Free National Competency Exam Practice Questions

Sample Practice Questions

Try these 10 sample questions from the National Competency Exam practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 38-year-old woman reports that her mother and her older sister each had surgery on one ear in their forties because of hearing loss. Over the past two years she has noticed that she can no longer follow low-pitched voices or hear a whisper. She has no ear pain, no drainage and no noise exposure, and otoscopy is unremarkable. Which pattern of hearing loss is MOST consistent with this history?

   1. A. A conductive loss that is greatest in the low frequencies
   2. B. A conductive loss that is greatest in the high frequencies
   3. C. A sensorineural loss that is greatest in the low frequencies
   4. D. A sensorineural loss that is greatest in the high frequencies

   Answer: A

   Explanation: The family pattern of surgically treated hearing loss beginning in middle age, with early loss of soft low-pitched speech and a normal-looking eardrum, points to otosclerosis. NIDCD states that "Otosclerosis is most often caused when one of the bones in the middle ear, the stapes, becomes stuck in place" and that "Many people with otosclerosis first notice that they are unable to hear low-pitched sounds or can’t hear a whisper." Because the block is in the middle ear, the loss is conductive, and the Navy occupational hearing conservation training manual describes the resulting audiogram shape: "Audiogram generally shows a rising configuration with greater loss in the low frequency range and better hearing in the high frequencies". A high-frequency emphasis, whether conductive or sensorineural, does not fit a fixed stapes.

   Reference: What Is Otosclerosis? Symptoms & Diagnosis| NIDCD — 'What causes otosclerosis?' and 'What are the symptoms of otosclerosis?'

2. 2A specialist examines a patient's right ear and can see most of the drum, which looks pearly and translucent, reflects the light of the otoscope, and shows a triangular bright reflection running from the centre toward the lower edge. How should this ear be recorded?

   1. A. Normal, because the appearance and the light reflection are both typical
   2. B. Abnormal, because a triangular bright reflection indicates a retracted drum
   3. C. Abnormal, because a translucent drum indicates fluid behind the membrane
   4. D. Normal, but only if no wax at all can be seen anywhere in the ear canal

   Answer: A

   Explanation: The Navy occupational hearing conservation training manual lists the features of a healthy drum: "Normal eardrum characteristics: Pearly/ translucent appearance, reflects light from otoscope, Cone of Light is triangular bright reflection (center to lower side edge), might see shadows of Ossicles". It also makes clear that some wax is expected: "Wide range of normal: Some cerumen is normal in ear canal, eardrum needs to be visible." The CDC audiometry procedures manual uses the same standard for recording a normal result: "Normal. At least half the eardrum can be clearly visualized, and it appears pearly-gray in color." The cone of light and translucency are therefore normal findings, not signs of retraction or effusion.

   Reference: Author: Mason, Theodore D. (CIV) — Module 2.1, 'Normal Ear Canal and Tympanic Membrane'

3. 3An 84-year-old with marked arthritis in both hands and reduced near vision needs amplification for a moderate loss. She lives alone and will handle the devices herself. Which consideration should drive the choice of style for her?

   1. A. Smaller canal styles are harder for a patient to adjust and to remove
   2. B. Smaller canal styles are easier for a patient to adjust and to remove
   3. C. Smaller canal styles carry a larger battery than the behind-the-ear styles
   4. D. Smaller canal styles carry more room for a telecoil than behind-the-ear ones

   Answer: A

   Explanation: NIDCD states the handling consequence of reduced size: "Because they are small, canal aids may be difficult for a person to adjust and remove. In addition, canal aids have less space available for batteries and additional devices, such as a telecoil." FDA makes the same comparison from the other direction, noting that "The ITE aids are larger than the in-the-canal and completely-in-the-canal aids, and may be easier to handle than smaller aids." For a patient with arthritis and reduced near vision, ease of handling is the governing factor, and the two options that credit canal styles with larger batteries or more room for a telecoil reverse what both sources state.

