PEDs: Chapter 18 (Resp)

A 6-month-old infant is admitted with nasal congestion and mild respiratory distress. Which anatomical characteristic places this infant at increased risk for airway obstruction?

A. Smaller tongue relative to the oropharynx

B. Obligate nasal breathing

C. Well-developed sinuses

D. Larger diameter bronchioles

B. Obligate nasal breathing

Rationale: Infants are obligate nose breathers and have small nasal passages; even mild congestion increases obstruction risk.

A. Incorrect: Their tongues are larger, but the major contributor to obstruction risk in infancy is nasal breathing.

C. Incorrect: Sinuses are underdeveloped, not a risk factor here.

D. Incorrect: bronchioles are narrow, not large.

The nurse is assessing a child with suspected respiratory acidosis. Which arterial blood gas finding supports this diagnosis?

A. pH 7.47, PaCO₂ 32 mmHg

B. pH 7.30, PaCO₂ 52 mmHg

C. pH 7.45, HCO₃ 18 mEq/L

D. pH 7.32, HCO₃ 12 mEq/L

B. pH 7.30, PaCO₂ 52 mmHg

Rationale: Low pH + high CO₂ = respiratory acidosis.

A. Incorrect: High pH + low CO₂ = respiratory alkalosis.

C. Incorrect: High pH + low HCO₃ = metabolic acidosis (compensated).

D. Incorrect: Low pH + low HCO₃ = metabolic acidosis.

A nurse cares for a premature infant with Respiratory Distress Syndrome (RDS). Which finding requires immediate intervention?

A. Grunting

B. Mild tachypnea

C. Nasal flaring while calm

D. Intermittent pauses in breathing <10 seconds

A. Grunting

Rationale: Grunting is a sign of impending respiratory failure.

B. Incorrect: Mild tachypnea is expected early in RDS.

C. Incorrect: Mild nasal flaring may occur but does not require immediate action alone.

D. Incorrect: Brief pauses <10 seconds are normal in infants.

A child with suspected foreign body aspiration has sudden onset stridor and difficulty breathing. What is the priority initial action?

A. Perform a chest x-ray

B. Encourage coughing

C. Perform back blows and chest thrusts

D. Prepare for bronchoscopy at bedside

C. Perform back blows and chest thrusts

Rationale: Sudden stridor + choking = foreign body aspiration → immediate airway clearance.

A. Incorrect: X-ray delays treatment.

B. Incorrect: Encouraging coughing may worsen obstruction if airway is severely compromised.

D. Incorrect: Bronchoscopy is done after stabilization.

A toddler with croup is brought to the ED. The parent reports the child has a "barky" cough and mild stridor at rest. Which provider order is most appropriate?

A. Albuterol nebulizer every hour

B. Cool mist humidification and dexamethasone

C. Immediate intubation

D. Broad-spectrum antibiotics

B. Cool mist humidification and dexamethasone

Rationale: Croup is treated with humidification + corticosteroids to reduce laryngeal inflammation.

A. Incorrect: Albuterol is for lower airway wheezing, not croup.

C. Incorrect: Intubation is only for severe respiratory distress.

D. Incorrect: Croup is viral → antibiotics not indicated.

A child is receiving chest physiotherapy (CPT) for thick pulmonary secretions. Which finding indicates CPT has been effective?

A. Decreased oxygen saturation

B. Increased work of breathing

C. Increased ability to expectorate sputum

D. Diminished breath sounds bilaterally

C. Increased ability to expectorate sputum

Rationale: CPT mobilizes secretions so they can be coughed out.

A. Incorrect: Decreased O2 saturation indicates worsening.

B. Incorrect: Increased work of breathing = ineffective treatment.

D. Incorrect: Diminished breath sounds may mean obstruction or collapse.

The nurse caring for a child with cystic fibrosis recognizes which diet prescription is appropriate?

A. Low-fat, high-protein diet

B. High-calorie, high-fat diet

C. Vegetarian, high-fiber diet

D. Low-sodium, low-protein diet

B. High-calorie, high-fat diet

Rationale: CF patients need high calories and fat due to malabsorption.

A. Incorrect: Low-fat would worsen malnutrition.

C. Incorrect: Fiber does not address malabsorption.

D. Incorrect: Sodium needs may be higher, not lower.

A child with bacterial pneumonia is admitted. Which clinical sign supports this diagnosis more than viral pneumonia?

A. Wheezing

B. Bark-like cough

C. Toxic appearance and high fever

D. Gradual onset congestion

C. Toxic appearance and high fever

Rationale: Bacterial pneumonia shows higher fever and sick appearance; viral is milder.

A. Incorrect: Wheezing suggests lower airway obstruction (e.g., asthma, RSV).

B. Incorrect: Barky cough = croup.

D. Incorrect: Gradual onset is viral.

A child with asthma has wheezing and decreased air movement on auscultation. Which medication should the nurse anticipate administering?

A. Dornase alfa

B. Palivizumab

C. Albuterol

D. Cetirizine

C. Albuterol

Rationale: Albuterol is a short-acting bronchodilator to relieve wheezing.

A. Incorrect: Dornase alfa is for CF mucus thinning.

B. Incorrect: Palivizumab prevents RSV, not used during asthma attack.

D. Incorrect: Cetirizine treats allergies, not acute wheezing.

A school-age child with allergic rhinitis reports persistent symptoms. Which teaching is most important for reducing symptom frequency?

A. Increase vitamin C intake

B. Avoid known environmental triggers

C. Begin prophylactic antibiotics

D. Restrict outdoor play entirely

B. Avoid known environmental triggers

Rationale: Best long-term management strategy for allergic rhinitis is trigger avoidance.

