Which of the following are the PRIMARY muscles of respiration? (Select All that Apply.)

A. Whisper a set of random numbers and letters, and then ask the patient to repeat them: The whispered voice test is a simple and reliable screening method for hearing loss. The nurse stands about 2 feet behind the patient, whispers a series of random numbers or letters, and asks the patient to repeat them. This helps assess high-frequency hearing loss.

B. Shield the lips so that the sound is muffled: While the test is performed without the patient seeing the nurse’s lips to prevent lip reading, deliberately muffling the sound is unnecessary and may alter the accuracy of the assessment.

C. Stand approximately 6 feet away to ensure that the patient can really hear at this distance: The whispered voice test is conducted at a standard distance of about 2 feet, not 6 feet. Increasing the distance may make the test unreliable.

D. Ask the patient to place his or her finger in their ears to occlude outside noise: The test should be performed in a quiet environment, but instructing the patient to occlude their ears is unnecessary. Instead, the nurse tests one ear at a time by covering the opposite ear.

A. Lymphadenopathy: Enlarged lymph nodes typically indicate an immune response to infection or inflammation. While allergies can cause mild lymph node enlargement due to chronic irritation, they do not directly cause the characteristic facial signs described, such as the transverse nasal crease and allergic shiners.

B. Nasal congestion: Nasal congestion is a symptom rather than a primary diagnosis. Although allergies can cause nasal congestion, the child exhibits additional hallmark signs of allergic rhinitis, including allergic shiners, Dennie-Morgan lines, and a nasal crease, suggesting a chronic allergic process rather than isolated congestion.

C. Upper respiratory infection: Viral upper respiratory infections (URIs) can cause nasal congestion, sneezing, and watery eyes, but they are usually short-lived and accompanied by fever, malaise, or yellow-green nasal discharge. The presence of a nasal crease and allergic shiners suggests a chronic process like allergic rhinitis rather than an acute infection.

D. Chronic allergies: The presence of a transverse nasal crease from frequent "allergic salute" rubbing, dark periorbital circles (allergic shiners) due to venous congestion, and Dennie-Morgan lines (double creases under the eyes) are classic findings in allergic rhinitis. These symptoms, along with watery eyes and clear nasal drainage, strongly indicate a chronic allergic condition rather than an infectious cause.