Chapter 17: Nursing care Eyes and Ears pediatric nursing

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 nursing instructor is teaching about eye disorders in childhood. Which statement made by a student indicates a need for further instruction?

"Cataracts are only present in adults."

A child comes to the clinic with a report of having trouble seeing. The nurse inspects the eyes and obtains a history from the child about the vision. Which question(s) will help the nurse determine if the child may have a refractive error? Select all that apply.

"Do you see the ball in the outfield when playing baseball?" "How far away do you have to hold a book to read?" "Do images look blurry when you play video games?"

The nurse is educating the parents of a 4-year-old boy who has been diagnosed with amblyopia ("lazy eye"). Which comment provides information most helpful for the parents to know?

"Give him a prize when he wears the patch."

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 child with infantile glaucoma are talking with the nurse about the disorder and the treatment options. Which statements by the parents require clarification by the nurse? Select all that apply.

"I am thankful that we will be able to manage this disorder with medications." "Thankfully this isn't a serious disorder. We were afraid vision loss would be a possibility."

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 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."

The nurse is educating a 13-year-old paintball enthusiast about sports-related injuries. Which comment is most likely to be accepted by the child?

"Play tough, but wear protective gear."

The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan?

Assess the child's ability to convey information.

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

The parents of a preschool-aged child ask the nurse what can be done to prevent ear infections. What response(s) by the nurse is correct? Select all that apply.

Avoid exposure to cigarette smoke in the car or home." "Discourage the use of earphones being inserted into the ear." "Encourage the child to use earplugs when swimming." "Use diluted rubbing alcohol to dry the ear after swimming."

The nurse is teaching parents of a 6-year-old child about otitis media (OM). What predisposes the child to OM infections?

Bacteria entering through the eustachian tube

The nurse is preparing a care plan for the school-age child with a congenital hearing loss of 60 to 80 dB. Which nursing diagnoses should the nurse include on the care plan for this child? Select all that apply.

Delayed growth and development Impaired verbal communication Risk for injury

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.

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.

A 1-year-old comes to the clinic for a routine visit. The eye examination reveals an enlarged, edematous, and hazy cornea. The child appears sensitive to light. What should the nurse suspect?

Infantile glaucoma

A nursing student is doing a clinical rotation on a pediatric floor and is learning about normal growth and development. What can impact normal growth and development? Select all that apply.

Interference with vision Interference with hearing

The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss?

It is caused by chronic otitis media or another infection.

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

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)

The student nurse is preparing a presentation on retinopathy of prematurity. What information should the nurse include? Select all that apply.

Low birth weight and early gestation age are risk factors. Oxygen therapy may play an important role in the development of retinopathy of prematurity. Sepsis is a risk factor.

A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The parent asks what can be done. What information should be included in the information provided to the parent?

Most of these conditions will spontaneously resolve.

A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation?

Moving a penlight toward the client's nose and observing whethe eyes can follow it

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.

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.

A child diagnosed with conjunctivitis is being seen in the pediatric clinic. Which statements are correct regarding conjunctivitis? Select all that apply.

Purulent drainage is a common symptom. It is highly contagious. Warm compresses are used to remove crusts that form on the eyes.

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

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

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.

A 9-year-old child has been diagnosed with impaired accommodation. When reviewing the child's responses during the assessment, the nurse understands that which finding is consistent with this disorder? Select all that apply.

The child reports having frequent headaches. The child's mother shares that her child has difficulty reading. When reading a selected passage, the child reports seeing double letters.

The nurse is discussing the ears and hearing in a child with a group of peers. Which statement is most accurate related to this topic?

The eustachian tube in the infant is straighter and wider than in the adult.

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.

The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment?

The infant does not imitate facial expressions.

