Peds - Ch 17: Alteration in Sensory Perception - Disorder of the Eyes or Ears

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 to understand? a. Student placement in the room is important but all other teaching methods may remain the same. b. Hands-on learning should account for 90% of the teaching method. c. Teaching sessions will need to be shortened due to eye strain. d. There are no teaching methods that need to be considered.

A Amblyopia is when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called "lazy eye." The student can still see and, in some cases, has limited impairment due to brain compensation. It is associated with other conditions such as poor refraction, ptosis, cataracts, or strabismus. The child should be placed where he or she can be in direct view of the teacher or blackboard but the other teaching methods may remain the same. The methods do not need to be shortened nor does the child require a large percentage of the learning to be hands-on.

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? a. "Play tough, but wear protective gear." b. "56% of paintball eye injuries have poor outcomes." c. "Most sports injuries happen to guys your age." d. "Paintball eye injuries have doubled in the past two years."

A Every study cited shows that safety gear prevents injury. However, adolescents tend to ignore safety warnings. So, encouraging the child to play as tough as he pleases if he's wearing safety gear has the best chance of being heard. He won't pay attention to statistics.

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? a. The eustachian tube in the infant is straighter and wider than in the adult. b. The eardrum is located between the middle and the internal ear. c. Most children do not have acutely developed hearing until the age of 5 years. d. The infant usually responds to sounds around the age of 6 months.

A In infants and young children, the eustachian tube is straighter, shorter, and wider than in the older child and adult. Hearing in children is acute, and the infant will respond to sounds within the first month of life.

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. "Although there are surgeries for vision, they are not normally recommended for someone your age." b. "We can talk with the doctor about referring you to a surgeon to get this taken care of." c. "Lots of girls your age wear glasses without issues." d. "Let's talk with your mother about getting contact lens."

A 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 lens may be something for consideration, this response does not address the teen's question.

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 does not imitate facial expressions. b. The infant can "fix and follow". c. The infant blinks quickly when a bright light is shown in the eyes, d. The infant makes eye contact.

A 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.

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 parent of a child having myringotomy tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer? a. "The tubes are inserted into a section of eardrum in which the hearing is not affected." 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. "Have you asked your child's surgeon about that?"

A Myringotomy 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.

The nurse is educating the parents of a 4-year-old boy who has been diagnosed with amblyopia. Which comment provides information most helpful for the parents to know? a. "Give him a prize when he wears the patch." b. "Surgery can provide fast recovery." c. "Amblyopia is often preventable." d. "It's good you didn't wait until age 7."

A Occlusion therapy with a patch is frequently used as treatment. The more compliant the child is, the faster the recovery; rewarding a 4-year-old child for wearing the patch improves compliance and outcome. Information about prevention or completion of visual center development at age 7 will not affect treatment. The benefits of surgical treatment are not pertinent.

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. "It seems like bright lights really bother him." b. "His eye doesn't seem to tear much." c. "He opens his eyes quite frequently when he's awake." d. "His eye looks about the same size as his other eye."

A 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 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 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The mother asks what can be done. What information should be included in the information provided to the parent? a. Most of these conditions will spontaneously resolve. b. Over-the-counter drops can be used sparingly. c. Once the child is 6 to 9 months old a specialist will be able to drain the duct. d. Antiviral therapy can be prescribed to manage this condition.

A Stenosis or simple obstruction of the nasolacrimal duct is a common disorder of infancy, occurring in about 6% to 20% of newborns and infants. It is unilateral in about 65% of cases. Chronic tearing occurs and buildup in the lacrimal sac causes a mucoid or mucopurulent drainage. Over 90% of all cases resolve spontaneously by 1 year of age.

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 12-year-old child has developed a stye. Which may be included in the child's care? a. Apply hot, moist compresses to the affected area. b. Apply petroleum jelly to reduce irritation. c. Apply cool, dry compresses to the affected area. d. Manually express the lesion when a head forms.

A The stye is an infection of a ciliary gland (a modified sweat gland) that enters the hair follicle at the lid margin, most commonly caused by Staphylococcus. Management of the stye includes the use of hot, moist compresses. Manual expression is not indicated. Petroleum jelly will not be appropriate nor will it reduce inflammation. Cool, dry compresses will not be therapeutic. Heat provides for vasodilation, which will be useful in the resolution of the inflammation.

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.

