EDITED peds ears and eyes 5
The nurse is caring for a child who has been diagnosed with acute otitis media three times in the past year. Which factors noted in the medical record would be considered contributing factors to this condition? Select all that apply. a. The child's older siblings have been diagnosed with acute otitis media in the past. b. The family home is occupied by 10 family members. c. The child shares a bedroom at home with 3 siblings. d. The child's father smokes. e. Breastfeeding after birth limited to the first 6 months of life.
A, B, C, D Acute otitis media may be linked to a series of factors in a child's medical / social history. Exposure to secondhand smoke is associated with acute otitis media. Additional factors include a family history, crowding in the home environment, and a large family size. Breastfeeding is considered a factor that reduced the incidence of acute otitis media.
A 5-year-old child is diagnosed with acute otitis media. Which nursing intervention would be priority? a. Administering a mydriatic b. Relieving the child's pain c. Cautioning the child not to pull on the ear d. Cautioning the child not to blow the nose
B Acute otitis media is caused by a bacterial or viral infection of fluid in the middle ear. The fluid behind the eardrum has difficulty draining back out because of the horizontal positioning of the eustachian tube. This causes increased pain. Antibiotics are prescribed to cure the infection. Children need pain relief until the antibiotic prescribed reduces the inflammation and pressure. Children pull on the ear as an attempt to reduce the pain and equalize the pressure. Pulling on the ears, especially in an infant, is one of the first signs the parent sees to warn of the ear infection. Blowing the nose is also an attempt by the child to equalize the pressure in the ear and help reduce the pain. A mydriatic is a drug that induces dilation of the pupils.
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? a. Stye b. Conjunctivitis c. Chalazion d. Blepharitis marginalis
B 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 nurse is caring for a 24-month-old boy with regressed retinopathy of prematurity. Which intervention is priority for this child? a. Teaching the parents to check how the child's glasses fit b. Referring the child to the local district of early intervention c. Assessing the child for asymmetric corneal light reflex d. Observing for rubbing, shutting the eyes, or squinting
C 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 be 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. Reference:
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? a. Prophylactic myringotomy tubes can be inserted at birth. b. Prophylactic acetic acid instillations may be helpful. c. The frequency of otitis media is reduced in breastfed infants. d. Starting immunizations at birth rather than age 2 months might help.
C 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.
A toddler has been diagnosed with otitis media with effusion. The parents of a toddler tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond? a. "There is an infection somewhere in the ear canal and their is fluid in the canal." b. "It would probably be best if you talked to the doctor again about the diagnosis." c. "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." d."It's just a medical term that means an infection of the middle ear."
C 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 AOM or may persist after the infectious process of AOM has resolved.
The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion? a. tendency to act silly in the classroom b. playing the radio loudly c. prevention and treatment of otitis media d. suddenly doing poorly in school
C The most common cause of conductive hearing impairment is otitis media. Hearing loss can be associated with intermittent bouts of acute otitis media and can hinder language development. Suddenly doing poorly in school, acting silly in the classroom, and playing the radio loudly are symptoms of hearing loss in children but they are symptoms after loss has occurred. The preventive education would include helping the child not develop otitis media.
The school nurse is educating the parents of a child with infectious conjunctivitis. Which comment provides the most value for prevention? a. "Place the ointment inside the lower eyelid." b. "Use all the medication as directed." c. "Don't use anything that touches her face." d. "This could have started with a head cold."
C Warning the parents how infectious conjunctivitis is spread is most valuable for preventing infection within the family. Directing the parents to use a full course of medication is very important to help prevent a recurrence in the child, but not the most valuable for prevention. Telling of a possible cause or proper administration of medication has little preventive value.
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
D 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 diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement? a. "Benzocaine drops should be placed in your eye to numb it and reduce pain." b. "Benzocaine is an antibiotic for your ear infection." c. "Benzocaine is an antibiotic for your eye infection." d. "Benzocaine drops should be placed in your ear to numb it and reduce pain."
D Benzocaine numbing eardrops can prescribed for acute otitis media to help with severe pain. Benzocaine is not an antibiotic and when prescribed for otitis media should be placed in the ear
A child having myringotomy 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 to 12 months until they come out by themselves." b. "You will have them replaced every 2 months until you reach age 18." c. "The tubes remain in place for 6 months and then are dissolved by vinegar." d. "The tubes are not removed; they grow permanently into place."
A The standard treatment for persistent otitis media with effusion is the placement of pressure-equalizing (PE) tubes via a myringotomy. 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 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? a. Encouraging the child to keep his hands away from his eyes b. Washing the child's hands and face when returning from outdoors c. Making sure the child showers and shampoos before bedtime d. Rinsing the child's eyelids with a clean washcloth and cool water
A 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.
