Chapter 39 THE POINT Questions

A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the common causes? (Select all that apply.) a. Chlamydia trachomatis b. Haemophilus influenzae c. Staphylococcus aureus d. Neisseria gonorrhoeae e. Streptococcus pneumoniae

a. Chlamydia trachomatis b. Haemophilus influenzae c. Staphylococcus aureus d. Neisseria gonorrhoeae e. Streptococcus pneumoniae Rationale: The most common bacterial causes are Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenza. In the newborn, Chlamydia trachomatis and Neisseria gonorrhoeae are more common causes.

A child is being prepared for discharge after sustaining a simple contusion of the eye. Which advice would the nurse expect to include in the discharge instructions? a. Encourage the parents to apply ice to the area for 20 minutes at a time for the first 24 hours. b. Teach the parents how to apply ophthalmologic antibiotic ointment properly. c. Tell the parents that although the condition is frightening, no intervention is needed. d. Inform the parents to call their pediatrician if the bruising persists for more than 2 days.

a. Encourage the parents to apply ice to the area for 20 minutes at a time for the first 24 hours. Rationale: To decrease the edema of a simple contusion, the parents should be instructed to apply an ice pack to the area for 20 minutes, then remove it for 20 minutes, continuing to repeat this cycle as often as possible during the first 24 hours. Bruising of the surrounding eye area may take up to 3 weeks to resolve. A sclera hemorrhage typically requires no treatment and resolves on its own over a period of a few weeks. A simple contusion does not require the use of antibiotic ointment. However, corneal abrasions may require antibiotic ointment.

When developing the plan of care for a child with a visual impairment, what would the nurse include? (Select all that apply.) a. Encouraging activities to stimulate development b. Ensuring that the child's environment is familiar and secure c. Referring the child to early intervention after the age of 5 years d. Encouraging the use of self-stimulatory behaviors e. Using touch and tone of voice to demonstrate affection

a. Encouraging activities to stimulate development b. Ensuring that the child's environment is familiar and secure e. Using touch and tone of voice to demonstrate affection Rationale: When caring for a child with a visual impairment, the nurse would ensure that the child's environment provides familiarity and security. The nurse would also encourage the parents to use activities to stimulate the child's development and use touch and tone of voice to demonstrate affection. The nurse would work with the parents to plan a strategy for the development of alternative behaviors specific to the child to minimize the use of self-stimulatory behaviors. Children younger than 3 years of age should be referred to early intervention to establish case management services for the child's developmental needs.

While obtaining the health history for an 11-year-old child, the nurse suspects the child may have myopia based on what information? (Select all that apply.) a. The child tells the nurse that it is difficult to see the ball in the outfield when playing baseball. b. The child tells the nurse that they have problems seeing their hand held video games. c. The parent tells the nurse that the child seems to hold books "closer and closer" to the face when reading. d. The child tells the nurse that they have to squint to see their teacher write on the white board at the front of the classroom. e. The parent tells the nurse that the child always wants to set close to the movie screen, but never did in the past.

a. The child tells the nurse that it is difficult to see the ball in the outfield when playing baseball. d. The child tells the nurse that they have to squint to see their teacher write on the white board at the front of the classroom. e. The parent tells the nurse that the child always wants to set close to the movie screen, but never did in the past. Rationale: When the light entering the eye focuses in front of the retina, it results in myopia (nearsightedness). Children who are nearsighted may see well at close range but have difficulty focusing on objects at a distance, such as the baseball in the outfield, the white board at school, and the movie screen.

The nurse is screening a 4-year-old child for vision problems. What problem could result in loss of vision? a. Diplopia b. Amblyopia c. Exotropia d. Nystagmus

b. Amblyopia Rationale: Amblyopia, if untreated, will get worse in the poorer eye and will cause strain on the better eye, which may also lead to worsening of acuity in that eye. Eventually blindness will result in one or both eyes. Exotropia can develop into amblyopia but not lead to a loss of vision. Diplopia can cause vision impairment but not loss of vision. Nystagmus can cause vision impairment but not lead to a loss of vision.

