can be eliminated if the test taker understands that otitis is not caused

by exposing the child to cold air.

35. 1. Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections.

2. A 2-year-old who has had multiple ear infections is a perfect candidate for ear tubes. The other issue is that a 2-year-old is at the height of language development, which can be adversely affected by recurrent ear infections.

3. A 7-year-old who has had two ear infec-tions is not the appropriate candidate.

Surgical intervention is usually reserved for children who have suffered from recurrent ear infections.

4. Surgery is not a prophylactic treatment.

Just because the sibling has had several ear infections does not suggest that the 3-year-old will also have frequent ear infections. The 3-year-old has not had an ear infection yet.

TEST-TAKING HINT:The test taker must also consider the developmental level of the child in this question. The 2-year-old has had multiple infections and is also at a stage at which language development is es-sential. If this child is not hearing appro-priately, speech will also be delayed. Surgi-cal intervention for otitis is reserved for those who have had recurrent infections.

36. 1. Hearing loss is not an issue that would be discussed following one ear infection.

Children with recurrent untreated ear infections are more likely to develop hearing loss.

2. Speech delays are not an issue that would be discussed following one ear infection.

Children with recurrent untreated ear infections are more likely to develop some hearing loss, which often results in delayed language development.

3. When children acquire an ear infection at such a young age, there is an in-creased risk of recurrent infections.

4. Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections.

TEST-TAKING HINT:Answers 1, 2, and 4 can be eliminated if the test taker under-stands that these are all long-term effects of recurrent ear infections. The question is asking about a single incident of otitis.

37. 1. It is important to educate the family about the signs and symptoms of an ear infection, but that is not the priority at this time. The infant has already been diagnosed with the infection.

2. The parents may need emotional support because they are likely suffering from a lack of sleep because their infant is ill.

However, this will not solve their current problems with their infant.

3. Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better.

4. Promoting drainage flow from the ear is important, but providing pain relief is the highest priority.

TEST-TAKING HINT:The test taker needs to consider the needs of the child and the parent at this time. If the pain is con-trolled, the parents and child will both be in a better state. The other items are all essential in providing care for the child with otitis, but pain relief offers the best opportunity for the child and the parent to return to normal conditions.

38. 1. RSV is not diagnosed by a blood draw.

2. Nasal secretions are tested to determine if a child has RSV.

3. The child is swabbed for nasal secre-tions. The secretions are tested to determine if a child has RSV.

4. Viral cultures are not done very often because it takes several days to receive

both a premature baby and a very young infant.

41. 1. Tachypnea, an increase in respiratory rate, should be monitored but is a common symptom of RAD.

2. Retractions should be monitored, but they are a common symptom of respiratory distress and RAD.

3. Wheezing should be monitored but is a common symptom of RAD.

4. Grunting is a sign of impending respi-ratory failure and is a very concerning physical finding.

TEST-TAKING HINT:The test taker can eliminate answers 1, 2, and 3 by knowing the signs and symptoms of respiratory distress. Answers 1, 2, and 3 are normal signs and symptoms of respiratory distress in an infant and can be expected. They warrant frequent respiratory assessment, but they are not the most concerning physical signs.

42. 1. RSV is a viral illness and is not treated with antibiotics.

2. Steroids are not used to treat RSV.

3. Racemic epinephrine promotes mucosal vasoconstriction.

4. Tylenol and Motrin can be given to the child for comfort, but they do not improve the child’s respiratory status.

TEST-TAKING HINT:This is a knowledge-level question that requires the test taker understand how RSV is treated.

43. 1. The night air will help decrease sub-glottic edema, easing the child’s respi-ratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider.

2. There is no immediate need to bring the child to the ER. The child’s symptoms will likely improve on the drive to the hospital because of the child’s exposure to the night air.

3. Over-the-counter cough suppressants are not recommended for children because they reduce their ability to clear secretions.

4. Warm liquids may increase subglottic edema and actually aggravate the child’s symptoms. Cool liquids or a popsicle are the best choice.

results. The culture does not have to be sent to an outside lab for evaluation.

TEST-TAKING HINT:The test taker can eliminate answers 1, 2, and 4 because the child’s nasal sections will be swabbed.

39. 1. Synagis will not help the child who has already contracted the illness. Synagis is an immunization and a method of primary prevention.

2. RSV is spread through direct contact with respiratory secretions, so it is a good idea to keep the ill child away from the healthy one.

3. RSV is spread through direct contact with respiratory secretions, so it is a good idea to have all persons coming in contact with the child wash their hands.

4. RSV is spread through direct contact with respiratory secretions, so it is a good idea to have ill persons avoid any contact with the children until they are well.

TEST-TAKING HINT:This is a knowledge-level question and requires that the test taker understand how RSV is transmitted and how to prevent the spread of the virus.

40. 1. Most children with RSV can be managed at home. Children 2 years and younger are at highest risk for developing complica-tions related to RSV. Children who were premature, have cardiac conditions, or have chronic lung disease are also at a higher risk for needing hospitalization.

The 3-year-old with a congenital heart disease is not the highest risk among this group of patients.

