CHAPTER 31: SENSORY ALTERATIONS My Nursing Test Banks

CHAPTER 31: SENSORY ALTERATIONS

MULTIPLE CHOICE

1.Which of the following structures of the ear equalizes pressure between the outer and middle ear?

a.

eustachian tube

c.

semicircular canal

b.

fluid-filled cochlea

d.

tympanic membrane

ANS: A

Feedback

A

Correct. The eustachian tube connects the middle ear with the nasopharynx. It allows fluid to drain into the nasopharynx and equalizes pressure between the outer and middle ear.

B

Incorrect. The fluid-filled cochlea does not equalize pressure between the outer and middle ear. The nerve endings in the inner ear are contained in the fluid-filled cochlea which transmits sound waves to the auditory nerve in the brain.

C

Incorrect. The semicircular canal in the inner ear maintains balance and body position.

D

Incorrect. The tympanic membrane (eardrum) vibrates to conduct sound waves to the 3 bones in the middle ear.

PTS:1REF:p. 1050 Hearing Impairment

OBJ: Cognitive Level: Comprehension

2.Which of the following structural differences between children and adults predisposes children to middle ear infections?

a.

The fluid-filled cochlea is less developed in children than in adults.

b.

Children have shorter, more horizontal, and more flaccid eustachian tubes.

c.

The outer ear of children is shorter and has fewer barriers, such as hair, in the ear.

d.

The semicircular canals are straighter and shorter in a childs ear.

ANS: B

Feedback

A

Incorrect. Children do not have less developed fluid-filled cochlea than adults.

B

Correct. The structural differences between children and adults that predispose children to middle ear infections is that children have shorter, more horizontal, and more flaccid eustachian tubes.

C

Incorrect. Having shorter outer ears with fewer barriers, such as hair, in the ear does not predispose children to middle ear infections.

D

Incorrect. The semicircular canals are not straighter and shorter in a childs ear.

PTS:1REF:p. 1050 Hearing Impairment

OBJ: Cognitive Level: Application

3.The nurse assessing infants is aware that an infant will not have tears until the lacrimal gland begins to function at about how many months of age?

a.

8 to 9

c.

4 to 5

b.

6 to 7

d.

1 to 3

ANS: D

Feedback

A

Incorrect. The lacrimal gland begins to function at 1 to 3 months of age, not 8 to 9.

B

Incorrect. The lacrimal gland begins to function at 1 to 3 months of age, not 6 to 7.

C

Incorrect. The lacrimal gland begins to function at 1 to 3 months of age, not 4 to 5.

D

Correct. An infant will not have tears until the lacrimal gland begins to function at 1 to 3 months of age.

PTS:1REF:p. 1050 Speech and Language

OBJ: Cognitive Level: Comprehension

4.Why does the nurse advise a new mother to talk to her baby while the baby is awake?

a.

to assure the baby that the mother is present and attending to the babys needs

b.

because babies learn receptive language first and have an understanding of language before they can speak

c.

to soothe the baby and help the baby to remain calm

d.

because the baby must learn baby talk before speaking words

ANS: B

Feedback

A

Incorrect. A new mother might talk to her baby while the baby is awake to assure the infant that the mother is present and attending to her or his needs. However, that is not the major reason.

B

Correct. The nurse advises a new mother to talk to her baby while the baby is awake because babies learn receptive language first and have an understanding of language before they can speak. Language development involves two inter-related processes: receptive language (understanding what others say to you) and expressive language (the ability to speak verbally in a way that others can understand). Children learn receptive language first; therefore, they can understand more than they can verbalize.

C

Incorrect. A new mother may talk to her baby while the baby is awake to soothe and calm the infant, but that is not the major rationale.

D

Incorrect. A baby does not need to learn baby talk before speaking words. In fact, caregivers should use correct language then talking to their infant. They should not use baby talk.

PTS:1REF:p. 1051 Hearing Impairment

OBJ: Cognitive Level: Application

5.The nurse working with parents of children who stutter will hear from parents a number of beliefs, some of which are true and some of which are false or challenged by research. Which of the following beliefs is true and will be encouraged by the nurse?

a.

