Chapter 50: Nursing Care of a Family when a Child has a Vision or Hearing Disorder

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

Ans: A Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 1429 Feedback: Acute otitis media is painful. Children need pain relief until the antibiotic also prescribed reduces the inflammation and pressure.

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

Ans: A Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Page: 1416 Feedback: Amblyopia can be treated if discovered before 6 years of age; early recognition is, therefore, important.

5. The nurse screens a school-aged boy for hearing and discovers he has a hearing loss of 60 dB. This means he would have difficulty hearing: A) very loud noises only. B) normal conversation and above. C) whispering only. D) all noise.

Ans: B Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Page: 1431 Feedback: Normal conversation is conducted at about 50 dB.

13. 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."

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 1412 Feedback: Helping children who are visually impaired remain as independent as possible increases self-esteem.

17. The outpatient care clinic receives the 2020 National Health Goals that focus on prevention, early detection, treatment, and rehabilitation of vision problems. What should the nurse remind each patient to do to ensure eye health? A) Flush the eyes every day with cool water. B) Instill artificial tears in the eyes at least twice a day. C) Cleanse the eyes with soap and warm water while taking a shower. D) Use personal protective eyewear during recreation and hazardous situations.

Ans: D Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 1411 Feedback: Nurses can help the nation achieve the 2020 National Health Goals that focus on prevention, early detection, treatment, and rehabilitation of vision problems by reminding all patients to use personal protective eyewear in recreational activities and hazardous situations around the home. This goal will not be met by instructing patients to flush the eyes with water, use artificial tears, or cleanse the eyes with soap and warm water.

12. The most effective approach to prepare a school-aged boy for a myringotomy procedure is to: A) show audiovisual films about the surgery. B) ask his mother to explain it to him the day before the procedure. C) explain the procedure to the child using puppets. D) show the child pictures of what he should expect.

Ans: C Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 1431 Feedback: Young children respond best to concrete illustrations introduced as a fun activity or game.

11. 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) "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 son's hearing will decrease while the tubes are in place." D) "Have you asked your son's physician about that?"

Ans: A Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 1430 Feedback: Myringotomy tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing.

9. A 5-year-old develops an otitis media with effusion. Myringotomy tube insertion is scheduled. The mother asks, "Why does this have to be done at the hospital?" What would be your best response? A) "He will need to lie still afterward, so he will need to remain at the hospital for a short time." B) "The procedure is uncomfortable so he will need postoperative pain medication." C) "The procedure causes bleeding, so he needs to be observed closely." D) "He will need to be assessed after the procedure for increased intracranial pressure."

Ans: A Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 1430-1431 Feedback: It is important that children lie still while the tubes are inserted so a portion of the tympanic membrane, important for hearing, is not punctured.

22. The nurse is caring for a preschool-aged child diagnosed with acute otitis media. Which intervention should be a priority for the nurse? A) Relieving pain B) Administering a mydriatic C) Cautioning the child not to blow the nose D) Cautioning the child not to pull on the ear

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 1429 Feedback: 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 patient. A mydriatic is a medication for an eye disorder. There is no reason why the child cannot blow the nose. Pulling on the ear is an attempt to reduce the pain.

18. A school-age child comes into the emergency department with tearing and pain in the right eye. Which method will the nurse use to assess for foreign body under the upper eyelid? A) Evert the upper lid. B) Apply topical anesthesia to the upper lid. C) Apply cool water to the lid to cause it to retract. D) Catch the child's attention with a toy so that he looks down.

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 1421 Feedback: Foreign bodies such as sand or dirt that are loose on the conjunctiva can be removed by gentle wiping with a well-moistened, sterile, cotton-tipped applicator after the eyelid is everted. Topical anesthetic, cool water, and diversion are not appropriate methods to assess for a foreign body under the upper eyelid.

21. The nurse is planning care for a toddler who is diagnosed with a profound hearing loss. Which nursing diagnosis should the nurse identify as the priority once the child is discharged? A) Risk for injury related to hearing loss B) Social isolation related to effects of hearing loss C) Impaired verbal communication related to congenital hearing deficit D) Risk for parental role strain related to responsibilities of caring for sensory impaired child

Ans: A Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Analyze Page: 1411 Feedback: The child is a toddler and will be exploring areas throughout and outside of the home. With a hearing deficit, the child will not be able to hear any warnings from the parents. This increases the child's risk of injury related to the hearing loss. The child may or may not experience social isolation from the hearing loss. It is too soon to determine if the child will have impaired verbal communication, and it is unknown if the hearing deficit is congenital. The parents will be challenged to care for a sensory impaired child; however, the child's risk for injury would be the priority.

