Alteration in Sensory Status

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. American Sign Language b. Oral deaf education c. Cued speech d. Total communication

a

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 raise the volume of our voices significantly so he can hear us." b. "We need to make sure we are speaking clearly." c. "We need to face our son when we are speaking." d. "Using hand gestures as visual cues should help our child understand a little better."

a

The nurse is caring for a male toddler with the genetic disorder of muscular dystrophy. The child has had numerous ear infections and is scheduled for pressure-equalizing (PE) tubes surgery. The parents state, "As if our child's muscular dystrophy isn't enough, now he has to endure ear surgery." What is the best response by the nurse? a. "The surgery is necessary to treat his repeated ear infections." b. "I know it is difficult but it's not unusual for children with genetic disorders to have ear structure problems. This will help prevent future ear infections." c. "Children with muscular dystrophy are prone to other anomalies. It is inevitable that there will be other issues to deal with." d. "The doctor feels that this is the best treatment so you just need to trust the physician's judgement."

b

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

d

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

A 12-year-old girl tells the nurse that she is so embarrassed that she is going to have to start wearing glasses. What is the best response by the nurse? a. "I wore glasses when I was 12. It wasn't so bad." b. "You look adorable in your glasses. Everyone will love them." c. "Let's talk about what it will be like wearing them for the first time." d. "You really don't have a choice if you want to see better."

c

A 5-year-old is diagnosed with acute otitis media. Which nursing intervention would be primary? a. Administration of a mydriatic b. Cautioning the child not to pull on the ear c. Relief of pain d. Cautioning the child not to blow the nose

c

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. "He opens his eyes quite frequently when he's awake." c. "His eye looks about the same size as his other eye." d. "His eye doesn't seem to tear much."

a

The school age child has been diagnosed with astigmatism. The parents state, "I never knew our child had trouble seeing at a distance." How should the nurse respond? a. "Astigmatism doesn't mean being farsighted, it's actually a curvature of the cornea that causes blurry vision." b. "Sometimes it's difficult to know when a child is farsighted unless they notice they are having trouble seeing at distances." c. "I'm surprised this was never discovered during a vision screening exam." d. "Well all that is important now is that glasses will help astigmatism."

a

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. Chalazion b. Stye c. Conjunctivitis d. Blepharitis marginalis

c

The mother of a child having myringotomy tubes placed asks, "Will my son lose his hearing while the tubes are in place?" What is the nurse's best answer? a. "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." b. "Your son's hearing will decrease while the tubes are in place." c. "The tubes are inserted into a section of eardrum in which the hearing is not affected." d. "Have you asked your son's physician about that?"

c

A nurse is assessing a child's vision. Which test should the nurse use to test for accommodation? a. Having the child touch the fly's wings in an image constructed of colored dots b. Performing Hirschberg test c. Moving a penlight toward the client's nose and observing whether his eyes can follow it d. Performing a Weber test

c

The parents of a blind child are reporting to the nurse that they have noticed their child rocking and bouncing repetitively. The nurse can best explain those behaviors by stating: a. "Your child will never make friends acting like that!" b. "Unfortunately there is nothing that can be done to stop him." c. "That's normal, all blind children do that." d. "Those behaviors are called blindisms and may indicate your child is trying to communicate with you."

d

The school nurse is assessing a student complaining of left eye pain. Upon visual inspection, the nurse notes left conjunctivae redness and thick, colored discharge. The nurse understands that these signs and symptoms are consistent with which diagnosis? a. Bacterial conjunctivitis b. Allergic conjunctivitis c. Viral conjunctivitis d. Chalazion

a

A mother asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the mother? a. Prophylactic acetic acid instillations may be helpful. b. The frequency of otitis media is reduced in breast-fed infants. c. Prophylactic myringotomy tubes can be inserted at birth. d. Starting immunizations at birth rather than age 2 months might help.

b

A nursing instructor is teaching about eye disorders in childhood. Which statement made by a student indicates a need for further instruction? a. "Glaucoma is caused by increased intraocular pressure." b. "Cataracts are only present in adults." c. "Cataracts can be present at birth." d. "A cataract is a marked opacity of the lens."

b

An infant with poor eye alignment cannot establish single binocular vision but has double vision. The nurse knows that another term for this disorder is: a. stereopsis. b. diplopia. c. myopia. d. hyperopia.

b

In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure? a. This procedure is performed as soon as otitis media is diagnosed. b. During this procedure, small tubes are inserted into the typmpanic membrane. c. A small incision is made in the earlobe during this procedure. d. The purpose of this procedure is to decrease or stop the drainage.

b

The Caucasian parents of a newborn state, "We are so excited that our baby was born with blue eyes! We were hoping the baby would take after our other child." How should the nurse respond? a. "It's not uncommon for babies to be born with blue eyes." b. "You probably won't know for sure the color of your baby's eyes until your infant is 6 to 12 months old." c. "You can hope they stay that color. There is no guarantee." d. "The infant's iris will likely become more pigmented, so it's unlikely the eyes will not be blue."

b

The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media infection. Which statement by the mother indicates she has the correct understanding of the information provided? a. "I should continue to smoke in the house." b. "I should continue to breastfeed my son because it lowers the incidence of acute otitis media." c. "Immunizations will not help prevent another otitis media infection." d. "Because the infection is in my son's ear, hand washing is not important."

b

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

b

What would the nurse include when teaching parents how to prevent otitis externa? a. Daily ear cleaning with cotton swabs b. Wearing ear plugs when swimming c. Using a hair dryer on high to dry the ear canals d. Using hydrogen peroxide to dry the canal skin

b

A 9-year-old boy who is blind is admitted to the hospital. When serving him a meal in bed, which statement would be most appropriate to increase his self-esteem? a. "Here is your tray; if you need help just call me." b. "I have cut your meat for you. Do you need any other help?" c. "You have a sandwich on your plate, a glass of milk to your right, and an apple to your left." d. "I'll have to feed you lunch; spaghetti is very messy."

c

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is your best response? a. "You will have them replaced every 2 months until you reach age 18." b. "The tubes remain in place for 6 months and then are dissolved by vinegar." c. "The tubes remain in place for 6 to 12 months until they come out by themselves." d. "The tubes are not removed; they grow permanently into place."

c