   Reference: Hearing Aids — Styles/Types & How They Work | NIDCD — 'Are there different styles of hearing aids?' > 'Canal aids'

4. 4Aided sound field testing shows that the patient now detects soft warble tones across the speech range, yet her aided word discrimination in quiet is no better than it was unaided. Which explanation fits this outcome?

   1. A. Audibility has been restored but the damaged inner ear still distorts
   2. B. Audibility has not been restored, so more overall gain is still needed
   3. C. Audibility has been restored but the test signals were far too loud
   4. D. Audibility has not been restored because the room was far too quiet

   Answer: A

   Explanation: The aided thresholds show that the sounds are now reaching the ear, so the remaining problem lies beyond audibility. NIDCD sets out that limit: "However, there are practical limits to the amount of amplification a hearing aid can provide. In addition, if the inner ear is too damaged, even large vibrations will not be converted into neural signals. In this situation, a hearing aid would be ineffective." The Navy occupational hearing conservation training manual describes the same mechanism, noting that damaged hair cells "cannot respond normally to components of speech (frequency, intensity, and timing)". Adding gain does not repair that, and the aided detection results rule out the two options that claim audibility was not achieved.

   Reference: Hearing Aids — Styles/Types & How They Work | NIDCD — 'How can hearing aids help?'

5. 5Otoscopy shows a dull, retracted-looking eardrum and the audiogram shows a 35 dB air-bone gap on that side. The patient asks the specialist what disease she has. How should the explanation be framed?

   1. A. Describe the findings and their meaning for hearing, and refer for a diagnosis
   2. B. Name the disease she most likely has, and reassure her that it will resolve
   3. C. Name the disease she most likely has, and begin the fitting on that same day
   4. D. Describe the findings only in general terms, and make no referral for a review

   Answer: A

   Explanation: The NBC-HIS Candidate Self-Study Guide sets the boundary for this profession in its description of the minimally qualified candidate. Among the things the candidate is not expected to do it lists "Medical diagnoses (unless licensed MD)." and "Exceed scope of practice set forth by governing agency’s license (or equivalent)." Among the things the candidate should be able to do without assistance it lists "Refer to other healthcare professionals when appropriate." Explaining what was seen and measured, and what it means for hearing, therefore sits inside the role, while naming a disease does not, and withholding a referral leaves an unexplained conductive finding unexamined.

   Reference: Candidate Self-Study Guide 2026_web file.pdf — 'DESCRIPTION OF THE MINIMALLY QUALIFIED CANDIDATE (MQC)', page 4

6. 6A 12-year-old girl is seen with her parents, who report that she was born with a moderate-to-severe hearing loss, sat up and walked at the usual ages, and has just been told by an eye specialist that she has night blindness. Two cousins on the mother's side have the same combination of findings. Which inherited condition BEST accounts for this family pattern?

   1. A. Usher syndrome type 2
   2. B. Usher syndrome type 1
   3. C. Usher syndrome type 3
   4. D. Usher gene carrier state

   Answer: A

   Explanation: NIDCD describes the three types by the combination of hearing level at birth, balance function and age of visual symptoms. Type 2 fits: "Children with type 2 Usher syndrome are born with moderate to severe hearing loss but normal balance." Type 1 does not fit, because "Children with type 1 Usher syndrome have profound hearing loss or deafness at birth and have severe balance problems" and "Walking rarely occurs prior to 18 months." Type 3 does not fit, because "Children with type 3 Usher syndrome have normal hearing at birth." A carrier does not have the disorder at all: "The hearing, balance, and vision of carriers with one mutant Usher gene is typically normal."

   Reference: What Is Usher Syndrome? Symptoms & Treatment | NIDCD — 'What are the characteristics of the three types of Usher syndrome?'; carrier illustration caption

7. 7During otoscopy before an audiogram, the specialist sees clear fluid tracking along the floor of the left ear canal. The patient reports no pain. Which two consequences follow from this single finding?

