Peds Exam 3 ch 38

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?

Encourage the parents to apply ice to the area for 20 minutes at a time for the first 24 hours.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger?

drinking three cans of diet cola

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:

Astigmatism 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; hyperopia is farsightedness.

A child returns to the clinic after an episode of external otitis (acute otitis externa or swimmer's ear) that has resolved. What would the nurse emphasize as the priority for preventing future episodes?

Keeping ear canals dry

The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the:

importance of patching as prescribed.

The nurse is performing a physical assessment for an 8-year-old child with an earache. Which sign or symptom indicates external otitis (acute otitis externa or swimmer's ear)?

The child cries out when the ear is grasped.

The nurse is preparing a child experiencing new-onset seizures for an electroencephalogram (EEG) test. How can the nurse best explain this procedure to the child?

Use a doll with electrodes attached to the head.

A 12-year-old child has suffered a concussion after being in an automobile accident. What will be included in the plan of care/treatment? Select all that apply.

rest observation of level of consciousness

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):

steroid

The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority?

Assess the client's respiratory status.

The nurse is caring for a 24-month-old boy with regressed retinopathy of prematurity. Which intervention is priority for this child?

Assessing the child for asymmetric corneal light reflex.

The nurse is caring for a 6-month-old infant diagnosed with otitis media. Which clinical manifestation would likely have been noted in this child?

Shaking the head and pulling the ear

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?

"It seems like bright lights really bother him."

An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client?

Instill a few drops of a topical anesthetic into the affected eye

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially?

Institute droplet precautions in addition to standard precautions.

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate?

Teach the child and his parents to keep a headache diary.

The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?

Tell me your concerns about your child's shunt.

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply.

eye opening verbal response motor response

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?

head trauma

The parents of a 4-year-old boy tell the nurse, "We're really worried that our child doesn't have 20/20 vision. It seems that he doesn't always see clearly at a distance." What is the best response by the nurse?

"20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns."

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?

"I hate to think that I will need to be worried about my child having seizures for the rest of his life."

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?

"I will need to apply heat to the eye four times a day."

Any individual taking phenobarbital for a seizure disorder should be taught:

never to discontinue the drug abruptly.

A 13-year-old reports she recently saw a television program showing surgery to correct vision problems. She states she hates wearing glasses and wants to have this procedure done. What is the best response by the nurse?

"Although there are surgeries for vision, they are not normally recommended for someone your age."

A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?

Decrease environmental stimulation

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question?

"Did you use any medications, like aspirin, for the fever?"

The mother of a toddler tells the nurse during a routine well-child appointment that she is concerned because, "It seems like my son is falling and hitting his head all of the time." What is the best response by the nurse?

"Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns."

The nurse is caring for a toddler who is scheduled to have myringotomy tubes placed. Which statement by the child's parents indicates a lack of understanding?

"Hearing loss after the tubes are placed may be permanent."

The parents of a toddler have just learned that their child has profound hearing loss. The parents are very upset and state to the nurse, "It just isn't fair. We did everything right during our pregnancy all the way to this point." How should the nurse respond?

"I can't imagine how difficult this must be. When you're ready I would be happy to arrange a meeting with a support group of other parents with children who have hearing loss."

The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education?

"I will use Visine drops in his infected eye to help reduce redness."

The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided?

"It's an overgrowth of retinal blood vessels."

A toddler has been diagnosed with otitis media with effusion. The parents tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond?

"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present."

A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse?

"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures."

The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed?

"We need to raise the volume of our voices significantly so he can hear us."

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 what age?

2 months of age

The nurse is educating the parents of an 18-month-old child being prepared to receive cochlear implants. Which statement by the parents requires further teaching?

After the implant surgery our child will have normal hearing.

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as:

Battle sign.

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure?

During this procedure, small tubes are inserted into the tympanic membrane.

To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority?

Cerebral edema The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of IV therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed?

Dramatic increase in head circumference

The vision impairment in which the child can see objects at close range but not at a distance is known as:

Myopia Myopia is nearsightedness, which means that the child can see objects clearly at close range but not at a distance. It occurs because the light entering the eye focuses in front of the retina. Hyperopia is farsightedness. Esotropia is better known as "cross-eyed." It is a form of strabismus in which one or both eyes focus inward. Exotropia is a form of strabismus where the eyes are deviated outward.

During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take?

Report the findings to the pediatric health care provider.

The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority?

Risk for injury

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 most common cause?