Children who stutter are not as bright as children who do not stutter.

b.

A child who stutters can control the stuttering if he or she tries.

c.

Stuttering is primarily an emotional disorder.

d.

Stuttering is normal between the ages of 2 and 4.

ANS: D

Feedback

A

Incorrect. The belief that children who stutter are not as bright as children who do not stutter is false.

B

Incorrect. The belief that a child who stutters can control the stuttering if he or she tries is false.

C

Incorrect. The belief that stuttering is primarily an emotional disorder is false.

D

Correct. The belief that stuttering is normal between the ages of 2 and 4 is true and should be encouraged by the nurse.

PTS:1REF:p. 1052 Hearing Impairment

OBJ: Cognitive Level: Application

6.The nurse evaluating children for speech or language dysfunction should begin the evaluation with:

a.

a hearing test or tests to see if hearing ability is normal

b.

language screening tests such as the Denver Articulation Screening Examination

c.

a report from the parents on the prenatal history and the circumstances at time of delivery

d.

the history of childhood illnesses and immunizations

ANS: A

Feedback

A

Correct. The nurse evaluating children for speech or language dysfunction should begin the evaluation with a hearing test or tests to see if hearing ability is normal. The link between hearing loss and poor communication has been well documented.

B

Incorrect. An evaluation for speech or language dysfunction should not begin with language screening tests such as the Denver Articulation Screening Examination. The childs hearing ability needs to be evaluated first. If it is normal, then a language screening test should be administered.

C

Incorrect. An evaluation for speech or language dysfunction should not begin with a report from the parents on the prenatal history and the circumstances at time of delivery. The childs hearing ability needs to be evaluated first.

D

Incorrect. An evaluation for speech or language dysfunction should not begin with the history of childhood illnesses and immunizations. The childs hearing ability needs to be evaluated first.

PTS:1REF:p. 1053 Hearing Impairment

OBJ: Cognitive Level: Application

7.Which of the following tests is best for the nurse to use to see if a child is color blind?

a.

the Ishihara color plates

b.

the Snellen E

c.

a color matching test designed by the nurse

d.

red versus green test of distinguishment

ANS: A

Feedback

A

Correct. The Ishihara color plates are the best test for the nurse to use to see if a child is color blind. Color blindness tends to be inherited as a sex-linked disorder seen more frequently in males. It affects the ability to distinguish red from green or blue from yellow colors. These plates have numbers of a particular color hidden within them. Children who are color blind cannot see the numbers and just see colored dots.

B

Incorrect. The Snellen E chart is used to test distance visual acuity in children ages 3 to 6 years. The child indicates which way the legs of the letter E point.

C

Incorrect. A color matching test designed by the nurse is not the best test to use to detect color blindness.

D

Incorrect. The red versus green test of distinguishment is not the best test to detect color blindness.

PTS:1REF:p. 1168 Hearing Impairment

OBJ: Cognitive Level: Comprehension

8.The role of the nurse who is working with a child who is color blind, as well as the childs family and teachers, is mainly one of:

a.

helping the caregivers and teachers find corrective resources

b.

teaching and encouraging the use of other ways to discriminate colors

c.

getting the child and everyone involved to accept the fact that this child has a deficit

d.

forcing the family and teaching team to make accommodations for the child

ANS: B

Feedback

A

Incorrect. The role of the nurse who is working with a child who is color blind is not mainly helping the caregivers and teachers find corrective resources.

B

Correct. The role of the nurse who is working with a child who is color blind, as well as the childs family and teachers, is mainly one of teaching and encouraging the use of other ways to discriminate colors. Examples include learning the order of lights on traffic signals or to be observant for warning signs that may have a flashing light associated with them (railroad crossing, school crossing walk).

C

Incorrect. The role of the nurse who is working with a child who is color blind is not mainly getting the child and everyone involved to accept the fact that this child has a deficit. Color blindness is not disabling. Often it is just a social inconvenience, although it may affect school performance in which color is a learning tool.

D

Incorrect. The role of the nurse is not mainly forcing the family and teaching team to make accommodations for the child.

