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

d) Amblyopia Pg. 1416 Eye patching is used for amblyopia or any condition that results in one eye being weaker than the other. Corrective lenses would be appropriate for astigmatism, hyperopia, and myopia.

11. A nurse develops a plan of care for a child that includes patching the eye. This plan of care would be most appropriate for which condition? a) Hyperopia b) Myopia c) Astigmatism d) Amblyopia

b) Ability to turn to light stimuli c) Ability to follow objects d) Corneal reflex Pg. 1413 Vision and hearing are assessed following birth. The nurse must select screening strategies appropriate to the client's age. For an infant, the vision parameters assessed are the ability to follow objects, corneal reflex, and ability to turn to light stimuli. No cognitive understanding of directions is needed for these assessment types. The cover test and hand-eye coordination require coordination and following directions; thus, these would be used for a toddler, not an infant.

23. A nurse is performing a vision test on a 3-month-old infant exhibiting poor eye alignment. Which assessment(s) is useful for an infant of this age? Select all that apply. a) Cover test b) Ability to turn to light stimuli c) Ability to follow objects d) Corneal reflex e) Hand-eye coordination

d) After the implant surgery our child will have normal hearing Pg. The cochlear implants will increase the child's hearing but do not restore normal hearing. This statement requires follow-up and further teaching by the nurse. Cochlear implants are surgically implanted and must heal for 2 to 3 weeks prior to activation. After activation, regular hearing tests and speech therapy are required to ensure that the implants are working and to promote speech and language development.

39. The nurse is educating the parents of an 18-month-old child being prepared to receive cochlear implants. Which statement by the parents requires further teaching? a) Our child will have hearing tests to assess how the implant is working b) We have arranged for speech-language therapy after the implant is activated c) The cochlear implant must heal and will be activated 2 to 3 weeks after surgery d) After the implant surgery our child will have normal hearing

c) "Don't use anything that touches her face" Pg. 1420 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.

4. The school nurse is educating the parents of a child with infectious conjunctivitis. Which comment provides the most value for prevention? a) "Use all the medication as directed" b) "This could have started with a head cold" c) "Don't use anything that touches her face" d) "Place the ointment inside the lower eyelid"

c) "It seems like bright lights really bother him" Pg. 1423 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.

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

c) "Color blindness can be treated" Pg. 1417 There is no therapy for color vision deficit; thus, color blindness cannot be treated.

9. A nursing instructor identifies a need for further teaching when a student makes which of the following statements? a) "Color blindness is inherited as a sex-linked disorder" b) "There is no therapy for color vision deficit" c) "Color blindness can be treated" d) "Structural problems of the eye in children tend to be congenital or present at birth"

a) It is caused by chronic otitis media or another infection Pg. 1425 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.

10. The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? a) It is caused by chronic otitis media or another infection b) It is caused by maternal rubella c) It is often undetected until the child goes to school d) It is generally severe and unresponsive to medical treatment

c) Shaking the head and pulling the ear Pg. 1429 With acute otitis media there is fluid and/or infection in the middle ear causing pain. The child may be very fussy, cry inconsolably, bat the head, tug at the ear or roll the head from side to side to help reduce the pain. Severe vomiting and confusion would be more related to gastroenteritis and dehydration. High-pitched cry and nuchal rigidity are associated with meningitis. Body stiffening and loss of consciousness are associated with seizures.

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

a) Pain Pg. 1419 Blepharitis has symptoms of redness, scaling, and edema, but not pain. Pain is typically associated with hordeolum.

17. The nurse is examining a 7-year-old boy with blepharitis. What symptom would be most unlikely to assess? a) Pain b) Scaling c) Redness d) Edema

b) Cones Pg. 1416 Color deficit, as the name implies, is the inability to perceive color correctly. It occurs in 4-8% of boys because one of the sets of cones of the retina that perceive red, green, or blue is absent.

28. A 12-year-old boy with color blindness asks his nurse what causes this condition. The nurse should explain to him that which of the following eye structures are genetically absent? a) Retinas b) Cones c) Lenses d) Rods

d) Evaluation of intraocular pressure (IOP) and adherence to the occlusive patch regimen Pg. 1422-1423 The patch and eye protector are made for the client to wear after surgery. During the follow-up visit, the physician looks for increased intraocular pressure, redness, swelling, and drainage.

