Chapter 23: The Child with a Sensory or Neurological Condition

1. A parent comments that her infant has had several ear infections in the past few months. Why

are infants more susceptible to otitis media?

a. Infants are in a supine or prone position most of the time.

b. Sucking on a nipple creates middle ear pressure.

c. They have increased susceptibility to upper respiratory tract infections.

d. The Eustachian tube is short, straight, and wide.

ANS: D

An infant's Eustachian tubes are short, wide, and straight, allowing microorganisms easy

access to the middle ear.

2. What statement by a patient's mother leads the nurse to determine she understands

instructions about administering an oral antibiotic for otitis media?

a. ―I will continue using the medication until symptoms are relieved.‖

b. ―I will share the medicine with siblings if their symptoms are the same.‖

c. ―I will give the medication with a glass of milk.‖

d. ―I will administer prescribed doses until all the medication is used.‖

ANS: D

Antibiotic therapy for otitis media is continued until the prescribed amount has been

completed, even if symptoms are alleviated.

3. Which situation would cause the nurse to suspect a hearing impairment?

a. 3-month-old infant with a positive Moro (startle reaction) reflex

b. 15-month-old toddler who is babbling

c. 18-month-old toddler who is speaking one-syllable words

d. 24-month-old toddler who communicates by pointing

ANS: D

The child who is not making verbal attempts by 24 months should undergo a complete

physical examination.

4. What is the best way for the nurse to communicate with a 10-year-old child who has a hearing

impairment?

a. Use gestures and signs as much as possible.

b. Let the child's parents communicate for her.

c. Face the child and speak clearly in short sentences.

d. Recognize that the child's ability to communicate will be on a 6-year-old child's

level.

ANS: C

The nurse who faces the child and speaks clearly will help the hearing-impaired child in the

hospital to develop a healthy personality.

5. What would the nurse include when planning postoperative teaching for a child who has had a

tympanostomy with insertion of tubes?

a. Keeping the infant flat after feeding

b. Giving over-the-counter decongestants

c. Avoiding getting water in the ears

d. Cleaning the ear canal with cotton-tipped applicators

ANS: C

After a tympanostomy, care should be taken to avoid getting water in the ears.

6. What assessment made by the school nurse would lead to the suspicion of strabismus?

a. Reddened sclera in one eye

b. Child covers one eye to read the chalkboard

c. Child complains of a headache

d. Copious tears while watching TV

ANS: B

Indicators of strabismus include covering one eye to see, tilting the head to see, and missing

objects in attempts to pick them up. Although headaches may be associated with amblyopia,

this symptom is too vague to point suspicion to any disorder.

7. What might the nurse explain as a common treatment for amblyopia?

a. Patching the good eye to force the brain to use the affected eye

b. Patching the affected eye to allow the refractory muscles to rest

c. Using glasses that will slightly blur the image for the good eye

d. Using corticosteroids to treat inflammation of the optic nerve

ANS: A

Early detection and treatment are essential for the child with amblyopia. Treatment includes

patching the good eye and using glasses to correct refractive errors.

8. What assessment does the school nurse recognize as the cardinal sign of a hyphema?

a. Opacity of the lens

b. A yellow-white reflex on the pupil

c. A dark-red spot in front of the iris

d. Inflamed mucous membranes of the eyelids

ANS: C

A dark red spot in front of the iris is blood that has drained into the anterior chamber as the

result of an injury.

9. The nurse is planning to teach parents about prevention of Reye's syndrome. What

information would the nurse include in this teaching?

a. Use aspirin instead of acetaminophen for children with viral illness.

b. Advise parents to have their children immunized against Reye's syndrome.

c. Avoid giving salicylate-containing medications to a child who has viral symptoms.

d. Get the child tested for Reye's syndrome if the child exhibits fever, vomiting, and

lethargy.

ANS: C

Prevention of Reye's syndrome includes educating parents not to give aspirin-containing

medication to children with viral symptoms.

10. What symptom leads the nurse caring for a 5-month-old child with viral influenza to suspect

the development of Reye's syndrome?

a. Respirations drop from 18 to 14 breaths/minute

b. Falling asleep after feeding

c. Sudden vomiting without effort

d. Development of a macular rash

ANS: C

A child with a viral infection is at risk for Reye's syndrome, the onset of which is effortless

vomiting, lethargy, and a change in level of consciousness. A 5-month-old child who sleeps

after eating is normal.

11. What does the nurse explain to parents of a child with febrile seizures?

a. They occur when the body temperature exceeds 38.3C (101F).

b. They can be prevented by anticonvulsant medication.

c. They usually lead to the development of epilepsy.

d. They occur when the temperature rises quickly.