PTS:1REF:p. 1168 Hearing Impairment

OBJ: Cognitive Level: Application

9.The nurse working with the parents of a child who stutters will advise the parents to do which of the following and model the behavior with children?

a.

talk faster, as this decreases the chance of stuttering

b.

adopt a slow rate of speech and avoid appearing hurried

c.

talk in front of a mirror to concentrate on speaking without stuttering

d.

talk with marbles in their mouth

ANS: B

Feedback

A

Incorrect. The nurse working with the parents of a child who stutters will not advise them to encourage the child to talk faster, as this decreases the chance of stuttering.

B

Correct. The nurse working with the parents of a child who stutters will advise them to adopt a slow rate of speech and avoid appearing hurried.

C

Incorrect. The nurse working with the parents of a child who stutters will not advise them to encourage the child to talk in front of a mirror to concentrate on speaking without stuttering.

D

Incorrect. The nurse working with the parents of a child who stutters will not advise them to encourage the child to talk with marbles in their mouth.

PTS:1REF:p. 1155 Hearing Impairment

OBJ: Cognitive Level: Application

10.At what stage does the National Institutes of Health and other groups recommend that hearing tests for children at risk for congenital hearing loss first be conducted?

a.

newborn

c.

preschool years

b.

toddler years

d.

school-age years

ANS: A

Feedback

A

Correct. The National Institutes of Health and other groups recommend that hearing tests for children at risk for congenital hearing loss first be conducted with the newborn.

B

Incorrect. The National Institutes of Health and other groups do not recommend that hearing tests for children at risk for congenital hearing loss first be conducted during toddler years.

C

Incorrect. The National Institutes of Health and other groups do not recommend that hearing tests for children at risk for congenital hearing loss first be conducted during preschool years.

D

Incorrect. The National Institutes of Health and other groups do not recommend that hearing tests for children at risk for congenital hearing loss first be conducted during the school-age years.

PTS:1REF:p. 1159 Hearing Impairment

OBJ: Cognitive Level: Comprehension

11.A parent tells the school nurse that his child has had extensive hearing tests and has been found to have a sensorineural hearing loss. The nurse will respond to the parent based on the knowledge that this type of hearing loss:

a.

can be helped by one or more of the four types of hearing aids available today

b.

has benefited in some cases by the relatively new technique of a cochlear implant

c.

has not been helped by hearing aids or other techniques

d.

is best adapted to by learning to speak sign language and attending a school for people who are deaf

ANS: B

Feedback

A

Incorrect. A sensorineural hearing loss does not improve with amplification of a hearing aid. The defect is not one of intensity of sound. Children with this type of hearing loss have damage to the tiny hairs lining the cochlea or to nerve cells that transmit auditory stimuli to the brain. Hearing aids provide little benefit because even amplified sounds cannot be processed as a result of damage to the inner ear.

B

Correct. A sensorineural hearing loss results from damage to the inner ear structures or the auditory nerve. This type of hearing loss results in distortion of sound and problems in discrimination. Although the child hears some of everything, the sounds are distorted, severely affecting discrimination and comprehension. This hearing loss has benefited in some cases by the relatively new technique of a cochlear implant.

C

Incorrect. A sensorineural hearing loss will not have been helped by hearing aids, but other techniques such as cochlear implantation have helped.

D

Incorrect. Implantation of cochlear devices as early as possible in children with sensorineural hearing loss appears to facilitate development of speech.

PTS:1REF:p. 1161 Hearing Impairment

OBJ: Cognitive Level: Application

12.In working with parents who have just learned that their child has a hearing loss, the nurse will realize that before working on the goal of promoting the childs communication, the nurse must do which of the following?

a.

Explain everything about all the various causes of hearing loss to the parents.

b.

Get the parents to accept that they are not to blame for the childs loss of hearing.

c.

Help the family to realize that their child is not the only child who ever suffered hearing loss.

d.

Assist the caregivers to accept and adapt to the impairment and go through the grieving process.

