FINAL EXAM PEDI 2023/ PrepU CH17
A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement? "Benzocaine drops should be placed in your eye to numb it and reduce pain." "Benzocaine is an antibiotic for your eye infection." "Benzocaine drops should be placed in your ear to numb it and reduce pain." "Benzocaine is an antibiotic for your ear infection."
"Benzocaine drops should be placed in your eye to numb it and reduce pain."
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? "It seems like bright lights really bother him." "He opens his eyes quite frequently when he's awake." "His eye looks about the same size as his other eye." "His eye doesn't seem to tear much."
"It seems like bright lights really bother him." Explanation: 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 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? "It's not uncommon for babies to be born with blue eyes." "You probably won't know for sure the color of your baby's eyes until your baby is 6 to 12 months old." "You can hope they stay that color. There is no guarantee." "The baby's iris will likely become more pigmented, so it's unlikely the eyes will not be blue."
"You probably won't know for sure the color of your baby's eyes until your baby is 6 to 12 months old." Explanation: Light-skinned children are often born with blue eyes. The iris becomes pigmented over time and eye color is determined by 6 to 12 months of age.
A 5-year-old child is diagnosed with acute otitis media. Which nursing intervention would be priority? Relieving the child's pain Administering a mydriatic Cautioning the child not to pull on the ear Cautioning the child not to blow the nose
Relieving the child's pain
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? "He might be suffering from hyperopia and probably will need glasses now." "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness." "He is likely to have a slight astigmatism, which almost always needs to be corrected by glasses." "His vision problem will get in the way of his learning, so he will probably have to have glasses before he starts school."
A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness." Explanation: 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.
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? Sclera appears to be blue Excess watering of the eyes Absence of the red reflex Edema of the eyelids
Absence of the red reflex
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? "Lots of girls your age wear glasses without issues." "Let's talk with your mother about getting contact lenses." "Although there are surgeries for vision, they are not normally recommended for someone your age." "We can talk with the doctor about referring you to a surgeon to get this taken care of."
Although there are surgeries for vision, they are not normally recommended for someone your age." Explanation: 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 lenses may be an option for consideration, this response does not address the teen's question.
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: Refraction Myopia Astigmatism Hyperopia
Astigmatism Explanation: Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image
The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media (AOM) infection. Which statement by the mother indicates she has the correct understanding of the information provided? "I should continue to smoke in the house." "I should continue to breastfeed my son because it lowers the incidence of acute otitis media." "Immunizations will not help prevent another otitis media infection." "Because the infection is in my son's ear, hand washing is not important."
I should continue to breastfeed my son because it lowers the incidence of acute otitis media." Explanation: Parents should be encouraged to quit smoking; however, if that is not possible they should not smoke inside the house or automobile. The Prevnar and influenza vaccines can help prevent ear infections. Breastfed infants have a lower incidence of AOM than formula-fed infants so mothers should be encouraged to continue breastfeeding for at least 6 to 12 months. Handwashing helps prevent the common cold, which often leads to AOM.
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? Instill a few drops of a topical anesthetic into the affected eye Press firmly on the lower lid with the fingertip until it turns out Grasp the eyelashes of the upper eyelid and evert it Touch the glass fragment in the eye with a moistened, sterile, cotton-tipped applicator
Instill a few drops of a topical anesthetic into the affected eye Explanation: 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.
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? Keeping ear canals dry Performing handwashing Avoiding upper respiratory tract infections Adhering to regular follow-up to assess for hearing loss
Keeping ear canals dry
In examining the vision of a 9-year-old girl, the nurse notices that she frequently reaches either too far or not far enough when attempting to take an object from the nurse's hand. Which condition does the nurse suspect? Lack of depth perception (stereopsis) Lack of accommodation Diplopia Refractive error
Lack of depth perception (stereopsis) Explanation: Depth perception or stereopsis is the ability to see objects as three-dimensional.
A child having tympanostomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response? "You will have them replaced every 2 months until you reach age 18." "The tubes remain in place for 6 months and then are dissolved by vinegar." "The tubes remain in place for 6 to 12 months until they come out by themselves." "The tubes are not removed; they grow permanently into place."
The tubes remain in place for 6 to 12 months until they come out by themselves." Explanation: The placement of tympanostomy tubes ( TT) (ventilation tubes) is the gold standard treatment for perisistent OME with a functional effect on hearing or with damage to the tympanic membrane. These tubes stay in place for several months and fall out on their own.
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? "We need to raise the volume of our voices significantly so he can hear us." "We need to make sure we are speaking clearly." "We need to face our son when we are speaking." "Using hand gestures as visual cues should help our child understand a little better
We need to raise the volume of our voices significantly so he can hear us." Explanation: 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.
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? administering antibiotics as soon as they're available obtaining a culture of fluid from the middle ear determining if the girl's balance is shaky when walking administering antivirals to ensure broad coverage of all organisms
administering antibiotics as soon as they're available Explanation: Because of the severity of the symptoms, the child will be treated with antibiotics immediately
The nurse is explaining information to the parents of a 3-year-old boy who may have strabismus. The nurse should explain that which examinations will be performed first to find out if he has strabismus? refractive examination visual acuity test corneal light reflex test ophthalmologic examination
corneal light reflex test Explanation: The corneal light reflex is extremely helpful in assessment of strabismus. It consists of shining a flashlight into the eyes to see if the light reflects at the same angle in both eyes. Strabismus is present if the reflections are not symmetrical
An adolescent reports wearing contact lenses 24 hours per day for the past several days. An irritation on the cornea is seen. Which information is significant when the nurse takes the adolescent's history? Select all that apply. eye pain eye tearing diplopia photophobia pupils dilated to 3 cm
eye pain eye tearing photophobia Explanation: Because of wearing the contact lenses for a long length of time, the adolescent has sustained a corneal abrasion. The symptoms this adolescent would report are eye pain, increased tearing, blurry vision and photophobia. T
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 best response by the nurse? "20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns." "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." "Until your child can read we can't check the visual acuity." "Vision continues to improve as the child ages. Hopefully you will notice improvement in your child's vision."
