Page 373 - Saunders Comprehensive Review For NCLEX-RN

any physical obstruction to the
transmission of sound waves.
e. Sensorineural hearing loss is caused by
a defect in the cochlea, eighth cranial
nerve, or the brain itself.
f. A mixed hearing loss is a combination
of a conductive and sensorineural
hearing loss; it results from problems
in both the inner ear and the outer ear
or middle ear.
4. Voice (Whisper) test
a. Used to determine whether hearing loss
has occurred
b. One ear is tested at a time (the ear not
being tested is occluded by the client).
c. The nurse stands 1 to 2 feet (30 to 60
cm) from the client, covers his or her
mouth so that the client cannot read
the lips, exhales fully, and softly
whispers 2-syllable words in the
direction of the unoccluded ear; the
client points a finger up during the test
when the nurse’s voice is heard (a
ticking watch may also be used to test
hearing acuity).
d. Failure to hear the sounds could
indicate possible fluid collection
and/or consolidation, requiring further
assessment.
5. Watch test
a. A ticking watch is used to test for high-
frequency sounds.
b. The examiner holds a ticking watch
about 5 inches (12.5 cm) from each ear
and asks the client if the ticking is
heard.
6. Tuning fork tests
a. Used to measure hearing on the basis of
air conduction or bone conduction;
includes the Weber’s and Rinne’s tests.
These tests are not commonly used
because of their limited sensitivity to
detect hearing loss.
7. Vestibular assessment (Box 12-6)
8. Otoscopic exam

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