ANS: D

Feedback

A

Incorrect. This does not address the parents feelings of depression and anger which are common, and are a normal part of the grieving process. Their loss and feelings must be dealt with before working on the goal of promoting communication.

B

Incorrect. The nurse does not need to get the parents to accept that they are not to blame for the childs loss of hearing.

C

Incorrect. This response is not helpful in assisting caregivers to accept and adapt to the impairment.

D

Correct. The impact of the childs hearing impairment on caregivers must be addressed first before working on the goal of promoting communication. Caregivers need assistance to accept and adapt to the impairment and go through the grieving process. They must go through the stages of the grieving process which is an important part of adjusting to the loss before they can adapt and begin to deal with the challenges of a hearing-impaired child.

PTS:1REF:p. 1163 Sensory Alterations

OBJ: Cognitive Level: Application

13.The parents of a child who has been diagnosed as being deaf report that their child who is 4 months old is babbling. The parents want to know if the diagnosis was wrong. Which of the following is the best response by the nurse?

a.

We need to retest the infant because this may be a sign that the diagnosis is wrong.

b.

Infants who are deaf will babble until approximately 6 months of age and then stop.

c.

This child has a small amount of hearing but not enough to drop the diagnosis of deafness.

d.

Deaf children sometimes have a small window of time then they hear and then it disappears.

ANS: B

Feedback

A

Incorrect. This is not the best response because the diagnosis is probably correct.

B

Correct. Deaf infants babble until approximately 6 months of age and then stop because of lack of auditory feedback.

C

Incorrect. This response is not a correct explanation of why a 4 month old deaf child is babbling.

D

Incorrect. This response is not a correct explanation of why a 4 month old deaf child is babbling.

PTS:1REF:p. 1163 Hearing Impairment

OBJ: Cognitive Level: Application

14.How often should a hearing aid be changed for children less than 4 years of age?

a.

once a month

c.

once a year

b.

every 3 to 6 months

d.

every 2 years

ANS: B

Feedback

A

Incorrect. A hearing aid should be changed every 3 to 6 months for children under 4 years of age

B

Correct. A hearing aid should be changed every 3 to 6 months for children less than 4 years of age.

C

Incorrect. A hearing aid should be changed every 3 to 6 months for children under 4 years of age

D

Incorrect. A hearing aid should be changed every 3 to 6 months for children under 4 years of age

PTS:1REF:p. 1163 Hearing Impairment

OBJ: Cognitive Level: Comprehension

15.The nurse will advise the parents of a child who has a hearing loss that communication can best be enhanced by doing which of the following?

a.

Speak somewhat louder and much slower than you would to a hearing person.

b.

Get the childs attention and look into the childs face at eye level.

c.

Hold the childs hands while speaking to her.

d.

Reduce or eliminate body gestures.

ANS: B

Feedback

A

Incorrect. To enhance communication with a child with a hearing loss the parents should speak slowly with normal volume and simple sentence structure.

B

Correct. To enhance communication with a child with a hearing loss the parents should get the childs attention and look into the childs face at eye level.

C

Incorrect. To enhance communication with a child with a hearing loss the parents avoid restraining the childs hands by holding them.

D

Incorrect. The parents should use normal body gestures and facial expressions then talking.

PTS:1REF:p. 1166 Hearing Impairment

OBJ: Cognitive Level: Application

16.Which of the following would the nurse do to care for the hearing aid of a hospitalized child?

a.

Keep the hearing aid in a warm place such as near a heat register.

b.

Leave the hearing aid turned on all the time except then washing it.

c.

Wash the entire hearing aid with the battery taken out.

d.

If the aid whistles, take it out, refit it, and turn down the volume.

ANS: D

Feedback

A

Incorrect. Heat and moisture damage hearing aids.

B

Incorrect. Hearing aids should be turned off then not in use to preserve battery life.

C

Incorrect. The ear mold is the only part of the hearing aid that can be cleaned with pipe cleaners or toothbrushes.

D

Correct. A whistling sound, called acoustic feedback, is caused by improper fit into the ear or by too high volume. To eliminate whistle, take it out, refit it, and turn down the volume.