2. The younger the child, the greater the risk for developing complications re-lated to RSV. The age and the prema-ture status of this child make the the patient the highest risk.

3. Children who were premature, have cardiac conditions, or have chronic lung disease are also at a higher risk for needing hospitaliza-tion. This child was a former premature in-fant but is now 4 years of age.

4. This child has a tracheostomy, but this is not an indication that the child cannot be managed at home.

TEST-TAKING HINT:The test taker must know who is at greatest risk of complica-tions from RSV. The test taker must also consider that whereas all of these children have some amount of risk for requiring hospitalization, the 2-month-old has two of the noted risk factors. That child is

TEST-TAKING HINT:The test taker must accurately identify that the question is de-scribing a child with croup. The test taker must also have some knowledge of how croup is treated.

44. 1. This child has signs and symptoms of epiglottitis and should receive immedi-ate emergency medical treatment. The patient has no spontaneous cough and has a frog-like croaking because of a significant airway obstruction.

2. This child has signs and symptoms of acute laryngitis and is not in a significant amount of distress.

3. This child has signs and symptoms of LTB and is not in significant respiratory distress.

4. This child has signs and symptoms of bac-terial tracheitis and should be treated with antibiotics but is not the patient in the most significant amount of distress.

TEST-TAKING HINT:The test taker must accurately identify that the question is describing a child with epiglottitis. The test taker must also understand that epiglottitis is a pediatric emergency and can cause the child to have complete airway obstruction.

45. 1. Nasopharyngitis is a viral illness and does not require antibiotic therapy.

2. Children who attend day care are more prone to catching viral illnesses, but it is not the nurse’s place to tell the parents not to send their child to day care. Often families do not have a choice about using day care.

3. Nursing care for nasopharyngitis is primarily supportive. Keeping the child comfortable during the course of the illness is all the parents can do. Nasal congestion can be relieved using normal saline drops and a bulb suction. Tylenol can also be given for discomfort or a mild fever.

4. There is no reason to restrict the child to clear liquids. Many children have a de-creased appetite during a respiratory ill-ness, so the most important thing is to keep them hydrated.

TEST-TAKING HINT:This question requires the test taker to understand how

nasopharyngitis is treated.

46. 1. Retractions, low-grade fever, and nasal congestion are common symptoms of a respiratory illness and are not overly concerning.

2. When children are sitting in the tripod position, that is an indication they are having difficulty breathing. The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds indicate that there is fluid in the lungs and are indicative of a wors-ening condition. A muffled cough indi-cates that the child has some subglottic edema. This child has several signs and symptoms of a worsening respiratory condition.

3. Coarse breath sounds, cough, and fussi-ness are common signs and symptoms of a respiratory illness.

4. Restlessness, wheezes, poor feeding, and crying are common signs and symptoms of a respiratory illness.

TEST-TAKING HINT:The test taker can eliminate answers 1, 3, and 4 if familiar with common signs and symptoms of respiratory illness.

47. 1. A blood test does not indicate a diagnosis of epiglottitis. A CBC may show an in-creased white blood cell count indicating that the child has some sort of infection.

2. A throat culture is not done to diagnose epiglottitis. It is contraindicated to insert anything into the mouth or throat of any patient who is suspected of having epiglot-titis. Inserting anything into the throat could cause the child to have a complete airway obstruction.

3. A lateral neck x-ray is the method used to diagnose epiglottitis definitively.

The child is at risk for complete airway obstruction and should always be ac-companied by a nurse to the x-ray department.

4. Epiglottitis is not diagnosed based on signs and symptoms. A lateral neck film is the definitive diagnosis.

TEST-TAKING HINT:The test taker can elim-inate answers 1, 2, and 4 because epiglotti-tis is diagnosed by lateral neck films.

48. 1. This child is exhibiting signs and symp-toms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction.

2. Respiratory treatments often frighten chil-dren. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction.

51. 1. All children should be treated as individuals when they are being treated for a particular illness. However, most children exhibit similar symptoms when they have the same diagnosis. Younger children have worse symptoms than older children because their immune systems are less developed.

2. Children have airways that are shorter and narrower than those of an adult. As chil-dren age, their airways begin to grow in length and diameter.

3. Children are more prone to ear infections because they have eustachian tubes that are short and wide and lie in a horizontal plane.

4. Younger children have less developed immune systems and usually exhibit worse symptoms than older children.

TEST-TAKING HINT:Answer 1 can be elimi-nated because it does not directly address the mother’s question. Answer 2 can be eliminated if the test taker has knowledge of the anatomical structure of a child’s airway. Answer 3 can be eliminated be-cause the eustachian tubes have no direct relationship to acquiring croup.

52. 1. The child is exhibiting signs and symp-toms of croup and is not in any significant respiratory distress.

2. The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.

3. A tracheostomy is not indicated for this child. A tracheostomy would be indicated for a child with a complete airway obstruction.

4. This child is exhibiting signs and symptoms of croup and has no indication of tonsillitis.

A tonsillectomy is usually reserved for chil-dren who have recurrent tonsillitis.