38. Which measures should receive priority when planning care for the child who is having surgery to remove a cataract? a) Prophylactic antibiotic drops b) Regular insertion and removal of contact lenses c) Regular evaluation of the intraocular lens implant d) Evaluation of intraocular pressure (IOP) and adherence to the occlusive patch regimen

a) Fovea centralis Pg. 1413 The fovea centralis is the center of the macula and an area of closely packed cones on the retinas, where color is best perceived.

8. A nursing instructor is teaching students about vision disturbances in children. In reviewing the anatomy of the eye, what does the instructor tell students is the area of closely packed cones where color is best perceived? a) Fovea centralis b) Posterior chamber c) Canal of Schlemm d) Sclera

a) Astigmatism Pg. 1415 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.

22. 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) Astigmatism b) Hyperopia c) Myopia d) Refraction

b) Pain Pg. 1419 Pain is typical of hordeolum or stye. Blepharitis has symptoms of redness, scaling, and edema but not pain.

35. A nurse is examining a 7-year-old boy with hordeolum. On which primary symptom will the nurse focus care and instruction? a) Scaling b) Pain c) Redness d) Edema

b) Absent red reflex Pg. 1422 Assessment findings associated with congenital cataract include a history of lack of visual awareness; clouding of the cornea, which may or may not be visible; and no red reflex. Rapid irregular eye movement would suggest nystagmus. Misalignment of the eyes would suggest strabismus. Enlarged appearance of the eye is associated with infantile glaucoma.

36. An infant is diagnosed with a congenital cataract. What would the nurse expect to assess? a) Enlarged eye appearance b) Absent red reflex c) Misalignment of the eyes d) Rapid irregular eye movement

d) Apply hot, moist compresses to the affected area Pg. 1419 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.

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

d) Conjunctivitis Pg. 1419 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.

1. 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) Blepharitis marginalis d) Conjunctivitis

c) Moving a penlight toward the client's nose and observing whether eyes can follow it Pg. 1413 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.

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

d) Keeping ear canals dry Pg. 1427 Since moisture contributes to external otitis (acute otitis externa or swimmer's ear), 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 external otitis (acute otitis externa or swimmer's ear). Hearing loss is not associated with otitis externa.

32. A child returns to the clinic after an episode of external otitis (acute otitis externa or swimmer's ear) that has resolved. What would the nurse emphasize as the priority for preventing future episodes? a) Adhering to regular follow-up to assess for hearing loss b) Performing handwashing c) Avoiding upper respiratory tract infections d) Keeping ear canals dry

c) Surgery Pg. 1422 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.

3. A child has recently been diagnosed with cataracts. The treatment for cataracts is: a) Eye drops to lower the pressure b) There is no treatment for childhood cataracts c) Surgery d) Wearing a patch until the cloudiness clears

a) "Your child needs to perform specific eye exercises to strengthen the muscles" Pg. Orthoptics are eye exercises used to strengthen the weak muscles in patients with strabismus. They are not specialized glasses, eye drops, or contact lenses.

14. A parent of a child with strabismus asks, "What are orthoptics?" Which response by the nurse would be appropriate? a) "Your child needs to perform specific eye exercises to strengthen the muscles" b) "Orthoptics is just a fancy word for using medicated eye drops" c) "These are custom-made contact lenses that will help your child focus" d) "These are specialized glasses that your child will need to wear"

c) Assess the child's ability to convey information Pg. 1426 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.

15. 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

a) "What you are describing may be what is called myopia" Pg. 1414 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.

16. The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate? a) "What you are describing may be what is called myopia" b) "These reports are consistent with hyperopia" c) "Your child will need to be evaluated for an accommodation disorder" d) "This may signal your child is having difficulty paying attention rather than a visual disorder"

d) Arranging for an evaluation of the child's hearing Pg. 1426 The behaviors the child displays are common in children who have a hearing deficit. Loud talk and play and turning the TV set to a high volume may occur because the child cannot hear lower levels of sound. The child may not understand directions he or she is given because of poor hearing and, therefore, cannot follow them. Articulation of words is likely not clear because the child cannot hear the sounds and then imitate them. Evaluation of this child's hearing is appropriate.

18. Parents request help from the nurse in managing their young child's "poor behavior." They describe "loud talk and play, not coming when called, seldom following directions, 'blasting' the volume on the TV set, and difficulty understanding spoken words." The appropriate nursing action is: a) Teaching the parents about consistent, age-appropriate discipline b) Describing how the child's behaviors fit within the range of normal development c) Suggesting referral of the child for a speech evaluation d) Arranging for an evaluation of the child's hearing

a) Prevention and treatment of otitis media Pg. 1414 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.

