Chapter 39 Eyes and Ears

3. The nurse is caring for a 10-year-old with allergic conjunctivitis. The nurse would be alert to the child's increased risk for which of the following? A) Atopic dermatitis B) Insect bite sensitivity C) Acute otitis media D) Frequent sore throats

A) Atopic dermatitis Atopic dermatitis is a risk factor specifically for allergic conjunctivitis because of repeated exposure to the particular allergens. Acute otitis media, insect bite sensitivity, and frequent sore throats can occur but are not related to the allergic conjunctivitis.

21. A nurse is developing a plan of care for a child who is admitted to the hospital for surgery. The child is visually impaired. Which of the following would be most appropriate for the nurse to include in the child's plan of care? Select all answers that apply. A) Explaining instructions using simple and specific terms the child understands B) Allowing the child to explore the postoperative equipment with his hands C) Touching the child on his shoulder before letting the child know someone is there D) Using the child's body parts to refer to the area where he may have postoperative pain E) Speaking to the child in a voice that is slightly louder than the usual tone of voice

A) Explaining instructions using simple and specific terms the child understands B) Allowing the child to explore the postoperative equipment with his hands D) Using the child's body parts to refer to the area where he may have postoperative pain When interacting with a visually impaired child, the nurse would make directions and instructions simple and specific, encourage exploration of objects such as postoperative equipment through touch, and use the parts of the child's body as reference points for the location of items or for this child, his postoperative pain. The nurse should identify him- or herself first before touching the child and speak in a tone of voice that is appropriate to the situation.

30. An infant is diagnosed with infantile glaucoma. When developing the plan of care for the infant, the nurse would expect to prepare the infant and family for which of the following? A) Goniotomy B) Antibiotic therapy C) Contact lenses D) Patching of affected eye

A) Goniotomy 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.

1. The nurse is developing a plan of care for a 5-year-old child with a severe hearing impairment focusing on psychosocial interventions based on assessment findings. Which behavior would the nurse have most likely assessed? A) Immature emotional behavior B) Self-stimulatory actions C) Inattention and vacant stare D) Head tilt or forward thrust

A) Immature emotional behavior Immature emotional behavior would be seen most frequently. The inability to hear impacts the socialization process and causes social problems for the child because the hearing impairment has inhibited normal development. Self-stimulatory actions, inattention, vacant stare, head tilt, or forward thrust may also cause problems with socialization, but they are typical of visually impaired children.

20. The parents of a 10-year-old girl with a refractive error ask the nurse about the possibility of laser surgery to correct the vision. Which statement by the nurse would be most appropriate? A) "As she gets older, her vision will begin to correct itself." B) "Laser surgery typically is not done until she's 18 years old." C) "She looks so cute in her glasses; why put her through surgery?" D) "She can use contact lenses soon, so surgery isn't necessary."

B) "Laser surgery typically is not done until she's 18 years old." Because of the continuing refractive development in the child's vision through adolescence, laser surgery for vision correction is not recommended by the American Academy of Ophthalmology until 18 years of age. The refractive error will continue to change as the child's vision continues to develop, making the refraction unstable. Thus, corrective lens prescription may change but the refraction error will not correct itself. Glasses still carry a stigma and the child may be teased or bullied. The statement about the child looking cute in her glasses ignores the parents' question and concerns and questions the parents' desire for information. The use of contact lenses does not negate the possibility of surgery. However, laser surgery would have to wait until the child is 18 years of age.

13. 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) Astigmatism B) Hyperopia C) Myopia D) Amblyopia

D) Amblyopia 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.

5. The nurse is instructing the parents of a school-age child with an eye disorder how to care for her eye. Which of the following conditions would the nurse explain as resolving by itself without the use of antibiotics? A) Blepharitis B) Hordeolum C) Corneal abrasion D) Chalazion

D) Chalazion A chalazion is caused by noninfectious meibomian gland occlusion, whereas a hordeolum usually is caused by infection.

19. A nurse is examining a child who has sustained blunt trauma to the eye area. The nurse suspects a simple contusion based on which of the following? A) Pain in the eye B) Impaired visual acuity C) Blurred vision D) Intact extraocular movements

D) Intact extraocular movements A simple contusion of the eye area is manifested by bruising and edema of the lids or surrounding eye area, intact extraocular eye movement, intact visual acuity, absence of diplopia or blurred vision, pain surrounding the eye but not within the eye, and pupils that are equal, are round, and react to light and accommodation.