A. Incorrect: Vitamin C does not prevent allergic symptoms.

C. Incorrect: Antibiotics do not treat allergic conditions.

D. Incorrect: Restriction is unnecessary and harmful to development.

A patient with a chest tube exhibits continuous bubbling in the water-seal chamber. What should the nurse suspect?

A. The lung has fully re-expanded

B. Normal functioning of the system

C. An air leak in the system

D. The chest tube is clogged

C. An air leak in the system

Rationale: Continuous bubbling in the water seal = air leak.

A. Incorrect: Re-expanded lung shows no bubbling.

B. Incorrect: Normal water seal has intermittent, not continuous, bubbling.

D. Incorrect: Clogged tubing would reduce drainage, not cause bubbling.

A nurse notes intercostal retractions and nasal flaring in a 9-month-old. How should the nurse interpret this finding?

A. A normal respiratory pattern in infants

B. An early sign of decreased work of breathing

C. A sign of respiratory distress

D. A late sign of respiratory failure only

C. A sign of respiratory distress

Rationale: Retractions and nasal flaring = increased work of breathing.

A. Incorrect: These are not normal findings.

B. Incorrect: They indicate increased, not decreased, respiratory effort.

D. Incorrect: They can occur early or late, not only late.

A child recovering after tonsillectomy begins swallowing frequently. What is the nurse's immediate action?

A. Offer sips of warm fluids

B. Apply warm compress to throat

C. Notify the provider immediately

D. Encourage coughing to clear mucus

C. Notify the provider immediately

Rationale: Frequent swallowing = possible hemorrhage, a surgical emergency.

A. Incorrect: Warm fluids increase vasodilation and bleeding risk.

B. Incorrect: Warm compress does nothing for internal bleeding.

D. Incorrect: Coughing could cause further bleeding.

A nurse suspects epiglottitis in a febrile 4-year-old with drooling and stridor. What is the priority action?

A. Obtain a throat culture

B. Lay the child supine

C. Prepare for airway stabilization

D. Administer oral fluids slowly

C. Prepare for airway stabilization

Rationale: Epiglottitis can cause rapid airway obstruction.

A. Incorrect: Throat culture can trigger airway spasm.

B. Incorrect: Supine worsens obstruction.

D. Incorrect: Oral fluids risk aspiration.

A child with bronchiolitis caused by RSV is hospitalized. Which treatment approach is expected?

A. Frequent deep suctioning

B. Broad-spectrum antibiotics

C. Supportive care and hydration

D. Continuous corticosteroids

C. Supportive care and hydration

Rationale: RSV bronchiolitis is viral → supportive treatment.

A. Incorrect: Deep suctioning causes trauma; gentle suction only.

B. Incorrect: Antibiotics are not effective.

D. Incorrect: Steroids are not routinely recommended.

A 3-year-old child presents with sinusitis. Which presentation is consistent with this condition?

A. Barky cough and worse symptoms at night

B. Thick nasal discharge and facial pain

C. Fever and sandpaper rash

D. Drooling and refusal to swallow

B. Thick nasal discharge and facial pain

Rationale: Classic sinusitis symptoms.

A. Incorrect: Barky cough suggests croup.

C. Incorrect: Sandpaper rash suggests strep with scarlet fever.

D. Incorrect: Drooling suggests epiglottitis.

A child with latent tuberculosis infection begins treatment. Which medication should the nurse anticipate for prevention of active disease?

A. Rifampin for 6 months

B. Isoniazid for 9 months

C. Pyrazinamide and ethambutol for 12 weeks

D. Streptomycin IM weekly

B. Isoniazid for 9 months

Rationale: Standard treatment for latent TB.

A. Incorrect: Rifampin for latent TB is an alternative but not first-line for children.

C. Incorrect: Combo therapy is for active TB.

D. Incorrect: Streptomycin is used for resistant active TB, not latent.

The nurse prepares to suction a child with increased respiratory secretions. Which action is correct?

A. Apply suction continuously on insertion

B. Hyperoxygenate before and after suctioning

C. Suction for at least 20 seconds each pass

D. Perform deep frequent suctioning to prevent mucus plugs

B. Hyperoxygenate before and after suctioning

Rationale: Suctioning removes air → always hyperoxygenate to prevent hypoxia.

A. Incorrect: Suction only while withdrawing, not inserting.

C. Incorrect: Suction should last ≤10 seconds.

D. Incorrect: Deep frequent suctioning irritates airway.

A pediatric client has diminished breath sounds on the right side, tachypnea, and chest pain after trauma. Which condition does the nurse suspect?

A. Asthma exacerbation

B. Pneumothorax

C. Bronchiolitis

D. Croup

B. Pneumothorax

Rationale: Diminished breath sounds + chest pain + tachypnea → air in pleural space.

A. Incorrect: Asthma produces wheezing, not absent breath sounds asymmetrically.

C. Incorrect: Bronchiolitis causes wheezing and secretions, not absent breath sounds.

D. Incorrect: Croup affects upper airway, not lung expansion.

A premature infant requires home apnea monitoring. Which teaching is most essential prior to discharge?

A. Avoid touching the infant when alarms sound

B. Call the provider only if apnea lasts more than 60 seconds

C. Caregivers must know infant CPR

D. The monitor replaces the need for caregiver supervision

C. Caregivers must know infant CPR

Rationale: CPR training is essential for safe discharge.

A. Incorrect: Caregivers should respond immediately to alarms.

B. Incorrect: Apnea >20 seconds requires intervention, not 60.

D. Incorrect: The monitor does not replace supervision.