can be eliminated if the test taker understands that bacterial

infections need to be treated with antibiotics.

12. 1. Gargling with warm saline is a recom-mended treatment to relieve some of the discomfort associated with pharyngi-tis and is appropriate for a 5-year-old child.

2. Encouraging ice chips is a recommended treatment to relieve some of the discom-fort associated with pharyngitis and is an acceptable choice for a 5-year-old child.

3. Tylenol is a suggested treatment for relief of discomfort related to pharyngitis for children of all ages.

4. Pharyngitis is a self-limiting viral ill-ness that does not require antibiotic therapy. Pharyngitis should be treated with rest and comfort measures, in-cluding Tylenol, throat sprays, cold liquids, and popsicles.

TEST-TAKING HINT:Answers 1, 2, and 3 are comfort measures and are develop-mentally appropriate for the age of the child. The question requires that the student have knowledge regarding pharyngitis.

4. The nurse’s best intervention is to let the parents express their concerns and fears. The nurse should be available if the parents have any other concerns or questions or if they just need someone with whom to talk.

TEST-TAKING HINT:When parents are given information that their child has a chronic life-threatening disease, they are not capable of processing all the informa-tion right away, they need time. The parents are often given more information than they can possibly understand and often just need someone to listen to their concerns and needs.

9. 1. Strict bedrest is not necessary. Children with respiratory illnesses usually self-limit their activity. Parents just need to ensure that their children are getting adequate rest.

2. It is not necessary to avoid contact with family members. Nasopharyngitis is spread by contact with the secretions, so hand washing is the key to limiting the spread of the virus.

3. Infants are nose breathers and often have increased difficulty when they are congested. Nasal saline drops and gen-tle suctioning with a bulb syringe are often recommended.

4. The head of the bed should be elevated in order to help with the drainage of secretions.

TEST-TAKING HINT:The test taker can eliminate answer 4 given a basic under-standing of interventions to improve respiratory function.

10. 1. It is common for children to have a de-creased appetite when they have a respira-tory illness. However, the nurse needs to be sure to instruct the parent that the child take in an adequate amount of fluid in order to stay hydrated.

2. It is common for children to have a decreased appetite when they have a respiratory illness. The nurse is appro-priately instructing the parent that the child will be fine by taking in an adequate amount of fluid.

3. The child may want to eat some favorite foods; however, the child will be fine if an adequate amount of fluid is maintained.

4. The parent should not force the child to eat; the child’s appetite should return in a couple of days.

TEST-TAKING HINT:Answer 4 can be elimi-nated because one should not force the

13. 1. School systems require that children re-main home for 24 hours after having a documented fever. However, in this ques-tion the child has been diagnosed with strep throat. Even if the child is fever-free, the child must have completed a 24-hour course of antibiotics before returning to school. Children with strep throat are no longer contagious 24 hours after initiation of antibiotic therapy.

2. Children with strep throat are no longer contagious 24 hours after initia-tion of antibiotic therapy.

3. Children with strep throat are no longer contagious 24 hours after initiation of antibiotic therapy.

4. School systems require that children remain home for 24 hours after having a documented fever. However, in this ques-tion the child has been diagnosed with strep throat. Even if the child is fever-free, the child must have completed a 24-hour course of antibiotics before returning to school. Children with strep throat are no longer contagious 24 hours after initiation of antibiotic therapy.

TEST-TAKING HINT:The test taker can elim-inate answers 1 and 4 given knowledge of the communicability of strep throat.

14. 1. The patient is complaining of pain so it is not unusual that there is an elevated heart rate and blood pressure. The nurse should address the pain by giving any prn pain medications ordered or calling the physi-cian for an order.

2. Most children will complain after a tonsil-lectomy. This is expected.

3. Oral intake is usually limited to popsicles, ice chips, and cold liquids following a ton-sillectomy. The child is in pain and should not be expected to be eating solid foods 8 hours after surgery.

4. Excessive swallowing is a sign that the child is swallowing blood. This should be considered a medical emer-gency, and the physician should be contacted immediately. The child is likely bleeding and will need to return to surgery.

TEST-TAKING HINT:Answer 1 can be elimi-nated if the test taker understands the common vital-sign changes that occur when a person is experiencing pain.

15. 1. A child should be restricted to soft foods for the first couple of days postoperatively.

Soft foods are recommended because the child will have a sore throat for several days

following surgery. Soft foods are also rec-ommended to decrease the risk of bleeding.

2. Most children self-limit their food intake postoperatively. Children can have solids, but soft foods are recommended for the first several postoperative days.

3. Most children prefer to eat cold foods, but they are not restricted to them.

4. Soft foods are recommended to limit the child’s pain and to decrease the risk for bleeding.

TEST-TAKING HINT:The test taker can eliminate answer 1 by knowing there are usually some dietary restrictions following any surgical procedure.

16. 1. The CBC gives the health-care team in-formation about the child’s red and white blood cell count and hemoglobin and hematocrit levels. The CBC indicates if the child has or is developing an infection but nothing about the child’s current respiratory status.

