Question 1

The primary care pediatric nurse practitioner observes a tender, swollen red
furuncle on the upper lid margin of a child's eye. What treatment will the nurse practitioner recommend?

Accepted Answer

A tender, swollen red furuncle on the upper lid margin is most likely a stye, which is a bacterial infection of the hair follicle in the eyelid. Treatment typically consists of warm, moist compresses applied to the affected eye 3 to 4 times per day to reduce inflammation and promote drainage. Culture of the lesion may be considered in recurrent or severe cases, but is not necessary for initial management. Referral to ophthalmology for incision and drainage may be necessary in rare cases, but is not the first-line treatment option. Topical steroid medication is not recommended for styes, as it can worsen the infection.

Question 2

A preschool­age child who attends day care has a 2­day history of matted eyelids
in the morning and burning and itching of the eyes. The primary care pediatric nurse practitioner notes yellow­green purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is correct?

Accepted Answer

The presence of purulent discharge, conjunctival erythema, and mild URI symptoms suggests a bacterial conjunctivitis. Topical antibiotic drops are the preferred treatment for bacterial conjunctivitis. Culture of the discharge is not necessary to initiate treatment. Observing the child for several days may lead to worsening of symptoms and possible spread of infection. An oral antibiotic medication may be prescribed in severe cases or cases with systemic involvement, but is not the first line treatment for bacterial conjunctivitis.

Question 3

The primary care pediatric nurse practitioner applies fluorescein stain to a child's
eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate?

Accepted Answer

D

Question 4

The primary care pediatric nurse practitioner is treating an infant with lacrimal duct
obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with topical antibiotics along with massage and frequent cleansing of secretions, the infant's symptoms have not improved. Which action is correct?

Accepted Answer

Despite the use of topical antibiotics and massage, the symptoms of bacterial conjunctivitis have not improved after 2 weeks. This indicates a possible underlying issue, such as lacrimal duct obstruction, that may require further evaluation by an ophthalmologist. Therefore, the correct action is to refer the infant to an ophthalmologist for further assessment and treatment. Performing massage more frequently or recommending hot compresses may not address the underlying issue and may delay necessary treatment. Prescribing an oral antibiotic is not indicated as the topical antibiotic has already been used for 2 weeks without improvement.

Question 5

A 14­year­old child has a 2­week history of severe itching and tearing of both
eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe?

Accepted Answer

The answer of A 14­year­old child has a 2­week history...

Question 6

The primary care pediatric nurse practitioner performs a well baby assessment of
a 5­day­old infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct?

Accepted Answer

The answer of The primary care pediatric nurse practitioner performs...

Question 7

A toddler exhibits exotropia of the right eye during a cover­uncover screen. The
primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment?

Accepted Answer

Patching of the unaffected eye encourages the use of the affected eye, which can help correct exotropia by strengthening the eye muscles and improving eye alignment.

Question 8

During a well child exam on a 4­year­old child, the primary care pediatric nurse
practitioner notes that the clinic nurse recorded "20/50" for the child's vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend?

Accepted Answer

The answer of During a well child exam on a...

Question 9

The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate

Accepted Answer

The Hirschberg test evaluates ocular alignment by assessing the position of the light reflex on the cornea. It is used to identify strabismus (eye misalignment) in children. The other options listed are evaluated using different tests.

Question 10

The primary care pediatric nurse practitioner performs a vision screen on a 4­
month­old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do?

Accepted Answer

The presence of mild esotropia at 4 months old is concerning and requires further evaluation by a pediatric ophthalmologist. Patching the right eye, reassurance, or waiting to recheck in a few weeks are not appropriate interventions in this case. Early intervention is important for the best visual outcomes for the infant.

Question 11

The primary care pediatric nurse practitioner performs a well child examination on
a 9­month­old infant who has a history of prematurity at 28 weeks' gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam?

Accepted Answer

Infants with a history of retinopathy of prematurity (ROP), especially those treated for it, should have an ophthalmologic exam at 12 months of age to monitor for any late-emerging sequelae or complications related to the condition or its treatment.

Question 12

A school­age child is hit in the face with a baseball bat and reports pain in one
eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct?

Accepted Answer

The presence of a dark red fluid level between the cornea and iris indicates a hyphema, which is an emergent condition that requires immediate referral to an ophthalmologist. The child's resistance to an exam with a light may indicate severe pain and the use of an anesthetic eye drop could worsen the injury. Administering an oral analgesic medication or applying a Fox shield may be appropriate in some cases, but it is not the best choice of action in this case.