The nurse in the emergency department is caring for a child who has a simple contusion of the right eye following a motor vehicle accident. Upon discharge to home, which response by the parents requires further clarification? a. "For the first 24 hours I will apply ice for 20 minutes, then leave it off for 20 minutes." b. "I will need to apply heat to the eye four times a day." c. "Our child will probably have a black eye for at least a couple of weeks." d. "The blood in the white part of the eye is normal with this type of injury."

b. "I will need to apply heat to the eye four times a day." Rationale: To decrease edema in the child with a simple contusion, instruct the parent to apply an ice pack to the area for 20 minutes, then remove it for 20 minutes, and continue to repeat the cycle as often as possible during the first 24 hours. Tell the parents and child that bruising of the surrounding eye area may take up to 3 weeks to resolve. Scleral hemorrhage is natural history of resolution without intervention over a period of a few weeks with this type of injury.

The nurse is obtaining the history from the parents of an infant who is suspected of having infantile glaucoma. Which statement by the parents would help to confirm this suspicion? a. "Our child's eye doesn't seem to tear much." b. "It seems like bright lights really bother our child." c. "Our child opens the eyes quite frequently when awake." d. "Our child's eye looks about the same size as the other eye."

b. "It seems like bright lights really bother our child." Rationale: Photophobia occurs with infantile glaucoma, so bright light may bother the infant. Typically, the infant with infantile glaucoma will keep the eyes closed most of the time. The affected eye may appear enlarged with infantile glaucoma. Tearing is associated with infantile glaucoma.

The nurse is caring for a 20-month-old child with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement? a. Determining if the child's balance is shaky when walking b. Administering antibiotics as soon as they're available c. Obtaining a culture of fluid from the middle ear d. Administering antivirals to ensure broad coverage of all organisms

b. Administering antibiotics as soon as they're available Rationale: Because of the severity of the symptoms, the child will be treated with antibiotics immediately. This decision is based on the clinical practice guideline developed by the American Academy of Pediatrics and American Academy of Family Physicians. This clinical practice guideline helps to eliminate the need for obtaining middle ear fluid for culture. It is unreasonable to obtain a culture of middle ear fluid with every episode of acute otitis media to determine the specific cause. A 20-month-old's gait would most likely appear as swaying from side to side while moving forward. It is not until the toddler is around 3 years of age that he or she demonstrates walking in a heel-to-toe fashion with a steady gait. Antiviral medications would be used if the diagnosis of a viral cause was confirmed and the child was older than the age of 2 years.

The parent of a 4-week-old infant is discussing what babies see with the nurse. What information should be included? (Select all that apply.) a. Your baby can see colors clearly. b. Children will not have 20/20 vision until they are school age. c. Babies can focus on multiple images at birth. d. Your baby can see about 8 to 10 in. e. Infants experience blurry vision due to the immaturity of their eye structures.

b. Children will not have 20/20 vision until they are school age. d. Your baby can see about 8 to 10 in. e. Infants experience blurry vision due to the immaturity of their eye structures. Rationale: The spherical shape of the newborn's lens does not allow for distance accommodation, so the newborn sees best at a distance of about 8 to 10 in and a decreased number of cones further contributes to neonatal blurry vision. The optic nerve is not completely myelinated, so color discrimination is incomplete. Visual acuity develops over the first few years of the child's life. Visual acuity improves over the first few years of the child's life, with 20/20 achieved by age 6 or 7 years. The rectus muscles are uncoordinated at birth and mature over time so that binocular vision may be achieved by 4 months of age.

A child returns to the clinic after an episode of otitis externa, which has resolved. What would the nurse emphasize as the priority for preventing future episodes? a. Performing hand washing b. Keeping ear canals dry c. Avoiding upper respiratory tract infections d. Adhering to regular follow-up to assess for hearing loss

b. Keeping ear canals dry Rationale: Since moisture contributes to otitis externa, the priority is to keep the ear canals dry. Hand washing would be a priority for preventing infections such as conjunctivitis. Upper respiratory tract infections are associated with otitis media, not otitis externa. Hearing loss is not associated with otitis externa.

A nurse is assessing a toddler who is brought to the clinic by the parent. The parent states, "My toddler has been so irritable lately and I've noticed the toddler frequently pulling on the right ear." The nurse suspects acute otitis media based on which assessment findings? (Select all that apply.) a. Upper respiratory infection 3 months ago b. Red bulging tympanic membrane c. Low-grade fever d. Mobile eardrum e. Loss of appetite

b. Red bulging tympanic membrane c. Low-grade fever e. Loss of appetite Rationale: Manifestations of acute otitis media include fever (low-grade or higher); dull or opaque, bulging or red tympanic membrane; loss of appetite or poor feeding; immobile eardrum; and recent upper respiratory infection.

