PEDs Chapt 17 Nursing Care of the Child with a Disorder of the Eyes or Ears
A nursing instructor is teaching about eye disorders in childhood. Which of the following statements made by a student indicates a need for further instruction? a) "Glaucoma is caused by increased intraocular pressure." b) "Cataracts can be present at birth." c) "A cataract is a marked opacity of the lens." d) "Cataracts are only present in adults."
"Cataracts are only present in adults." Correct Explanation: A cataract is a marked opacity of the lens and may be present at birth.
A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is your best response?
"The tubes remain in place for 6 to 12 months until they come out by themselves." Correct Explanation: Because myringotomy tubes are foreign objects, the tympanic membrane will extrude them after a time.
A mother brings her school-age child to the clinic for a check-up. She precedes to tell the nurse that the patient is getting bad grades in school and has trouble focusing on what is on the page while reading. Upon performing an eye examination, the nurse notices that the patient has one eye that wanders. What does the nurse suspect that this patient may have? a) Color blindness b) Amblyopia c) Nystagmus d) Coloboma
Amblyopia Correct Explanation: Amblyopia is "lazy eye" or subnormal vision in one eye. With this defect, central vision fails to develop and the patient becomes functionally blind in that one eye. The child appears to be resting one eye and only using the other eye for vision. (less)
During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which of the following signs or symptoms suggests the child has a cataract? a) Absence of the red reflex b) Edema of the eyelids c) Sclera appears to be blue d) Excess watering of the eyes
Absence of the red reflex Correct Explanation: The absence of the red reflex and a white, opaque appearance of the lens are telltale signs of a cataract. A blue tinge to the sclera and excess watering of the eyes are signs of glaucoma. Edema of the eyelids is a sign of allergic conjunctivitis.
The nurse is caring for a 6-year-old boy with sensorineural hearing loss. Which of the following would the nurse be least likely to identify as the cause of the child's hearing loss? a) Excess noise exposure b) Ototoxic medication use c) Intrauterine exposure to rubella d) Acute otitis media
Acute otitis media Correct Explanation: 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 caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which of the following interventions would the nurse expect to implement? a) Determining if the girl's balance is shaky when walking b) Administering antivirals to ensure broad coverage of all organisms c) Obtaining a culture of fluid from the middle ear d) Administering antibiotics as soon as they're available
Administering antibiotics as soon as they're available Correct Explanation: 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 nurse is screening a 4-year-old girl for vision problems. Which of the following problems could result in loss of vision? a) Amblyopia b) Exotropia c) Nystagmus d) Diplopia
Amblyopia Correct Explanation: 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 is discussing communication options with the parents of a 2-year-old girl with congenital hearing loss. The nurse integrates knowledge of which of the following as having no verbal component? a) Oral deaf education b) Total communication c) Cued speech d) American Sign Language
American Sign Language Correct Explanation: 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 develops 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 preparing a nursing care plan for a 2-year-old child with hearing impairment. Which of the following interventions will be part of the plan? a) Assess vision to determine functional capability b) Assess the child's ability to convey information c) Explain botulinum injection procedure and risks d) Teach parents to make vinegar and alcohol eardrops
Assess the child's ability to convey information Correct Explanation: Children who are unable to hear during the first 36 months of life are unable to learn the language necessary for normal verbal communication; therefore, it will be important to assess the child's ability to convey information. Visual assessment is not indicated. Educating parents about botulinum injections is an intervention for strabismus. Vinegar and alcohol eardrops are a treatment for swimmer's ear.
The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is which of the following? a) Hyperopia b) Myopia c) Astigmatism d) Refraction
Astigmatism Correct Explanation: Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. Refraction is the way light rays bend as they pass through the lens to the retina. Myopia is nearsightedness; and hyperopia is farsightedness.
After conducting vision screening and examination of a preschooler, the nurse suspects amblyopia based on which of the following? a) Crossing of the eyes b) Asymmetric corneal light reflex c) Irregular rapid eye movement d) Absent red reflex
Asymmetric corneal light reflex Correct Explanation: 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.