PTS:1REF:p. 1166 Vision Impairment

OBJ: Cognitive Level: Application

17.When a person does lip reading or speech reading what percent of the spoken word is understood?

a.

100%

c.

60%

b.

80%

d.

40%

ANS: D

Feedback

A

Incorrect. When a person does lip reading or speech reading, 40% of the spoken word is understood, not 100%.

B

Incorrect. When a person does lip reading or speech reading, 40% of the spoken word is understood, not 80%.

C

Incorrect. When a person does lip reading or speech reading, 40% of the spoken word is understood, not 60%.

D

Correct. When a person does lip reading or speech reading, 40% of the spoken word is understood.

PTS:1REF:p. 1166 Vision Impairment

OBJ: Cognitive Level: Comprehension

18.The nurse will advise parents or caregivers that a feeling of adequacy and self-confidence is most likely to be established in children who are deaf if they:

a.

are given more attention than children with hearing

b.

learn to play with other children, especially children with hearing

c.

are protected a lot by members of the family and extended family

d.

play with lots of educational toys beginning at an early age

ANS: B

Feedback

A

Incorrect. Much time and energy is devoted to the child who is deaf, but this does not necessarily establish a feeling of adequacy and self-confidence.

B

Correct. A feeling of adequacy and self-confidence is most likely to be established in children who are deaf if they learn to play with other children, especially children with hearing

C

Incorrect. A feeling of adequacy and self-confidence is not most likely to be established in children who are deaf if they are protected a lot by members of the family and extended family.

D

Incorrect. Playing with lots of educational toys beginning at an early age will not establish a feeling of adequacy and self-confidence.

PTS:1REF:p. 1166 Vision Impairment

OBJ: Cognitive Level: Application

19.The parents of a child with a hearing impairment ask the nurse about getting an education for their child. The nurse will explain that the Education of All Handicapped Children Act of 1975, renamed as the Individuals with Disabilities Education Act, provides:

a.

an education for children who are deaf in private schools beginning at age 8

b.

early intervention services for children from birth to 3 years with disabilities and for their families, too

c.

manuals and training for parents who want to homeschool their child who is deaf

d.

canes, wheelchairs, special vans, and other special mobility equipment

ANS: B

Feedback

A

Incorrect. The Individuals with Disabilities Education Act does not provide an education for children who are deaf in private schools beginning at age 8.

B

Correct. The Individuals with Disabilities Education Act provides early intervention services for children from birth to 3 years with disabilities and for their families, too.

C

Incorrect. The Individuals with Disabilities Education Act does not provide manuals and training for parents who want to homeschool their child who is deaf.

D

Incorrect. The Individuals with Disabilities Education Act does not provide canes, wheelchairs, special vans, and other special mobility equipment.

PTS:1REF:p. 1167 Vision Impairment

OBJ: Cognitive Level: Application

20.At what age is binocularity established?

a.

birth

c.

6 months

b.

3 months

d.

1 year

ANS: C

Feedback

A

Incorrect. Binocularity (fixation of two ocular images into one cerebral picture, i.e., fusion) is established by 6 months of age, not by birth.

B

Incorrect.Binocularity (fixation of two ocular images into one cerebral picture, i.e., fusion) is established by 6 months of age, not by 3 months of age.

C

Correct. Binocularity (fixation of two ocular images into one cerebral picture, i.e., fusion) is established by 6 months of age,

D

Incorrect. Binocularity (fixation of two ocular images into one cerebral picture, i.e., fusion) is established by 6 months of age, not by 1 year of age.

PTS:1REF:p. 1168 Vision Impairment

OBJ: Cognitive Level: Comprehension

21.Parents are quizzing the nurse about the babys eyes and want to know about visual acuity and eye color. Which of the following beliefs by parents will the nurse reinforce as being true?

a.

Permanent eye color may not appear until 1 year of age.

b.

Babies are born with a preference for bright colors such as red.

c.

Babies do not have visual accommodation until they are 1 year old.

d.

Visual acuity is 20/20 then the baby is born.

ANS: A

Feedback

A

Correct. Permanent eye color may not appear until 1 year of age is true.