A nurse is preparing a presentation for a group of parents about vision impairment. When describing the causes, what would the nurse include as a common cause? (Select all that apply.) a. Trauma b. Retinopathy of prematurity c. Conjunctivitis d. Amblyopia e. Infantile glaucoma f. Refractive error

b. Retinopathy of prematurity d. Amblyopia e. Infantile glaucoma f. Refractive error Rationale: In the United States, visual impairment and blindness are most often caused by refractive error, astigmatism, strabismus, amblyopia, nystagmus, infantile glaucoma, congenital cataract, retinopathy of prematurity, and retinoblastoma.

The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority? a. Instructing parents about using protective sunglasses b. Explaining to the parents about patching the eye as therapy c. Ensuring the protective eye patch is securely in place d. Teaching the family how to use antibiotic eye drops

c. Ensuring the protective eye patch is securely in place Rationale: The priority intervention is to protect the operative site with an eye patch. Teaching about the use of protective sunglasses would be done later in the postoperative period in preparation for the child's discharge. Teaching the parents about administering eye drops would be done later in the postoperative period in preparation for the child's discharge. Explaining about eye patching would be done later in the postoperative period in preparation for the child's discharge.

The nurse is assessing a child with a hordeolum. Which would the nurse be least likely to observe? a. Lesion along the lid margin b. Pain c. Reddened conjunctiva d. Eyelid edema

c. Reddened conjunctiva Rationale: The conjunctiva is clear with a hordeolum. A hordeolum is usually painful. Eyelid edema is present with a hordeolum. A hordeolum may be visible as an enlarged lesion along the lid margin.

The nurse is caring for an 11-year-old with otalgia and fever. When reviewing the child's medical record, which would the nurse identify as a risk factor for acute otitis media? a. The child had a first episode of acute otitis media 3 months ago. b. The child lives with the parents and older sister. c. The parent has had recurrent otitis media. d. The child was breastfed, not bottle-fed.

c. The parent has had recurrent otitis media. Rationale: A positive family history of acute otitis media, as evidenced by the report that the parent has had recurrent otitis media, is a risk factor. Breastfeeding is associated with decreasing the risk for otitis media. A first episode of acute otitis media before 3 months of age would be a risk factor. Crowding in homes or a large family size would be considered a risk factor.

The nurse is performing an assessment on a child who is 6 days old. When assessing the eyes, the nurse notes the presence of a bluish tinge to the sclerae. What can the nurse infer about this finding? a. Autoimmune disorders are often preceded with these findings. b. Blue hues noted in the sclerae in a child of this age is associated with a renal disorder. c. This is normal in infants up to several weeks of age. d. This may signal a connective tissue disorder.

c. This is normal in infants up to several weeks of age. Rationale: At the time of birth the newborn's sclerae may have a bluish hue. This is a normal finding due to the thin nature of the tissue of the eye. This will begin to fade by the time the child is a few months of age, as the tissues begin to thicken. Finding this in a child who is 6 months of age may signal the presence of osteogenesis imperfecta type I, an inherited connective tissue disorder but is more rare.

After conducting vision screening and examination of a preschooler, the nurse suspects amblyopia based on: a. crossing of the eyes. b. absent red reflex. c. asymmetric corneal light reflex. d. irregular rapid eye movement

c. asymmetric corneal light reflex. Rationale: Asymmetry of the corneal light reflex may be the only sign of amblyopia in a preverbal child. An absent red reflex is suggestive of congenital cataract. Very rapid, irregular eye movement suggests nystagmus. Eyes not facing in the same direction suggest strabismus.

The nurse is assessing a 13-year-old adolescent with an eye injury. The nurse determines that evaluating pupillary response to light and accommodation is not appropriate based on the suspicion of a: a. simple contusion. b. corneal abrasion c. scleral hemorrhage. d. foreign body.

c. scleral hemorrhage. Rationale: Scleral hemorrhage appears as erythema in the sclera and can be quite large initially, but vision is unaffected by it. A simple contusion can affect visual acuity and may cause diplopia or blurred vision. Therefore, the nurse needs to check pupillary response. A foreign body can affect vision, necessitating evaluation of pupillary response. Corneal abrasion can affect vision. Therefore, the nurse should check the adolescent's pupillary response.

