TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTARO
Chapter 63: Cerumen Impaction Buttaro: Primary Care: A Collaborative Practice, 6th Edition MULTIPLE CHOICE 1. A child has recurrent impaction of cerumen in both ears and the parent asks what can be done
to help prevent this. What suggestion will the provider provide? a. Cleaning the outer ear and canal with a soft cloth b. Removing cerumen with a cotton-tipped swab c. Trying thermal-auricular therapy when needed d. Using an oral irrigation tool to remove cerumen ANS: A
Parents should be instructed to use a soft cloth to clean the outer ear and canal only. Use of a cotton-tipped swab or any other implement may push cerumen deeper into the canal and risk damaging the tympanic membrane. Thermal-auricular therapy is not recommended. Oral irrigation tools have high pressure and a risk of damage to the tympanic membrane. 2. A patient reports symptoms of otalgia and difficulty hearing from one ear. The provider
performs an otoscopic exam and notes a dark brown mass in the lower portion of the external canal blocking the patient’s tympanic membrane. What is the initial action? a. Ask the patient about previous problems with that ear. b. Irrigate the canal with normal saline. c. Prescribe a ceruminolytic agent for that ear. d. Use a curette to attempt to dislodge the mass. ANS: A
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Before attempting to remove impacted cerumen, the provider must determine whether the tympanic membrane (TM) is intact and should ask about pressure equalizing ear tubes, a history of ruptured TM, and previous ear surgeries. Once the TM is determined to be intact, the other methods may be attempted, although the curette should only be used if the mass is in the lateral third of the ear canal. 3. A provider is recommending a cerumenolytic for a patient who has chronic cerumen buildup.
The provider notes that the patient has dry skin in the ear canal. Which preparation is US Food and Drug Administration (FDA) approved for this use? a. Carbamide peroxide b. Hydrogen peroxide c. Liquid docusate sodium d. Mineral oil ANS: A
Any preparation with carbamide peroxide is FDA approved as a cerumenolytic. Patients with dry skin in the ear canal should not use any product containing hydrogen peroxide. Liquid docusate sodium and mineral oil are often used, but do not have specific FDA approval.
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