B

Incorrect. Babies are not born with a preference for bright colors such as red and yellow. This occurs at 4 to 6 months of age.

C

Incorrect. Babies have visual accommodation (the ability of the eye to focus clearly on objects at all distances) by 4 to 6 months of age equal to that of an adult.

D

Incorrect. Visual acuity (clearness or sharpness of the image) changes with age from 20/50 at 18 months of age to 20/20 at 4 years of age.

PTS:1REF:p. 1169 Vision Impairment

OBJ: Cognitive Level: Application

22.Which of the following definitions of visual impairment most emphasizes the clearness of vision at various distances (visual acuity)?

a.

educational

c.

legal-medical

b.

functional

d.

common usage

ANS: C

Feedback

A

Incorrect. The educational definition emphasizes the extent to which vision can be used for reading and learning.

B

Incorrect. The functional definition describes what a person actually can see.

C

Correct. The legal-medical definition emphasizes the clearness of vision at various distances (visual acuity).

D

Incorrect. There is no common usage definition for visual impairment.

PTS:1REF:p. 1169 Vision Impairment

OBJ: Cognitive Level: Comprehension

23.The pediatric nurse working with newborns and infants will find which of the following types of newborns having a significantly increased incidence of ocular muscle weakness?

a.

postmaturity

b.

those delivered by cesarean section

c.

very low birth weight

d.

those delivered to drug-abusing mothers

ANS: C

Feedback

A

Incorrect. Postmature newborns and infants do not having a significantly increased incidence of ocular muscle weakness.

B

Incorrect. Infants delivered by cesarean section do not having a significantly increased incidence of ocular muscle weakness.

C

Correct. Very low birth weight newborns and infants having a significantly increased incidence of ocular muscle weakness.

D

Incorrect. Infants delivered to drug-abusing mothers do not having a significantly increased incidence of ocular muscle weakness.

PTS:1REF:p. 1169 Sensory Alterations

OBJ: Cognitive Level: Application

24.The nurse wants to assess visual acuity with a preschool child who is developmentally delayed. The nurse selects the Blackbird Preschool Vision test, which is best described as a test that:

a.

presents the letter B in various positions

b.

is named after a person by the name of Blackbird

c.

uses blackbirds of various sizes flying in different directions

d.

offers various birds of various colors doing various things

ANS: C

Feedback

A

Incorrect. The Blackbird Preschool Vision test does not present the letter B in various positions.

B

Incorrect. The Blackbird Preschool Vision test is not is named after a person by the name of Blackbird.

C

Correct. The Blackbird Preschool Vision test uses blackbirds of various sizes flying in different directions. The child is to indicate the direction the bird is flying.

D

Incorrect. The Blackbird Preschool Vision test does not offer various birds of various colors doing various things.

PTS:1REF:p. 1170 Vision Impairment

OBJ: Cognitive Level: Comprehension

25.The parent of a child diagnosed as having astigmatism asks the school nurse to explain what the eye doctor meant by astigmatism. Which of the following responses by the nurse would best describe astigmatism?

a.

The eyeball is too long, causing light rays to focus in front of the retina.

b.

The eyeball is too short, causing light rays to focus in back of the retina.

c.

The cornea or lens has uneven curvature, so the light rays dont focus correctly on the retina.

d.

There is loss of vision in one eye, or more commonly, a reduction of vision in one eye.

ANS: C

Feedback

A

Incorrect. Myopia (nearsightedness) occurs then the eyeball is too long, causing light rays to focus in front of the retina.

B

Incorrect. Hyperopia (farsightedness) occurs then the eyeball is too short, causing light rays to focus in back of the retina.

C

Correct. Astigmatism (blurred vision) occurs then there is uneven curvature of the cornea or lens, so the light rays dont focus correctly on the retina.

D

Incorrect. Astigmatism is not described as loss of vision in one eye, or more commonly, a reduction of vision in one eye.

