
Cognitive Level: Analysis
Client Need: Physiological Integrity

Scarred Tympanic Membrane is the correct answer because it describes the condition of having white patches of scar tissue on the eardrum, which is caused by repeated ear infections. This condition can lead to hearing loss and other complications.

The helix is the external large rim of the auricle of the ear. It is a curved ridge that runs along the outer edge of the ear. The helix helps to shape and support the structure of the ear, and it also plays a role in directing sound into the ear canal. It is made up of cartilage and is covered by skin. The helix is an important anatomical feature of the ear and is involved in the overall function of hearing.

Perforation of the tympanic membrane refers to a rupture in the eardrum, which can occur due to trauma or infection. During otoscopic inspection, a perforation may be visible as a dark spot on the eardrum. This condition can cause hearing loss, pain, and sometimes discharge from the ear. Treatment options vary depending on the size and cause of the perforation, and may include observation, medication, or surgery.

Oral cancers are most commonly found on the lower lip or the base of the tongue. The presence of a sore or lesion that does not heal within a few weeks is a common sign of cancer. Risk factors for oral cancer include heavy smoking, especially pipe smoking, chewing tobacco, and chronic heavy use of alcohol. Carcinoma refers to a type of cancer that originates in the epithelial cells, which are the cells that line the surfaces of the body. Therefore, given the information provided, carcinoma is the most likely condition to be associated with the given symptoms and risk factors.

Techniques and Normal Findings, Ear

Lateralization of the Weber test indicates that the client could have a hearing loss. The client could have either a conductive hearing loss or nerve damage with lateralization of the Weber test. The normal response is no lateralization-the client should hear the sound equally in both ears. If the client has poor conduction in one ear, the sound is heard better in the impaired ear because the sound is being conducted directly through the bone to the ear and the extraneous sounds in the environment are not picked up. There is no indication that the test should be repeated. The Rinne test should be performed if the results of the Weber test are abnormal.

Nursing Process Step: Assessment
Cognitive Level: Application
Client Need: Physiological Integrity

Use of cotton-tipped applicators to remove cerumen can cause trauma to the tympanic membrane and cause cerumen to become impacted. Ear canals should never be cleaned. Cerumen moves to the outside of the canal naturally. Commercial cerumen removal products should be used with the guidance of a health care provider. Use of cotton-tipped applicators does not predispose the individual to a middle ear infection.

Nursing Process Step: Implementation
Cognitive Level: Application
Client Need: Physiological Integrity

The correct answer is lobule. A lobule is a small flap of flesh located at the inferior end of the auricle of the ear. It is a distinct anatomical feature that helps to shape the external ear. The other options, cerumen, helix, and tragus, do not accurately describe this specific flap of flesh.

Cold sores, also known as vesucykar, are caused by the herpes simplex virus and typically occur on the lip or corner of the mouth. They are characterized by small, fluid-filled blisters that can be painful and may crust over. Nasal polyps are abnormal growths in the nasal cavity, presbycusis refers to age-related hearing loss, and fever blisters are another term for cold sores.

Techniques and Normal Findings, Ear

White patches on the tympanic membrane (TM) indicate scars from prior infections, perforations, or injuries. With an infection in the middle ear, the TM would be erythematous and bulging. Increased pressure in the middle ear would present as bulging of the TM. A blocked eustachian tube would cause the TM to retract into the middle ear.

Nursing Process Step: Assessment
Cognitive Level: Application
Client Need: Physiological Integrity

Hemotympanum refers to a bluish tinge in the tympanic membrane, which is the eardrum, indicating the presence of blood in the middle ear. This condition is commonly caused by head trauma, such as a direct blow to the ear or a skull fracture. The blood accumulation in the middle ear can cause hearing loss, dizziness, and pain. Prompt medical attention is necessary to assess and treat the underlying cause of the hemotympanum and prevent further complications.

Gingival hyperplasia refers to the abnormal enlargement of the gums. This condition is commonly observed during pregnancy, in individuals with leukemia, or as a side effect of prolonged use of phenytoin (dilantin). It is characterized by an excessive growth of gum tissue, leading to a swollen and puffy appearance. This condition can cause discomfort, difficulty in maintaining oral hygiene, and may increase the risk of gum disease. Treatment typically involves improving oral hygiene practices and, in severe cases, surgical intervention may be required to remove the excess gum tissue.

Anatomy and Physiology Review, External Ear

Cerumen helps to lubricate and protect the ear. It is not needed to assist in air conduction of sound vibrations to the middle ear. The presence and amount of cerumen is not related to hygiene practices. Cerumen removal with cotton swabs is not recommended.

Nursing Process Step: Assessment
Cognitive Level: Comprehension
Client Need: Physiological Integrity

Techniques and Normal Findings, Nose and Sinuses

Normal findings of the frontal and maxillary sinuses are no tenderness to palpation or percussion. Swelling should not be present. With transillumination of the maxillary sinuses, a red glow should be present under the eyes. The mucous membranes of the sinuses are not directly visible and are unable to be assessed.

Nursing Process Step: Assessment
Cognitive Level: Application
Client Need: Physiological Integrity

Nasal polyps are a correct answer because they are described as a pale, round, firm, nonpainful overgrowth of nasal mucosa. They are commonly caused by chronic allergic rhinitis. Epistaxis, rhinitis, sinusitis, deviated septum, and perforated septum do not match the given description of nasal polyps.

Smooth tongue, also known as glossitis, is a condition that can occur as a result of vitamin B and iron deficiency. It is characterized by the surface of the tongue being smooth and red with a shiny appearance. This condition can cause discomfort and difficulty in eating or swallowing. Treatment usually involves addressing the underlying nutritional deficiencies and improving oral hygiene practices.

Aphthous ulcers, commonly called canker sores, are small, round, white lesions that occur on the oral mucosa. They can occur singly or in clusters and are acutely painful when they come in contact with the tongue, a toothbrush, or food. These ulcers are often caused by oral trauma, such as jabbing the side of the mouth with a toothbrush, but they can also be associated with stress, exhaustion, and allergies to certain foods.