If the child is following a normal development process, visual acuity gradually increases from birth. Which of the following is most accurate regarding the age children develop 20/20 vision? a) Most children develop 20/20 vision by 2 years of age. b) A few children develop 20/20 vision by 4 years of age. c) Children usually develop 20/20 vision by 7 years of age. d) Most children do not develop 20/20 vision until about 18 years of age.
Children usually develop 20/20 vision by 7 years of age. Correct Explanation: Visual acuity of children gradually increases from birth, when the visual acuity is usually between 20/100 and 20/400, until about 7 years of age, when most children have 20/20 vision.
A 12-year-old boy with color blindness asks his nurse what causes this condition. The nurse should explain to him that which of the following eye structures are genetically absent? a) Cones b) Lenses c) Rods d) Retinas
Cones Explanation: Color deficit is, as the name implies, the inability to perceive color correctly. It occurs in 4-8% of boys because one of the sets of cones of the retina that perceive red, green, or blue is absent.
A 1 year old comes to the clinic for a routine visit. The eye examination reveals an enlarged, edematous, and hazy cornea. The patient appears sensitive to light. Which of the following should the nurse suspect? a) Cataract b) Stye c) Congenital glaucoma d) Conjunctivitis
Congenital glaucoma Explanation: Glaucoma is increased intraocular pressure caused by inadequate or blocked drainage of aqueous humor. The cornea, which appears enlarged, may be edematous and hazy. In addition there may be tearing, pain, and photophobia.
A young child in the clinic has watery eyes and reddened conjunctiva. The child keeps the eyes closed a lot, because it hurts them. Which problem does the nurse suspect for this patient? a) Conjunctivitis b) Blepharitis marginalis c) Stye d) Chalazion
Conjunctivitis Correct Explanation: Conjunctivitis is inflammation of the conjunctiva and is demonstrated by watery eyes with reddened conjunctiva and sensitivity to light. Sticking of eyelids with pustular drainage is also a sign.
The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. Which of the following would the nurse anticipate as being most difficult for the family to implement? a) Making sure the child showers and shampoos before bedtime b) Encouraging the child to keep his hands away from his eyes c) Washing the child's hands and face when returning from outdoors d) Rinsing the child's eyelids with a clean washcloth and cool water
Encouraging the child to keep his hands away from his eyes Correct Explanation: Keeping a 6-year-old child's hands away from his face is a difficult task, particularly when he is playing by himself or is at school. Washing his 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.
In examining the vision of a 9-year-old girl, the nurse notices that she frequently reaches either too far or not far enough when attempting to take an object from the nurse's hand. Which of the following conditions does the nurse suspect in this child? a) Lack of stereopsis b) Refractive error c) Diplopia d) Lack of accommodation
Lack of stereopsis Explanation: Stereopsis is depth perception, or the ability to see objects as three-dimensional. Children with vision loss in one eye do not develop stereopsis and, consequently, tend to reach farther or closer than the actual distance of an object when attempting to grasp it. Accommodation is the adjustment the eye makes to focus on a close image. Children who cannot accommodate are unable to fuse their vision to follow a penlight toward their nose this way; instead, they demonstrate double vision (diplopia). Refractive errors, such as hyperopia (farsightedness) and myopia (nearsightedness), which cause visual impairment, are one of the most common visual deficits in school age children.
The nurse is teaching the parents of a visually impaired baby about development potential for their child. Which of the following learning functions is unique to sight-impaired children?
Learning to use facial expressions Correct Explanation: Visually impaired children may need to be taught to purposefully use facial expressions more frequently in order to improve interpersonal communication. Learning how to dress, feed, and bathe themselves; learning physical fitness skills; and learning how to participate in a group are common to the needs of all children.
