Ch46 ENT fxn

Question 135791Id: 135791

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Type: MCSADifficulty Level:

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Question Stem

The nurse is caring for a young child with otitis media. The parent asks the nurse why children seem to get otitis media frequently but adults do not. The nurse would explain that younger children get otitis media more often because:

Stimulus

Answer

Choice 1 The eustachian tube is shorter, wider, and horizontal in younger children.

Rationale 1

The eustachian tube, which connects the nasopharynx to the middle ear, is proportionately shorter, wider, and more horizontal in infants and young children than in older children or adults. This promotes an increase in the incidence of ear infections.

Answer 1 true

Choice 2The eustachian tube is shorter, more narrow, and horizontal in younger children.

Rationale 2

The eustachian tube, which connects the nasopharynx to the middle ear, is proportionately shorter, wider, and more horizontal in infants and younger children than in older children or adults. This promotes an increase in the incidence of ear infections.

Answer 2 false

Choice 3 The eustachian tube is longer, wider, and vertical in younger children.

Rationale 3

The eustachian tube, which connects the nasopharynx to the middle ear, is proportionately shorter, wider, and more horizontal in infants and younger children than in older children or adults. This promotes an increase in the incidence of ear infections.

Answer 3 false

Choice 4 The eustachian tube is longer, more narrow, and vertical in younger children.

Rationale 4 The eustachian tube, which connects the nasopharynx to the middle ear, is proportionately shorter, wider, and more horizontal in infants and younger

children than in older children or adults. This promotes an increase in the incidence of ear infections.

Answer 4 false

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Learning Outcome 1:46.1 Identify anatomy, physiology, and pediatric differences in the eye, ear, nose, and throat of children and adolescents.

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Question Stem

The nurse is caring for four clients in the neonatal intensive care unit. Which infant has the greatest risk of developing retinopathy of prematurity (ROP)?

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Answer

Choice 128-weeks'-gestation infant who has been on long-term oxygen and weighed 1,400 grams

Rationale 1The 28-weeks'-gestation infant on oxygen weighing 1,400 grams has the greatest risk of retinopathy of prematurity because of gestational age (28 weeks or less), weight (less than 1,600 g), and oxygen therapy.

Answer 1 true

Choice 232-weeks'-gestation infant of African heritage with a congenital heart defect who needed no oxygen and weighed 1,850 grams

Rationale 2

The 32-weeks'-gestation infant was not placed on oxygen, and therefore is not at risk. Risk for developing retinopathy of prematurity is lower for infants of African heritage than Caucasian infants. Congenital heart defects are not associated with ROP.

Answer 2 false

Choice 328-weeks'-gestation female infant who was on short-term oxygen, weighed 1,420 grams, and was treated with phototherapy

Rationale 3The 28-weeks'-gestation infant was only placed on short-term oxygen. Phototherapy is associated with hyperbilirubinemia and is not associated with ROP.

Answer 3 false

Choice 436-weeks'-gestation, small-for-gestational-age infant who was in an oxyhood for 12 hours and weighed 1,800 grams

Rationale 4 The 36-weeks'-gestation infant was on oxygen for short period of time. A

small-for-gestational-age baby would be more mature than an infant of the same weight but lower gestational age.

Answer 4 false

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Learning Outcome 1:46.2 Describe abnormalities of the eyes, ears, nose, throat, and mouth in children.

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Question Stem

The nurse is taking care of a child who had a tonsillectomy. During the postoperative period, the nurse should observe the child for which clinical manifestation?

Stimulus

Answer

Choice 1 Arrhythmias

Rationale 1Unless the child has a heart condition prior to surgery, arrhythmias is not a possible postoperative complication

Answer 1 false

Choice 2 Dehydration

Rationale 2The child is at risk for dehydration due to deficient fluid volume related to inadequate intake after surgery. The child will anticipate having pain if she tries to swallow.

Answer 2 true

Choice 3 Increased blood sugar

Rationale 3 Increased blood sugar will result only if the child is a diabetic.

Answer 3 false

Choice 4 Increased urinary output

Rationale 4 Increased urinary output is not an expected complication of surgery.

Answer 4 false

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Learning Outcome 1:46.2 Describe abnormalities of the eyes, ears, nose, throat, and mouth in children.

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A neonate has been diagnosed with a herpes simplex viral infection of the eye. Which medication will the nurse prepare to administer?

Stimulus

Answer

Choice 1 Oral erythromycin

Rationale 1 Oral erythromycin is used to treat Chlamydial eye infections.

Answer 1 false

Choice 2 Fluoroquinolone eyedrops or ointment

Rationale 2 Fluoroquinolone eyedrops are used to treat bacterial eye infections.

