Sensory Impairments: Hearing Loss, Deafness, and Visual Impairment Practice Questions

25 multiple-choice questions on Sensory impairments: hearing loss, deafness, and visual impairment for paramedic and EMT students, from Chapter 46 (Patients With Special Challenges). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Conductive hearing loss is caused by a problem in the:

   1. A. Cochlea or auditory nerve
   2. B. External ear canal or middle ear
   3. C. Temporal lobe of the brain
   4. D. Semicircular canals of the inner ear
   Show answer

   Answer: B. External ear canal or middle ear

   Conductive loss means sound cannot reach the inner ear, as with impacted cerumen, otitis media, or a ruptured eardrum. Damage to the cochlea or auditory nerve is sensorineural loss, which is usually permanent.

2. Which condition causes sensorineural hearing loss?

   1. A. Impacted earwax filling the ear canal
   2. B. Fluid behind the eardrum
   3. C. Prolonged exposure to loud noise
   4. D. A foreign body in the ear canal
   Show answer

   Answer: C. Prolonged exposure to loud noise

   Loud noise damages cochlear hair cells, producing permanent sensorineural loss; aging (presbycusis) and ototoxic drugs do the same. Earwax, middle ear fluid, and foreign bodies block sound conduction and are often reversible.

3. Which medication is known to cause hearing loss as a side effect?

   1. A. Acetaminophen
   2. B. Metoprolol
   3. C. Albuterol
   4. D. Gentamicin
   Show answer

   Answer: D. Gentamicin

   Aminoglycoside antibiotics such as gentamicin, and high-dose loop diuretics such as furosemide, are ototoxic. Acetaminophen is not linked to hearing loss, although high-dose aspirin can cause reversible tinnitus.

4. A 70-year-old man does not respond when you speak from behind him, talks very loudly, and watches your face closely. You should suspect:

   1. A. Receptive aphasia
   2. B. Acute delirium
   3. C. Visual impairment
   4. D. Hearing loss
   Show answer

   Answer: D. Hearing loss

   Failing to respond to sound from behind, speaking loudly, and watching lips are clues to hearing loss. A patient with receptive aphasia does not understand language even face to face, and watching your lips would not help him.

5. An 84-year-old man with severe hearing loss left his hearing aids at home, and the ambulance is noisy. A simple way to help him hear you is to:

   1. A. Shout your questions directly into his better ear
   2. B. Speak into your stethoscope placed in his ears
   3. C. Write every question in long, full sentences
   4. D. Rely on his nodding to confirm each answer
   Show answer

   Answer: B. Speak into your stethoscope placed in his ears

   Placing your stethoscope earpieces in his ears and speaking quietly into the diaphragm (or using a personal amplifier) carries your voice straight to him and blocks road noise. Shouting distorts speech and is undignified. Written questions help, but long sentences are slow to read, and he may not have his glasses; short, simple notes work better. Nodding often hides a lack of understanding, so confirm key answers. (Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter; Hearing Loss Association of America, communication tips.)

6. About how much of spoken English can typically be understood by lip reading alone?

   1. A. About one-third
   2. B. Nearly all of it
   3. C. About three-fourths
   4. D. About nine-tenths
   Show answer

   Answer: A. About one-third

   Many speech sounds look alike on the lips, so even skilled lip readers catch only about 30% to 40% of words. Written notes or an interpreter are needed for important information such as consent and medical history.

7. A Deaf woman who communicates in American Sign Language needs an IV and a blood pressure cuff during transport. When placing them, you should:

   1. A. Secure both of her arms so the lines stay in place
   2. B. Ask her to keep both hands still on the cot
   3. C. Leave her dominant hand free so she can sign
   4. D. Use soft restraints to protect the IV site
   Show answer

   Answer: C. Leave her dominant hand free so she can sign

   For a person who signs, her hands are her voice; tying down both arms is like gagging a hearing patient. Place lines on her nondominant side when you can and agree on how she will communicate (signing, writing, or video interpreting). Securing both arms or asking her to keep her hands still takes away her ability to report pain, answer questions, or consent. Restraints are not used to protect an IV in a cooperative patient. (ADA effective communication; National Association of the Deaf.)