The nurse is preparing an ongoing assessment plan for a child with multiple sensory disorders. Which of the following will contribute most to the detection and intervention of problems? a) Behavioral assessments as scheduled by the school b) Ongoing parental assessments of their child's capabilities c) Physical assessments when the child is sick or hurt d) Behavioral assessments when problems occur
Ongoing parental assessments of their child's capabilities Correct Explanation: Parental observations of the child's abilities and responses are very important to accurate cognitive and behavioral assessment and prevention of problems. Making assessments only when the child is sick, hurt, or is experiencing problems are not preventive measures. Behavioral assessments should be made on a regular basis, not just when schools provide them.
The nurse is taking a health history for a 9-year-old with conjunctivitis. Which of the following findings would suggest that this is allergic conjunctivitis? a) Family history of conjunctivitis b) Recent upper respiratory infection c) Exposure to infective agents d) Recently helped clean the basement
Recently helped clean the basement Explanation: Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen. Exposure to infective agents is related to infectious conjunctivitis. Recent upper respiratory infection and a family history of conjunctivitis are not contributing factors for allergic conjunctivitis.
A child has recently been diagnosed with cataracts. The nurse is discussing the treatment with the parents, which involves which of the following? a) Wearing a patch until the cloudiness clears b) Surgery c) Eye drops to lower the pressure d) There is no treatment for childhood cataracts
Surgery Correct Explanation: A cataract is marked opacity of the lens. It can be present at birth. Treatment for childhood cataracts is surgical removal of the cloudy lens, followed by insertion of an internal intraocular lens.
The nurse is discussing the ears and hearing in a child with a group of peers. Which of the following statements is most accurate related to this topic? a) The eustachian tube in the infant is straighter and wider than in the adult. b) The infant usually responds to sounds around the age of 6 months. c) The eardrum is located between the middle and the internal ear. d) Most children do not have acutely developed hearing until the age of 5 years.
The eustachian tube in the infant is straighter and wider than in the adult. Explanation: In infants and young children, the eustachian tube is straighter, shorter, and wider than in the older child and adult. Hearing in children is acute, and the infant will respond to sounds within the first month of life.
A 7-year-old girl who recently immigrated to the United States from India as a refugee is suffering from night blindness. The nurse recognizes that this condition is caused by a deficiency in which of the following vitamins? a) Vitamin B12 b) Vitamin A c) Vitamin C d) Vitamin K
Vitamin A Correct Explanation: Assess children to make sure they are receiving adequate vitamin A because, although not common in the United States, a deficiency of this may cause diminished night vision or even blindness.
When teaching a mother about amblyopia, it would be most important to explain that a) amblyopia is correctable if the child is properly treated before 6 years of age. b) if the child is not treated, he or she is likely to resent it later on. c) amblyopia is a rapid irregular movement of the eye. d) amblyopia can result from a refractive error in one eye.
amblyopia is correctable if the child is properly treated before 6 years of age. Correct Explanation: Amblyopia can be treated if discovered before 6 years of age; early recognition is, therefore, important.
The nurse is talking with the mother of a 4-year-old son who will soon be going to a prekindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which of the following statements made by the nurse would be most appropriate to tell this mother regarding the child's vision? a) His vision problem will get in the way of his learning, so he will probably have to have glasses before he starts school." b) "He is likely to have a slight astigmatism, which almost always needs to be corrected by glasses." c) "He might be suffering from hyperopia and probably will need glasses now." d) "Children's vision is not completely developed by this age. Your child might outgrow this nearsightedness."
"Children's vision is not completely developed by this age. Your child might outgrow this nearsightedness." Explanation: Visual acuity of children gradually increases from birth, when the visual acuity is usually between 20/100 and 20/400, until about 7 years of age, when most children have 20/20 vision. Hyperopia (farsightedness) is a refractive condition in which the person can see objects better at a distance than close up. Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions.