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 mostappropriate? a. "What you are describing may be what is called myopia." b. "This may signal your child is having difficulty paying attention rather than a visual disorder." c. "These reports are consistent with hyperopia." d. "Your child will need to be evaluated for an accommodation disorder."
A 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 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. Washing hands frequently b. Properly applying the prescribed antibiotic c. Staying home from school d. Keeping hands away from eyes
A Proper hand washing 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 preventative measures, but not as important as frequent hand washing.
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? a. Staphylococcus aureus b. Streptococcus pneumoniae c. Chlamydia trachomatis d. Haemophilus influenzae
A 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.
A 1-year-old female has been diagnosed with her 4th ear infection since birth. The nurse understands that children are more at susceptible to ear infections than adults because of which anatomical difference? a. Infants have narrow Eustachian tubes b. The Eustachian tubes of infants are in a slanted position c. Infants have horizontally placed Eustachian tubes d. Infants have long Eustachian tubes
C Infants' Eustachian tubes are relatively short, wide, and horizontally placed, which allows bacteria and viruses to enter the middle ear more easily, resulting in increased number of ear infections. As a child matures the tubes assume a slanted position.
The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis? a. Recent upper respiratory infection b. Recently helped clean the basement c. Family history of conjunctivitis d. Exposure to infective agents
B 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 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)? a. The ear canal is devoid of cerumen. b. The child cries out when the ear is grasped. c. Symptoms of upper respiratory infection are present. d. The tympanic membrane reacts to a puff of air.
B External otitis (acute otitis externa or swimmer's ear) is an infection and inflammation of the skin of the external ear canal. The classic sign of external otitis is pain on movement of the pinna or pain on pressure over the tragus. Upon examination, the ear canal is red and swollen. Many times the tympanic membrane cannot be visualized because the swelling does not allow the insertion of an otoscope. Symptoms of upper respiratory infection many times accompany otitis media but are not seen in external otitis. 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 related to external otitis.
The caregiver of a 2-year-old child tells the nurse, "They told me my daughter has an eye disorder called hyperopia." Which statement made by the mother 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. "Now I know why when she is working on puzzles she says her eye is sleepy." c. "She can see better close up than at a distance." d. "She has to have glasses right away."
B 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 caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? a. It is often undetected until the child goes to school. b. It is caused by chronic otitis media or another infection. c. It is caused by maternal rubella. d. It is generally severe and unresponsive to medical treatment.
B 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 nurse is providing teaching to the parent of a 4-year-old child being treated for otitis media. When discussing the condition, the parent indicates an understanding of the information provided when making which statement? a. "Aspirin may be taken to relieve my child's fever during this time." b. "A brief hearing loss after the infection is an abnormal development." c. "My child can use the decongestant drops for up to 2 weeks." d. "Swelling behind my child's ears is normal as the infection resolves."
B Otitis media may develop with a complication known as mastoiditis. This presents as a lump behind the ear. It is a serious complication and must be reported and treatment sought. Aspirin should not be administered to children with afebrile illness. Decongestant drops may be used for 2 to 3 days but not after that point in the treatment of the condition. Hearing loss may result from the disorder for a period of time.
A toddler has been diagnosed with otitis media with effusion. The parents of a toddler tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond? a. "It would probably be best if you talked to the doctor again about the diagnosis." b. "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." c. "There is an infection somewhere in the ear canal and their is fluid in the canal." d. "It's just a medical term that means an infection of the middle ear."
B 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 AOM or may persist after the infectious process of AOM has resolved.
The nurse is caring for an 8-year-old boy with otitis media with effusion. Which situation may have caused this disorder? a. He had recent bacterial conjunctivitis. b. He is experiencing recurrent nasal congestion. c. He has good attendance at school. d. He frequently goes swimming.
B Recurrent nasal congestion contributes to the presence of otitis media with effusion. Frequent swimming would put the child at risk for otitis externa. Attendance at school is a risk factor for infective conjunctivitis. Although otitis media is a risk factor for infective conjunctivitis, infective conjunctivitis is not a risk factor for otitis media with effusion.
A child returns to the clinic after an episode of external otitis (acute otitis externa) that has resolved. What would the nurse emphasize as the priority for preventing future episodes? a. Performing handwashing b. Keeping ear canals dry c. Avoiding upper respiratory tract infections d. Adhering to regular follow-up to assess for hearing loss
B Since moisture contributes to external otitis (otitis externa), 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 otitis externa. Hearing loss is not associated with otitis externa.