8. A 60-year-old man who is both deaf and blind communicates by touch. The most effective way to talk with him is usually to:

   1. A. Speak loudly and slowly right next to his ear
   2. B. Write large-print notes for him to read
   3. C. Sign or print letters into his open palm
   4. D. Direct every question to his caregiver
   Show answer

   Answer: C. Sign or print letters into his open palm

   Many DeafBlind people use tactile signing (hands over the signer's hands) or print-on-palm, in which letters are traced on the palm; ask his companion how he communicates, agree on a touch signal that identifies you, and request a tactile interpreter for complex discussions. Speaking loudly does not help profound deafness. Large print does not help blindness. Talking only to the caregiver leaves him out of his own care. (Helen Keller National Center; ADA effective communication.)

9. A 34-year-old Deaf woman with abdominal pain is looking away from you. To get her attention, you should:

   1. A. Clap your hands loudly close behind her head
   2. B. Gently tap her shoulder or wave in her view
   3. C. Call her name loudly from where you stand
   4. D. Wait until she happens to look your way
   Show answer

   Answer: B. Gently tap her shoulder or wave in her view

   A light touch on the shoulder or a wave in her line of sight is the accepted way to get a Deaf person's attention. Clapping behind her produces no useful cue and may startle her if she senses the vibration. Calling her name relies on hearing she does not have, and waiting for her to look up delays care when a simple touch works.

10. A 78-year-old woman's hearing aid whistles loudly while you take her history. The most likely cause is that the aid is:

    1. A. Not seated properly or turned up too high
    2. B. Low on battery and about to shut off
    3. C. Damaged by moisture and must be removed
    4. D. Picking up radio traffic from the ambulance
    Show answer

    Answer: A. Not seated properly or turned up too high

    Feedback whistling occurs when amplified sound leaks out and is picked up again, usually from poor fit or excessive volume; reseat the device or lower the volume. A weak battery typically causes weak or absent sound, not whistling.

11. After a fall, a 66-year-old man's right pupil is fixed and does not react to light. He is alert and oriented, and his wife says he has an artificial right eye. You should:

    1. A. Treat the fixed pupil as a sign of herniation
    2. B. Remove the eye to examine the socket
    3. C. Hyperventilate him to lower his ICP
    4. D. Note the prosthesis and assess the other eye
    Show answer

    Answer: D. Note the prosthesis and assess the other eye

    An ocular prosthesis has no pupil response, so record that it is present and assess the natural eye, the GCS, and other neurologic signs; an alert, oriented patient with a true blown pupil would be unusual. Treating the prosthesis as herniation leads to the wrong care. Removing it is unnecessary in the field and can injure the socket. Hyperventilation is reserved for clear signs of herniation and is harmful otherwise. (Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter; Brain Trauma Foundation prehospital guidelines.)

12. A patient has a cochlear implant. Compared with a hearing aid, a cochlear implant:

    1. A. Simply amplifies sound in the ear canal
    2. B. Sits deep inside the ear canal
    3. C. Stimulates the auditory nerve directly
    4. D. Is used mainly for conductive hearing loss
    Show answer

    Answer: C. Stimulates the auditory nerve directly

    A cochlear implant has an external processor worn behind the ear and an internal electrode array in the cochlea that stimulates the auditory nerve directly, bypassing damaged hair cells in severe sensorineural loss. Hearing aids amplify sound; that is the main difference. No part of an implant sits in the ear canal; the internal part lies under the skin behind the ear and in the cochlea. Conductive loss is usually treated with hearing aids, surgery, or bone-anchored devices, not cochlear implants. Bring the processor and its batteries with the patient. (NIDCD, cochlear implants.)