An infant with poor eye alignment cannot establish single binocular vision but has double vision. The nurse knows that another term for this disorder is which of the following? a) Stereopsis b) Hyperopia c) Myopia d) Diplopia
Diplopia Correct Explanation: Diplopia is another name for double vision. Stereopsis is depth perception or the ability to locate an object in space relative to other objects. Myopia is nearsightedness. Hyperopia is farsightedness.
The nurse is assessing a 13-year-old boy with an eye injury. The nurse determines that evaluating pupillary response to light and accommodation is not appropriate based on the suspicion of which of the following? a) Foreign body b) Corneal abrasion c) Scleral hemorrhage d) Simple contusion
Scleral hemorrhage Correct Explanation: 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 boy's pupillary response.
The nurse is caring for a 6-month-old infant diagnosed with otitis media. Which of the following clinical manifestations would likely have been noted in this child? a) Shaking the head and pulling the ear b) Severe vomiting and confusion c) High-pitched cry and nuchal rigidity d) Body stiffening and loss of consciousness
Shaking the head and pulling the ear Correct Explanation: A restless infant who repeatedly shakes the head and rubs or pulls at one ear should be checked for an ear infection.
A nurse is preparing a presentation for a parent group about ear infections. The nurse would identify the highest incidence of acute otitis media as occurring during which time? a) Spring b) Fall c) Summer d) Winter
Winter Explanation: Acute otitis media occurs mostly in the fall through the spring, with the highest incidence in the winter.
The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which of the following statements by the parents indicates that further education is needed? a) "We need to make sure we are speaking clearly." b) "We need to face our son when we are speaking." c) "We need to raise the volume of our voices significantly so he can hear us." d) "Using hand gestures as visual cues should help our child understand a little better."
"We need to raise the volume of our voices significantly so he can hear us." Correct Explanation: 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 mother of a child with conjunctivitis asks you if her son will develop amblyopia later in childhood because of the infection. You would teach her that amblyopia results from a condition such as a) prematurity. b) ptosis. c) conjunctivitis. d) eye strain.
ptosis. Explanation: Amblyopia occurs when vision in the two eyes shows a marked difference. It is associated with poor refraction, ptosis, and strabismus.
The nurse is teaching a parent how to medicate her 1-year-old child with corticosteroid eye drops. Which of the following instructions will be included? a) Visual therapy will begin in one week. b) The ophthalmologist must be seen as scheduled. c) Give the medication on an empty stomach. d) Elbow restraints are needed until healing is complete.
The ophthalmologist must be seen as scheduled. Correct Explanation: Because steroids are associated with numerous side effects and complications, ensure that the child is seen by the ophthalmologist at regular 2- to 3-month intervals to check for side effects. Elbow restraints and visual therapy would be included in postoperative instructions. Ophthalmic corticosteroids are applied to the eye and are not affected by stomach contents.
A mother asks you if there is any way to prevent acute otitis media. A suggestion you would make to her would be a) prophylactic acetic acid instillations may be helpful. b) beginning immunizations at birth rather than age 2 months might help. c) the frequency of otitis media is reduced in breastfed infants. d) prophylactic myringotomy tubes can be inserted at birth.
the frequency of otitis media is reduced in breastfed infants. Correct Explanation: Acute otitis media tends to occur less often in breastfed than bottle-fed infants, probably because of the more upright position in which they are fed.
A child diagnosed with conjunctivitis is being seen in the pediatric clinic. Which of the following are correct regarding conjunctivitis? Select all that apply. a) Treatment is symptomatic b) Warm compresses are used to remove crusts that form on the eyes c) Purulent drainage is a common symptom d) It is highly contagious e) It is most often caused by a virus
• Warm compresses are used to remove crusts that form on the eyes • Purulent drainage is a common symptom • It is highly contagious Correct Explanation: Most commonly, conjunctivitis is caused by bacteria. The purulent drainage, a common characteristic, can be cultured to determine the causative organism. Because of the danger of spreading infection, bacterial conjunctivitis is treated with ophthalmic antibacterial agents. Warm moist compresses can be used to remove the crusts that form on the eyes. The child who has bacterial conjunctivitis should be kept separate from other children until the condition has been treated.
