NURS 5220 ENT Case Study Mrs. Kathryn U. Hearing Loss
Actual Exam 2026/2027 – Complete Solutions with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+ Graded
Section A: Subjective Data Collection & History of Present Illness (12
Questions)
Q1: Mrs. Kathryn U., an 85-year-old female residing in a retirement community, presents
with the chief complaint that her husband says he has to repeat himself too many
times. When the nurse asks Mrs. U. about her own perception of the problem, she
states she does not believe she is hard of hearing and wants the provider to confirm her
husband is wrong. This response is best characterized as:
A. Denial of sensory deficit with underlying depressive disorder
B. Lack of insight due to cognitive impairment
C. A common patient response in early age-related hearing loss where the patient is
often the last to recognize the deficit [CORRECT]
D. Evidence of malingering for secondary gain
Correct Answer: C
Rationale: In presbycusis and early hearing loss, patients often fail to recognize their
own hearing deficit because the loss is gradual and they compensate through
lip-reading and context clues. Family members typically notice the problem first. There
is no evidence in the case of depression, cognitive impairment, or malingering.
,Q2: Mrs. U. reports that her hearing loss began approximately 2 months ago with no
prior history of hearing issues. The onset of her hearing loss is best described as:
A. Acute, with sudden onset over hours to days
B. Chronic, with gradual onset over months to years
C. Subacute, with onset over weeks to months [CORRECT]
D. Congenital, present since birth
Correct Answer: C
Rationale: A 2-month onset with no prior history describes a subacute presentation.
Acute onset occurs over hours to days (e.g., sudden sensorineural hearing loss), chronic
develops over years (typical presbycusis trajectory), and congenital is present from
birth. The subacute timeframe warrants evaluation for reversible causes such as
cerumen impaction.
Q3: When asked to describe her hearing difficulty, Mrs. U. states, "Everything sounds
funny. I can hear noises, but speech isn't clear. It's worse on my right side." This
description most strongly suggests:
A. Conductive hearing loss with bilateral tympanic membrane perforation
B. Sensorineural hearing loss with cochlear damage
C. A mixed pattern with conductive and sensorineural components, worse on the right
[CORRECT]
D. Functional hearing loss with no organic cause
,Correct Answer: C
Rationale: The ability to hear noises but not understand speech, combined with worse
symptoms on one side, suggests a mixed pattern. The "hollow" sound quality and
unilateral worsening are consistent with conductive loss (cerumen impaction)
superimposed on age-related sensorineural changes. Functional hearing loss is unlikely
given the consistent, specific description.
Q4: Mrs. U. describes the quality of sounds as "rather hollow—a little like international
phone calls used to sound." This quality descriptor is most consistent with:
A. Sensorineural hearing loss producing high-frequency distortion
B. Conductive hearing loss producing muffled, hollow sound conduction [CORRECT]
C. Tinnitus producing phantom ringing sensations
D. Auditory hallucinations from psychosis
Correct Answer: B
Rationale: A "hollow" or muffled quality to sound is characteristic of conductive hearing
loss, where sound transmission through the external or middle ear is impaired.
Sensorineural loss typically produces distorted or absent sounds rather than hollow
quality. Mrs. U. denies tinnitus, and there is no evidence of psychosis.
Q5: Mrs. U. reports the most difficulty hearing in the dining hall in the evening. This
contextual clue is significant because:
A. It indicates social anxiety rather than true hearing loss
, B. Background noise masks high-frequency consonants, which are already diminished in
presbycusis, making speech discrimination worse [CORRECT]
C. It suggests the hearing loss is worse in the morning and improves throughout the day
D. It indicates barotrauma from changes in atmospheric pressure
Correct Answer: B
Rationale: Presbycusis and conductive hearing loss both impair speech discrimination,
especially in noisy environments. Background noise in the dining hall masks
high-frequency consonants, which are critical for speech understanding. This is a
hallmark of sensorineural and mixed hearing loss, not social anxiety or barotrauma.
