Wong's Ch. 18: part 2

Which of the following is the most common clinical manifestation of retinoblastoma? a. Glaucoma b. Amblyopia c. Cats eye reflex d. Sunken eye socket

ANS: C When the eye is examined, the light will reflect off the tumor, giving the eye a whitish appearance. This is called a cats eye reflex. A late sign of retinoblastoma is a red, painful eye with glaucoma. Amblyopia, or lazy eye, is reduced visual acuity in one eye. The eye socket is not sunken.

Which term refers to the ability to see objects clearly at close range but not at a distance? a. Myopia b. Amblyopia c. Cataract d. Glaucoma

ANS: A Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not a distance. Amblyopia, or lazy eye, is reduced visual acuity in one eye. A cataract is opacity of the lens of the eye. Glaucoma is a group of eye diseases characterized by increased intraocular pressure.

The nurse is talking to the parent of a 13-month-old child. The mother states, My child does not make noises like da or na like my sisters baby, who is only 9 months old. Which statement by the nurse would be most appropriate to make? a. I am going to request a referral to a hearing specialist. b. You should not compare your child to your sisters child. c. I think your child is fine, but we will check again in 3 months. d. You should ask other parents what noises their children made at this age.

ANS: A By 11 months of age a child should be making well-formed syllables such as da or na and should be referred to a specialist if not. You should not compare your child to your sisters child, I think your child is fine, but we will check again in 3 months, and You should ask other parents what noises their children made at this age are not appropriate statements to make to the parent.

Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through which intervention? a. Being involved in immunization clinics for children b. Assessing a newborn for hearing loss c. Answering parents questions about hearing aids d. Participating in hearing screening in the community

ANS: A Childhood immunizations can eliminate the possibility of acquired sensorineural hearing loss from rubella, mumps, or measles encephalitis. Assessing a newborn for hearing loss, answering parents questions about hearing aids, and participating in hearing screening in the community are interventions to screen for the presence of hearing loss or deal with an identified loss, not prevention.

A nurse should suspect possible visual impairment in a child who displays which characteristic? a. Excessive rubbing of the eyes b. Rapid lateral movement of the eyes c. Delay in speech development d. Lack of interest in casual conversation with peers

ANS: A Excessive rubbing of the eyes is a clinical manifestation of visual impairment. Rapid lateral movement of the eyes, delay in speech development, and lack of interest in casual conversation with peers are not associated with visual impairment.

A child with autism spectrum disorder (ASD) is admitted to the hospital with pneumonia. The nurse should plan which priority intervention when caring for the child? a. Maintain a structured routine and keep stimulation to a minimum. b. Place child in a room with a roommate of the same age. c. Maintain frequent touch and eye contact with the child. d. Take the child frequently to the playroom to play with other children.

ANS: A Providing a structured routine for the child to follow is a key in the management of ASD. Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization. Because physical contact often upsets these children, minimum holding and eye contact may be necessary to avoid behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits with staff caregivers kept short whenever possible. The playroom would be too overwhelming with new people and situations and should not be a priority of care.

A nurse is caring for a hearing-impaired child who lip reads. The nurse should plan which intervention to facilitate lip reading? a. Speak at an even rate. b. Exaggerate pronunciation of words. c. Avoid using facial expressions. d. Repeat in exactly the same way if child does not understand.

ANS: A The child should be helped to learn and understand how to read lips by speaking at an even rate. It interferes with the childs comprehension of the spoken word to exaggerate pronunciation of words, to avoid using facial expressions, and to repeat in exactly the same way if the child does not understand.

Which assessment findings indicate to the nurse a child has Down syndrome? (Select all that apply.) a. High arched narrow palate b. Protruding tongue c. Long, slender fingers d. Transverse palmar crease e. Hypertonic muscle tone

ANS: A, B, D The assessment findings of Down syndrome include high arched narrow palate, protruding tongue, and transverse palmar creases. The fingers are stubby and the muscle tone is hypotonic not hypertonic.

A nurse is instructing a nursing assistant on techniques to facilitate lip reading with a hearing-impaired child who lip reads. Which techniques should the nurse include? (Select all that apply.) a. Speak at eye level. b. Stand at a distance from the child. c. Speak words in a loud tone. d. Use facial expressions while speaking. e. Keep sentences short.

ANS: A, D, E To facilitate lip reading for a hearing-impaired child who can lip read, the speaker should be at eye level, facing the child directly or at a 45-degree angle. Facial expressions should be used to assist in conveying messages, and the sentences should be kept short. The speaker should stand close to the child, not at a distance, and using a loud tone while speaking will not facilitate lip reading.

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which areas with onset before age 3 years? (Select all that apply.) a. Language as used in social communication b. Parallel play c. Gross motor development d. Growth below the 5th percentile for height and weight e. Symbolic or imaginative play f. Social interaction

ANS: A, E, F These are three of the areas in which autistic children may show delayed or abnormal functioning: language as used in social communication, symbolic or imaginative play, and social interaction. Parallel play is typical play of toddlers and is usually not affected. Gross motor development and growth below the 5th percentile for height and weight are usually not characteristic of autism.

Which is an implanted ear prosthesis for children with sensorineural hearing loss? a. Hearing aid b. Cochlear implant c. Auditory implant d. Amplification device

ANS: B Cochlear implants are surgically implanted, and they provide a sensation of hearing for individuals who have severe or profound hearing loss of sensorineural origin. Hearing aids and amplification devices are external devices for enhancing hearing. Auditory implants do not exist.

Parents of a child with Down syndrome ask the nurse about techniques for introducing solid food to their 8-month-old childs diet. The nurse should give the parents which priority instruction? a. It is too early to add solids; the parents should wait for 2 to 3 months. b. A small but long, straight-handled spoon should be used to push the food toward the back and side of the mouth. c. If the child thrusts the food out, the feeding should be stopped. d. Solids should be offered only three times a day.

