NCLEX RN Practice Question # 460

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Otoscopic examination

  • The client’s head is tilted slightly away and the otoscope is held upside down as if it were a large pen; this permits the examiner’s hand to lay against the client’s head for support.
  • In an adult, pull the pinna up and back to straighten the external canal.
  • Visualize the external canal while slowly inserting the speculum.
  • The normal external canal is pink and intact, without lesions and with varying amounts of cerumen and fine little hairs.
  • Assess the tympanic membrane for intactness; the normal tympanic membrane is intact, without perforations, and should be free from lesions.
  • The tympanic membrane is transparent, opaque, pearly gray, and slightly concave.
  • A fluid line or the presence of air bubbles is not normally visible.
  • If the tympanic membrane is bulging or retracting, the edges of the light reflex will be fuzzy (diffuse) and may spread over the tympanic membrane.

The otoscope is never introduced blindly into the external canal because of the risk of perforating the tympanic membrane.

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