Staphylococcus aureus

A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent?

The frequency of otitis media is reduced in breastfed infants. Breastfeeding is a way to help prevent acute otitis media in infants. Acute otitis media tends to occur less often in breastfed than bottle-fed infants. One reason is the immunologic benefits from the breast milk. An infant should not start immunizations until 2 months of age, because the organs and immune system are not mature enough at birth. Placing medications and tubes are never done prophylactically.

The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)?

While assessing the child's pupils, there is no change in diameter in response to a light.

The nurse admits a 13-year-old client with possible appendicitis to the hospital, accompanied by the parent. The client and parent are both deaf and use sign language to communicate. The nurse needs to assess baseline vital signs and the intake assessment. What should the nurse do while awaiting the arrival of the sign language interpreter?

Write a note to explain the need to assess vital signs. Clients with hearing impairment have a right to be provided with a sign language interpreter and the nurse should defer nonurgent components of the assessment until the interpreter arrives. The nurse should not assume that the child can lip-read or will understand gestures. At age 13, written communication is the best option to communicate the key components of the assessment and to obtain consent and understanding from this child and parent.

The nurse is caring for an adolescent who suffered an injury during a diving accident. During assessment the client is demonstrating the posturing in the figure. The nurse is aware that this type of posturing is the result of injury to what area?

brain stem Decerebrate posturing is seen with injuries occurring at the level of the brain stem. Decorticate posturing occurs with damage of the cerebral cortex. Both types of posturing are characterized by extremely rigid muscle tone. Injuries to the frontal lobe of the brain and the mid-cervical spine would not cause these types of posturing.

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?

moving the infant's head every 2 hours

A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply.

padding for side rails oxygen gauge and tubing suction at bedside

The mother of a 10-day-old infant reports her baby has been having "lots of eye discharge." What is the best initial response by the nurse?

"Tell me more about this drainage." Tearing or discharge from one or both eyes is often first noted at the 2-week checkup. Obtain a thorough history about the eye drainage to distinguish it from neonatal conjunctivitis. Determine the onset and progression of symptoms, as well as the newborn's response to any interventions attempted so far. The best response by the nurse is an attempt to obtain additional information. Telling the child's mother this is normal in the absence of additional information is inappropriate. Asking if this looks like an infection is asking the child's mother to make a diagnosis. There is no need at this time to consult an eye specialist.

After performing eye tests, the school nurse notes a child has symptoms of myopia. Which recommendation will the nurse make to the child's teacher?

Place the child close to the blackboard.

The parents of a 10-month-old child bring the infant to the emergency department after finding the infant face down in the bathtub. The parent states, "I just left the bathroom to answer the phone." Which assessments are priority for the nurse to complete? Select all that apply.

circulation airway respiratory status With a submersion injury, hypoxia is the primary problem. Therefore, assessment of the airway, breathing, and circulation (ABCs) are the primary assessments the nurse will complete. These guide implementation of resuscitative measures. Other assessments such as level of consciousness, vital signs, and pupillary response would be done once the child is stable. The nurse would also perform a complete assessment, looking for signs of child abuse (child mistreatment) once the child is stable.

The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion?

prevention and treatment of otitis media

A child has recently been diagnosed with cataracts. The treatment for cataracts is:

surgery 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.

A school nurse knows that most of the students in the community's elementary school have not received routine vision screening because the families live below the federal poverty threshold. What is the most effective method to promote vision screening for this client population?

offering vision screening to all students in kindergarten

The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement?

encouraging the child to keep his hands away from his eyes

The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP?

hypertension

In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care?

Risk for injury related to seizure activity The child's risk for injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and if the child has a history of seizures, it would specifically impact airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.

The nurse is performing an assessment on a child who is 6 months of age. When assessing the eyes, the nurse notes the presence of a bluish tinge to the sclerae. What can the nurse infer about this finding?

This may signal a connective tissue disorder. At the time of birth, the newborn's sclerae may have a bluish hue. This is a normal finding. This will begin to fade by the time the child is a few months of age. 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.

The parents of a newborn with congenital hearing loss ask the nurse if they should take sign language lessons to learn to communicate with their newborn. How does the nurse best respond?

Introducing sign language early is controversial; some people believe it will improve communication and others feel that it delays learning to speak.

A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent?

Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours.

A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement?

"Benzocaine drops should be placed in your ear to numb it and reduce pain."

A child having tympanostomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response?