ANS: B Down syndrome children have a protruding tongue which can interfere with feeding, especially of solid foods. Parents need to know that the tongue thrust is not an indication of refusal to feed but a physiologic response. Parents are advised to use a small but long, straight-handled spoon to push the food toward the back and side of the mouth. If food is thrust out, it should be re-fed. Six months is the time to introduce solid foods to a child, so waiting 2 to 3 months is inappropriate. Small frequent feedings should be initiated to prevent the child from tiring. Three times a day is too infrequent.

The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which intervention? a. Apply a regular eye patch. b. Apply a Fox shield to affected eye and any type of patch to the other eye. c. Apply ice until the physician is seen. d. Irrigate eye copiously with a sterile saline solution.

ANS: B The nurses role in a penetrating eye injury is to prevent further injury to the eye. A Fox shield (if available) should be applied to the injured eye and a regular eye patch to the other eye to prevent bilateral movement. It may cause more damage to the eye to apply a regular eye patch, apply ice until the physician is seen, or irrigate the eye copiously with a sterile saline solution.

Which expected appearance will the nurse explain to parents of an infant returning from surgery after an enucleation was performed to treat retinoblastoma? (Select all that apply.) a. A lot of drainage will come from the affected socket. b. The face may be edematous or ecchymotic. c. The eyelids will be sutured shut for the first week. d. There will be an eye pad dressing taped over the surgical site. e. The implanted sphere is covered with conjunctiva and resembles the lining of the mouth.

ANS: B, D, E After enucleation surgery, the parents are prepared for the childs facial appearance. An eye patch is in place, and the childs face may be edematous or ecchymotic. Parents often fear seeing the surgical site because they imagine a cavity in the skull. A surgically implanted sphere maintains the shape of the eyeball, and the implant is covered with conjunctiva. When the eyelids are open, the exposed area resembles the mucosal lining of the mouth. The dressing, consisting of an eye pad taped over the surgical site, is changed daily. The wound itself is clean and has little or no drainage. So expecting a lot of drainage is not accurate to tell parents. The eyelids are not sutured shut after enucleation surgery.

When assessing the eyes of a neonate, the nurse observes opacity of the lens. This represents which impairment? a. Blindness b. Glaucoma c. Cataracts d. Retinoblastoma

ANS: C A cataract is opacity of the lens of the eye. The child may have visual impairment secondary to the cataract, but the opacity is a cataract. Glaucoma is increased intraocular pressure. Retinoblastoma is a tumor of the eye.

A nurse is preparing to perform a dressing change on a 6-year-old child with mild cognitive impairment (CI) who sustained a minor burn. Which strategy should the nurse use to prepare the child for this procedure? a. Verbally explain what will be done. b. Have the child watch a video on dressing changes. c. Demonstrate a dressing change on a doll. d. Explain the importance of keeping the burn area clean.

ANS: C Children with CI have a marked deficit in their ability to discriminate between two or more stimuli because of difficulty in recognizing the relevance of specific cues. However, these children can learn to discriminate if the cues are presented in an exaggerated, concrete form and if all extraneous stimuli are eliminated. Therefore, demonstration is preferable to verbal explanation, and learning should be directed toward mastering a skill rather than understanding the scientific principles underlying a procedure. Watching a video would require the use of both visual and auditory stimulation and might produce overload in the child with mild cognitive impairment. Explaining the importance of keeping the burn area clean would be too abstract for the child.

Which of the following terms refers to opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina? a. Myopia b. Amblyopia c. Cataract d. Glaucoma

ANS: C Opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina is the definition of a cataract. Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not at a distance. Amblyopia, or lazy eye, is reduced visual acuity in one eye. Glaucoma is a group of eye diseases characterized by increased intraocular pressure.

A father calls the emergency department nurse saying that his daughters eyes burn after getting some dishwasher detergent in them. The nurse recommends that the child be seen in the emergency department or by an ophthalmologist. The nurse also should recommend which action before the child is transported? a. Keep eyes closed. b. Apply cold compresses. c. Irrigate eyes copiously with tap water for 20 minutes. d. Prepare a normal saline solution (salt and water) and irrigate eyes for 20 minutes.

ANS: C The first action is to flush the eyes with clean tap water. This will rinse the detergent from the eyes. Keeping eyes closed and applying cold compresses may allow the detergent to do further harm to the eyes during transport. Normal saline is not necessary. The delay can allow the detergent to cause continued injury to the eyes.

A nurse is preparing a teaching session for parents on prevention of childhood hearing loss. The nurse should include that the most common cause of hearing impairment in children is: a. auditory nerve damage. b. congenital ear defects. c. congenital rubella. d. chronic otitis media.

ANS: D Chronic otitis media is the most common cause of hearing impairment in children. It is essential that appropriate measures be instituted to treat existing infections and prevent recurrences. Auditory nerve damage, congenital ear defects, and congenital rubella are rarer causes of hearing impairment.

An adolescent gets hit in the eye during a fight. The school nurse, using a flashlight, notes the presence of gross hyphema (hemorrhage into anterior chamber). The nurse should: a. apply a Fox shield. b. instruct the adolescent to apply ice for 24 hours. c. have adolescent rest with eye closed and ice applied. d. notify parents that adolescent needs to see an ophthalmologist.

ANS: D The parents should be notified that the adolescent needs to see an ophthalmologist as soon as possible. Applying a Fox shield, instructing the adolescent to apply ice for 24 hours, and having the adolescent rest with eye closed and ice applied may cause further damage. Referral to an ophthalmologist is indicated.