16. A mother is concerned that her toddler is diagnosed with amblyopia. What should the nurse explain as possible treatments for this eye condition? Select all that apply. A) Wearing corrective eye glasses B) Covering the good eye with a patch C) Using a patch and corrective eye glasses D) Applying eye drops prior to applying an eye patch E) Scheduling for immediate surgery to cut the eye muscle

Ans: A, B, C, D Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 1420 Feedback: Treatment for amblyopia can consist of wearing correcting glasses, covering the good eye with a patch, or a combination of the two. An additional option is using the medication levodopa and an eye patch. LASIK surgery might be considered, which corrects the refractive error but does not cut the eye muscle.

23. The nurse is preparing a program for the parents of school-age children on ways to prevent hearing loss. What information should the nurse include in this program? Select all that apply. A) Avoid placing any objects into the ears. B) Ensure that all immunizations are current. C) Use over-the-counter remedies to treat sore throats. D) The impact of chronic exposure to loud music when using earphones. E) Protect the ears with earplugs or earmuffs when in loud environments.

Ans: A, B, D, E Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Page: 1414 Feedback: Strategies to protect hearing include not placing any objects into the ears, ensuring that all immunizations are current, understanding the impact of chronic exposure to loud music when using earphones, and protecting the ears when in loud environments. The nurse should teach that prompt treatment should be obtained for sore throats because these can lead to middle ear infections.

8. 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.

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 1428 Feedback: Acute otitis media tends to occur less often in breast-fed than bottle-fed infants, probably because of the more upright position in which they are fed.

14. An infant is born with congenital glaucoma. She is scheduled for surgery to relieve this condition at age 2 days. Which preoperative order would you question for her? A) Nothing by mouth (with intravenous therapy) prior to surgery B) A preoperative injection of atropine C) A preoperative antibiotic D) Arm restraints to be applied after surgery

Ans: B Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Page: 1423-1424 Feedback: Glaucoma means the exit for intraocular fluid is blocked. A drug that causes pupil dilation narrows the exit of fluid further and, thus, is contraindicated.

19. When assessing school-age children for vision problems, which child would be most important for the nurse to assess for a deficiency in color perception? A) A girl who was born prematurely B) A boy who does not participate well in art class C) A boy who has had frequent middle ear infections D) A girl whose teacher reports that she rubs her eyes

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 1416 Feedback: Color deficit is the inability to perceive color correctly. It occurs in 4% to 8% of boys because one of the sets of cones of the retina that perceive red, green, or blue is absent. It is important for the loss of color perception to be detected early so the child can learn changes in traffic signals or other color-dependent signs necessary for safety. The child who does not participate well in art class could be color blind. Since this is a condition that occurs in boys, the girls do not need to be assessed for color deficit. Color deficit is not associated with ear infections.

26. The nurse is planning care for a school-age child with a black eye. Which outcome would be the most appropriate for this patient? A) The swelling will be reduced in a month. B) Evidence of bleeding will be reabsorbed within 1 to 3 weeks. C) The child will have double vision upon waking in the morning. D) The child will begin wearing corrective lenses after the swelling subsides.

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 1422 Feedback: For an eye contusion or a black eye, an appropriate outcome would be for evidence of the bleeding to be reabsorbed within 1 to 3 weeks. The swelling should be reduced much sooner than a month. The child should not experience any double vision with a black eye. The child will not need to be prescribed corrective lenses because of a black eye.

24. The nurse instructs a hearing-impaired school-age child on to how self-inject a prescribed medication. Which observation indicates to the nurse that additional teaching is required? A) The child pinches the skin together before inserting the needle. B) The child injects the appropriate amount of air into the vial before withdrawing medication. C) The child places the filled syringe and uncapped needle on the bed to open the alcohol wipe. D) The child slowly pushes on the plunger to inject the medication before withdrawing the needle.

Ans: C Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Page: 1412 Feedback: Children who are unable to hear may need additional time for explanations and support. By placing the syringe and uncapped needle on the bed, the child is contaminating the needle. This would indicate that additional teaching is necessary. Pinching the skin, injecting air, and slowly pushing on the plunger all indicate that teaching has been effective.

6. A mother telephones you because her physician told her that her son has wax in one ear canal. What advice would you give the mother? A) Observe her son carefully for hearing impairment for the next week. B) Teach her son to clean his ear with a Q-tip and tap water weekly. C) Inform her that ear wax is helpful in removing dirt from the ear canal. D) Apply ear drops daily for at least 3 days.

Ans: C Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 1428 Feedback: Earwax rarely leads to hearing impairment. Excess removal can interfere with its function of removing dirt from the ear canal.

10. 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."

Ans: C Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 1431 Feedback: Because myringotomy tubes are foreign objects, the tympanic membrane will extrude them after a time.