TEST-TAKING HINT:The test taker must accurately identify that the question is describing a child with croup and know the accepted treatments.

53. 1. Cough suppressants are not recommended for children. Coughing is a protective mechanism, so do not try to stop it.

2. Cough expectorants are not recommended for children younger than 6 years of age.

There is no research information that they are effective.

3. Cold and flu medications are not indi-cated for children younger than 6 years of age as there is no indication they are effective.

3. This child is exhibiting signs and symp-toms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction.

The child should be allowed to remain on the parent’s lap and kept as comfortable as possible until a lateral neck film is obtained.

4. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. The child should be allowed to remain in the parent’s lap until a lateral neck film is obtained for a definitive diagnosis.

TEST-TAKING HINT:The test taker must accurately identify that the question is describing a child with epiglottitis. The test taker must understand that agitation in a child with epiglottitis can result in complete airway obstruction.

49. 1. Epiglottitis is bacterial in nature and requires intravenous antibiotics. A 7- to 10-day course of oral antibiotics is usually ordered following the intra-venous course of antibiotics.

2. Surgery is not the course of treatment for epiglottitis. Epiglottal swelling usually diminishes after 24 hours of intravenous antibiotics.

3. Ribavirin is an antiviral medication that is used to treat RSV.

4. Epiglottitis is bacterial in nature and re-quires intervention. A course of intravenous antibiotics is indicated for this patient.

TEST-TAKING HINT:Understanding that epiglottitis is bacterial in nature will lead the test taker to choose the correct answer.

50. 1. Epiglottitis is most common in children from 2 to 5 years of age. The onset is very rapid. Telling parents not to blame themselves is not effective. Parents tend to blame themselves for their child’s illnesses even though they are not responsible.

2. The nurse should not tell the parent to seek medical attention for any and all signs of illness.

3. Epiglottitis is rapidly progressive and can-not be predicted.

4. Epiglottitis is rapidly progressive and cannot be predicted.

TEST-TAKING HINT:When something hap-pens to a child, the parents always blame themselves. Telling them epiglottitis is rapidly progressive may be helpful.

4. Warm fluids, humidifcation, and honey are best treatments for a URI.

TEST-TAKING HINT:The latest recommen-dations for treatment of URIs in children are to treat the symptoms because cough medications are not effective.

54. 1. Pneumonia is most frequently caused by viruses but can also be caused by bacteria such as Streptococcus pneumoniae.

2. Children with bacterial pneumonia are usually sicker than children with viral pneumonia. Children with bacterial pneumonia can be treated effectively, but they require a course of antibiotics.

3. Children with viral pneumonia are not usually as ill as those with bacterial pneu-monia. Treatment for viral pneumonia in-cludes maintaining adequate oxygenation and comfort measures.

4. Treatment for viral pneumonia includes maintaining adequate oxygenation and comfort measures.

TEST-TAKING HINT:The test taker must have an understanding of the differences between viral and bacterial infections.

55. 1. These are all common symptoms of pneu-monia and should be monitored but do not require hospitalization. Most people with pneumonia are treated at home, with a focus on treating the symptoms and keeping the patient comfortable. Comfort measures include cool mist, CPT, an-tipyretics, fluid intake, and family support.

2. The teen who has been vomiting for several days and is unable to tolerate oral fluids and medication should be admitted for intravenous hydration.

3. These are all common symptoms of pneumonia and should be monitored but do not require hospitalization.

4. These are all common symptoms of pneumonia and should be monitored but do not require hospitalization.

TEST-TAKING HINT:The test taker can eliminate answers 1, 3, and 4 if familiar with the common signs and symptoms of pneumonia.

56. 1. The Trendelenburg position is not effec-tive for improving respiratory difficulty.

Patients with pneumonia are usually most comfortable in a semierect position.

2. Lying on the left side may provide the patient with the most comfort. Lying on the left splints the chest and reduces the pleural rubbing.

3. It is most comfortable for the patient to lie on the affected side. Lying on the left splints the chest and reduces the pleural rubbing.

4. Lying in the supine position does not pro-vide comfort for the patient and does not improve the child’s respiratory effort.

TEST-TAKING HINT:The test taker can eliminate answers 1 and 4 because neither of them would improve the child’s respi-ratory effort. Both these positions may actually cause the patient increased respiratory distress.

57. 1. The nurse should instruct the parents on signs and symptoms of aspiration pneumo-nia, but that is not the most beneficial piece of information the nurse can pro-vide. The most valuable information re-lates to preventing aspiration pneumonia from occurring in the future.

2. The nurse should instruct the parents on the treatment plan of aspiration pneumo-nia, but that is not the most beneficial piece of information the nurse can pro-vide. The most valuable information re-lates to preventing aspiration pneumonia from occurring in the future.

3. The nurse should instruct the parents on the risks associated with recurrent aspira-tion pneumonia, but that is not the most beneficial piece of information the nurse can provide. The most valuable informa-tion relates to preventing aspirainforma-tion pneumonia from occurring in the future.

4. The most valuable information the

4. The most valuable information the

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