When screening a 5-year-old for strabismus, which action should the nurse take?
Observe the child for blank, sunken eyes.
Inspect the child for the setting-sun sign.
Have the child identify colored patterns on polychromatic cards.
Direct the child through the six cardinal positions of gaze.
The Correct Answer is D
A. Observe the child for blank, sunken eyes. Blank, sunken eyes are not associated with strabismus. These could be signs of other conditions, such as dehydration or severe malnutrition, but they are not relevant for assessing strabismus.
B. Inspect the child for the setting-sun sign. The setting-sun sign is more commonly associated with increased intracranial pressure in infants and is not a relevant observation for detecting strabismus in a 5-year-old child.
C. Have the child identify colored patterns on polychromatic cards. Identifying colored patterns on polychromatic cards is a test for color vision, not for strabismus. Strabismus involves misalignment of the eyes rather than a problem with color perception.
D. Direct the child through the six cardinal positions of gaze. The six cardinal positions of gaze test the alignment and movement of the eyes. The nurse asks the child to follow an object with their eyes as it is moved through these six positions. Any inability of the eyes to maintain proper alignment or any deviation from the expected movement can indicate strabismus. This is an effective and commonly used method to screen for strabismus in children.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Correct answer: D
D. Risk for infection related to impaired skin integrity: Bladder exstrophy exposes the bladder to the external environment, significantly increasing the risk of infection. This is a critical concern that requires immediate attention to prevent serious complications.
Incorrect:
A. Knowledge deficit related to caring for the infant: While educating the parents about caring for an infant with bladder exstrophy is important, it is not the highest priority compared to preventing infection.
B. Risk for impaired parenting related to appearance of the infant: While the appearance of the infant may be challenging for parents, addressing the immediate risk of infection is more critical.
C. Altered urinary elimination related to exposure of the bladder: This is a known consequence of bladder exstrophy and is addressed through surgical intervention and ongoing care. However, preventing infection is the most immediate priority.
Correct Answer is ["0.61"]
Explanation
The calculation for this question involves converting the prescribed dose from milligrams (mg) to millilitres (mL) using the available concentration of the medication.
Given: Prescribed dose of benztropine: 0.61 mg Medication concentration: 1 mg/mL
To calculate the volume (mL) to administer, use the formula: Volume (mL) = Prescribed dose (mg) / Medication concentration (mg/mL)
Volume (mL) = 0.61 mg / 1 mg/mL = 0.61 mL
Therefore, the nurse should administer 0.61 mL of benztropine.
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