13. Macular degeneration typically causes loss of:

    1. A. Peripheral vision
    2. B. Night vision
    3. C. Color vision
    4. D. Central vision
    Show answer

    Answer: D. Central vision

    Macular degeneration destroys the macula, the part of the retina used for central, detailed vision, so the patient may see around the edges but not faces or print. Glaucoma typically steals peripheral vision first.

14. Glaucoma causes vision loss by:

    1. A. Clouding of the lens of the eye
    2. B. Increased pressure damaging the optic nerve
    3. C. Bleeding from fragile retinal vessels
    4. D. Gradual flattening of the cornea's curvature
    Show answer

    Answer: B. Increased pressure damaging the optic nerve

    Elevated intraocular pressure damages the optic nerve, starting with peripheral vision. Clouding of the lens is a cataract, which is usually correctable with surgery.

15. After a stroke last year, a 70-year-old woman lost the left half of the visual field in both eyes. To help her see you and follow along, you should:

    1. A. Approach and speak from her right side
    2. B. Stand directly behind her as you talk
    3. C. Stay on her left so she turns her head
    4. D. Shine a light into her left visual field
    Show answer

    Answer: A. Approach and speak from her right side

    With a left homonymous hemianopia she cannot see anything to her left, so approach from her right (seeing) side, place items there, and tell her what is happening on her left. Standing behind her keeps you out of view entirely. Staying on her left means she may not notice you at all. A light does not restore vision in the blind half of the field. (American Stroke Association, vision loss after stroke; Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter.)

16. A 77-year-old woman with macular degeneration gives her own insulin and has a glucose of 41 mg/dL for the third time this week. A likely contributor is:

    1. A. Trouble reading her insulin pen or syringe
    2. B. Eating too many carbohydrates at meals
    3. C. Insulin that has lost its strength over time
    4. D. Normal age-related insulin resistance
    Show answer

    Answer: A. Trouble reading her insulin pen or syringe

    Loss of central vision makes dose markings hard to read, so patients may dial or draw up the wrong dose; ask how she prepares her insulin, look at her pens and syringes, and pass the concern to the hospital and her family. Extra carbohydrates raise the glucose rather than lower it. Weakened insulin would also cause high, not low, readings. Insulin resistance raises the glucose. (ADA Standards of Care 2025, older adults; Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter.)

17. A 52-year-old blind man with a wrist injury has his guide dog in harness beside him. You should:

    1. A. Pet the dog first so that it learns to trust you
    2. B. Avoid petting or distracting the working dog
    3. C. Have the dog ride in a separate vehicle
    4. D. Hold the leash yourself to guide the dog
    Show answer

    Answer: B. Avoid petting or distracting the working dog

    A dog in harness is working, and distraction can interfere with its job of keeping the handler safe. Ask the handler before interacting with the dog in any way. Under the ADA the dog may ride with him unless it is out of control or a direct threat, and taking the leash from the handler disrupts the working team.

18. Under the Americans with Disabilities Act, a service animal is defined as:

    1. A. Any pet that provides emotional comfort to its owner
    2. B. Any animal with a certificate from an online registry
    3. C. A dog prescribed by a therapist for anxiety
    4. D. A dog trained to do tasks for a person's disability
    Show answer

    Answer: D. A dog trained to do tasks for a person's disability

    The ADA defines a service animal as a dog (with a separate provision for miniature horses) individually trained to perform tasks related to a disability. Emotional support animals are not service animals under the ADA, and online certificates carry no legal weight.

19. A patient's service dog needs to ride in the ambulance. Under the ADA, you may ask:

    1. A. For written proof of the dog's training certificate
    2. B. What the patient's specific disability is
    3. C. Whether it is required and what task it performs
    4. D. For a demonstration of the dog's task
    Show answer

    Answer: C. Whether it is required and what task it performs

    Only two questions are allowed: is the animal required because of a disability, and what work or task has it been trained to perform. You may not demand documentation, ask about the disability, or require a demonstration.