19. 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) Prevention and treatment of otitis media b) Suddenly doing poorly in school c) Tendency to act silly in the classroom d) Playing the radio loudly

a) Myopia Pg. 1414 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.

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

b) The nurse talks to the child when entering and leaving the room Pg. 1425 The highest priority is for the nurse to identify herself to the child when entering or leaving the room. This helps reduce fear and anxiety and the possibility of being startled by an unexpected touch. It is important for the child to have activities related to normal growth and development, such as touching and playing with the toys in the playroom, talking on the telephone, and having the nurse spend time with the child, but these are not the highest priorities.

20. The nurse is caring for an 8-year-old hospitalized child who is visually impaired. Which nursing intervention would be the highest priority in helping this child reduce anxiety related to hospitalization? a) The nurse encourages the child to call her friends on the telephone b) The nurse talks to the child when entering and leaving the room c) The nurse stays with the child during meals and helps her eat d) The nurse takes the child to the playroom and lets her touch the toys

a) Reports of headache with close-up work d) Frequent squinting e) Diminished reading fluency Pg. Astigmatism is a common refractive error that is characterized by an irregular curvature of the cornea. This irregularity in the cornea changes the way light enters the eye and is received by the retina as multiple focal points as opposed to a single focal point, resulting in blurry vision. When children with astigmatism look at the letter T, for example, they may see the crossbar but not the letter stem. If they focus on the stem, they cannot see the crossbar. On any given page of print, therefore, these children may see only half the letters or can have great difficulty with reading fluency as well as speed of reading. They may report headache and eyestrain after doing close-up work. Even though their visual acuity appears deceptively normal on vision screening tests, these children need to be referred to an ophthalmologist on the basis of their other symptoms such as headaches, eye strain, squinting, and difficulty with reading. Nystagmus is rapid, involuntary eye movement, either vertically or horizontally.

21. An 8-year-old child with astigmatism is scheduled to come to the clinic for a visit. Upon reviewing the child's history, which finding(s) does the nurse expect to note? Select all that apply. a) Reports of headache with close-up work b) Normal reading speed c) Involuntary vertical eye movement d) Frequent squinting e) Diminished reading fluency

b) "Your child will need to wear the patch for a few days to keep him/her from rubbing or putting pressure on the eye" Pg. 1418 Strabismus refers to a misalignment of the eyes, if the strabismus persists past 6 months of age this warrants referral to an ophthalmologist for further evaluation. Clinical therapy involves occlusion therapy (patching of the good eye) for 1-2 hours a day to force use of the weak eye. The child may have to wear the patch intermittently, no restraints are needed if the patch is left in place, and the surgery on the muscle is what puts the eye back into alignment.

24. A 7-month-old is scheduled for surgical correction of strabismus. The child's mother says to the nurse, "I'm glad my child will never have to wear that patch again." Which of these responses would be most appropriate for the nurse to make? a) "Your child will need to wear the patch for several months to keep the eye in alignment" b) "Your child will need to wear the patch for a few days to keep him/her from rubbing or putting pressure on the eye" c) "Your child will have to be in restraints for a week to keep him/her from rubbing the eye" d) "Your child will never need to wear the patch again"

c) Recently helped clean the basement Pg. 1419-1420 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.

25. 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) Exposure to infective agents b) Recent upper respiratory infection c) Recently helped clean the basement d) Family history of conjunctivitis

d) The resting position of the eye is turned in Pg. 1417 In strabismus, the resting position of one eye may be divergent (turned out) or convergent (turned in). One pupil may be higher than the other (vertical strabismus). Strabismus may be monocular, in which the same eye deviates constantly.

26. A child has been diagnosed with strabismus. After further examination, the client is told that the resting position of the right eye is convergent. The nurse further explains that this means which of the following? a) The same eye deviates constantly b) The resting position of the eye is turned out c) One pupil is higher than the other d) The resting position of the eye is turned in

d) Myopia Pg. 1414 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.

27. 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

a) Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours Pg. 1416 A black eye is caused by a simple contusion to the eye. It affects the surrounding tissue of the eye but does not affect the eye itself. It produces swelling and bruising. It also causes scleral hemorrhage due to rupture of the blood vessels. The best treatment for the contusion is to place ice on for 20 minutes then off for 20 minutes for a 24-hour period. This helps reduce the swelling and pain. The bruising (the "black" eye) occurs from the vessels broken and leaking into the tissue. This may take about 3 weeks to go away. The nurse should assure the parent that scleral hemorrhages are benign but may take several weeks to resolve. The child would not need to be referred to an ophthalmologist unless the vision is impaired. Acetaminophen can be given for pain, but it is not the most important form of treatment for the problem.