PTS:1REF:p. 1171 Vision Impairment

OBJ: Cognitive Level: Application

26.The nurse will teach the family and the child who is wearing contacts for the first time that care and cleaning directions must be followed explicitly. The reason for following the instructions exactly is mainly to prevent:

a.

dirt and dust from getting into the eye

b.

discomfort from itching and burning

c.

complications such as corneal damage

d.

redness of the eyes

ANS: C

Feedback

A

Incorrect. The reason for following the instructions exactly with contacts is not to prevent dirt and dust from getting into the eye.

B

Incorrect. The reason for following the instructions exactly with contacts is not to prevent discomfort from itching and burning.

C

Correct. Following the instructions exactly with contacts is mainly to prevent complications such as corneal damage.

D

Incorrect. The reason for following the instructions exactly with contacts is not to prevent redness of the eyes.

PTS:1REF:p. 1173 Vision Impairment

OBJ: Cognitive Level: Application

27.The school nurse observes a child who has strabismus. Which of the following is the most obvious sign of strabismus?

a.

squinting to get a better image

c.

having difficulty picking up objects

b.

stumbling and appearing clumsy

d.

a cross-eyed appearance

ANS: D

Feedback

A

Incorrect. The most obvious sign of strabismus is not squinting to get a better image.

B

Incorrect. The most obvious sign of strabismus is not stumbling and appearing clumsy.

C

Incorrect. The most obvious sign of strabismus is not having difficulty picking up objects.

D

Correct. The most obvious sign of strabismus is a cross-eyed appearance. Strabismus is a condition there the visual lines of each eye do no simultaneously focus on the same object in space because of a lack of muscular coordination.

PTS:1REF:p. 1173 Vision Impairment

OBJ: Cognitive Level: Comprehension

28.The nurse will begin screening babies for strabismus at 3 to 6 months of age. A parent asks the nurse why this screening is being done at this early age. Which of the following is the nurses best response?

a.

Surgery needs to be done before the child is 1 year old if he or she has strabismus.

b.

This is the best time to begin the eye exercises if strabismus is present.

c.

Identification of strabismus requires a regimen of vitamin E to be started early.

d.

The longer a child has uncorrected strabismus, the more vision loss he or she tends to have.

ANS: D

Feedback

A

Incorrect. Screening babies for strabismus at 3 to 6 months of age is not done because surgery needs to be done before the child is 1 year old.

B

Incorrect. Screening babies for strabismus at 3 to 6 months of age is not done because this is the best time to begin the eye exercises.

C

Incorrect. Screening babies for strabismus at 3 to 6 months of age is not done because treatment requires a regimen of vitamin E to be started early.

D

Correct. Screening for strabismus should begin at 3-6 months of age because the longer a child has uncorrected strabismus, the more vision loss he or she tends to have. In strabismus then one eye deviates (moves upward, inward, or outward), the brain is unable to fuse the dissimilar-similar images and double vision results. The brain will learn to suppress the image from the deviated eye to allow clear sight in the straight eye. The earlier suppression begins and the longer it is allowed to continue, the more permanent the loss of vision.

PTS:1REF:p. 1173 Vision Impairment

OBJ: Cognitive Level: Application

29.In assessing a child with strabismus, the nurse charts that the child has esotropia. This means that the nurse has found which of the following then assessing the eyes?

a.

One eye turns toward the midline.

b.

The eyes are out of vertical alignment, with one pupil appearing higher.

c.

One eye turns outward or away from the midline.

d.

Both eyes appear to be turning away from the midline.

ANS: A

Feedback

A

Correct. Esotropia (convergent) occurs then one eye turns toward the midline.

B

Incorrect. Esotropia does not mean the eyes are out of vertical alignment, with one pupil appearing higher. This is the description of hypertropia.

C

Incorrect. exotropia (divergent) occurs then one eye turns outward or away from the midline.

D

Incorrect. Esotropia does not occur then both eyes appear to be turning away from the midline.

PTS:1REF:p. 1174 Vision Impairment

OBJ: Cognitive Level: Comprehension

30.The nurse is talking with a parent of a child with strabismus. The nurse is talking about alternatives to surgery and explains that there is a correction for strabismus, which is an alternative to surgery, and it is successful in about 50% of clients. Which of the following substances is involved in this treatment?

a.

smallpox vaccine

c.

influenza vaccine

b.

botulism toxin

d.

tetanus toxin

ANS: B

Feedback

A

Incorrect.An alternative to surgery for correction of strabismus does not involve smallpox vaccine.