Answer 2 false

Choice 3Parenteral acyclovir (Zovirax) and vidarabine (VIRA-A) ophthalmic ointment

Rationale 3Neonatal herpes simplex virus is treated vigorously with parenteral acyclovir for 14 days or longer and topical ophthalmic medication (trifluridine, iododeoxyuridine, or vidarabine).

Answer 3 true

Choice 4 Intravenous penicillin

Rationale 4 Intravenous penicillin treats selected bacterial infections.

Answer 4 false

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Learning Outcome 1: 46.4 Plan nursing care for children with vision or hearing impairments.

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A nurse is caring for a visually impaired 20-month-old who has not begun to walk. Which nursing diagnosis would be appropriate for this child?

Stimulus

Answer

Choice 1 Self-care deficit

Rationale 1 Self-care deficit does not apply to this age of child.

Answer 1 false

Choice 2 Impaired physical mobility

Rationale 2The child's mobility is not due to a physiological problem, so impaired mobility is not appropriate.

Answer 2 false

Choice 3 Impaired home maintenance

Rationale 3 There are not enough data to determine if home maintenance is impaired.

Answer 3 false

Choice 4 Delayed growth and development

Rationale 4A 20-month-old child who is not walking is delayed in growth and development. Toddlers generally walk by 15 months of age.

Answer 4 true

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A nurse is caring for a visually impaired 10-year-old child. The nursing intervention with the highest priority for this child during the admission process would be:

Stimulus

Answer

Choice 1 Explaining playroom policies.

Rationale 1 Policies can be covered at a later time

Answer 1 false

Choice 2 Orienting the child to where furniture is placed in the room.

Rationale 2The priority intervention is to orient the child to furniture placement in the room. This is priority because it addresses basic safety for a visually impaired client.

Answer 2 true

Choice 3 Taking the child on a tour of the unit.

Rationale 3 Tours can be done at a later time.

Answer 3 false

Choice 4Letting the child touch equipment that will be used during the hospitalization.

Rationale 4 Handling equipment can be covered at a later time.

Answer 4 false

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Question Stem

An infant has acute otitis media. Which of the following would be the most important for the nurse to teach the parents?

Stimulus

Answer

Choice 1 Keep the baby in a flat position during sleep.

Rationale 1A flat position could exacerbate the discomfort. Elevating the head slightly is recommended.

Answer 1 false

Choice 2 Administer a decongestant.

Rationale 2 Decongestants are not recommended for treatment of acute otitis media.

Answer 2 false

Choice 3 Place the baby to sleep with a pacifier.

Rationale 3Placing infants to sleep with a pacifier can increase the incidence of otitis media.

Answer 3 false

Choice 4 Administer acetaminophen (Tylenol) to relieve discomfort.

Rationale 4An infant with a bulging tympanic membrane because of acute otitis media will have pain. Parents are taught to administer acetaminophen (Tylenol) to relieve the discomfort associated with acute otitis media.

Answer 4 true

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Learning Outcome 1:46.5 Select and apply latest recommendations when implementing care and teaching for children with abnormalities of eyes, ears, nose, and throat.

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Question Stem

The nurse has taught a group of parents how to care for their children who have just had tympanostomy tubes inserted. The nurse will know the parents understand how to care for their child's tympanostomy tubes if they:

Standard Text Select all that apply.

Stimulus

Answer

Choice 1 Limit their diets to soft, bland foods.

Rationale 1Limiting the diet to soft, bland foods and administering decongestants are not needed after surgery. A regular diet should be resumed.

Answer 1 false

Choice 2 Restrict the children to quiet activities after surgery.

Rationale 2The correct responses include encouraging the children to drink generous amounts of water, restricting the children to quiet activities after surgery, and avoiding water in the children's ears at bath time.

Answer 2 true

Choice 3 Administer a decongestant for one to two weeks following surgery.

Rationale 3Incorrect responses include administering a decongestant for one to two weeks following surgery and limiting their diets to soft, bland foods.

Answer 3 false

Choice 4 Encourage the children to drink generous amounts of fluids.


Answer 4 true

Choice 5 Avoid getting water in their ears during bath time.


Answer 5 true

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Question Stem

The nurse can assist a child who has a mild hearing loss and reads lips to adapt to hospitalization by:

Stimulus

Answer

Choice 1 Touching the child lightly before speaking.

Rationale 1The nurse can facilitate hospital adaptation of a child who has a hearing loss and can lip-read by obtaining the child's visual attention by lightly touching the child before communicating.