26. A group of students are reviewing information about the anatomic differences in the eyes and ears of a child in comparison to an adult. The students demonstrate a need for additional study when they identify which of the following? A) Hearing is completely developed at the time of birth. B) Visual acuity develops from birth throughout childhood. C) Binocular vision is usually achieved by 2 months of age. D) The ability to discriminate colors is completed by birth.

D) The ability to discriminate colors is completed by birth. The optic nerve is not completely myelinated at birth, so color discrimination is incomplete. Hearing is intact at birth and visual acuity develops from birth throughout childhood. Binocular vision is achieved by 4 months of age.

9. The nurse is taking a health history for a 9-year-old girl. Which finding would alert the nurse to a possible risk factor specifically associated with visual impairment? A) Being born at 39 weeks' gestation B) Having several hours of homework daily C) Being of African American heritage D) Being active in sports

C) Being of African American heritage African American heritage is a risk factor specifically for visual impairment. Although family history of the disorder, genetic syndrome, and previous medication use are risk factors for visual impairment, they are also risk factors for hearing impairment.

7. The nurse is examining a 7-year-old boy with blepharitis. Which of the following would the nurse least likely expect to assess? A) Redness B) Scaling C) Pain D) Edema

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

11. A nurse is examining a 7-year-old boy with hordeolum. Which of the following would the nurse expect to find? A) Redness B) Scaling C) Pain D) Edema

C) Pain Pain is typical of hordeolum. Blepharitis has symptoms of redness, scaling, and edema but not pain.

28. The parents of a 5-year-old bring their son to the emergency department because of significant eyelid edema. The mother states, "He scratched himself near his eye a couple of days ago while playing outside in the yard." The nurse suspects periorbital cellulitis based on which of the following? A) Evidence of discharge B) Reddened conjunctiva C) Purplish discoloration of eyelid D) Altered visual acuity

C) Purplish discoloration of eyelid Periorbital cellulitis is a bacterial infection of the eyelids and tissue surrounding the eye. The bacteria may gain entry into the skin via an abrasion, laceration, insect bite, foreign body, or impetiginous lesion. It may also result from a nearby bacterial infection such as sinusitis. Findings include marked eyelid edema, purplish or red color of the eyelid, clear conjunctivae, absence of discharge, and normal visual acuity.

29. After teaching a group of students about visual disorders, the instructor determines that the teaching was successful when the students identify which of the following as the most common cause of visual difficulties in children? A) Astigmatism B) Strabismus C) Refractive errors D) Nystagmus

C) Refractive errors The most common cause of visual difficulties in children is refractive errors. Astigmatism, strabismus, and nystagmus are other common visual disorders in children but are less common than refractive errors.

12. After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful? A) Infants with congenital deformities have an increased risk for ear infections. B) Ear infections typically increase as the child gets older. C) The shorter and wider eustachian tubes of an infant increase the risk. D) Adenoids shrink as the child grows, allowing more bacteria to enter.

C) The shorter and wider eustachian tubes of an infant increase the risk. The infant has relatively short, wide, horizontally placed Eustachian tubes, allowing bacteria and viruses to gain access to the middle ear and resulting in an increased number of infections as compared to adults. Congenital deformities of the ear are associated with other body system anomalies, but not necessarily an increase in ear infections. As the child matures, the Eustachian tubes assume a more slanted position, so older children and adults have fewer infections. A child's adenoids are often enlarged, leading to obstruction of the Eustachian tubes and infection

4. The nurse is caring for a 6-year-old visually impaired boy and is about to begin the physical examination. Which intervention would be most appropriate to promote effective communication with the child? A) Show him the stethoscope. B) Describe the examination room. C) Use his name before touching him. D) Allow him to explore the exam room.

C) Use his name before touching him. When interacting with a visually impaired child, it is a good communication technique to use his name to gain his attention before touching him. Letting him listen to his heart with the stethoscope, describing the examination room, and promoting exploration by touch are sound ways to interact, but are not specific to communicating with the child at the beginning of the assessment.