2. The ABG gives the health-care team valuable information about the child’s respiratory status: level of oxygenation, carbon dioxide, and blood pH.

3. The BUN provides information about the patient’s kidney function but nothing re-garding the patient’s respiratory status.

4. The PTT provides information about how long it takes the patient’s blood to clot but nothing about the patient’s respiratory status.

TEST-TAKING HINT:The test taker can eliminate answers 1, 2, and 4 with a knowledge of common laboratory tests.

17. 1. The nurse needs to know when the child ate last in the event that the child may need to be intubated for severe respiratory distress, but it is not the most vital piece of information in order to best treat the child for the current state of distress.

2. The nurse needs to know if the child was exposed to anything that usually triggers the asthma, but that is not the most im-portant information for treating the child’s immediate need.

3. Knowing when the child was admitted last will give the nurse an idea of the severity of the child’s asthma, but that is not the most important information for treating the child’s immediate need.

4. The nurse needs to know what med-ication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.

child for allergies can help avoid an asthma attack. Singulair, however, does not help a child immediately with the symptoms of a particular asthma attack.

3. Albuterol is the quick-relief bron-chodilator of choice for treating an asthma attack.

4. Flovent is a long-term therapy medication for asthmatics and should be used in con-junction with quick-relief medications.

TEST-TAKING HINT:The test taker must know the medications used to treat asthma and which are used in which situations.

21. 1. This child is exhibiting symptoms of mild asthma and should not be seen before the other children.

2. This child is exhibiting signs of moderate asthma and should be watched but is not the patient of highest priority.

3. This child is exhibiting signs of severe asthma. This child should be seen first.

The child no longer has wheezes and now has diminished breath signs.

4. This child is exhibiting signs of moderate asthma and is not the patient of highest priority.

TEST-TAKING HINT:The test taker can eliminate answers 1, 2, and 4 by knowing that diminished breath sounds are a sign the patient has a worsening condition.

The other bit of information that is essential in this problem is the child’s age. The younger the child, the faster the respiratory status can diminish.

22. 1. A child of 3 years old is too young to comply with incentive spirometry.

2. Breathing into a paper bag results in a prolonged inspiratory and expiratory phase.

3. Blowing a pinwheel is an excellent means of increasing a child’s expira-tory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child’s expiratory phase.

4. Taking deep breaths results in a prolonged inspiratory phase.

TEST-TAKING HINT:The test taker can eliminate answers 1 and 4 by considering the age of the child: 3 years. Play is one of the best ways to engage young children in therapeutic activities.

TEST-TAKING HINT:Whereas all of the in-formation here is essential, answer 4 gives the most important information. The test taker can eliminate answers 2 and 3 be-cause the responses to these inquiries have no direct impact on the immediate treatment of the child. These two answers give information about the severity of the child’s illness but they do not affect the immediate treatment plan. Answer 4 is essential to deciding what medication should be given the child to relieve the current symptoms.

18. 1. It is essential that the child take all of the scheduled asthma medications, but there is no guarantee the child will be fine and be able to play all sports.

2. When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging.

3. Children diagnosed at an early age usually exhibit worse symptoms than those diag-nosed later in life.

4. Children with asthma are encouraged to participate in sports, but they are also in-structed to take scheduled bronchodilator medication prior to any sports activity.

TEST-TAKING HINT:The test taker can eliminate answer 4 because not all asthmatics also have exercise-induced asthma necessitating use of a fast-acting bronchodilator before playing.

19. 1. The parent should always give one puff at a time and should wait 1 minute be-fore administering the second puff.

2. A spacer is recommended when adminis-tering medications by MDI to children.

3. The child should be in an upright posi-tion when medicaposi-tions are administered by MDI.

4. The inhaler should always be shaken before administering a dose of the medication.

TEST-TAKING HINT:The test taker evalu-ates how the parents administer the MDI.

20. 1. Prednisone, a corticosteroid, is often given to children with asthma, but it is not a quick-relief medication. The pred-nisone will take time to relieve the child’s symptoms.

2. Singulair is an allergy medication that should be taken daily by asthmatics with significant allergies. Allergens are often triggers for asthmatics, so treating the

23. 1. It is better to maintain 30% to 50% humid-ity in homes of asthmatic children. How-ever, humidifiers are not recommended because they can harbor mold as a result of lack of proper cleaning.

2. Chemical cleaning is not recommended because the chemicals used can be a trig-ger and actually cause the child to have an asthma attack. The best recommendation is to remove all carpet from the house, if possible.

3. Household pets are not recommended for children with asthma.

4. Leather furniture is recommended rather than upholstered furniture.

Upholstered furniture can harbor large amounts of dust, whereas leather furniture may be wiped off regularly with a damp cloth.

TEST-TAKING HINT:The test taker can eliminate answer 3 because there is no known way to make a pet allergy-free.

Household pets are discouraged for all children with asthma or severe allergies.

Answer 2 can be eliminated if the test