Answer 1 true

Choice 2 Using a picture board as the main means of communication.

Rationale 2Picture boards, while useful, should not be the primary means of communication for a child who reads lips.

Answer 2 false

Choice 3 Speaking in a loud voice while facing the child.

Rationale 3 Speaking in a loud voice might not promote hearing in the child.

Answer 3 false

Choice 4 Speaking directly to the parents for communication.

Rationale 4 Speaking to only the parents does not help the child with the hospitalization.

Answer 4 false

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A child has epistaxis while at school. The school nurse appropriately intervenes by:

Stimulus

Answer

Choice 1 Lying the child down and applying a warm pack.

Rationale 1Lying the child down would allow the blood to drain down the throat, which could lead to aspiration. Warmth would promote the bleeding.

Answer 1 false

Choice 2Tilting the child's head back, squeezing the bridge of the nose, and applying a warm moist pack to the nose.

Rationale 2Tilting the child's head back could cause the blood to trickle down the throat. Warmth can cause an increase in bleeding because of vasodilation.

Answer 2 false

Choice 3Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose.

Rationale 3The correct initial treatment for a nosebleed is to tilt the head forward, squeeze the nares below the nasal bone for 10-15 minutes, and apply ice to the nose or back of the head.

Answer 3 true

Choice 4Immediately packing the nares with a cotton ball soaked with Neo-Synephrine.

Rationale 4A cotton ball soaked with Neo-Synephrine would only be used if the bleeding did not stop with pressure and ice.

Answer 4 false

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Question Stem

The nurse has completed postoperative discharge teaching to the parents of a child who has had a tonsillectomy. Which statement indicates the parents have understood the teaching?

Stimulus

Answer

Choice 1 "We will call the physician for any indication of ear pain."

Rationale 1Ear pain four to eight days after a tonsillectomy might be experienced and does not indicate an ear infection.

Answer 1 false

Choice 2 "We will be sure to give our child adequate amounts of citrus juices."

Rationale 2Citrus juices should be avoided for the first week because highly acidic foods and beverages can cause irritation.

Answer 2 false

Choice 3 "We will plan on administering acetaminophen (Tylenol) for pain."

Rationale 3 Acetaminophen (Tylenol) is recommended for pain after a tonsillectomy.

Answer 3 true

Choice 4 "We will keep our child on bed rest for ten days after the surgery."

Rationale 4Children do not need to be confined to bed. They can return to school in 10 days.

Answer 4 false

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A nurse who is planning to teach school-age children about the "common cold" should include what information?

Stimulus

Answer

Choice 1Aspirin should be taken for alleviation of fever if the common cold is contracted.

Rationale 1Aspirin should not be taken for fever because of its association with Reye's syndrome.

Answer 1 false

Choice 2 Antibiotics will eliminate the nasopharyngitis virus.

Rationale 2 Antibiotics are not used to treat viral infections.

Answer 2 false

Choice 3 Vaccinations can prevent contraction of a nasopharyngitis virus.

Rationale 3 No vaccine can prevent the common cold.

Answer 3 false

Choice 4 Proper hand washing can prevent the spread of the common cold.

Rationale 4Proper hand washing should be taught to school-age children to reduce the spread of the "common cold" virus.

Answer 4 true

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Learning Outcome 1:46.6 Integrate preventive and treatment principles when implementing care for children related to eyes, ears, nose, and throat.

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The school nurse is screening all second graders for tonsillitis and pharyngitis. Which finding is a normal finding in this age group?

Stimulus

Answer

Choice 1 Tonsils are large and seem to fill the throat.

Rationale 1This is a normal finding as the tonsilar material grows faster than the child and reaches adult size in this age group. It is not a reason to refer the child for follow-up.

Answer 1 true

Choice 2 Child is complaining of sore throat and drooling

Rationale 2 Both symptoms indicate pharyngitis and should be evaluated by a physician.

Answer 2 false

Choice 3 White patches are observed on the tonsils.

Rationale 3 White exudate is associated with tonsillitis and requires further evaluation.

Answer 3 false

Choice 4 Throat appears red, and child has a low-grade fever

Rationale 4 These symptoms suggest pharyngitis; the child should be evaluated further.

Answer 4 false

Choice 5

Rationale 5

Answer 5

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Learning Outcome 1:46.1 Identify anatomy, physiology, and pediatric differences in the eye, ear, nose, and throat of children and adolescents.

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Question Stem

A 10-month-old infant has had numerous ear infections since birth. The nurse will discuss with the parents ways that might reduce the incidence of otitis media and will include which strategies?


