Chapter 39 PREPU
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? A) "Until your child can read we can't check the visual acuity." B) "20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns." C) "Vision continues to improve as the child ages. Hopefully you will notice improvement in your child's vision." D) "We don't check a child's vision until they are 6 to 7 years old because their visual acuity hasn't peaked until then."
"20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns." While 20/20 vision isn't usually achieved until the age of 6 or 7 years, it is important to notify the physician in case there is another cause for the lack of vision clarity. Visual acuity can be assessed prior to the child's ability to read.
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? A) "We can talk with the doctor about referring you to a surgeon to get this taken care of." B) "Let's talk with your mother about getting contact lenses." C) "Although there are surgeries for vision, they are not normally recommended for someone your age." D) "Lots of girls your age wear glasses without issues."
"Although there are surgeries for vision, they are not normally recommended for someone your age." In most cases, laser surgery for someone this young is not recommended. Explaining that other girls wear glasses does not answer the teen's original question. While contact lenses may be an option for consideration, this response does not address the teen's question.
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? A) "Even when we do the right thing, it doesn't always ensure that our child will be healthy. It's important to think positively." B) "Many children who have a profound hearing loss function very well. There are lots of treatments available." C) "There could be much worse things to happen to your child. At least your child is healthy in all other aspects." D) "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."
"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." Telling the parents to "think positively" or that "things could be much worse" disregards the concern the parents have voiced to the nurse. The nurse generalizes the parents' feelings by telling them "many children who have a profound hearing loss function very well....."
The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media (AOM) infection. Which statement by the mother indicates she has the correct understanding of the information provided? A) "I should continue to breastfeed my son because it lowers the incidence of acute otitis media." B) "I should continue to smoke in the house." C) "Immunizations will not help prevent another otitis media infection." D) "Because the infection is in my son's ear, hand washing is not important."
"I should continue to breastfeed my son because it lowers the incidence of acute otitis media." Parents should be encouraged to quit smoking; however, if that is not possible they should not smoke inside the house or automobile. The Prevnar and influenza vaccines can help prevent ear infections. Breastfed infants have a lower incidence of AOM than formula-fed infants so mothers should be encouraged to continue breastfeeding for at least 6 to 12 months. Handwashing helps prevent the common cold, which often leads to AOM.
The nurse in the emergency department is caring for a child who has a simple contusion of the right eye following a motor vehicle accident. Upon discharge to home, which response by the parents requires further clarification? A) "For the first 24 hours I will apply ice for 20 minutes, then leave it off for 20 minutes." B) "The blood in the white part of the eye is normal with this type of injury." C) "I will need to apply heat to the eye four times a day." D) "Our child will probably have a black eye for at least a couple of weeks."
"I will need to apply heat to the eye four times a day." To decrease edema in the child with a simple contusion, instruct the parent to apply an ice pack to the area for 20 minutes, then remove it for 20 minutes, and continue to repeat the cycle as often as possible during the first 24 hours. Tell the parents and child that bruising of the surrounding eye area may take up to 3 weeks to resolve. Scleral hemorrhage is natural history of resolution without intervention over a period of a few weeks with this type of injury.
The nurse is obtaining the history from the parents of an infant who is suspected of having infantile glaucoma. Which statement by the parents would help to confirm this suspicion? A) "His eye doesn't seem to tear much." B) "His eye looks about the same size as his other eye." C) "He opens his eyes quite frequently when he's awake." D) "It seems like bright lights really bother him."
"It seems like bright lights really bother him." Photophobia occurs with infantile glaucoma, so bright light may bother the infant. Typically, the infant with infantile glaucoma will keep his eyes closed most of the time. The affected eye may appear enlarged with infantile glaucoma. Tearing is associated with infantile glaucoma.
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? A) "This is normal in infants of this age." B) "Tell me more about this drainage." C) "Your baby will need to be seen by a neonatal ophthalmologist." D) "Do you think this looks like an infection?"
"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.
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? A) "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." B) "It's just a medical term that means an infection of the middle ear." C) "There is an infection somewhere in the ear canal and their is fluid in the canal." D) "It would probably be best if you talked to the doctor again about the diagnosis."
"The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." Otitis media with effusion refers to the presence of fluid within the middle ear space, without signs or symptoms of infection. It may occur independent of acute otitis media (AOM) or may persist after the infectious process of AOM has resolved.
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? A) "Have you asked your child's surgeon about that?" B) "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." C) "Your child's hearing will decrease while the tubes are in place." D) "The tubes are inserted into a section of eardrum in which the hearing is not affected."