20. An 82-year-old woman with severe vision loss from macular degeneration calmly says she sees small people in old-fashioned clothes in her room. She knows they are not real and is otherwise oriented. This is most consistent with:

    1. A. New-onset schizophrenia with hallucinations
    2. B. Charles Bonnet syndrome from vision loss
    3. C. Delirium from an acute infection
    4. D. Lewy body dementia with delusions
    Show answer

    Answer: B. Charles Bonnet syndrome from vision loss

    Charles Bonnet syndrome causes vivid, silent visual hallucinations in people with significant vision loss; insight is preserved, and there are no other psychiatric or cognitive symptoms. Reassure her that it is a known effect of vision loss, and still assess for other causes. Schizophrenia rarely begins at 82, its hallucinations are usually voices, and insight is poor. Delirium brings fluctuating attention and disorientation, and she is oriented. Lewy body dementia causes cognitive fluctuation and parkinsonism, and the hallucinations usually come without insight. (American Academy of Ophthalmology.)

21. A 66-year-old woman with diabetic retinopathy is anxious in the moving ambulance. A helpful step is to:

    1. A. Stay quiet so she can rest during transport
    2. B. Turn the dome lights up so she can see better
    3. C. Hold her hand but say nothing to her
    4. D. Describe what you are doing as you do it
    Show answer

    Answer: D. Describe what you are doing as you do it

    Narrating procedures and movements ('You will feel a cuff on your arm,' 'We are turning now') reduces fear when she cannot see what is coming. Silence leaves her guessing about each touch and sudden motion. Brighter lights rarely help vision loss from retinopathy and do not tell her what is about to happen. Holding her hand is kind, but without words she is still unprepared for procedures and movement. (Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter.)

22. Which statement about patients who are legally blind is correct?

    1. A. Many have some remaining vision
    2. B. They see nothing but darkness
    3. C. They cannot live independently
    4. D. They also have hearing loss
    Show answer

    Answer: A. Many have some remaining vision

    Legal blindness means acuity of 20/200 or worse in the better eye with correction, or a visual field of 20° or less; many such patients still perceive light, shapes, or movement. Most live independently, so ask what the patient can see and what help she wants.

23. A patient with hearing loss nods 'yes' to all your questions, including one about allergies that a family member says she answered wrongly. You should suspect:

    1. A. She is deliberately hiding her allergy history
    2. B. She has a receptive aphasia from a stroke
    3. C. She is nodding without understanding the questions
    4. D. Her family member is mistaken about her allergies
    Show answer

    Answer: C. She is nodding without understanding the questions

    Patients with hearing loss often nod along to avoid embarrassment, so confirm understanding with written questions or by asking them to repeat key answers. Assuming deception or aphasia skips the simplest explanation.

24. The term 'Deaf' written with a capital D usually refers to:

    1. A. A legal term for total hearing loss in both ears
    2. B. A formal diagnosis given by an audiologist
    3. C. A type of hearing loss caused by noise exposure
    4. D. A cultural identity built around sign language
    Show answer

    Answer: D. A cultural identity built around sign language

    Many people who use ASL identify with Deaf culture and do not see deafness as a problem to be fixed; respect their preferred communication method. Lowercase 'deaf' refers to the audiologic condition.

25. A 70-year-old blind woman refuses transport after a minor fall. Before leaving her home, you should:

    1. A. Turn on all the lights in the home for her safety
    2. B. Put items back where they were and say goodbye
    3. C. Rearrange the furniture to clear a safer path
    4. D. Leave without speaking to avoid startling her
    Show answer

    Answer: B. Put items back where they were and say goodbye

    A visually impaired person relies on objects staying where she left them; moved furniture or medications become hazards. Telling her you are leaving keeps her from talking to an empty room.