23. An infant is diagnosed with a congenital cataract. Which of the following would the nurse expect to assess? A) Absent red reflex B) Rapid irregular eye movement C) Misalignment of the eyes D) Enlarged eye appearance

A) Absent red reflex 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.

16. The mother of a school-age child brings the child to the clinic for evaluation because he is having difficulty reading. His last visual screening was normal. He also complains of headaches and dizziness. Which of the following would the nurse suspect? A) Astigmatism B) Myopia C) Hyperopia D) Nystagmus

A) Astigmatism Children with astigmatism often have blurry vision and difficulty seeing letters as a whole, affecting their reading ability. They may have headaches and dizziness and often learn to tilt their heads slightly so that they can focus more effectively (which leads to normal vision screenings). Children with myopia can see well at close range but have difficulty focusing well on the blackboard or other objects at a distance. Hyperopia is characterized by blurriness at close range, with the ability to see at a distance. Nystagmus is manifested by a very rapid irregular eye movement.

27. A child is diagnosed with bacterial conjunctivitis and is prescribed topical antibiotic therapy. The child's mother asks when he can return to school. Which response by the nurse would be most appropriate? A) "You need to wait until you finish the entire prescription of antibiotic." B) "Once the drainage is gone, he can go back to school." C) "You can send him to school this afternoon after his first dose of antibiotic." D) "He needs to be symptom-free for at least 72 hours."

B) "Once the drainage is gone, he can go back to school." For the child with bacterial conjunctivitis, the child may safely return to school or day care when the mucopurulent drainage is no longer present, usually after 24 to 48 hours of treatment with the topical antibiotic. There is no need to wait until the prescription is finished. The antibiotic is being given topically, not systemically. One dose of antibiotic is not sufficient to eradicate the infection. Typically 24 to 48 hours of treatment is needed to stop the drainage, which, when no longer present, indicates that the child can return to school.

14. After teaching a group of new parents about their newborns' eyes and vision, which statement by the group indicates effective teaching? A) "Our newborn can see at distances of about 1 to 2 feet." B) "We won't know the baby's eye color until he's at least 6 months old." C) "A baby can easily distinguish colors, but they must be bright colors." D) "A newborn can focus with both eyes at the same time shortly after birth."

B) "We won't know the baby's eye color until he's at least 6 months old." The eye color of an infant is determined by 6 to 12 months of age. A newborn sees best at distances of about 8 to 10 inches. The optic nerve is not completely myelinated, so color discrimination is incomplete. The rectus muscles are uncoordinated at birth and mature over time, so binocular vision may be achieved by 4 months of age

24. A mother brings her child to the health care clinic because she thinks that the child has conjunctivitis. Which assessment finding would lead the nurse to suspect bacterial conjunctivitis? Select all answers that apply. A) Itching of the eyes B) Inflamed conjunctiva C) Stringy discharge D) Photophobia E) Mild pain F) Tearing

B) Inflamed conjunctiva E) Mild pain terial conjunctivitis is manifested by inflamed conjunctiva, a purulent or mucoid discharge, mild pain, and occasional eyelid edema. Itching and a stringy discharge suggest allergic conjunctivitis. Photophobia and tearing suggest viral conjunctivitis

10. The nurse is examining a 3-year-old boy with acute otitis media who has a mild earache and a temperature of 38.5º C (101.3) . Which of the following actions will be taken? A) Obtain a culture of the middle ear fluid. B) Instruct the parents to watch for worsening symptoms. C) Administer antibiotics. D) Administer antivirals.

B) Instruct the parents to watch for worsening symptoms. In this case, the child will be continually observed. If the symptoms persist or become worse, antibiotics will be prescribed. This clinical practice guideline was developed by the American Academy of Pediatrics and the American Academy of Family Physicians in order to avoid overusing antibiotics or obtaining a middle ear fluid culture with every occurrence of acute otitis media. Administering antiviral agents would not be appropriate for this child. (Refer to Table 39.3 for treatment recommendations for acute otitis media.)

18. A nurse is reviewing the medical record of a child with hearing loss and notes that the child's hearing loss is in the range 40 to 60 decibels (dB). The nurse interprets this as indicating which of the following? A) Mild loss B) Moderate loss C) Severe loss D) Profound loss

B) Moderate loss A hearing loss of 40 to 60 decibels (dB) indicates a moderate loss; 20 to 40 dB indicates a mild loss; 60 to 80 dB indicates a severe loss; and greater than 80 dB indicates a profound loss.

