Chapter 35: The Child with a Sensory/Neurologic Disorder

The vision impairment in which the child can see objects at close range but not at a distance is known as: a) Hyperopia b) Myopia c) Estropia d) Exotropia

b) Myopia Myopia is nearsightedness, which means that the child can see objects clearly at close range but not at a distance.

The nurse is preparing an ongoing assessment plan for a child with multiple sensory disorders. Which of the following will contribute most to the detection and intervention of problems? a) Behavioral assessments when problems occur b) Ongoing parental assessments of their child's capabilities c) Physical assessments when the child is sick or hurt d) Behavioral assessments as scheduled by the school

b) Ongoing parental assessments of their child's capabilities Parental observations of the child's abilities and responses are very important for accurate cognitive and behavioral assessment and prevention of problems. Making assessments only when the child is sick, hurt, or is experiencing problems is not a preventive measure. Behavioral assessments should be made on a regular basis, not just when they are provided by schools.

The prevention of cerebral palsy is the most important aspect of care. Which of the following are focus areas for the prevention of cerebral palsy? Select all that apply a) Postnatal prevention of rubella b) Perinatal monitoring to decrease birth trauma c) Prenatal care to improve nutrition d) Postnatal prevention of infection e) Prenatal prevention of gestational diabetes

b) Perinatal monitoring to decrease birth trauma c) Prenatal care to improve nutrition d) Postnatal prevention of infection Because brain damage in CP is irreversible, prevention is the most important aspect of care. Prevention of CP focuses on prenatal care to improve nutrition, perinatal monitoring with appropriate interventions to decrease birth trauma, and postnatal prevention of infection through breast-feeding, improved nutrition, and immunizations. Rubella is significant prenatally, not postnatally. Diabetes is not a known cause.

A child diagnosed with conjunctivitis is being seen in the pediatric clinic. Which statements are correct regarding conjunctivitis? Select all that apply. a) Treatment is symptomatic. b) Purulent drainage is a common symptom. c) Warm compresses are used to remove crusts that form on the eyes. d) It is most often caused by a virus. e) It is highly contagious.

b) Purulent drainage is a common symptom. c) Warm compresses are used to remove crusts that form on the eyes. e) It is highly contagious. Most commonly, conjunctivitis is caused by bacteria. The purulent drainage, a common characteristic, can be cultured to determine the causative organism. Because of the danger of spreading infection, bacterial conjunctivitis is treated with ophthalmic antibacterial agents. Warm, moist compresses can be used to remove the crusts that form on the eyes. The child who has bacterial conjunctivitis should be kept separate from other children until the condition has been treated.

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: a) down and forward. b) up and back. c) down and back. d) down and forward.

c) down and back. 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 mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" Which response by the nurse would be most appropriate? a) "Do you think that maybe your child took aspirin on his own?" b) "Aspirin in combination with the virus will make the brain swell and the liver fail." c) "Don't worry; you're in good hands. We have it under control now." d) "Sometimes it's hard to tell if a product contains aspirin."

d) "Sometimes it's hard to tell if a product contains aspirin." Although warning labels are placed on containers of salicylates, salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education. Don't state the obvious, but also don't minimize the situation. Encourage the mother to ask for information, and be sure to explain in terms she will understand

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? a) Shaking the head and pulling the ear b) Severe vomiting and confusion c) Body stiffening and loss of consciousness d) High-pitched cry and nuchal rigidity

a) Shaking the head and pulling the ear A restless infant who repeatedly shakes the head and rubs or pulls at one ear should be checked for an ear infection.

The nurse is taking a health history for a 9-year-old with conjunctivitis. Which statement by the parents leads the nurse to suspect that the child is experiencing allergic conjunctivitis? a) "He recently helped clean the basement." b) He just recovered from an upper respiratory infection. c) We have a family history of conjunctivitis. d) "He was exposed to several family members with an infection."

a) "He recently helped clean the basement." Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen. 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 caring for a 12-month-old infant diagnosed with Haemophilus influenzae meningitis. Which clinical manifestation would likely have been noted in this child? a) High-pitched cry and nuchal rigidity b) Shaking the head and pulling the ear c) Body stiffening and loss of consciousness d) Severe vomiting and confusion

a) High-pitched cry and nuchal rigidity Children with meningitis may have a characteristic high-pitched cry, fever, and irritability. Other symptoms include headache, nuchal rigidity (stiff neck) that may progress to opisthotonos (arching of the back), and delirium.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2°F(39°C). What is the nurse's highest priority? a) Institute safety precautions. b) Encourage the child to do his or her own self-care. c) Offer age-appropriate activities. d) Provide family teaching related to the child's history

a) Institute safety precautions. A child who presents with an elevated temperature is at high risk for having a febrile seizure; therefore, actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in a roller skating accident. What should the caregivers be instructed to do? Select all that apply a) Observe and report any vomiting that occurs within 6 hours. b) Observe for and report to provider any double or blurred vision. c) Check the pupil reaction to light every 15 minutes for 12 hours. d) Wake the child every 1 to 2 hours to check level of consciousness. e) Administer acetaminophen for headache

a) Observe and report any vomiting that occurs within 6 hours. b) Observe for and report to provider any double or blurred vision. d) Wake the child every 1 to 2 hours to check level of consciousness. The caregiver should observe the child for at least 6 hours for vomiting or a change in the child's level of consciousness. If the child falls asleep, he or she should be awakened every 1 to 2 hours to determine that the level of consciousness has not changed. No analgesics or sedatives should be administered during this period of observation. The child's pupils are checked for reaction to light every 4 hours for 48 hours.

The nurse is caring for a child who has an intellectual disability. Of the following factors, which is a cause of postnatal intellectual disability? a) Prematurity b) Lead poisoning c) Genetic factors d) Intrauterine infection

b) Lead poisoning Postnatal causes include poisoning such as lead poisoning.

The nurse is in the room when a child with a seizure disorder is having a seizure. The child is exhibiting generalized jerking muscle movement, and the nurse notes the bed appears to be wet with urine. The child is in which stage of the generalized seizure? a) Postictal b) Clonic c) Tonic d) Prodromal

b) Clonic The initial rigidity of the tonic phase changes rapidly to generalized jerking muscle movements in the clonic phase. The child may bite the tongue or lose control of bladder and bowel functions. The jerking movements gradually diminish and then disappear, and the child relaxes.

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) It is caused by chronic otitis media or another infection. In conductive hearing loss, middle ear structures fail to carry sound waves to the inner ear. This type of impairment most often results from chronic serious otitis media or other infection.

A child presents to the clinic after receiving a letter from the local school requesting a hearing evaluation. In assessing the child, the nurse notes that the child has slight speech impairment and doesn't seem to hear when turned away from the nurse while the nurse is speaking. The nurse assesses that the child may have what degree of hearing impairment? a) Slight b) Moderate c) Profound d) Mild e) Severe

d) Mild Children with mild hearing loss demonstrate slight speech impairment, may have difficulty hearing when not directly facing the person with whom they are speaking, and have some difficulty in maintaining a conversation.