A 12-year-old child expresses embarrassment about having to start wearing glasses. What is the best response by the nurse? a. "You look adorable in your glasses. Everyone will love them." b. "I wore glasses when I was 12. It wasn't so bad." c. "You really don't have a choice if you want to see better." d. "Let's talk about what it will be like wearing them for the first time."

d. "Let's talk about what it will be like wearing them for the first time." Rationale: Stating, "Let's talk about what it will be like wearing them for the first time" opens up dialogue with the child so that she can explore feelings. This allows the nurse to provide support and help the child feel more at ease with the situation. Telling the child that the nurse "wore glasses when I was 12" and that there is "no choice" doesn't acknowledge the child's anxiety. Complimenting the child on how the child looks in the glasses may make the child feel good temporarily, but it doesn't allow for exploration of feelings.

The nurse is educating the parents of a 7-year-old child who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed? a. "Using hand gestures as visual cues should help our child understand a little better." b. "We need to face our child when we are speaking." c. "We need to make sure we are speaking clearly." d. "We need to raise the volume of our voices significantly so our child can hear us."

d. "We need to raise the volume of our voices significantly so our child can hear us." Rationale: It is not necessary for the parents to raise their voices more than slightly in order to be heard. Speaking clearly is an appropriate technique for communicating with the child. Facing the child when speaking is an effective method for communicating with the child. Using visual clues, such as hand gestures, is an effective technique for communicating with this child.

The nurse is caring for a 6-year-old child with sensorineural hearing loss. Which would the nurse be least likely to identify as the cause of the child's hearing loss? a. Intrauterine exposure to rubella b. Excess noise exposure c. Ototoxic medication use d. Acute otitis media

d. Acute otitis media Rationale: Acute otitis media can cause damage to the middle ear, bringing about conductive hearing loss. Ototoxic medications can damage the hair cells of the cochlea or along the auditory pathway, in turn causing sensorineural hearing loss. Intrauterine infection with rubella causes damage to the hair cells in the cochlea or along the auditory pathway, which in turn causes sensorineural hearing loss. Excess noise exposure causes damage to the hair cells in the cochlea or along the auditory pathway, which in turn causes sensorineural hearing loss.

The nurse is discussing communication options with the parents of a 2-year-old child with congenital hearing loss. The nurse integrates knowledge of what form of communication as having no verbal component? a. Oral deaf education b. Total communication c. Cued speech d. American Sign Language

d. American Sign Language Rationale: American Sign Language is entirely communicated through hand signs, gestures, and facial expression. It has its own grammar and syntax. Oral deaf education uses technology to boost auditory potential and teaches children to notice sound and give it meaning. It helps develop oral speech. Cued speech is a system using hand signs to clarify lip-reading. It gives the person clues about the sounds the speaker is making. Total communication combines auditory training and teaching spoken language with signing exact English, which corresponds to the words and syntax of English.

The nurse is teaching the family of a 6-year-old child with allergic conjunctivitis how to minimize the exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement? a. Washing the child's hands and face when returning from outdoors b. Making sure the child showers and shampoos before bedtime c. Rinsing the child's eyelids with a clean washcloth and cool water d. Encouraging the child to keep the hands away from the eyes

d. Encouraging the child to keep the hands away from the eyes Rationale: Keeping a 6-year-old child's hands away from the face is a difficult task, particularly when the child is playing by oneself or is at school. Washing the hands and face when returning from outdoors is something the parents can supervise and ensure occurs and thus would be less difficult to implement. Rinsing the child's eyelids is an activity that the parents can supervise and ensure occurs and thus would be less difficult to implement. Showering and shampooing before bedtime is an activity that the parents can supervise and ensure occurs and thus would be less difficult to implement.

A nurse is preparing a presentation for a group of parents who have children with significant visual impairment. What would the nurse be least likely to include as an example of self-stimulatory actions? a. Rocking b. Head banging c. Spinning d. Shouting

d. Shouting Rationale: Shouting would not be considered an example of a self-stimulatory action for blindism. Head banging is an example of a self-stimulatory action for blindism. Rocking is an example of a self-stimulatory action for blindism. Spinning is an example of a self-stimulatory action for blindism.

Vision screening reveals that a child has myopia. The nurse interprets this as: a. eye and brain are not working together properly. b. light rays being bent unevenly. c. farsightedness. d. light rays being focused in front of the retina.

d. light rays being focused in front of the retina. Rationale: When the light entering the eye focuses in front of the retina, it results in myopia or nearsightedness. Farsightedness or hyperopia involves light rays being focused behind the retina. Astigmatism involves light rays being refracted or bent unevenly due to an uneven curvature of the cornea. Amblyopia results when the vision in one eye is reduced because the eye and brain are not working together properly.