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. Excess watering of the eyes b. Absence of the red reflex c. Edema of the eyelids d. Sclera appears to be blue
B 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 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. Administering antivirals to ensure broad coverage of all organisms b. Determining if the girl's balance is shaky when walking c. Administering antibiotics as soon as they're available d. Obtaining a culture of fluid from the middle ear
C 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 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? a. "We need to make sure we are speaking clearly." b. "Using hand gestures as visual cues should help our child understand a little better." c. "We need to raise the volume of our voices significantly so he can hear us." d. "We need to face our son when we are speaking."
C 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.
In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure? a. A small incision is made in the earlobe during this procedure. b. This procedure is performed as soon as otitis media is diagnosed. c. During this procedure, small tubes are inserted into the tympanic membrane. d. The purpose of this procedure is to decrease or stop the drainage.
C Myringotomy (incision of the eardrum) may be performed to establish drainage and to insert tiny tubes into the tympanic membrane to facilitate drainage. The procedure is done for children with chronic otitis media, not as soon as the child is diagnosed.
A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation? a. Performing a Weber test b. Performing Hirschberg test c. Moving a penlight toward the client's nose and observing whether his eyes can follow it d. Having the child touch the fly's wings in an image constructed of colored dots
C 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 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. a. Encourage the parent use a few drops of hydrogen peroxide each evening to help keep the ear wax softened. b. Encourage the parent to consider using a few drops of normal saline solution each evening to help keep the ear canal clean and free from wax buildup. c. Advise the parent that swabs can force the ear wax further down into the ear canal. d. Suggest that the parent try a smaller swab to clean the ears. e. Teach the parent that cleaning the ears with the swab may scratch the ear canal.
C, E Cerumen (earwax) serves the important function of cleansing the external ear canal as it gradually moves outward, bringing with it shed epithelial cells and any foreign object. Parents are often concerned that earwax will lead to a loss of hearing (or they view it as dirty) and so ask health care professionals to have it removed. 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 the ear canal, creating a site for a secondary infection. This practice may also push accumulated cerumen farther into the ear canal, resulting in plugging of wax. Commercial softeners are available if cerumen accumulates to such an extent that hearing is affected. In some instances, a dilute solution of hydrogen peroxide may be necessary to dissolve cerumen. Again, this should not be done regularly because this will keep the ear canal constantly moist, an environment that leads to external otitis.
The vision impairment in which the child can see objects at close range but not at a distance is known as: a. Esotropia b. Hyperopia c. Exotropia d. Myopia
D 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.
The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the: a. possibility that multiple operations may be necessary. b. need for ultraviolet-protective glasses postoperatively. c. importance of completing the full course of oral antibiotics. d. importance of patching as prescribed.
D Teaching the parents the importance of patching the child's eye as prescribed is most important for the treatment of strabismus. The need for ultraviolet-protective glasses postoperatively is a subject for the treatment of cataracts. The possibility of multiple operations is a teaching subject for infantile glaucoma. Teaching the importance of completing the full course of oral antibiotics is appropriate to periorbital cellulitis.
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? a. "I will use a warm compress to help loosen crust that accumulated on his eyelid overnight." b. "I will wash my hands immediately after caring for him." c. "I will encourage my son to not touch his eyes." d. "I will use Visine drops in his infected eye to help reduce redness."
D Using a warm compress to remove crust from eyelids, washing hands frequently, and refraining from touching infected eyes are all ways to help manage bacterial conjunctivitis and prevent spreading the infection. Visine should not be used as it does not treat the cause of the infection and can cause rebound redness.
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. "He is likely to have a slight astigmatism, which almost always needs to be corrected by glasses." b. "He might be suffering from hyperopia and probably will need glasses now." c. "His vision problem will get in the way of his learning, so he will probably have to have glasses before he starts school." d. "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."
D Visual acuity of children gradually increases from birth, when the visual acuity is usually between 20/100 and 20/400, until about 5 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.
A child has been diagnosed with bacterial conjunctivitis. Which statements by the child's parent indicate the need for further education? Select all that apply. a. "All of us at home need to wash our hands really well." b. "This is really contagious." c. "We should not use a towel that he has used." d. "He can go back to school in 4 hours after that thick yellow drainage is gone." e. "I'll continue to use eye drops to help with the redness."
D, E Eye drops are not appropriate to use because rebound vasoconstriction may occur and it is not actually treating the infection. The child can go back to school 24 to 48 hours after the mucopurulent drainage is no longer present.