29. A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent? a) Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours b) Administer acetaminophen if needed for pain c) Refer the child to an ophthalmologist for further evaluation d) Assure the parent that the scleral hemorrhages will resolve

b) Write a note to explain the need to assess vital signs Pg. Clients with hearing impairment have a right to be provided with a sign language interpreter and the nurse should defer nonurgent components of the assessment until the interpreter arrives. The nurse should not assume that the child can lip-read or will understand gestures. At age 13, written communication is the best option to communicate the key components of the assessment and to obtain consent and understanding from this child and parent.

30. The nurse admits a 13-year-old client with possible appendicitis to the hospital, accompanied by the parent. The client and parent are both deaf and use sign language to communicate. The nurse needs to assess baseline vital signs and the intake assessment. What should the nurse do while awaiting the arrival of the sign language interpreter? a) Leave the child and parent alone and defer assessment until the interpreter arrives b) Write a note to explain the need to assess vital signs c) Complete the intake physical assessment using gestures to communicate d) Speak loudly and clearly and face the child to explain the assessment so the child can lip read

d) 2 months of age Pg. 1411 Newborns are born nearsighted. They prefer the human face to other objects. At 1 month they can recognize by site the people they know. By 2 months of age, the infant can focus and follow an object with the eyes. Binocularity develops at 6 months and color vision follows at 7 months.

31. The nurse recognizes that if the infant is following normal development, the infant will be able to focus and follow an object with the eyes by what age? a) 1 month of age b) 21 days of age c) 7 days of age d) 2 months of age

a) Goniotomy Pg. 1423 Therapeutic management of infantile glaucoma is focused on surgical intervention via a goniotomy. Antibiotic therapy would be used to treat an infection. Contact lenses would be indicated for refractive errors and following removal of congenital cataracts. Patching of the affected eye is used for treating amblyopia and after surgery for congenital cataract.

33. An infant is diagnosed with infantile glaucoma. When developing the plan of care for the infant, for what would the nurse expect to prepare the infant and family? a) Goniotomy b) Patching of affected eye c) Antibiotic therapy d) Contact lenses

b) "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness" Pg. 1413 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.

34. 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) "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness" c) "He might be suffering from hyperopia and probably will need glasses now" d) "His vision problem will get in the way of his learning, so he will probably have to have glasses before he starts school"

c) "Introducing fluids slowly reduces the risk of vomiting, which can increase intraocular pressure" Pg. After cataract surgery, the plan of care should include slow reintroduction of fluids to reduce the risk of vomiting, which can increase intraocular pressure (IOP). It should also include other measures to prevent increased IOP, such as comforting the child in order to decrease crying. Aspiration is not expected in the postoperative child who is awake after surgery. Bowel obstruction is unlikely after cataract surgery and fluids do not need to be limited for prevention. Electrolyte imbalances are not an anticipated side effect of oral fluid introduction.

37. A 4-month-old child underwent cataract surgery 3 hours ago. The parents ask why they are only allowed to give the child small amounts of fluid now. How does the nurse respond? a) "Introducing fluids slowly reduces the risk of electrolyte imbalances, which can lead to cardiac arrhythmias" b) "Introducing fluids slowly allows the bowel time to recover from the anesthetic, which decreases the risk of bowel obstruction" c) "Introducing fluids slowly reduces the risk of vomiting, which can increase intraocular pressure" d) "Introducing fluids slowly prevents aspiration, which would increase the risk of pneumonia"

d) Offering vision screening to all students in kindergarten Pg. The inequities in vision screening and eye care are greater in communities with families whose incomes are below the federal poverty threshold, who are uninsured, and who are members of ethnic minority groups. Many children in these communities never have vision screening. Offering vision screening universally in school could prevent many challenges with health and literacy, and this is the most effective way to screen this population. Vision screening is ideally offered between ages 3 and 5, so screening all students in kindergarten is the best method to promote vision health, rather than waiting until grade 6. Sending home information about screening or signs and symptoms of visual problems does not address the barriers and challenges of affordability and access to vision screening.

5. A school nurse knows that most of the students in the community's elementary school have not received routine vision screening because the families live below the federal poverty threshold. What is the most effective method to promote vision screening for this client population? a) Providing information about signs and symptoms of vision problems b) Sending information home to families about the importance of vision screening c) Requiring vision screening prior to enrollment in grade 6 d) Offering vision screening to all students in kindergarten