NU 627 EXAM 4 | ACTUAL QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS – HERZING
1. 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
Answer: C
Explanation: The 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, but it is a symptom, not the underlying problem.
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.
2. A new nursing assistant asks the nurse how best to approach a hearing-
impaired 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.
Answer: C
,Explanation: 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. Raising the volume can distort
words, and exaggerated lip movements make speech reading difficult.
3. 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
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
Answer: A, B, D
Explanation: 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.
4. The incidence of hearing loss in a long-term 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.
Answer: D
Explanation: 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.
5. A nurse has been caring for an 83-year-old resident of a nursing home for 2
years and has developed a high level of trust with the resident. Which of the
following 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.
Answer: C
Explanation: Short attention span and easy distractibility are indicators of hearing
loss. Aggression and agitation more often suggest alternative etiologies, such as
neurologic health problems. Disorientation to time and disagreeable demeanor
are not specific indicators of hearing loss.
6. 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) Antihypertensives
, C) Antidiabetic agents
D) Bronchodilators
Answer: A
Explanation: Nonsteroidal anti-inflammatory agents (NSAIDs) are known ototoxic
medications. Other ototoxic drugs include aminoglycoside antibiotics, loop
diuretics, and certain chemotherapeutic agents. Antihypertensives, antidiabetic
agents, and bronchodilators are not typically considered ototoxic.
7. An older adult client reports gradual hearing loss over the past several years.
The client states, "I can hear people talking, but I can't understand what they're
saying." Which type of hearing loss is most consistent with these symptoms?
A) Conductive hearing loss
B) Sensorineural hearing loss
C) Mixed hearing loss
D) Central auditory processing disorder
Answer: B
Explanation: Sensorineural hearing loss, which is common in aging (presbycusis),
typically affects the ability to distinguish speech sounds, especially high-frequency
consonants. Clients often report hearing speech but not understanding it.
Conductive hearing loss affects volume more than clarity.
8. A nurse is assessing an older adult's hearing using the whisper test. Which
technique is correct?
A) Stand behind the client and whisper a word from 2 feet away.
B) Face the client and whisper a word from 1 foot away while occluding the
opposite ear.
C) Stand to the side and whisper a word from 6 inches away.
D) Whisper a word from 2 feet away while the client covers both ears.
COMPLETE SOLUTIONS – HERZING
1. 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
Answer: C
Explanation: The 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, but it is a symptom, not the underlying problem.
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.
2. A new nursing assistant asks the nurse how best to approach a hearing-
impaired 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.
Answer: C
,Explanation: 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. Raising the volume can distort
words, and exaggerated lip movements make speech reading difficult.
3. 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
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
Answer: A, B, D
Explanation: 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.
4. The incidence of hearing loss in a long-term 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.
Answer: D
Explanation: 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.
5. A nurse has been caring for an 83-year-old resident of a nursing home for 2
years and has developed a high level of trust with the resident. Which of the
following 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.
Answer: C
Explanation: Short attention span and easy distractibility are indicators of hearing
loss. Aggression and agitation more often suggest alternative etiologies, such as
neurologic health problems. Disorientation to time and disagreeable demeanor
are not specific indicators of hearing loss.
6. 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) Antihypertensives
, C) Antidiabetic agents
D) Bronchodilators
Answer: A
Explanation: Nonsteroidal anti-inflammatory agents (NSAIDs) are known ototoxic
medications. Other ototoxic drugs include aminoglycoside antibiotics, loop
diuretics, and certain chemotherapeutic agents. Antihypertensives, antidiabetic
agents, and bronchodilators are not typically considered ototoxic.
7. An older adult client reports gradual hearing loss over the past several years.
The client states, "I can hear people talking, but I can't understand what they're
saying." Which type of hearing loss is most consistent with these symptoms?
A) Conductive hearing loss
B) Sensorineural hearing loss
C) Mixed hearing loss
D) Central auditory processing disorder
Answer: B
Explanation: Sensorineural hearing loss, which is common in aging (presbycusis),
typically affects the ability to distinguish speech sounds, especially high-frequency
consonants. Clients often report hearing speech but not understanding it.
Conductive hearing loss affects volume more than clarity.
8. A nurse is assessing an older adult's hearing using the whisper test. Which
technique is correct?
A) Stand behind the client and whisper a word from 2 feet away.
B) Face the client and whisper a word from 1 foot away while occluding the
opposite ear.
C) Stand to the side and whisper a word from 6 inches away.
D) Whisper a word from 2 feet away while the client covers both ears.
