Level 1
A 2-month-old infant has nasal congestion. Why can this quickly cause breathing difficulty?
A. Infants mainly breathe through their mouths
B. Infants are obligate nose breathers early in life
C. Infants have large nasal passages
D. Infants have stronger intercostal muscles
Answer: B
Rationale:Young infants primarily breathe through their nose, so congestion can significantly impair breathing. Their nasal passages are also small, which worsens obstruction.
Which finding best describes a retraction?
A. Bluish lips
B. Widening of the nostrils
C. Sinking of the skin of the chest or neck during breathing
D. Crackling heard on auscultation
Answer: C
Rationale:Retractions are the sinking in of the skin around the chest or neck caused by increased work of breathing.
A child with RSV is admitted to the pediatric unit. Which intervention is the priority?
A. Encourage running to mobilize secretions
B. Frequent suctioning and close respiratory assessment
C. Begin oral antibiotics
D. Restrict oxygen to prevent dependence
Answer: B
Rationale:RSV care is largely supportive, and frequent suctioning with close respiratory monitoring is a key intervention.
A 3-year-old child is admitted with worsening respiratory distress. The nurse notes tachypnea, moderate retractions, nasal flaring, and an oxygen saturation of 88% on room air. The provider prescribes oxygen therapy. Which device would the nurse anticipate using first for severe hypoxia without intubation?
A. Nasal cannula
B. Simple face mask
C. Non-rebreather mask
D. Humidifier by bedside
Correct answer: C. Non-rebreather mask
Rationale:The non-rebreather mask provides the highest oxygen concentration without intubation and is used for severe hypoxia and emergency situations.
A 7-year-old child with asthma is brought to the clinic after playing outside during high pollen season. The child has wheezing, chest tightness, and shortness of breath. Which statement best explains the child’s symptoms?
A. Allergens decrease airway inflammation
B. Allergens can trigger airway inflammation, mucus production, and bronchospasm
C. Asthma symptoms are usually caused only by bacterial infection
D. Pet dander and pollen do not affect asthma
Correct answer: B. Allergens can trigger airway inflammation, mucus production, and bronchospasm
Rationale:Common asthma triggers such as pollen, pet dander, dust, smoke, and cold air can increase inflammation, mucus, wheezing, and shortness of breath.
Which assessment finding is an early sign of respiratory distress in a child?
A. Lethargy
B. Weak respiratory effort
C. Nasal flaring
D. Respiratory arrest
Answer: C
Rationale:Nasal flaring is an early sign of increased work of breathing. Late findings include weak effort and lethargy.
Which respiratory finding is considered a late sign of respiratory distress in an infant?
A. Tachypnea
B. Restlessness
C. Head bobbing
D. Nasal drainage
Answer: C
Rationale:Head bobbing is a late sign of respiratory distress and suggests the infant is working very hard to breathe.
Which illness is most associated with a barking cough and inspiratory stridor?
A. Bronchitis
B. Croup
C. Sinusitis
D. Otitis media
Answer: B
Rationale:Croup causes swelling of the larynx, trachea, and bronchi and is associated with inspiratory stridor and a barking cough.
A 10-month-old infant with bronchiolitis is admitted with moderate to severe respiratory distress. The infant is tachypneic, has increased work of breathing, and is not tolerating a simple mask well. Which oxygen delivery method is most appropriate?
A. Standard nasal cannula at 1 L/min
B. Heated high-flow nasal cannula
C. Room air with suctioning only
D. Noninvasive ventilation should always be first
Correct answer: B. Heated high-flow nasal cannula
Rationale:Heated high-flow nasal cannula is commonly used in pediatrics for moderate to severe respiratory distress because it improves oxygenation, decreases work of breathing, and is often better tolerated.
A school-age child with asthma uses a peak flow meter at home. Today the child’s reading is 45% of personal best and the child is wheezing. How should the nurse interpret this finding?
A. Green zone, continue routine medications only
B. Yellow zone, repeat tomorrow
C. Red zone, this is a medical alert
D. Normal result for a child with asthma
Correct answer: C. Red zone, this is a medical alert
Rationale:A peak flow of less than 50% of personal best is the red zone and indicates a medical alert. The chart on page 21 shows this zone as requiring urgent action.
Which breath sound is most concerning because it suggests upper airway obstruction?
A. Crackles
B. Rhonchi
C. Wheezing
D. Stridor
Answer: D
Rationale:Stridor is a high-pitched inspiratory sound and is a medical emergency because it suggests upper airway obstruction.
A child has a low-pitched snoring sound caused by secretions in larger airways. Which sound is this?
A. Wheeze
B. Rhonchi
C. Stridor
D. Pleural friction rub
Answer: B
Rationale:Rhonchi are low-pitched, continuous sounds caused by secretions in the larger airways.
Which statement about antibiotics for respiratory illness requires correction?
A. “Cultures should be obtained before starting antibiotics.”
B. “My child should finish the full prescription.”
C. “Antibiotics work well for viral colds.”
D. “I should watch for allergic reactions.”
Answer: C
Rationale: Antibiotics do not treat viral colds. They are used only when a bacterial infection is present or suspected.
A nurse is suctioning the nares of a 6-month-old infant with RSV. Which action by the nurse is appropriate?