"The tubes are inserted into a section of eardrum in which the hearing is not affected." Tymanostomy tubes help to ventilate the cavities of the middle ear and balance the pressure on each side of the tympanic membrane..Tympanoplasty tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing. There is no risk of permanent deafness and hearing will be increased while the tubes are in place, not decreased. The nurse should answer the parent's question honestly without dismissing it or referring to another health care provider. This indicates to the parent that something may be wrong or serious. The nurse can refer the parent to the surgeon if the parent's questions have not been adequately addressed.
A child having tympanostomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response? A) "The tubes remain in place for 6 months and then are dissolved by vinegar." B) "You will have them replaced every 2 months until you reach age 18." C) "The tubes remain in place for 6 to 12 months until they come out by themselves." D) "The tubes are not removed; they grow permanently into place."
"The tubes remain in place for 6 to 12 months until they come out by themselves." The placement of tympanostomy tubes ( TT) (ventilation tubes) is the gold standard treatment for perisistent OME with a functional effect on hearing or with damage to the tympanic membrane. These tubes stay in place for several months and fall out on their own. They are not replaced after they fall out nor are they meant to be a permanent solution to the child's frequent ear infections. Vinegar should not be placed in the ears.
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? A) "This may signal your child is having difficulty paying attention rather than a visual disorder." B) "Your child will need to be evaluated for an accommodation disorder." C) "These reports are consistent with hyperopia." D) "What you are describing may be what is called myopia."
"What you are describing may be what is called myopia." Myopia (nearsightedness) occurs when light rays focus anterior to the retina, causing objects that are far away to be unfocused. Typically, this develops around age 8 years and then progresses. These children can read a book or a computer screen immediately in front of them but are unable to read the blackboard clearly from a distance. There is no indication that the child is experiencing issues with paying attention. This suggestion does not address the parent's initial complaint. Accommodation disorders present with complaints of diplopia and headaches. Hyperopia (farsightedness) presents with vision that is blurry at a close range and clear at a far range, which is opposite of what is being reported for this child.
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? A) "You probably won't know for sure the color of your baby's eyes until your baby is 6 to 12 months old." B) "The baby's iris will likely become more pigmented, so it's unlikely the eyes will not be blue." C) "It's not uncommon for babies to be born with blue eyes." D) "You can hope they stay that color. There is no guarantee."
"You probably won't know for sure the color of your baby's eyes until your baby is 6 to 12 months old."
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? A) Sclera appears to be blue B) Excess watering of the eyes C) Edema of the eyelids D) Absence of the red reflex
Absence of the red reflex 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 preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan? A) Teach parents to make vinegar and alcohol ear drops. B) Explain botulinum injection procedure and risks. C) Assess vision to determine functional capability. D) Assess the child's ability to convey information.
Assess the child's ability to convey information. 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 caring for a 24-month-old boy with regressed retinopathy of prematurity. Which intervention is priority for this child? A) Referring the child to the local district of early intervention. B) Observing for rubbing, shutting the eyes, or squinting. C) Assessing the child for asymmetric corneal light reflex. D) Teaching the parents to check how the child's glasses fit.
Assessing the child for asymmetric corneal light reflex. Assessing for asymmetric corneal light reflex is the priority intervention as strabismus may develop in the child with regressed retinopathy of prematurity. Observing for signs of visual impairment is not critical for this child, nor is teaching the parents to check how the glasses fit the child. Referral to early intervention would be appropriate if the child was visually impaired.
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: A) Hyperopia B) Refraction C) Myopia D) Astigmatism
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.
Is the following statement true or false? The nurse caring for an infant with strabismus tells the concerned parent that there is no need to correct the visual disorder until the child reaches school age.
False.
he nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? A) It is generally severe and unresponsive to medical treatment. B) It is often undetected until the child goes to school. C) It is caused by maternal rubella. D) It is caused by chronic otitis media or another infection.
It is caused by chronic otitis media or another infection. In conductive hearing loss, the transmission of sound through the middle ear is disrupted. Structures fail to carry sound waves to the inner ear. Fluid fills the ear so the tympanic membrane is unable to move properly. This type of impairment most often results from chronic serious otitis media or other infection. Infants have hearing tests before being discharged from the hospital to determine hearing loss, especially premature infants. Hearing loss can be detected early because language development will be impaired. This type of hearing loss is treatable with the use of hearing aids, cochlear implants and communication devices. Rubella causes sensorineural hearing loss.
The parents of a 2-year-old child ask the nurse how to best remove the small amount of wax in their child's ears. What should the nurse recommend? A) Gently use a cotton-tipped swab wipe the ear canal. B) Add a few drops of mineral oil to soften the wax before removing. C) Leave it to clear on its own. D) See a practitioner for ear candling.