   1. A. Refer the ear for examination, and do not use an insert earphone in it
   2. B. Refer the ear for examination, and use an insert earphone to seal the canal
   3. C. Proceed without referral, and do not use an insert earphone in that ear
   4. D. Proceed without referral, and use an insert earphone to seal off the canal

   Answer: A

   Explanation: The CDC audiometry procedures manual groups drainage under the category it calls other abnormality: "This could include drainage (fluid) in the ear canal; blood; a foreign body (e.g., bugs, cotton, a p.e. tube that has ejected itself from the eardrum, etc.); a perforation in the eardrum; a growth in the ear canal; significant skin abnormalities; or anything else that you feel may be cause for concern." It then attaches both consequences: "This finding precludes the use of insert earphones. In addition, SPs with abnormalities should be referred to the MEC physician." FDA lists the same history among the reasons a patient should be seen, naming "Fluid, pus, or blood coming out of the ear in the past six months".

   Reference: NHANES Audiometry Manual 2018 — Section 3.3.4 'Recording Results of Otoscopy' > 'Other Abnormality'

8. 8A seven-year-old with a moderate bilateral loss is to be fitted, and his parents ask why a behind-the-ear instrument has been recommended rather than a device made to sit inside his ear. Which reason applies to a growing child?

   1. A. The earmold can be replaced as the ear grows while the aid is kept
   2. B. The earmold does not need replacing because it stretches as ears grow
   3. C. The custom shell can be reground each year to match the growing ear
   4. D. The custom shell is preferred because it is less easily lost by children

   Answer: A

   Explanation: FDA gives this as the reason the style is chosen for children: "This style is often chosen for young children because it can accommodate various earmold types, which need to be replaced as a child grows." NIDCD states the corresponding limitation of a device built into the ear: "ITE aids usually are not worn by young children because the casings need to be replaced often as the ear grows." The earpiece is the part that must change, and it is separable on a behind-the-ear instrument but integral to a custom shell, so grinding a shell is not an equivalent solution and ease of loss is not the deciding factor.

   Reference: Types of Hearing Aids | FDA — 'What are the styles of hearing aids?' > 'Behind-the-ear (BTE) aids'

9. 9Before adjusting an instrument that a patient says is weak, a specialist wants an objective measurement of what the device itself is actually producing. Which equipment is intended for that measurement?

   1. A. A hearing aid calibrator and analysis system
   2. B. An audiometer calibration reference set of tools
   3. C. An auditory impedance testing instrument set
   4. D. An electronic noise generator for audiometry

   Answer: A

   Explanation: The federal classification names the device intended for this job: "A hearing aid calibrator and analysis system is an electronic reference device intended to calibrate and assess the electroacoustic frequency and sound intensity characteristics emanating from a hearing aid, master hearing aid, group hearing aid or group auditory trainer." The other three are real, separately classified instruments with different targets: an audiometer calibration set "is an electronic reference device that is intended to calibrate an audiometer", an auditory impedance tester evaluates "the functional condition of the middle ear", and an electronic noise generator is intended "to introduce a masking noise into the non-test ear during an audiometric evaluation".

   Reference: Part 874 — § 874.3310(a), 874.1080(a), 874.1090(a) and 874.1120(a)

10. 10A patient with a moderate hearing loss asks what her audiogram means in practical terms for everyday listening. Which plain description matches that degree of loss?

    1. A. She may hear almost no speech when another person talks at a normal level
    2. B. She may hear some speech sounds, but the softest sounds are hard for her
    3. C. She may hear no speech at a normal level, and only some very loud sounds
    4. D. She may hear no speech at all, and only sounds that are extremely loud

    Answer: A

    Explanation: CDC gives a plain functional description for each degree of loss. For this one it states: "Moderate hearing loss. A person with a moderate hearing loss may hear almost no speech when another person is talking at a normal level." The three other options are the descriptions CDC gives for the neighbouring degrees: "Mild hearing loss. A person with a mild hearing loss may hear some speech sounds but soft sounds are hard to hear.", "Severe hearing loss. A person with severe hearing loss will hear no speech when a person is talking at a normal level and only some loud sounds." and "Profound hearing loss. A person with a profound hearing loss will not hear any speech and only very loud sounds."

    Reference: Types of Hearing Loss | Hearing Loss in Children | CDC — 'Degree of hearing loss'