Question 13

A school­age child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do?

Accepted Answer

A fragment from a glass bottle can cause serious injury to the eye and immediate referral to an ophthalmologist is necessary for evaluation and potential treatment.

Question 14

During a well child assessment of an African­American infant, the primary care
pediatric nurse practitioner notes a dark red­brown light reflex in the left eye and a slightly brighter, red­orange light reflex in the right eye. The nurse practitioner will

Accepted Answer

A difference in the red reflex between the eyes may indicate a potential problem with the eye, such as a cataract or other structural abnormality. Referral to an ophthalmologist is the most appropriate action to further evaluate and manage the infant's eye health. Dilating the pupils or performing auto-refractor screening would not address the underlying issue and rechecking in one month could potentially delay important treatment.

Question 15

During a well­baby assessment on a 1­week­old infant who had a normal exam
when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis?

Accepted Answer

Chlamydia trachomatis conjunctivitis typically presents in the first week of life with symptoms such as eyelid swelling, conjunctival injection, and purulent discharge, matching the description given.

Quiz 29: Eye Disorders

The primary care pediatric nurse practitioner observes a tender, swollen red furuncle on the upper lid margin of a child's eye. What treatment will the nurse practitioner recommend?

A preschoolage child who attends day care has a 2day history of matted eyelids in the morning and burning and itching of the eyes. The primary care pediatric nurse practitioner notes yellowgreen purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is correct?

The primary care pediatric nurse practitioner applies fluorescein stain to a child's eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate?

A 14yearold child has a 2week history of severe itching and tearing of both eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe?

The primary care pediatric nurse practitioner performs a well baby assessment of a 5dayold infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct?

A toddler exhibits exotropia of the right eye during a coveruncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment?

During a well child exam on a 4yearold child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded "20/50" for the child's vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend?

The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate

The primary care pediatric nurse practitioner performs a vision screen on a 4 monthold infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do?

The primary care pediatric nurse practitioner performs a well child examination on a 9monthold infant who has a history of prematurity at 28 weeks' gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam?

A schoolage child is hit in the face with a baseball bat and reports pain in one eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct?

A schoolage child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do?

During a well child assessment of an AfricanAmerican infant, the primary care pediatric nurse practitioner notes a dark redbrown light reflex in the left eye and a slightly brighter, redorange light reflex in the right eye. The nurse practitioner will

Quiz 29: Eye Disorders

The primary care pediatric nurse practitioner observes a tender, swollen red furuncle on the upper lid margin of a child's eye. What treatment will the nurse practitioner recommend?

The primary care pediatric nurse practitioner applies fluorescein stain to a child's eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate?

A 14­year­old child has a 2­week history of severe itching and tearing of both eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe?

The primary care pediatric nurse practitioner performs a well baby assessment of a 5­day­old infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct?

A toddler exhibits exotropia of the right eye during a cover­uncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment?

During a well child exam on a 4­year­old child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded "20/50" for the child's vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend?

The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate

The primary care pediatric nurse practitioner performs a vision screen on a 4­ month­old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do?

A school­age child is hit in the face with a baseball bat and reports pain in one eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct?

A school­age child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do?

During a well child assessment of an African­American infant, the primary care pediatric nurse practitioner notes a dark red­brown light reflex in the left eye and a slightly brighter, red­orange light reflex in the right eye. The nurse practitioner will

A 14yearold child has a 2week history of severe itching and tearing of both eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along with stringy, mucoid discharge. What will the nurse practitioner prescribe?

The primary care pediatric nurse practitioner performs a well baby assessment of a 5dayold infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct?

A toddler exhibits exotropia of the right eye during a coveruncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment?

During a well child exam on a 4yearold child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded "20/50" for the child's vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend?

The primary care pediatric nurse practitioner performs a vision screen on a 4 monthold infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do?

A schoolage child is hit in the face with a baseball bat and reports pain in one eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is correct?

A schoolage child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do?

During a well child assessment of an AfricanAmerican infant, the primary care pediatric nurse practitioner notes a dark redbrown light reflex in the left eye and a slightly brighter, redorange light reflex in the right eye. The nurse practitioner will