The nurse is educating the parents of a 4-year-old boy who has been diagnosed with amblyopia. Which of the following comments provides information most helpful for the parents to know? a) "It's good you didn't wait until age 7." b) "Give him a prize when he wears the patch." c) "Amblyopia is often preventable." d) "Surgery can provide fast recovery."
"Give him a prize when he wears the patch." Explanation: Occlusion therapy with a patch is frequently used as treatment. The more compliant the patient is, the faster the recovery; rewarding a 4-year-old child for wearing the patch improves compliance and outcome. Information about prevention or completion of visual center development at age 7 will not affect treatment. Benefits of surgical treatment are not pertinent.
The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which of the following comments will be part of the information provided? a) "The liquid inside the eye can't drain." b) "This can be genetic or acquired." c) "It's an overgrowth of retinal blood vessels." d) "This is caused by silver nitrate."
"It's an overgrowth of retinal blood vessels." Correct Explanation: The pathophysiology of ROP is one of injury to the developing blood vessels and tissues of the retina, and the healing process of regrowth or overgrowth of retinal vessels. Cataracts may be caused by genetics or may be acquired after birth. The inability of the aqueous humor to drain from the eye is a result of glaucoma. Silver nitrate 1% is an antibacterial prophylaxis that may cause conjunctivitis.
The caregiver of a 2 1/2-year-old child tells the nurse, "They told me my daughter has an eye disorder called hyperopia." Which of the following statements made by the mother most indicates she has an understanding of this child's current condition? a) "At least by the time she gets married maybe she can have contacts." b) "She can see better close up than at a distance." c) "She has to have glasses right away." d) "Now I know why when she is working on puzzles she says her eye is sleepy."
"Now I know why when she is working on puzzles she says her eye is sleepy." Explanation: Hyperopia is farsightedness in which a person sees objects better at a distance than close up. Considerable eye fatigue may result from efforts at accommodation for close work. It is common in young children and often persists into the first grade or even later. Usually correction is not needed in a preschooler.
The nurse is educating a 13-year-old paintball enthusiast about sports-related injuries. Which of the following comments is most likely to be accepted by the child? a) "Play rough, but wear protective gear." b) "56% of paintball eye injuries have poor outcomes." c) "Paintball eye injuries have doubled in the past two years." d) "Most sports injuries happen to guys your age."
"Play rough, but wear protective gear." Correct Explanation: Every study cited shows that safety gear prevents injury. However, adolescents tend to ignore safety warnings. So, encouraging the child to play as rough as he pleases if he's wearing safety gear has the best chance of being heard. He won't pay attention to statistics.
The nurse is assessing the vision of 9-year-old boy. His vision appears normal on a vision screening test, although the nurse notices that he has to tilt his head occasionally as he is reading the chart. His mother tells the nurse that he has trouble reading and reports having a headache after doing his homework. Which of the following conditions should the nurse suspect in this boy? a) Myopia b) Nystagmus c) Amblyopia d) Astigmatism
Astigmatism Explanation: Astigmatism is an irregular curvature of the cornea, causing light to focus incorrectly on the retina resulting in an uneven quality of vision. On any given page of print, therefore, they may see only half the letters or can have great difficulty reading or following written instructions. They may report headache and vertigo after doing close work. Even though their vision appears deceptively normal on vision screening tests (they are able to see all of the numbers on a chart by tilting their head), these children need referred to an ophthalmologist on the basis of their other problems such as vertigo, headaches, and difficulty with reading. Amblyopia is "lazy eye," or subnormal vision in one eye which causes a child to use only one eye for vision while "resting" the other eye. Myopia is nearsightedness. Nystagmus is rapid, irregular eye movement, either vertically or horizontally.