Leave it to clear on its own. Cerumen (ear wax) gradually moves outward and small amounts of cerumen do not need to be removed. Parents should not put a finger, washcloth, or cotton-tipped applicator in the ear, as this can scratch the ear canal. They do not need to use drops, and the practice of ear candling is not recommended.
A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation? A) Moving a penlight toward the client's nose and observing whether eyes can follow it B) Having the child touch the fly's wings in an image constructed of colored dots C) Performing a Weber test D) Performing Hirschberg test
Moving a penlight toward the client's nose and observing whether eyes can follow it 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. Hirschberg test is used to detect true strabismus. The Weber test is a test for hearing.
The vision impairment in which the child can see objects at close range but not at a distance is known as: A) Hyperopia B) Esotropia C) Myopia D) Exotropia
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.
A family has a 3-year-old child with recurrent ear infections. What health promotion measure(s) will the nurse recommend to reduce the chance of future infections? Select all that apply. not smoking in home daily bathing breastfeeding hand hygiene no pets in the home
Not smoking in the home Hand Hygiene Ear infections (acute otitis media) are infections of the fluid of the middle ear. Hand hygiene can help to prevent the spread of viral and bacterial illnesses that commonly precede acute otitis media. Avoiding smoking in the home can also help to reduce the chance of infection. Breastfeeding can reduce the chance of otitis media, but this would apply to an infant, not a 3-year-old child. Avoiding pets in the home is not necessary unless there is an allergy. Although the child should maintain good general hygiene, daily baths are not necessary as a preventive measure.
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? A) Adhering to regular follow-up to assess for hearing loss B) Keeping ear canals dry C) Performing handwashing D) Avoiding upper respiratory tract infections
Since moisture contributes to external otitis (acute otitis externa or swimmer's ear), the priority is to keep the ear canals dry. Handwashing would be a priority for preventing infections such as conjunctivitis. Upper respiratory tract infections are associated with otitis media, not external otitis (acute otitis externa or swimmer's ear). Hearing loss is not associated with otitis externa.
A child has recently been diagnosed with cataracts. The treatment for cataracts is: A) wearing a patch until the cloudiness clears. B) there is no treatment for childhood cataracts. C) eye drops to lower the pressure. D) surgery.
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.
The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment? A) The infant makes eye contact. B) The infant blinks quickly when a bright light is shone in the eyes. C) The infant does not imitate facial expressions. D) The infant can "fix and follow."
The infant does not imitate facial expressions. Infants who have visual impairments may not "fix and follow," do not make eye contact, are unaffected by bright light, and do not imitate facial expressions.
A child with poor eye alignment cannot establish single binocular vision but has double vision. Which nursing action is most appropriate for this client?
The nurse would refer the child experiencing diplopia (double vision) to a pediatric ophthalmologist for further testing; it is imperative to determine the cause to properly treat diplopia. Treatment may be as simple as eye exercises or glasses or could entail surgery. CT or magnetic resonance imaging (MRI) may be prescribed to assist in determining the cause. Knowledge of previous testing would not be a priority at this time. Botulinum toxin injections may be prescribed for treatment. Surgery may be discussed once the underlying cause is identified.
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? A) keeping hands away from eyes B) washing hands frequently C) properly applying the prescribed antibiotic D) staying home from school
Washing hands frequently Proper handwashing is the single most important factor to reduce the spread of acute infectious conjunctivitis. Proper application of the antibiotic is important for the treatment of the infection, not prevention of transmission; keeping the child home from school until she is no longer infectious and encouraging the child to keep her hands away from her eyes are sound preventive measures, but not as important as frequent handwashing.
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? A) obtaining a culture of fluid from the middle ear B) administering antibiotics as soon as they're available C) administering antivirals to ensure broad coverage of all organisms D) determining if the girl's balance is shaky when walking
administering antibiotics as soon as they're available 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 age 2 years.
An 8-year-old child comes to the clinic with reports of purulent drainage from the left ear. Child reports itching to left ear. No inflammation or redness noted to external ear. Family reports recent vacation at lakeside cabin with daily swimming. No fever noted. What does the nurse anticipate will be needed next in the plan of care for this client? A) prescription for antibiotic ear drops B) culture and sensitivity swab of drainage from ear C) prescription for anelgesic
culture and sensitivity swab of drainage from ear This child is presenting with symptoms of external otitis (acute otitis externa or swimmer's ear), including a history of frequent swimming, pain upon touching the outer ear, and purulent drainage, without fever. The yellow-green purulent drainage is most commonly associated with Pseudomonas infection. The next step will be a culture and sensitivity swab to determine the effective antibiotic agent to be prescribed