Instructor s Manual Chapter 31 Sensory Alterations. 1. Rebecca, an 8-year-old girl with a severe hearing impairment, was hit by a car while

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1 1 Instructor s Manual Chapter 31 Sensory Alterations Answers to Study Questions 1. Rebecca, an 8-year-old girl with a severe hearing impairment, was hit by a car while riding her bicycle. Although she was wearing a helmet she was unconscious and has been admitted to the emergency department. She is now awake and somewhat agitated. What should be your first priority? a. Determine what her level of consciousness is and prepare her for a CAT scan. b. Establish communication with her using eye contact, touch, and correctly placing her hearing aids. c. Assign a patient care technician to stay at her side to help restrain her and to prevent her from injury. d. Assess her for any additional injuries that are likely to co-exist in an autobicycle accident, such as a fractured leg. Answer: b. Rebecca is severely hearing impaired and has awakened in an unfamiliar and strange environment that is most likely the reason for her agitation. Although unconscious before, she is awake now and aware of her unfamiliar surroundings. She may need a CAT scan, but needs to have communication established prior to the procedure. At this point and time she should not be restrained and the assessment should have already identified additional possible injuries. 2. Which of the following statements would be most indicative of a language disorder?

2 2 a. A 2-year-old child unable to carry on a conversation using at least 30 words. b. A 3-year-old child who has not spoken in a completed sentence. c. An 18-month-old who uses short, one- to two-word phrases. d. A 3-year-old who occasionally stutters, particularly when stressed. Answer: b. A 3-year-old should be able to communicate in brief sentences using more than twenty words. A 2-year-old will not have a vocabulary of more than 20 words. An 18-month-old will only use short one-to two-word sentences or phrases. It is not uncommon for a 3- to 4-year-old child to stutter when stressed or agitated. 3. Parents of a child who stutters should be encouraged to: a. request that the child begin to speak again but more slowly. b. reward the child when proper speech is used instead of stuttering. c. complete the child s sentence while showing unconcern. d. be patient and give the child time to complete thought and sentence. Answer: d. It is important that parents are patient and allow the child adequate time to express his or her thoughts and ideas. Reward systems and having the child begin to re-speak do not help, but emphasize the abnormal rather than facilitating the child s communication skill development. Completing the child s statement may lead to the child feeling inadequate and frustrated. 4. Sarah, age 3 years, has recently been diagnosed with a hearing impairment. What would your major immediate goal be for Sarah?

3 3 a. Prepare Sarah and her parents for a cochlear implant. b. Develop a teaching plan on how to use a hearing aid. c. Facilitate communication with Sarah. d. Provide Sarah s parents with a community resource guide. Answer: c. Facilitate communication. Receiving and sending spoken language is a priority for Sarah. It has not been determined if Sarah will receive a cochlear implant, hearing aid, use American Sign Language, etc. It is critical to identify and work with Sarah s abilities and to promote communication in the manner and process that will benefit her the most. 5. Mario, born at 28 weeks, is deaf and blind. He is now 2 years old. To help Mario establish communication skills his parents will most likely: a. place Mario in the same place in the room to help him identify his surroundings. b. keep communication clues to him and received from him to a limited number. c. limit his environmental stimuli to help him feel safe and secure. d. select and consistently use the same clue to help him discriminate one person from another. Answer: d. It will be important to establish clues that identify each person. This is key when Mario socializes and communicates with family and friends. Placing Mario in the same place will not help him in communicating; limiting clues also would limit

4 4 people Mario could communicate with and limits his ability to socialize and develop. Limiting environmental stimuli also limits development, socialization, and a sense of normalcy. 6. As the school nurse you are concerned about preventative eye care and sports. Which of the following statements would be considered when developing educational programs? a. Children who wear glasses may need to select noncontact sports. b. Protective eyewear should be required for sports such as baseball and volleyball. c. Children should be educated about the value of wearing contact lenses for improved visual acuity during sports. d. It is not a challenge to get children and adolescents to agree to wear their protective eyewear for sports activities. Answer: b. It is important to teach children and adolescents about the need to wear protective eye wear. Trauma is a leading cause of blindness. Children who wear glasses should be encouraged to participate in any sport they desire, even contact sports. Contact lenses may not be right for every child or adolescent and may not improve visual acuity. Research has demonstrated that both boys and girls often fail to wear protective eyewear during sports activities. 7. Which of the following describes amblyopia? a. increased intraocular pressure b. squint or cross-eye; malalignment of one or both eyes

5 5 c. lazy eye; reduced visual acuity in one eye d. different refractive strengths in one eye Answer: c. Lazy eye; reduced visual acuity in one eye. Glaucoma is associated with increased intraocular pressure; squinting or cross-eyes is associate with strabismus; anisometropia is associated with different refractive strength in each eye. 8. Conductive hearing loss in infants and children is most often caused by: a. recurrent otitis media that causes scarring and interferes with sound transmission. b. antibiotics such as gentamicin or tobramycin which damage the eighth cranial nerve. c. other disorders such as kernicterus. d. frequent exposure to high decibel levels in the NICU as a premature infant. Answer: a. Conductive hearing loss is most often caused by recurrent serous otitis media which causes interference of transmission of sound to or by the middle ear. Antibiotics such as gentamicin and tobramycin, kernicterus, other infections, and high noise levels cause sensorineural hearing loss. 9. Which of the following circumstances would need evaluation? a. a newborn who lacks binocularity b. a toddler whose mother expresses concern over his cross-eyed appearance

6 6 c. a six-year-old child with hyperopia d. the presence of a red reflex in an eight-year-old Answer: b. The child may have strabismus. It is important that treatment begin as soon as possible to promote normal vision. It is normal for the infant to lack binocularity. Children up to age 7 years have hyperopia but because of their accommodative ability can see objects at all ranges. It is normal to have a red reflex. 10. As the nurse working with Henry, a five-year-old boy newly diagnosed with moderate hearing loss, you identify altered growth and development related to impaired communication as a nursing diagnosis. To achieve the goal of optimum independence for age you will exclude which of the following nursing interventions? a. Encourage family to attend the local rehabilitation program. b. Discuss with family the importance of discipline and limit-setting. c. Provide opportunities for the child to express his feelings and concerns. d. Discuss advantages and disadvantages of amplifying devices. Answer: b. Discipline is needed by all children, but is not central to this health concern. Rehabilitation programs are helpful in establishing methods of communication and other support needed by the family. Expressing feelings and concerns is an aspect of adjusting to the hearing loss and may be an opportunity to express grief in adjustment to loss. Discussing advantages and limitations of amplifying devices is important to help the family make an informed decision about how to best assist their child s hearing.