Q6: Mrs. U. reports that her husband and best friend repeat themselves frequently, but
no one has shouted at her. The fact that people repeat themselves rather than shout is
clinically significant because:
A. It proves the hearing loss is feigned
B. It suggests the hearing loss is primarily a volume problem rather than a clarity
problem
C. It suggests the hearing loss is primarily a clarity/speech discrimination problem
rather than a volume problem [CORRECT]
D. It indicates the hearing loss is improving spontaneously
Correct Answer: C
Rationale: When people repeat themselves rather than shout, it indicates the patient can
hear sound (volume is adequate) but cannot understand speech (clarity/discrimination
Actual Exam 2026/2027 – Complete Solutions with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+ Graded
Section A: Subjective Data Collection & History of Present Illness (12
Questions)
Q1: Mrs. Kathryn U., an 85-year-old female residing in a retirement community, presents
with the chief complaint that her husband says he has to repeat himself too many
times. When the nurse asks Mrs. U. about her own perception of the problem, she
states she does not believe she is hard of hearing and wants the provider to confirm her
husband is wrong. This response is best characterized as:
A. Denial of sensory deficit with underlying depressive disorder
B. Lack of insight due to cognitive impairment
C. A common patient response in early age-related hearing loss where the patient is
often the last to recognize the deficit [CORRECT]
D. Evidence of malingering for secondary gain
Correct Answer: C
Rationale: In presbycusis and early hearing loss, patients often fail to recognize their
own hearing deficit because the loss is gradual and they compensate through
lip-reading and context clues. Family members typically notice the problem first. There
is no evidence in the case of depression, cognitive impairment, or malingering.
,Q2: Mrs. U. reports that her hearing loss began approximately 2 months ago with no
prior history of hearing issues. The onset of her hearing loss is best described as:
A. Acute, with sudden onset over hours to days
B. Chronic, with gradual onset over months to years
C. Subacute, with onset over weeks to months [CORRECT]
D. Congenital, present since birth
Correct Answer: C
Rationale: A 2-month onset with no prior history describes a subacute presentation.
Acute onset occurs over hours to days (e.g., sudden sensorineural hearing loss), chronic
develops over years (typical presbycusis trajectory), and congenital is present from
birth. The subacute timeframe warrants evaluation for reversible causes such as
cerumen impaction.
Q3: When asked to describe her hearing difficulty, Mrs. U. states, "Everything sounds
funny. I can hear noises, but speech isn't clear. It's worse on my right side." This
description most strongly suggests:
A. Conductive hearing loss with bilateral tympanic membrane perforation
B. Sensorineural hearing loss with cochlear damage
C. A mixed pattern with conductive and sensorineural components, worse on the right
[CORRECT]
D. Functional hearing loss with no organic cause
,Correct Answer: C
Rationale: The ability to hear noises but not understand speech, combined with worse
symptoms on one side, suggests a mixed pattern. The "hollow" sound quality and
unilateral worsening are consistent with conductive loss (cerumen impaction)
superimposed on age-related sensorineural changes. Functional hearing loss is unlikely
given the consistent, specific description.
Q4: Mrs. U. describes the quality of sounds as "rather hollow—a little like international
phone calls used to sound." This quality descriptor is most consistent with:
A. Sensorineural hearing loss producing high-frequency distortion
B. Conductive hearing loss producing muffled, hollow sound conduction [CORRECT]
C. Tinnitus producing phantom ringing sensations
D. Auditory hallucinations from psychosis
Correct Answer: B
Rationale: A "hollow" or muffled quality to sound is characteristic of conductive hearing
loss, where sound transmission through the external or middle ear is impaired.
Sensorineural loss typically produces distorted or absent sounds rather than hollow
quality. Mrs. U. denies tinnitus, and there is no evidence of psychosis.
Q5: Mrs. U. reports the most difficulty hearing in the dining hall in the evening. This
contextual clue is significant because:
A. It indicates social anxiety rather than true hearing loss
, B. Background noise masks high-frequency consonants, which are already diminished in
presbycusis, making speech discrimination worse [CORRECT]
C. It suggests the hearing loss is worse in the morning and improves throughout the day
D. It indicates barotrauma from changes in atmospheric pressure
Correct Answer: B
Rationale: Presbycusis and conductive hearing loss both impair speech discrimination,
especially in noisy environments. Background noise in the dining hall masks
high-frequency consonants, which are critical for speech understanding. This is a
hallmark of sensorineural and mixed hearing loss, not social anxiety or barotrauma.
Q6: Mrs. U. reports that her husband and best friend repeat themselves frequently, but
no one has shouted at her. The fact that people repeat themselves rather than shout is
clinically significant because:
A. It proves the hearing loss is feigned
B. It suggests the hearing loss is primarily a volume problem rather than a clarity
problem
C. It suggests the hearing loss is primarily a clarity/speech discrimination problem
rather than a volume problem [CORRECT]
D. It indicates the hearing loss is improving spontaneously
Correct Answer: C
Rationale: When people repeat themselves rather than shout, it indicates the patient can
hear sound (volume is adequate) but cannot understand speech (clarity/discrimination