"20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns." Explanation: 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.
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? "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." "Even when we do the right thing, it doesn't always ensure that our child will be healthy. It's important to think positively." "There could be much worse things to happen to your child. At least your child is healthy in all other aspects." "Many children who have a profound hearing loss function very well. There are lots of treatments available."
"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." Explanation: This comment is the most empathic and supportive. Encouraging a support group, when the parents are ready, is very helpful. Those in a support group know how these parents feel and 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 parents' feelings by telling them "many children who have a profound hearing loss function very well....."
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? "I will need to apply heat to the eye four times a day." "For the first 24 hours I will apply ice for 20 minutes, then leave it off for 20 minutes." "The blood in the white part of the eye is normal with this type of injury." "Our child will probably have a black eye for at least a couple of weeks."
"I will need to apply heat to the eye four times a day." Explanation: 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.
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? "This may signal your child is having difficulty paying attention rather than a visual disorder." "Your child will need to be evaluated for an accommodation disorder." "What you are describing may be what is called myopia." "These reports are consistent with hyperopia."
"What you are describing may be what is called myopia." Explanation: Myopia (nearsightedness) occurs when light rays focus anterior to the retina, causing objects that are far away to be unfocused.
In children with otitis media, a procedure known as a myringotomy may be performed. Which statement is most accurate regarding this procedure? During this procedure, small tubes are inserted into the tympanic membrane. This procedure is performed as soon as otitis media is diagnosed. A small incision is made in the earlobe during this procedure. The purpose of this procedure is to decrease or stop the drainage.
During this procedure, small tubes are inserted into the tympanic membrane.
A child with poor eye alignment cannot establish single binocular vision but has double vision. Which nursing action is most appropriate for this client? Ask if the child has had a computed tomography (CT) before Refer the child to a pediatric ophthalmologist Schedule the child for botulinum toxin injections Discuss surgical options for treatment
Refer the child to a pediatric ophthalmologist Explanation: The nurse would refer the child experiencing diplopia (double vision) to a pediatric ophthalmologist for further testing; it is imperative to determine the cause to properly treat diplopia.
A young child in the clinic reports pain and has redness on the lid of the right eye. Upon further examination, the nurse notices swelling in the preauricular lymph node along with tenderness. What should the nurse suspect? Conjunctivitis Chalazion Stye Cellulitis
Stye Explanation: A stye or hordeolum is a localized infection of the sebaceous gland of the eyelid follicle, usually caused by bacterial invasion. There is usually pain and redness at a localized point on the lid margin, as well as preauricular lymph node swelling and tenderness
The mother of a 10-day-old infant reports her baby has been having "lots of eye discharge." What is the best initial response by the nurse? "This is normal in infants of this age." "Tell me more about this drainage." "Do you think this looks like an infection?" "Your baby will need to be seen by a neonatal ophthalmologist."
Tell me more about this drainage." Explanation: Tearing or discharge from one or both eyes is often first noted at the 2-week checkup. Obtain a thorough history about the eye drainage to distinguish it from neonatal conjunctivitis. Determine the onset and progression of symptoms, as well as the newborn's response to any interventions attempted so far. The best response by the nurse is an attempt to obtain additional information.
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)? The tympanic membrane reacts to a puff of air. Symptoms of upper respiratory infection are present. The ear canal is devoid of cerumen. The child cries out when the ear is grasped.
The child cries out when the ear is grasped. Explanation: External otitis (acute otitis externa or swimmer's ear) is an infection and inflammation of the skin of the external ear canal. T
A toddler has been diagnosed with otitis media with effusion. The parents tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond? "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." "It's just a medical term that means an infection of the middle ear." "There is an infection somewhere in the ear canal and their is fluid in the canal." "It would probably be best if you talked to the doctor again about the diagnosis."
The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." Explanation: 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 acute otitis media (AOM) or may persist after the infectious process of AOM has resolved.
The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment? The infant can "fix and follow." The infant does not imitate facial expressions. The infant makes eye contact. The infant blinks quickly when a bright light is shone in the eyes.
The infant does not imitate facial expressions. Explanation: 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 educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the: need for ultraviolet-protective glasses postoperatively. importance of completing the full course of oral antibiotics. possibility that multiple operations may be necessary. importance of patching as prescribed.
importance of patching as prescribed. Explanation: Teaching the parents the importance of patching the child's eye as prescribed is most important for the treatment of strabismus
The nurse is caring for a child who has had persistent otitis media effusions and is scheduled to have pressure equalizing tubes placed in 3 days. What should the parents observe after the tubes have been placed? improvement of the child's language and speech development constant fluid draining from the child's ears decreased ability for the child to hear slow increases in language development
improvement of the child's language and speech development
The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion? suddenly doing poorly in school tendency to act silly in the classroom playing the radio loudly prevention and treatment of otitis media
prevention and treatment of otitis media Explanation: 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.
A child has recently been diagnosed with cataracts. The treatment for cataracts is: eye drops to lower the pressure. surgery. wearing a patch until the cloudiness clears. there is no treatment for childhood cataracts.
surgery.