ANS: D

Febrile seizures occur in response to a rapid rise in temperature, often above 38.8C (102F).

12. A parent reports that her child has begun to do poorly at school and experiences episodes

where he appears to be staring into space. Of which type of seizure is this behavior a

characteristic?

a. Absence

b. Akinetic

c. Myoclonic

d. Complex partial

ANS: A

Absence seizures are characterized by transient loss of consciousness where the child appears

to stare blankly, and may last only a few seconds.

13. An adolescent has just had a generalized seizure and collapsed in the school nurse's office.

When should the nurse should call 911?

a. The seizure lasts more than 5 minutes.

b. The child is sleepy and lethargic after the seizure.

c. The child vomited at the onset of the seizure.

d. The child is confused and has slurred speech after the seizure.

ANS: A

If there are multiple seizures or if seizures last more than 5 minutes, call 911 because these are

indicators of possible status epilepticus, a medical emergency.

14. What is an appropriate nursing action when a child is experiencing a generalized tonic-clonic

seizure?

a. Assist the child to bed and then go for help.

b. Move objects out of the child's immediate area.

c. Stick a padded tongue blade between the child's teeth.

d. Manually restrain the child.

ANS: B

During a generalized tonic-clonic seizure, the immediate area is cleared to protect the child

from injury.

15. A child diagnosed with epilepsy had a generalized tonic-clonic seizure that lasted 90 seconds.

What would the nurse expect to assess after a generalized tonic-clonic seizure?

a. Restlessness

b. Sleepiness

c. Nausea

d. Anxiety

ANS: B

Following a generalized tonic-clonic seizure, the child may have some confusion and may

sleep for a time (postictal lethargy) and then return to full consciousness.

16. What would the nurse include when creating a teaching plan that includes the long-term

administration of phenytoin (Dilantin)?

a. The medication should be given on an empty stomach.

b. Insomnia can be a significant side effect.

c. Gums should be massaged regularly to prevent hyperplasia.

d. Blood pressure should be closely monitored.

ANS: C

Dilantin can cause gum overgrowth, which can be minimized by regular massaging. Dilantin

frequently causes drowsiness and should be given with meals at the same time each day.

17. The nurse observes that the legs of a child with cerebral palsy cross involuntarily, and the

child exhibits jerky movements with his arms as he tries to eat. The nurse recognizes that he

has which type of cerebral palsy?

a. Athetoid

b. Ataxic

c. Spastic

d. Mixed

ANS: C

Spasticity is characterized by tension in certain muscle groups, which makes voluntary

movements of muscles jerky and uncoordinated.

18. Which assessment finding in a child with meningitis should be reported immediately?

a. Irregular respirations

b. Tachycardia

c. Slight drop in blood pressure

d. Elevated temperature

ANS: A

Irregular respirations in conjunction with slowing heart rate and increasing blood pressure are

reported immediately, because they could indicate increased intracranial pressure.

19. The nurse observes a child's position is supine with his arms and legs rigidly extended and the

hands pronated. How does the nurse identify this posture?

a. Correct anatomical position

b. Decorticate

c. Decerebrate

d. Opisthotonos

ANS: C

In decerebrate posturing, arms are extended along the side of the body and hands are pronated.

This posture indicates brainstem function only.

20. What will the nurse teach parents when giving instructions for acute conjunctivitis?

a. Apply cool compresses to the affected eye several times a day.

b. Instill topical steroid eyedrops for 1 week.

c. Clear drainage from the inner to the outer aspect of the eye.

d. Keep the eye patched until the inflammation resolves.

ANS: C

Eye secretions are always cleared from the inner canthus downward and away from the

opposite eye (inner to outer direction).

21. A child is brought to the emergency department after he fell and hit his head on the ground.

Which nursing assessment suggests the child has a concussion?

a. Sleepy but easily arousable

b. Complaining of a stiff neck

c. Cannot remember what happened to him

d. Pupils react sluggishly to light

ANS: C

A concussion is a temporary disturbance of the brain that is immediately followed by a period

of unconsciousness. It is accompanied often by a loss of memory of the events that occurred

immediately before, during, or after the injury.

22. A child is admitted to the hospital because she had a seizure. Her parents report that for the

past few weeks she has had headaches, with vomiting, that are worse in the morning. What

does the nurse suspect?

a. Meningitis

b. Reye's syndrome

c. Brain tumor

d. Encephalitis

ANS: C

The signs and symptoms of a brain tumor are related to its size and location. Most tumors

create increased intracranial pressure (ICP) with the hallmark symptoms of headache,

vomiting, drowsiness, and seizures.