A child is being prepared for discharge after sustaining a simple contusion of the eye. Which instruction would the nurse expect to include in the discharge instructions to the parents? a) Tell the parents that although the condition is frightening, no intervention is needed. b) Inform the parents to call their pediatrician if the bruising persists for more than 2 days. c) Encourage parents to apply ice to the area for 20 minutes at a time for the first 24 hours. d) Teach the parents how to apply ophthalmologic antibiotic ointment properly.
Encourage parents to apply ice to the area for 20 minutes at a time for the first 24 hours. Correct Explanation: 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.
The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which of the following interventions would be the priority? a) Explaining to the parents about patching the eye as therapy b) Ensuring the protective eye patch is securely in place c) Instructing parents about using protective sunglasses d) Teaching the family how to use antibiotic eye drops
Ensuring the protective eye patch is securely in place Correct Explanation: 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.
Regular use of cotton-tipped applicators to clean the ears is recommended. a) False b) True
False Correct Explanation: Wax accumulation rarely is extensive enough in children that it interferes with hearing and removing it can diminish its protective function so it should not be removed routinely. Using cotton-tipped applicators to clean ears as a regular practice can also scratch an ear canal, causing an invasion site for a secondary infection. This practice may also push accumulated cerumen farther into the ear canal, causing a true plugging of wax.
An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which of the following interventions should the nurse do first while assisting this client? a) Touch the glass fragment in the eye with a moistened, sterile, cotton-tipped applicator b) Press firmly on the lower lid with the fingertip until it turns out c) Instill a few drops of a topical anesthetic into the affected eye d) Grasp the eyelashes of the upper eyelid and evert it
Instill a few drops of a topical anesthetic into the affected eye Correct Explanation: Children who have eye injuries are usually in acute pain immediately after the injury. A few drops of a topical anesthetic instilled into the eye may be necessary to relieve the pain and allow the eye to be opened for examination. To visualize the inner surface of the lower lid and the bottom half of the eye globe, press firmly on the lower lid with your fingertip until it turns out. Grasp the eyelashes and gently stretch the upper eyelid downward. Place the stick of a cotton-tipped applicator horizontally against the center of the upper lid. While still grasping the eyelashes, pull the eyelid upward and over the applicator until it is everted. A foreign body, such as a speck of dirt or a fragment of glass, often clings to the inside of the upper lid and can be readily removed by touching it with a moistened, sterile, cotton-tipped applicator while the lid is everted.
The nurse is caring for a child who has conductive hearing loss. Which of the following is true regarding this type of hearing loss? a) It is caused by maternal rubella. b) It is generally severe and unresponsive to medical treatment. c) It is often undetected until the child goes to school d) It is caused by chronic otitis media or other infection.
It is caused by chronic otitis media or other infection. Correct Explanation: In conductive hearing loss, middle ear structures fail to carry sound waves to the inner ear. This type of impairment most often results from chronic serious otitis media or other infection.
A child returns to the clinic after an episode of otitis externa, which has resolved. Which of the following would the nurse emphasize as the priority for preventing future episodes? a) Adhering to regular follow-up to assess for hearing loss b) Keeping ear canals dry c) Avoiding upper respiratory tract infections d) Performing hand washing
Keeping ear canals dry Correct Explanation: 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.
The nurse is teaching a class on children's eye and ear safety to a group of parents. Which of the following would the nurse describe as most likely causing the greatest difficulty related to child compliance? a) Supervising children during play b) Requiring the use of safety gear for sports activities c) Teaching children safety around the home d) Limiting time and volume when using earphones listening to music
Limiting time and volume when using earphones listening to music Correct Explanation: Parents will have the most difficulty getting their child to comply with an appropriate volume and exposure time when they listen to music with earphones. Often the child will engage in this activity alone, without adult supervision. Teaching home safety commonly involves the presence of an adult to supervise and reinforce the teaching. Supervising during play allows for parental presence to reinforce safety practices. Requiring the use of safety gear is a precaution where an adult is more likely to be present to reinforce safe practices.