While obtaining the health history for an 11-year-old, the nurse suspects the child may have myopia based on what information? Select all that apply. a. The parent tells the nurse that the child always wants to sit close to the movie screen, but never did in the past. b. The parent tells the nurse that the child seems to hold books "closer and closer" to the face when reading. c. The child tells the nurse that they have to squint to see their teacher write on the white board at the front of the classroom. d. The child tells the nurse that it is difficult to see the ball in the outfield when playing baseball. e. The child tells the nurse that they have problems seeing their hand held video games.

A, C, D, When the light entering the eye focuses in front of the retina, it results in myopia (nearsightedness). Children who are nearsighted may see well at close range but have difficulty focusing on objects at a distance, such as the baseball in the outfield, the white board at school, and the movie screen.

The nurse has recently admitted a blind child to the pediatric unit. Which interventions should the nurse implement? Select all that apply. a. Allow the child additional time to think about a response to a question. b. Provide detailed and complex directions. c. Provide all of the care for the client in order to minimize independence. d. Explain what individuals are doing. e. Identify herself to let child know she is there before touching the child.

A, D, E Tips for interacting with the visually impaired include identifying yourself to let the child know you are there before touching them, encouraging independence while maintaining safety, explaining what other children and individuals are doing, allowing the child additional time to respond to questions, and providing directions that are simple and specific.

The nurse is assessing an adolescent who has a corneal abrasion as a result of wearing their contacts 24 hours a day for the last several days. What does the nurse expect the client to report during the nursing history? (Select all that apply) a. Redness b. Eye pain c. Eye tearing d. Unaffected vision e. Photophobia

B, C, E Signs and symptoms that normally occur include tearing, eye pain, blurry vision, and photophobia. Redness and unaffected vision are typical of scleral hemorrhage.

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.

The nurse is discussing communication options with the parents of a 2-year-old girl with congenital hearing loss. The nurse integrates knowledge of what form of communication as having no verbal component? a. Oral deaf education b. American Sign Language c. Total communication d. Cued speech

B American Sign Language is entirely communicated through hand signs, gestures, and facial expression. It has its own grammar and syntax. Oral deaf education uses technology to boost auditory potential and teaches children to notice sound and give it meaning. It helps develops oral speech. Cued speech is a system using hand signs to clarify lip-reading. It gives the person clues about the sounds the speaker is making. Total communication combines auditory training and teaching spoken language with signing exact English, which corresponds to the words and syntax of English.

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 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 caring for a 10-year-old girl with acute periorbital cellulitis. Which nursing intervention (therapy) is primary for this disorder? a. Applying heated aqua pad to site b. Administering antibiotics IV as ordered c. Monitoring for increased intracranial pressure d. Administering morphine sulfate as ordered

B Intravenous antibiotics will be the primary therapy for this child, followed by oral antibiotics. Warm compresses will be applied for 20 minutes every 2 to 4 hours. However, narcotic analgesics are not necessary to handle the pain associated with this disorder.

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 providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority? a. Teaching the family how to use antibiotic eye drops b. Ensuring the protective eye patch is securely in place c. Instructing parents about using protective sunglasses d. Explaining to the parents about patching the eye as therapy

B The priority intervention is to protect the operative site with an eye patch. Teaching about the use of protective sunglasses would be done later in the postoperative period in preparation for the child's discharge. Teaching the parents about administering eye drops would be done later in the postoperative period in preparation for the child's discharge. Explaining about eye patching would be done later in the postoperative period in preparation for the child's discharge.

The nurse is caring for a 7-year-old child in an outpatient clinic. The child is diagnosed with amblyopia that is unrelated to other disorders. Which intervention should be most helpful at this time? a. Discouraging the child from roughhousing b. Educating parents on how to use prescribed atropine drops c. Ensuring follow-up visits with the ophthalmologist d. Explaining postsurgical treatment of the eye

B Therapeutic management of amblyopia may be achieved by using atropine drops in the better eye. Educating parents on how to use atropine drops is the most helpful intervention. Explaining postsurgical treatment and discouraging the child from roughhousing would be appropriate only if the amblyopia required surgery. While follow-up visits to the ophthalmologist are important, compliance with treatment is priority.

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. "Many children who have a profound hearing loss function very well. There are lots of treatments available." b. "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." c. "There could be much worse things to happen to your child. At least your child is healthy in all other aspects." d. "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 This comment is the most empathetic and supportive. Encouraging a support group, when the parents are ready, is very helpful since these parent are truly the only ones who know what these parents are facing. They can also offer helpful options for dealing with a hearing impaired child. 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 child and parents feelings by telling them "many children who have a profound hearing loss function very well....."

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:

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.

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.