15. Assessment of a child leads the nurse to suspect viral conjunctivitis based on which of the following? A) Mild pain B) Photophobia C) Itching D) Watery discharge

B) Photophobia Viral conjunctivitis is characterized by lymphadenopathy, photophobia, and tearing. Mild pain is associated with bacterial conjunctivitis. Itching and watery discharge are associated with allergic conjunctivitis.

2. The nurse is caring for a 3-month-old with nasolacrimal duct obstruction. Which intervention would be most appropriate for the nurse to implement? A) Being careful to prevent spread of infection B) Teaching the parents how to gently massage the duct C) Applying hot, moist compresses to the affected eye D) Referring the child to an ophthalmologist

B) Teaching the parents how to gently massage the duct Massaging the nasolacrimal duct can cause it to open and drain. Teaching the parents how to do this would be part of the nurse's plan of care. Nasolacrimal duct obstruction is not infectious. Applying hot, moist compresses to the eye is an intervention for conjunctivitis. Nasolacrimal duct obstruction is often self-resolving, so there would be no need for a specialist's care.

8. The nurse is caring for a newborn and knows that his vision, unlike his hearing, is not fully developed. Which aspect of the child's vision would the nurse expect to be similar to his father's vision? A) Adequate color detection B) Visual acuity of 20/100 C) Nearsightedness D) Monocular vision

B) Visual acuity of 20/100 If the child's father has lost visual acuity, he and his new son could possibly have the same 20/100 vision. Poor color detection, nearsightedness, and monocular vision are characteristic of newborns and are the result of their lack of development.

17. Which of the following 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) Wearing ear plugs when swimming To prevent otitis externa, the nurse would teach parents and children to wear earplugs when swimming and to avoid use of cotton swabs, headphones, and earphones. A hair dryer on a low setting can be used to dry the ear canals. A mixture of half rubbing alcohol and half vinegar can be used to dry the canal and alter the pH to discourage organism growth.

25. The nurse is instructing a 7-year-old child and his parents about using his prescribed corrective lenses. Which of the following would the nurse include in these instructions? A) "Make sure to take your glasses off from time to time to allow your eyes to rest." B) "Remove your glasses with both hands and lay them with the lens upright on the surface." C) "Clean the glasses every day with a mild soap and water or commercial cleaning agent." D) "Use paper towels or tissues to dry and periodically clean the lenses.

C) "Clean the glasses every day with a mild soap and water or commercial cleaning agent." Eyeglasses should be cleaned daily with mild soap and water or a commercial cleaning agent. The glasses should be worn at all times, but when removed, they should be removed with both hands and placed on their side (not directly on the lens on any surface). A soft cloth, not paper towels, tissues, or toilet paper, should be used to clean the lenses.

22. A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful? A) "The tubes will stay in place for about a month and then fall out on their own." B) "His chances for ear infections now have dramatically decreased." C) "He should wear earplugs when swimming in a pool or a lake." D) "We should keep the ears protected with cotton balls for the first 24 hours."

C) "He should wear earplugs when swimming in a pool or a lake." When pressure-equalizing tubes are inserted, the surgeon may recommend avoiding water entry into the ears. Therefore, earplugs are suggested when the child is in the bathtub or swimming. When swimming in a lake, earplugs are especially important because lake water is contaminated with bacteria and entry of that water into the middle ear must be avoided. Typically, the tubes remain in place for at least several months and generally fall out on their own. Placement of pressure-equalizing tubes does not prevent middle ear infection. Other than earplugs for bathing and swimming, nothing else is placed in the child's ear.

6. The nurse is caring for a 4-year-old boy with infectious conjunctivitis. Which intervention would be least appropriate to include in the child's plan of care? A) Rinsing the eye with cool water B) Educating the family about the disease C) Encouraging frequent hand washing D) Promoting eye safety

D) Promoting eye safety Promoting eye safety would be appropriate if the child had an eye injury. Rinsing the eye with cool water, educating the family about the disorder, and encouraging frequent hand washing are interventions for infectious conjunctivitis.