3. A boy is seen in the emergency room with tearing and pain in his right eye. To assess for a foreign body under the upper lid, which method would you use? A) Catch the child's attention with a toy so that he looks down. B) Apply cool water to the lid to cause it to retract. C) Avert the upper lid over an applicator stick. D) Apply topical anesthesia to the upper lid.

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 1421 Feedback: Averting the upper lid over an applicator stick offers a full view of the anterior globe.

29. An infant born with congenital glaucoma is scheduled for surgery. Which preoperative order should the nurse question for this patient? A) A preoperative antibiotic B) Nothing by mouth prior to surgery C) A preoperative injection of atropine D) Arm restraints to be applied after surgery

Ans: C Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 1423-1424 Feedback: Before surgery, the infant should not receive any drug, such as atropine sulfate, that dilates the pupil because this will further occlude the canal of Schlemm. Preoperative antibiotics, nothing by mouth before surgery, and the use of arm restrains after surgery are all orders that would be appropriate for the care of this child.

1. A 10-year-old boy develops bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. An important measure you would want to teach him is: A) to keep his eye covered at all times. B) not to apply ophthalmic drops for more than 3 days. C) to clean the discharge away from the inner to outer canthus. D) not to attend school for 2 weeks.

Ans: C Client Needs: Safe, Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Page: 1420 Feedback: Preventing the infection from spreading to the other eye is important.

27. 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. A) Apply an eye patch. B) Maintain on bed rest for 3 days. C) Support for nausea and vomiting. D) Provide pain medication as prescribed. E) Apply antibiotic ointment as prescribed.

Ans: C, D, E Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 1418 Feedback: After eye surgery for strabismus, the patient may experience nausea and vomiting and pain on eye movement. The patient 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.

25. A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" How should the nurse respond to this patient? A) "The tubes are not removed; they grow permanently into place." B) "You will have them replaced every 2 months until you reach age 18 years." C) "The tubes remain in place for 6 months and then are dissolved by vinegar." D) "The tubes remain in place for 6 to 12 months until they come out by themselves."

Ans: D Client Needs: Physiological Integrity: Basic Care and Comfort Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 1431 Feedback: 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 2 months, and they are not dissolved by vinegar.

4. A school nurse is screening children for vision problems. Which child would the nurse identify as most important to screen for a deficiency in color perception? A) A boy who has had frequent middle ear infections B) A girl who was born prematurely C) A girl whose teacher reports that she rubs her eyes D) A boy who says he does not like television

Ans: D Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Page: 1421 Feedback: Color deficiency is a sex-linked trait, so it only occurs in males; middle ear infections are not associated with color deficiency.

28. A school-age child who is blind is hospitalized for another health problem. What should the nurse say when providing the child with a meal tray? A) "Here is your tray; if you need help, just call me." B) "I'll have to feed you lunch; spaghetti is very messy." C) "I have cut your meat for you. Do you need any other help?" D) "You have a sandwich on your plate, a glass of milk to your right, and an apple to your left."

Ans: D Client Needs: Psychosocial Integrity Client Needs 2: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 1425 Feedback: Children who are blind often want to be told what is on their food tray when it is first presented to them. Name the foods so they can identify tastes with names as well as location of foods on the plate. The child needs to know what is on the meal try and should not be expected to call for help. Children with vision disorders have difficulty getting food from spoons or forks to their mouths neatly. However, they should not be spoon-fed just because it is neater and faster; eating is an important self-care skill a blind child must learn in order to be independent as an adult. The nurse needs to do more than cut the child's meat. The child has no way of knowing where any of the food is located on the tray.

20. During a routine hearing test, a school-age boy is discovered as having a hearing level of 60 dB. What does this finding indicate to the nurse about the child's ability to hear? A) Whispering only B) Very loud noises only C) Able to hear all noises and sounds D) Difficulty with normal conversation

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 1431 Feedback: At the hearing level of 60 dB, the person will have difficulty with normal conversation. A person who can hear whispered words is not experiencing a hearing loss. The person who can only hear loud noises would have a severe hearing loss at the decibel level between 70 and 90. The person who is able to hear all noises and sounds is not experiencing a hearing loss.

15. The nurse is caring for a 10-year-old child with bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. What should the nurse teach the patient about the care of the eye? A) Do not attend school for 2 weeks. B) Use ophthalmic drops for 3 days. C) Keep the eye covered at all times. D) Clean the discharge away from the inner to outer canthus.

Ans: D Client Needs: Safe, Effective Care Environment: Safety and Infection Control Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 1420 Feedback: Conjunctivitis is inflammation of the conjunctiva that causes pustular drainage. The eye should be cleansed from the inner to the outer canthus to prevent the spread of infection to the other eye. School does not need to be missed for 2 weeks with this eye infection. Ophthalmic medication should be used as prescribed, which might be longer than 3 days. The eye does not need to be covered.