A nurse is assessing a child's vision. Which test should she use to test for accommodation? a) Moving a penlight toward the client's nose and observing whether his eyes can follow it b) Performing Hirshberg's test c) Having the child touch the fly's wings in an image constructed of colored dots d) Performing a Weber test
Moving a penlight toward the client's nose and observing whether his eyes can follow it Correct Explanation: To test for accommodation, ask a child (over 6 months of age) to follow a penlight as you move it in toward the nose. Children who cannot accommodate are unable to fuse their vision to follow a penlight toward their nose this way; instead, they demonstrate double vision (diplopia). The Stereo-Fly dot test, a test where the image of a fly is constructed from a series of colored dots, is used to test stereopsis. When asked to touch the fly's wings, a child with good depth perception touches them accurately. A child with poor depth perception touches a spot 2 or 3 inches above the pattern. Hirshberg's test is used to detect true strabismus. The Weber test is a test for hearing.
The vision impairment seen in a child in which the child can see objects at close range but not at a distance is known as which of the following? a) Exotropia b) Estropia c) Hyperopia d) Myopia
Myopia Correct Explanation: Myopia is nearsightedness, which means that the child can see objects clearly at close range but not at a distance.
A nurse is giving instructions to the parents of a girl with otitis media with effusion who has just undergone placement of myringotomy tubes in her ears. Which of the following should she mention to the parents? a) Use cotton-tipped applicators to clean around the tubes b) Have the child shower rather than bathe c) Notify the school nurse of the child's condition d) Encourage the child to swim for exercise
Notify the school nurse of the child's condition Correct Explanation: Otitis media with effusion occurs when otitis media becomes chronic. If the source of air to the middle ear is closed off due to inflammation or edema of the eustachian tube, the epithelial cells of the middle ear begin to secrete a thin, watery mucus. A source of air can be supplied to the middle ear by the insertion of small plastic (Teflon) tubes inserted through the tympanic membrane (tympanostomy). When myringotomy tubes are in place, the child has to be careful to not allow water to enter the ears. It's better if they bathe rather than shower, but showering is all right if ear plugs are used, especially while washing hair. Similarly, swimming is either contraindicated or allowed only with ear plugs in place. Urge parents to notify the school nurse their child has reduced hearing because of the middle ear fluid and has myringotomy tubes in place. The use of cotton-tipped applicators to clean around the tubes is not recommended.
The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which of the following will be included in the discussion? a) Playing the radio loudly b) Tendency to act silly in the classroom c) Prevention and treatment of otitis media d) Suddenly doing poorly in school
Prevention and treatment of otitis media Correct Explanation: The most common cause of conductive hearing impairment is otitis media. Suddenly doing poorly in school, acting silly in the classroom, and playing the radio loudly are symptoms of hearing loss in children.
The nurse is assessing a child with a hordeolum. Which of the following would the nurse be least likely to observe? a) Eyelid edema b) Lesion along the lid margin c) Reddened conjunctiva d) Pain
Reddened conjunctiva Correct Explanation: 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.
A 5-year-old is diagnosed with acute otitis media. Which nursing intervention below would be a primary one? a) Relief of pain b) Administration of a mydriatic c) Cautioning the child not to blow the nose d) Cautioning the child not to pull on the ear
Relief of pain Correct Explanation: Acute otitis media is painful. Children need pain relief until the antibiotic also prescribed reduces the inflammation and pressure.
A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify which of the following as the most common cause? a) Staphylococcus aureus b) Streptococcus pneumoniae c) Haemophilus influenzae d) Chlamydia trachomatis
Staphylococcus aureus Correct Explanation: S. aureus is the most common bacterial cause of conjunctivitis. Although a common cause, S. pneumoniae is not the most common cause of bacterial conjunctivitis. Although a common cause, H. influenzae is not the most common cause of bacterial conjunctivitis. Although a common cause, C. trachomatis is not the most common cause of bacterial conjunctivitis.