The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority?

ensuring the protective eye patch is securely in place

A toddler is diagnosed with acute otitis media and prescribed antipyretics and numbing ear drops. Which instruction is most important to teach the parents about treatment?

how to administer the ear drops

The nurse is caring for a child who has had persistent otitis media effusions and is scheduled to have pressure equalizing tubes placed in 3 days. What should the parents observe after the tubes have been placed?

improvement of the child's language and speech development

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

The nurse in the neonatal intensive care unit places earplugs in the premature infant's ears. What type of hearing loss is the nurse trying to prevent?

sensorineural hearing loss

A nurse is preparing a presentation for a group of parents who have children with significant visual impairment. Which action would the nurse be least likely to include as an example of a self-stimulatory action?

shouting

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 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 teaching parents of a 9-year-old girl about the importance of wearing the prescribed glasses. Which subject is least important to promoting compliance?

encouraging the use of eye protection for sports

The parent of a 7-year-old child reports having difficulty cleaning the child's ears with a cotton swab. What information should be provided to the parent? Select all that apply.

Teach the parent that cleaning the ears with the swab may scratch the ear canal. Advise the parent that swabs can force the ear wax further down into the ear canal.

The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten 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 statement made by the nurse would be most appropriate regarding the child's vision?

"A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."

The nurse is caring for a male toddler with the genetic disorder of muscular dystrophy. The child has had numerous ear infections and is scheduled for pressure-equalizing (PE) tubes surgery. The parents state, "As if our child's muscular dystrophy isn't enough, now he has to endure ear surgery." What is the best response by the nurse?

"I know it is difficult but it's not unusual for children with genetic disorders to have ear structure problems. This will help prevent future ear infections."

A child has been diagnosed with bacterial conjunctivitis. Which statement(s) by the child's parent indicates the need for further education? Select all that apply.

"I will continue to use eye drops until the redness is gone." "Our child can go back to school in 4 hours, after that thick yellow drainage is gone."

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."

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."

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."

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 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."

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."

The parent of a child having tympanoplasty tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer?

"The tubes are inserted into a section of eardrum in which the hearing is not affected."

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 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 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."

A toddler requires the placement of pressure-equalizing (PE) tubes due to recurrent ear infections. Which information should the nurse include in teaching the parent about the PE tubes and surgical insertion? Select all that apply.

"Your child will have the procedure as an outpatient." "One purpose of the PE tubes is to help speech development." "The tubes will fall out on their own." "The tubes allow infected fluid to drain."

An infant is born with congenital glaucoma. The infant is scheduled for surgery to relieve this condition at age 2 days. Which prescription should the nurse question for the infant?

A preoperative injection of atropine

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

During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which sign or symptom suggests the child has a cataract?

Absence of the red reflex

The nurse is screening a 4-year-old girl for vision problems. What problem could result in loss of vision?

Amblyopia

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

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

Myopia

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

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.

A 16-year-old child has experienced a small corneal abrasion. What will be included in the plan of treatment?

Use analgesics as prescribed.

The nurse is caring for a 10-year-old girl with acute periorbital cellulitis. Which nursing intervention (therapy) is primary for this disorder?

administering antibiotics IV as ordered

When teaching a parent about amblyopia, it would be most important to explain that:

amblyopia is correctable if the child is properly treated before 6 years of age.

The school nurse is assessing a student complaining of left eye pain. Upon visual inspection, the nurse notes left conjunctivae redness and thick, colored discharge. The nurse understands that these signs and symptoms are consistent with which diagnosis?

bacterial conjunctivitis

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

surgery.

A 1-year-old female has been diagnosed with her fourth ear infection since birth. The nurse understands that children are more susceptible to ear infections than adults because of which anatomical difference?

Infants have horizontally placed Eustachian tubes.

The nurse is educating the parents of a 5-year-old girl with infectious conjunctivitis about the disorder. Which information is most important to provide to prevent the spread of the disorder?

washing hands frequently

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."

A school-age child was admitted to the emergency department following a simple contusion to the eye from playing baseball. The nurse has given discharge instructions to the parents. Which comment(s) by the parents indicate they understood the discharge teaching? Select all that apply.

"We should use ice intermittently for the first 24 hours." "When we apply ice to the eye, it should only be for about 20 minutes at a time." "It will likely take about 3 weeks or so for all of that bruising to go away."

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 12-year-old child has developed a stye. Which may be included in the child's care?

Apply hot, moist compresses to the affected area.

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.