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. Assess vision to determine functional capability. b. Explain botulinum injection procedure and risks. c. Assess the child's ability to convey information. d.Teach parents to make vinegar and alcohol eardrops.

C 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.

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 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 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 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. "The blood in the white part of the eye is normal with this type of injury." b. "For the first 24 hours I will apply ice for 20 minutes, then leave it off for 20 minutes." 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."

C 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.

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? a. Teach the parents how to apply ophthalmologic antibiotic ointment properly. b. Inform the parents to call their pediatrician if the bruising persists for more than 2 days. c. Encourage the parents to apply ice to the area for 20 minutes at a time for the first 24 hours. d. Tell the parents that although the condition is frightening, no intervention is needed.

C To decrease the edema of a simple contusion, the parents should be instructed to apply an ice pack to the area for 20 minutes, then remove it for 20 minutes, continuing to repeat this cycle as often as possible during the first 24 hours. Bruising of the surrounding eye area may take up to 3 weeks to resolve. A sclera hemorrhage typically requires no treatment and resolves on its own over a period of a few weeks. A simple contusion does not require the use of antibiotic ointment. However, corneal abrasions may require antibiotic ointment.

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 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 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.

A child has recently been diagnosed with cataracts. The treatment for cataracts is: a. eye drops to lower the pressure. b. wearing a patch until the cloudiness clears. c. there is no treatment for childhood cataracts. d. surgery.

D 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.

When teaching a parent about amblyopia, it would be most important to explain that: a. amblyopia is a rapid irregular movement of the eye. b. if the child is not treated, he or she is likely to resent it later on. c. amblyopia can result from a refractive error in one eye. d. amblyopia is correctable if the child is properly treated before 6 years of age.

D Amblyopia is poor vision which develops in an otherwise structurally normal eye. With this condition the vision in one eye is decreased because the eye and the brain are not working together. The condition is known as "lazy eye" because one eye is stronger than the other. Amblyopia can be treated if discovered before 6 years of age. This is the reason early detection is so important. Strabismus, not amblyopia, is the rapid movement of the eye. Amblyopia is not caused by a refractive error in the eye. Telling the parent that if the child does not get treated, the child will resent it is not educating the parent. It is the nurse forcing judgment onto the parent, which should not happen.

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

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? a. Grasp the eyelashes of the upper eyelid and evert it b. Press firmly on the lower lid with the fingertip until it turns out c. Touch the glass fragment in the eye with a moistened, sterile, cotton-tipped applicator d. Instill a few drops of a topical anesthetic into the affected eye

D Children who have eye injuries are usually in acute pain immediately after the injury. A few drops of a topical anesthetic instilled into the eye may be necessary to relieve the pain and allow the eye to be opened for examination. To visualize the inner surface of the lower lid and the bottom half of the eye globe, press firmly on the lower lid with your fingertip until it turns out. Grasp the eyelashes and gently stretch the upper eyelid downward. Place the stick of a cotton-tipped applicator horizontally against the center of the upper lid. While still grasping the eyelashes, pull the eyelid upward and over the applicator until it is everted. A foreign body, such as a speck of dirt or a fragment of glass, often clings to the inside of the upper lid and can be readily removed by touching it with a moistened, sterile, cotton-tipped applicator while the lid is everted.

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? a. Conductive hearing loss b. Congenital hearing loss c. Mixed hearing loss d. Sensorineural hearing loss

D Earplugs or covers are used to block ambient noise in premature infants in the neonatal intensive care unit to prevent sensorineural hearing loss. Sensorineural hearing loss results from damage to the hair cells in the cochlea or along the auditory pathway. Conductive hearing loss results when transmission of sound through the middle ear is disrupted, as in the case of otitis media with effusion. Mixed hearing loss is a combination of sensorineural and conductive hearing loss. Congenital hearing loss is present at birth.

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 is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided? a. "This is caused by silver nitrate." b. "This can be genetic or acquired." c. "The liquid inside the eye can't drain." d. "It's an overgrowth of retinal blood vessels."

D The pathophysiology of ROP is one of injury to the developing blood vessels and tissues of the retina, and the healing process of regrowth or overgrowth of retinal vessels. Cataracts may be caused by genetics or may be acquired after birth. The inability of the aqueous humor to drain from the eye is a result of glaucoma. Silver nitrate 1% is an antibacterial prophylaxis that may cause conjunctivitis.

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.

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 bestresponse by the nurse? a. "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." b. "Vision continues to improve as the child ages. Hopefully you will notice improvement in your child's vision." c. "Until your child can read we can't check the visual acuity." d. "20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns."

D 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 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.