CH. 35 The Child with Sensory/Neuro Disorders

The nurse is assessing a child with an eye problem. Which symptom, if present, would rule out a hordeolum?

- Reddened conjunctiva Explanation: The conjunctiva is clear with a hordeolum. A hordeolum is usually painful. Eyelid edema is present with a hordeolum. A hordeolum may be visible as an enlarged lesion along the lid margin.

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

- Myopia Explanation: 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 helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure?

- "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." Explanation: Correct positioning for a lumbar puncture is to place the child on his or her side with the neck flexed and knees bent and drawn up to their chest. This helps to keep the back arched as much as possible. Newborns may be seated upright with their head bent forward. The child is not placed prone; this does not allow the back to be arched.

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." Explanation: Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures.

A parent of a child child having tympanostomy tubes placed asks, "How long will my child have to have the tubes?" How should the nurse respond to this parent?

- "The child will have the tubes for about 1 year, until the tubes fall out on their own," Explanation: Tympanostomy tubes tend to be extruded or come out by themselves after 6 to 12 months. The tubes do not grow permanently into place. They will not need to be replaced every 3 months, and they are not flushed out with vinegar.

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." Explanation: 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?

- "The tubes remain in place for 6 to 12 months until they come out by themselves." Explanation: - 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 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." Explanation: It is not necessary for the parents to raise their voices more than slightly in order to be heard. - Speaking clearly is an appropriate technique for communicating with the child. - Facing the child when speaking is an effective method for communicating with the child. - Using visual clues, such as hand gestures, is an effective technique for communicating with this child.

The 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." Explanation: 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.

A nurse develops a plan of care for a child that includes patching the eye. This plan of care would be most appropriate for which condition?

- Amblyopia Explanation: Eye patching is used for amblyopia or any condition that results in one eye being weaker than the other. Corrective lenses would be appropriate for astigmatism, hyperopia, and myopia.

A 10-month-old infant is brought to the emergency department by the parents after they found the infant face down in the bathtub. The parent states, "I just left the bathroom to answer the phone. When I came back, I found my infant." Which nursing action is priority?

- Assess the client's respiratory rate. Explanation: With a submersion injury, hypoxia is the primary problem. Therefore, assessment of airway and breathing are priority. Based on this assessment, the nurse would determine if resuscitative measures were needed. Other actions such as applying a heart monitor and obtaining additional information about the event would be done once the infant's airway and breathing are assessed and emergency interventions are instituted.

The nurse is planning care for a preschool-age child diagnosed with bacterial meningitis. What should the nurse identify as a priority goal for this client's care?

- Reduce the pain related to nuchal rigidity. Explanation: Meningitis is an infection of the cerebral meninges. Pathologic organisms spread to the meninges. Once organisms enter the meningeal space, they multiply rapidly and then spread throughout the CSF to invade brain tissue through the meningeal folds, which extend down into the brain itself. A child with meningitis usually has an upper respiratory tract infection prior to the development of meningitis. Then the child will become increasingly irritable because of an intense headache with sharp pain when bending the head forward. Reducing the pain caused by neck pain would be the priority goal for this client's care. Inspecting the teeth, providing opportunities for play, and increasing stimulation would not be priority goals for this client

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 Explanation: S. aureus is the most common bacterial cause of conjunctivitis. Although a common cause, S. pneumoniae is not the most common cause of bacterial conjunctivitis. Although a common cause, H. influenzae is not the most common cause of bacterial conjunctivitis. Although a common cause, C. trachomatis is not the most common cause of bacterial conjunctivitis.

The nurse is caring for a child recovering from surgery to correct strabismus. Which interventions should the nurse include when planning this child's care? Select all that apply. - Apply an eye patch. - Maintain on bed rest for 3 days. - Support for nausea and vomiting. - Provide pain medication as prescribed. - Apply antibiotic ointment as prescribed.

- Support for nausea and vomiting. - Provide pain medication as prescribed. - Apply antibiotic ointment as prescribed. Explanation: After eye surgery for strabismus, the client may experience nausea and vomiting and pain on eye movement. The client will also be prescribed antibiotic ointment. An eye patch is not usually required. The child will not need to be on bed rest for 3 days.

After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful?

- The shorter and wider eustachian tubes of an infant increase the risk. Explanation: The infant has relatively short, wide, horizontally placed eustachian tubes, allowing bacteria and viruses to gain access to the middle ear and resulting in an increased number of infections as compared to adults. Congenital deformities of the ear are associated with other body system anomalies, but not necessarily an increase in ear infections. As the child matures, the eustachian tubes assume a more slanted position, so older children and adults have fewer infections. A child's adenoids are often enlarged, leading to obstruction of the eustachian tubes and infection.

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. Explanation: To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination.

A nursing instructor is working with a student caring for an 18-month-old client. In order to ascertain that the tympanic membrane is optimally visualized, the faculty will assess that the student pulls the pinna of the ear:

- down and back. Explanation: The eardrum of the infant and young child is best visualized by utilizing an otoscope and pulling the pinna of the ear down and back.

The nurse is teaching the parents of a visually impaired baby about the developmental potential for their child. Which of the following learning functions would the nurse explain as being unique to visually impaired children?

- learning to use facial expressions Explanation: Visually impaired children may need to be taught to purposefully use facial expressions more frequently in order to improve interpersonal communication. Learning how to dress, feed, and bathe themselves; learning physical fitness skills; and learning how to participate in a group are common to the needs of all children.

The nurse is caring for a 4-year-old with meningitis. A primary nursing goal would be to:

- reduce the pain related to nuchal rigidity. Explanation: Irritation of the meninges causes pain on forward flexion of the neck.

The nurse is caring for a toddler diagnosed with acute otitis media. Which should be the nurse's concern?

- relieving pain Explanation: Acute otitis media causes sharp, constant pain in one or both ears. Older children can verbalize they have pain and point to where it is at. Relief of pain should be the nurse's priority when caring for this client. Using a mydriatic to dilate the pupil is eye disorders. There is no reason why the child cannot blow their nose. Pulling on the ear is an attempt to reduce the pain.