23. The nurse urges the mother of a 6-month-old child to get her child inoculated with

Haemophilus influenzae type B. What does this immunization protect against?

a. Encephalitis

b. Influenza

c. Bacterial meningitis

d. Otitis media

ANS: C

H. influenzae type B and conjugated pneumococcal vaccines have decreased the incidence of

bacterial meningitis.

24. The nurse is caring for a 3-year-old child with a head injury. Which assessment would lead

the nurse to report the probability of increasing intracranial pressure (ICP)?

a. Temperature increase from 37.2C (99F) to 37.7C (100F)

b. Increase in blood pressure with an attendant decrease in pulse

c. Increase in respirations

d. Equilateral pupils

ANS: B

Increasing blood pressure, accompanied by decreasing pulse, and accompanied by unequal

pupils are indicators of ICP.

25. A child is diagnosed with nonparalytic strabismus. How will this disorder most likely be

corrected?

a. Patching the unaffected eye

b. Corrective lenses

c. Laser treatment

d. Surgery

ANS: B

In nonparalytic strabismus, the refractory error is usually corrected with eyeglasses.

26. Parents of a 10-year-old child diagnosed with an intellectual deficit are sharing multiple

approaches they implement in dealing with various challenges. Which statement by the

parents alerts the nurse they need further instruction?

a. ―We dress our son every morning for school.‖

b. ―Our son participates in the Special Olympics every year.‖

c. ―Our son attends play therapy at a center close to home.‖

d. ―We attend a support group once a week.‖

ANS: A

The mentally handicapped child needs to develop a sense of accomplishment. Caregivers

should not ―take over‖ projects because of their own need to assist or speed up the process

27. What would the nurse include in teaching when preparing to teach parents about air travel

instructions to prevent barotrauma in infants?

a. Using ear plugs during takeoff

b. Omitting the meal just before takeoff

c. Letting the infant nurse during descent

d. Applying ear drops before takeoff

ANS: C

Encouraging an infant to swallow reduces the pressure in the ears during descent

SATA

1. Which assessments would cause the pediatric nurse to suspect the probability of an ear

infection in a 6-month-old child? (Select all that apply.)

a. Hypersensitivity to noise

b. Irritability

c. Ecchymotic ear canal

d. Rolls head from side to side

e. Temperature of 39.4C (103F)

ANS: B, D, E

Infants signal ear infections by being irritable, rolling their heads from side to side, spiking a

temperature, and pulling at or rubbing their ears.

2. Which aspect(s) of a child's development does the nurse caution parents that hearing

impairment can affect? (Select all that apply.)

a. Speech clarity

b. Language development

c. Immunity to disease

d. Personality development

e. Academic achievement

ANS: A, B, D, E

All the options, except immunity to disease, are areas in which a hearing impairment could

interfere with normal development.

3. What intervention(s) would the nurse caring for a child with infectious meningitis include?

(Select all that apply.)

a. Isolation precautions

b. Provision of brightly lit room

c. Observation for increasing intracranial pressure

d. Preparation for spinal tap

e. Seizure precautions

ANS: A, C, D, E

All elements of nursing care listed in the options, except a brightly lit room, would be part of

comprehensive care of a child with meningitis.

4. What will the nurse include when documenting a grand mal seizure? (Select all that apply.)

a. Presence of incontinence

b. Current dose of antispasmodic medication

c. Activity level prior to and following seizure

d. Level of consciousness following seizure

e. Length of seizure

ANS: A, C, D, E

Documentation on a seizure should include LOC following episode, activity prior to and

following seizure, change in color, respiration, muscle tone, and length of seizure. Reporting

of medication regimen is not necessary.

5. The nurse is educating parents on prevention of eyestrain in their 5-year-old child. What

information will the nurse include? (Select all that apply.)

a. Encourage books with large type.

b. Words in books should be closely spaced.

c. Provide adequate lighting without glare.

d. Be sure desks and chairs are adequate height.

e. Instruct child to squint when reading.

ANS: A, C, D

Children who are beginning to read need books with large type in which the letters are spaced

far apart. The lighting must be adequate and without glare. Chairs and desks must be of the

proper height.

6. An 8-year-old near-drowning victim is rushed into the ED. What priorities of care will be

implemented? (Select all that apply.)

a. Parental education regarding prevention

b. Respiratory support

c. Cardiovascular support

d. Controlled rewarming

e. Adequate cerebral oxygenation

ANS: B, C, D, E

Respiratory and cardiovascular support, controlled rewarming, and maintenance of adequate

cerebral oxygenation are priorities of care. The parents should be offered support,

explanations of the therapy, and referral to social services, religious, or community agencies

for follow-up.