The nurse is performing a physical assessment for an 8-year-old with an earache. Which of the following signs and symptoms indicates acute otitis externa? a) The child cries out when the ear is grasped. b) Symptoms of upper respiratory infection are present. c) The tympanic membrane reacts to a puff of air. d) The ear canal is devoid of cerumen.
The child cries out when the ear is grasped. Correct Explanation: The classic sign of acute otitis media is pain on movement of the pinna or pain on pressure over the tragus. Symptoms of upper respiratory infection many times accompany otitis media but do not affect otitis externa. The tympanic membrane reacting to a puff of air is a sign that there is no fluid buildup in the middle ear. The absence of cerumen in the ear canal is not a symptom of otitis externa.
The mother of a child having myringotomy tubes placed asks, "Will my son lose his hearing while the tubes are in place?" What is your best answer? a) "Your son's hearing will decrease while the tubes are in place." b) The tubes are inserted into a section of eardrum in which the hearing is not affected." c) "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." d) "Have you asked your son's physician about that?"
The tubes are inserted into a section of eardrum in which the hearing is not affected." Correct Explanation: Myringotomy tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing.
The nurse recognizes that if the infant is following normal development, the infant will be able to focus and follow an object with the eyes by which of the following ages? a) Twenty-one days of age b) Seven days of age c) Two months of age d) One month of age
Two months of age Explanation: Newborns do not focus clearly but will stare at a human face directly in front of them. By two months of age, the infant can focus and follow an object with the eyes
A 5-year-old girl is diagnosed with amblyopia. Which of the following are treatment options available for this child? (Select all that apply.) a) Administration of levodopa b) Lasik surgery to the eye with the refractive error c) Use of correcting lenses (glasses) d) Covering the good eye with a patch e) Covering the bad eye with a patch f) Orthoptics
• Covering the good eye with a patch • Use of correcting lenses (glasses) • Lasik surgery to the eye with the refractive error • Administration of levodopa Explanation: Amblyopia is "lazy eye," or subnormal vision in one eye which causes a child to use only one eye for vision while "resting" the other eye. Treatment can consist of wearing correcting lenses (glasses), covering the good eye with a patch, or a combination of the two. Wearing a patch over the good eye forces the child to use the poor eye, thus developing vision in that eye. If patching does not produce the anticipated result, Lasik surgery to improve the refractive error may be necessary. Yet a further option is the administration of levodopa in addition to occlusion therapy as this almost immediately improves vision in both eyes. Orthoptics are eye exercises to strengthen a weak muscle in the case of strabismus.
When developing the plan of care for a child with a visual impairment, which of the following would the nurse include? Select all that apply. 1 Ensuring that the child's environment is familiar and secure 2 Encouraging activities to stimulate development 3 Using touch and tone of voice to demonstrate affection 4 Use of self-stimulatory behaviors 5 Referal to early intervention at 5 years of age
• Ensuring that the child's environment is familiar and secure • Encouraging activities to stimulate development • Using touch and tone of voice to demonstrate affection Correct Explanation: 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.
A nursing student is doing a clinical rotation on a pediatric floor and is learning about normal growth and development. The student is aware that many things can interfere. Examples include which of the following? (Select all that apply.) a) Education of the father b) Interference with hearing c) Interference with vision d) Number of siblings e) Education of the mother
• Interference with vision • Interference with hearing Explanation: Any interference with vision or hearing poses a threat to normal growth and development
A nurse is assessing a toddler who is brought to the clinic by his mother. The mother states, "He's been so irritable lately and I've noticed him frequently pulling on his right ear." The nurse suspects acute otitis media based on assessment of which of the following? Select all that apply. a) Low-grade fever b) Upper respiratory infection 3 months ago c) Red bulging tympanic membrane d) Mobile eardrum e) Loss of appetite
• Low-grade fever • Red bulging tympanic membrane • Loss of appetite Explanation: 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.