"The tubes remain in place for 6 to 12 months until they come out by themselves."

The school nurse is instructing the classroom teacher regarding a student newly diagnosed with amblyopia. To prepare for classroom instruction, which concept is most important for the nurse to convey to the teacher?

Student placement in the room is important but all other teaching methods may remain the same.

The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond?

"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."

The parents of a child with a history of seizures who has been taking phenytoin ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate?

"Small increments in dosage lead to sharp increases in plasma drug levels." Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity.

The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis?

Recently helped clean the basement Conjunctivitis may be classified as allergic, infectious or chemical. Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen as might be found when cleaning unused spaces. 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.

The nurse is performing the intake assessment of a 6-month-old in the pediatrician's office. The nurse alerts the physician that the child is showing signs of hearing loss based on what assessment findings? Select all that apply.

The parent reports that the infant does not wake up when the siblings are being loud during nap time. The infant does not turn the head when the nurse stands next to the infant and calls their name. The child is not making any babbling sounds and the parent reports the child never does. The nurse dropped a metal tray in the room and the infant did not react.

The nurse is reviewing the history and performing a physical assessment on a 6-week-old infant. The nurse notes glaucoma in the health care provider notes. Which physical assessment finding is congruent with the diagnosis?

The right eye appears larger than the left

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?

Understanding the side effects of medications

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 intervention would the nurse expect to implement?

administering antibiotics as soon as they're available

The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching?

"I need to watch for any new bruises or bleeding and let my health care provider know about it."

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?

Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention

A young child in the clinic has watery eyes and reddened conjunctiva. The child keeps the eyes closed a lot, because it hurts to have them open. Which problem does the nurse suspect for this client?

Conjunctivitis 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. It is very contagious and requires antibiotics for treatment. Blepharitis is a chronic scaling with discharge along the eyelid margin. A stye is a localized infection of the sebaceous gland of the eyelid. A chalazion is a chronic painless infection of the meibomian gland. The stye and blepharitis will require antibiotic treatment. A chalazion will clear on its own.

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate?

"What you are describing may be what is called myopia."

The parents of a newborn state, "We are so excited that our baby was born with blue eyes! We were hoping the baby would take after our other child." How should the nurse respond?

"You probably won't know for sure the color of your baby's eyes until your baby is 6 to 12 months old." Light-skinned children are often born with blue eyes. The iris becomes pigmented over time and eye color is determined by 6 to 12 months of age.

A 5-year-old child is receiving hearing aids for the first time. What instruction(s) will the nurse provide to the family? Select all that apply.

Change hearing aid batteries weekly. Turn off batteries when not wearing hearing aids. Remove hearing aids when showering or bathing.

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 condition does the nurse suspect?

Lack of depth perception (stereopsis) Depth perception or stereopsis is 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.

A child with poor eye alignment cannot establish single binocular vision but has double vision. Which nursing action is most appropriate for this client?

Refer the child to a pediatric ophthalmologist

A young child in the clinic reports pain and has redness on the lid of the right eye. Upon further examination, the nurse notices swelling in the preauricular lymph node along with tenderness. What should the nurse suspect?

Stye A stye or hordeolum is a localized infection of the sebaceous gland of the eyelid follicle, usually caused by bacterial invasion. There is usually pain and redness at a localized point on the lid margin, as well as preauricular lymph node swelling and tenderness. A chalazion is a chronic painless infection of the meibomian gland. It generally resolves on its own. Conjunctivitis, also known as "pink eye," is an infection of the conjunctiva. It is caused by a bacteria and is extremely contagious. Cellulitis is an infection of the skin and tissues around the eye. It is a serious condition that must be treated with antibiotics.

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be:

The child is in status epilepticus. Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes, or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.

A 9-year-old child is brought to the urgent care center by the parent. Based on assessment findings, the nurse suspects external otitis (acute otitis externa or swimmer's ear). Which finding on otoscopic examination supports this suspicion?

swollen, inflamed ear canal On otoscopic examination, the canal will likely be swollen and inflamed. Cerumen, which is normally soft and yellow, is a normal finding. A bulging red tympanic membrane suggests otitis media. Any discharge seen is often the result of Pseudomonas and Candida, agents frequently involved in secondary infections. Pseudomonas infection is characterized by a yellow-green discharge. Candidiasis of the ear canal is characterized by intense itching of the ear canals with creamy-white discharge concealing the tympanic membrane. A secondary infection would take longer to develop so those symptoms would have not yet developed.