Stimulus

Answer

Choice 1 Prohibiting tobacco smoke in the home

Rationale 1 This has been shown to decrease the incidence of otitis media.

Answer 1 true

Choice 2 Avoiding use of a pacifier while the child is sleeping

Rationale 2The use of a pacifier for the sleeping baby has been associated with otitis media.

Answer 2 true

Choice 3 Breastfeeding the infant

Rationale 3While breastfeeding is associated with lower incidences of otitis media, this child is 10 months old.

Answer 3 false

Choice 4 Cleaning the child’s ears nightly with peroxide

Rationale 4 Otitis media is not prevented by cleaning the ears.

Answer 4 false

Choice 5 Avoiding use of wood-burning stoves

Rationale 5 Wood-burning stoves are associated with higher rates of otitis media.

Answer 5 true

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A three-year-old child has been found to have a mild to moderate hearing loss. The mother tells the nurse: “The doctor told me I should put my child in day care but didn’t tell me why. Do you know why the doctor recommends day care?” The nurse’s response will be based on the knowledge that day care will:

Stimulus

Answer

Choice 1 Help the child recognize his hearing deficit.

Rationale 1This would not be a goal of treatment. The child is aware of what he hears but may not be aware of what he is not hearing.

Answer 1 false

Choice 2 Increase the child’s socialization skills.

Rationale 2By increasing the interaction with other children, the hearing-impaired child will improve his socialization skills.

Answer 2 true

Choice 3 Improve the child’s immunity by increased exposure to organisms.

Rationale 3Increased exposure to organisms will occur, but this is not the goal of the recommendation.

Answer 3 false

Choice 4 Teach other children that children are different.

Rationale 4The physician’s concern is the well-being of this child, not the other children.

Answer 4 false

Choice 5

Rationale 5

Answer 5

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While screening children, the nurse notes that one child seems to have “crossed eyes.” Which screening tool might the nurse utilize to further screen this child?

Stimulus

Answer

Choice 1 Examine the eye with an otoscope.

Rationale 1 An otoscope is used to examine the ear, not the eye.

Answer 1 false

Choice 2 Check for the “red reflex” in the eyes.

Rationale 2The red reflex visualizes the retina and is used to identify infants with cataracts.

Answer 2 false

Choice 3 Perform the cover-uncover test.

Rationale 3When one eye is covered while the child is looking at an object, the uncovered eye will deviate from the location; this tool is used to detect strabismus.

Answer 3 true

Choice 4 Use a tonometer to evaluate the eyes.

Rationale 4The tonometer measures intraocular pressure and is used to evaluate glaucoma.

Answer 4 false

Choice 5

Rationale 5

Answer 5

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Learning Outcome 1:46.3 Carry out screening programs to identify children with vision and hearing abnormalities.

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Question Stem

The nurse is reviewing discharge instructions for a child who has received a cochlear implant. In addition to encouraging speech therapy for the child, the nurse will instruct the parents to monitor the child for signs of:

Stimulus

Answer

Choice 1 Ringing in the ears.

Rationale 1 This is not a common complication of a cochlear implant.

Answer 1 false

Choice 2 Pharyngitis.

Rationale 2 Pharyngitis is not associated with cochlear implants.

Answer 2 false

Choice 3 Hearing loss.

Rationale 3The child already has hearing loss. That is why the child receives a cochlear implant.

Answer 3 false

Choice 4 Bacterial meningitis.

Rationale 4There is an increased risk of bacterial meningitis following insertion of a cochlear implant.

Answer 4 true

Choice 5

Rationale 5

Answer 5

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Question Stem

Following a facial injury of a 12-year-old youth during a baseball game, a nurse speaks with the league administrators about first aid for teeth that may be lost. The nurse will instruct the administration that appropriate first aid will include:


Stimulus

Answer

Choice 1Not worrying about the tooth loss, as children this age still have their “baby” teeth.

Rationale 1 By twelve years of age, children have their permanent teeth.

Answer 1 false

Choice 2Only handling the lost tooth by the roots and avoiding touching the crown of the tooth.

Rationale 2First aid includes handling the tooth only by the crown and not touching the roots.

Answer 2 false

Choice 3 Rinsing the lost tooth with sterile saline.

Rationale 3 This is appropriate, as there is hope that the tooth can be re-implanted.

Answer 3 true

Choice 4Placing the tooth back into its socket and taking the child to an emergency dental facility.

Rationale 4 This is an appropriate way to manage the tooth.

Answer 4 true

Choice 5Keeping the tooth clean and dry during transport to an emergency dental facility.

Rationale 5 The tooth should be kept moist.

Answer 5 false

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Ch46 ENT fxn

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