A. Suction for 60 seconds to fully clear secretions
B. Insert the catheter forcefully if resistance is felt
C. Use gentle technique, appropriate-sized equipment, and limit suction time
D. Suction only after the infant becomes cyanotic
Correct answer: C. Use gentle technique, appropriate-sized equipment, and limit suction time
Rationale:Pediatric suctioning should be gentle, use the correct-sized equipment, and last less than 30 seconds to reduce trauma and worsening hypoxia.
A 6-year-old child is postoperative day 8 after a tonsillectomy. The parent reports the child keeps swallowing, looks pale, and seems restless. What is the nurse’s priority interpretation?
A. These are normal healing findings
B. The child may be having a postoperative hemorrhage
C. The child is probably dehydrated only
D. These are expected effects of sore throat
Correct answer: B. The child may be having a postoperative hemorrhage
Rationale:The highest risk for hemorrhage after tonsillectomy is 7 to 10 days post-op. Frequent swallowing, pallor, restlessness, tachycardia, and bright red bleeding are concerning findings.
A nurse is caring for a child with a viral cold. Which treatment is most appropriate?
A. Start antibiotics immediately
B. Restrict fluids
C. Provide supportive care and monitor for respiratory distress
D. Avoid fever treatment
Answer: C
Rationale:Most pediatric viral illnesses are treated with supportive care, such as hydration, fever management, suctioning, and monitoring for worsening respiratory distress. Antibiotics are not used for viral colds.
Which child is showing a red-flag sign of worsening respiratory status?
A. Mild runny nose
B. Capillary refill greater than 3 seconds
C. Sneezing after suctioning
D. Occasional cough
Answer: B
Rationale:Poor perfusion, such as capillary refill greater than 3 seconds, is a red flag and may indicate worsening oxygenation and circulation.
A child receiving vancomycin develops flushing and an itchy red rash during infusion. What should the nurse suspect?
A. Anaphylaxis only
B. Stevens-Johnson syndrome
C. Red man syndrome
D. Pneumothorax
Answer: C
Rationale:Vancomycin can cause red man syndrome, especially if it is infused too quickly.
A 5-year-old child is admitted with fever, irritability, poor appetite, congestion, and increased work of breathing. The child requires oxygen support and frequent suctioning. Which interpretation by the nurse is best?
A. These findings are not consistent with pneumonia in children
B. Children with pneumonia often present with nonspecific findings like these
C. Pneumonia in children always presents with chest pain first
D. Productive cough must be present for pneumonia
Correct answer: B. Children with pneumonia often present with nonspecific findings like these
Rationale:Pediatric pneumonia often presents with nonspecific symptoms, including fever, irritability, poor appetite, congestion, increased work of breathing, and oxygen need.
A toddler with cystic fibrosis is seen in clinic for follow-up. Which assessment finding should the nurse expect?
A. Thin secretions and low sweat chloride
B. Salty-tasting skin and thick mucus
C. Bradycardia and absent cough
D. No risk for respiratory infection
Correct answer: B. Salty-tasting skin and thick mucus
Rationale:Cystic fibrosis commonly presents with salty-tasting skin, thick mucus, persistent cough, wheezing, and frequent lung infections.
A parent asks why their toddler gets tired quickly when sick with a respiratory illness. Which explanation by the nurse is best?
A. Children have more lung reserve than adults
B. Children have less efficient gas exchange and limited reserve
C. Children use intercostal muscles more effectively than adults
D. Children have larger alveoli than adults
Answer: B
Rationale:Children have higher oxygen needs, less efficient gas exchange, and limited reserve, so they fatigue faster during respiratory illness.
A child with respiratory distress is anxious, irritable, and breathing fast. What should the nurse recognize?
A. These are harmless signs of fever only
B. These are early signs of hypoxia and respiratory distress
C. These are expected signs of recovery
D. These are signs of renal failure
Answer: B
Rationale:Restlessness, irritability, anxiety, and tachypnea are important early signs that a child may be becoming hypoxic and struggling to breathe.
The nurse is teaching about cephalosporins. Which history is most important to review before administration?
A. Use of sunscreen
B. Penicillin allergy
C. Last bowel movement
D. Daily protein intake
Answer: B
Rationale:Cephalosporins can have cross-sensitivity with penicillins, so allergy history is especially important.
A child is receiving oxygen through a non-rebreather mask for acute hypoxia. During reassessment, the nurse notes the reservoir bag is collapsed. What is the nurse’s priority action?
A. Remove the mask and place the child on room air
B. Document the finding as expected
C. Correct the oxygen setup because the child may not be receiving adequate oxygen
D. Lower the oxygen flow rate to prevent oxygen toxicity
Correct answer: C. Correct the oxygen setup because the child may not be receiving adequate oxygen
Rationale:With a non-rebreather mask, the reservoir bag must remain inflated. If it collapses, oxygen delivery is inadequate and the setup must be corrected right away.
A child with cystic fibrosis has had frequent lung infections and poor weight gain. Which provider order should the nurse question?
A. Chest physiotherapy
B. High-calorie, high-fat diet
C. Encourage airway clearance therapy
D. Start a low-fat, low-calorie diet
Correct answer: D. Start a low-fat, low-calorie diet
Rationale:Children with cystic fibrosis need a high-calorie, high-fat diet because of increased nutritional needs and malabsorption risk. A low-fat, low-calorie diet would be inappropriate.