B

Correct. An alternative to surgery for correction of strabismus involves botulinum toxin (Botox). This toxin is injected into the eye muscle to produce temporary paralysis. This allows the muscles opposite the paralyzed muscle to straighten the eye. When the medication wears off in about 2 months, the correction will be successful in 50% of clients.

C

Incorrect. An alternative to surgery for correction of strabismus does not involve influenza vaccine.

D

Incorrect. An alternative to surgery for correction of strabismus does not involve tetanus toxin.

PTS:1REF:p. 1174 Sensory Alterations

OBJ: Cognitive Level: Comprehension

31.The parent of a 6-year-old child who will be wearing an eye patch and a bandage around the entire head asks the nurse for suggestions on how to get the child to comply and not remove these items. Which of the following are the best suggestions and are most likely to be successful interventions?

a.

Encourage the child to pretend to be a pirate, and use rewards to reinforce compliance.

b.

Apply tincture of benzoin or glue to the edges of the patch to adhere it to the childs face.

c.

Tie cardboard tubes on the elbows, and put mittens on the childs hands.

d.

Apply tape across the patch from the forehead to the cheek or jaw, making a big X to secure the patch.

ANS: A

Feedback

A

Correct. The best suggestion to get the child to comply with wearing the eye patch is to encourage the child to pretend to be a pirate, and use rewards to reinforce compliance.

B

Incorrect. Tincture of benzoin, not glue, can be applied around the eye there the sticky part of the patch goes. Tincture of benzoin is not applied to the patch itself.

C

Incorrect. For a 6 year old child cardboard tubes secured with gauze longitudinally around the elbows when all else fails to restrict the childs ability to remove the patch. Taping mittens on the hands is appropriate for the younger child.

D

Incorrect. Applying tape from the forehead to the cheek is another method to maintain treatment of eye patching. The tape should not be applied across the patch, making a big X to secure the patch.

PTS:1REF:p. 1176 Speech and Language

OBJ: Cognitive Level: Application

32.The nurse doing screenings for eye problems in children realizes that amblyopia is going to present in children at which of the following ages or periods in a childs life?

a.

before the age of 7 years

c.

after the child begins to read

b.

during latency

d.

after the age of 8 years

ANS: A

Feedback

A

Correct. Amblyopia (lazy eye) is the chief cause of preventable visual loss in children. The most common cause is strabismus. Amblyopia develops before the age of 7 years.

B

Incorrect. Amblyopia is not going to present after the child begins to read.

C

Incorrect. The latency stage according to Freud encompasses ages 6 to 11 years. This is an incorrect option.

D

Incorrect. Amblyopia is not going to present after the age of 8 years.

PTS:1REF:p. 1176 Speech and Language

OBJ: Cognitive Level: Comprehension

MULTIPLE RESPONSE

1.The nurse assessing newborns is aware that a baby can be born with a cataract. When the mother asks what caused her baby to have a cataract, the nurse will explain that which of the following causes cataracts to be present at birth? Select all that apply.

a.

can be caused by an autosomal dominant trait

b.

are almost always due to maternal infection such as influenza or childhood communicable diseases during pregnancy

c.

no one knows what causes cataracts to be present at birth, but it is believed to be an allergic response in utero

d.

a number of causes including prenatal trauma, anoxia, maternal disease, or inherited autosomal dominant trait

ANS: A, D

Feedback

Correct

Cataracts can be acquired or congenital. Congenital cataracts can be inherited as an autosomal dominant trait or anoxia.

Cataracts can be acquired or congenital. Acquired cataracts are typically caused by maternal infection during pregnancy, trauma, systematic disease, or idiopathic factors.

Incorrect

While infections can be a potential etiology, cataracts are not almost always due to maternal infection.

Cataracts are not associated with an allergic response.

PTS:1REF:p. 1176 Speech and Language

OBJ: Cognitive Level: Application

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