Shadow Health Pediatrics - Kyle Reeves |
Focused Exam: Cystic Fibrosis | Complete
Subjective & Objective Data, Respiratory
Assessment, Documentation, Care Plan &
Clinical Reasoning | 2026/2027 Updated
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
147 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam evaluates application-level mastery of the Shadow Health Pediatrics Focused Exam for a pediatric
client with cystic fibrosis, integrating complete subjective and objective data collection, respiratory
assessment, clinical documentation, care planning, and clinical reasoning. Items span pathophysiology,
respiratory and GI manifestations, diagnostic testing, pharmacologic and airway-clearance management,
nutrition, infection control, and patient/family education.
STUDY GUIDE
Recommended duration: 75 minutes. Passing target: 75% (minimum); 90%+ recommended for A-level
mastery.
HIGHP - Page 1 of 48
,1. A pediatric client with cystic fibrosis is admitted with a pulmonary exacerbation. Which
set of assessment findings best reflects the underlying pathophysiology of the disease?
[ ] A. Increased anterior-posterior chest diameter, hyperresonance to percussion, and decreased tactile
fremitus
[ ] B. Inspiratory stridor, barky cough, and diminished breath sounds at the lung bases
[ ] C. Fine crackles at the bases, dullness to percussion, and increased tactile fremitus
[ ] D. Wheezing throughout all lung fields, prolonged expiration, and a barrel-shaped chest
CORRECT: A. Increased anterior-posterior chest diameter, hyperresonance to percussion, and
decreased tactile fremitus
CF causes hyperinflation from air trapping, producing barrel chest, hyperresonance, and decreased fremitus.
Fine crackles with dullness and increased fremitus (C) suggest consolidation, not CF. Stridor and barky
cough (B) suggest croup, and diffuse wheezing (D) is more consistent with asthma.
2. A child with cystic fibrosis is prescribed a high-calorie, high-fat diet. Which rationale
best supports this prescription?
[ ] A. Fat provides essential fatty acids that reduce pulmonary inflammation
[ ] B. Pancreatic insufficiency impairs fat digestion, so increased intake compensates for malabsorption
[ ] C. High-fat foods decrease mucus viscosity in the airways
[ ] D. Fat slows gastric emptying, improving pancreatic enzyme efficacy
CORRECT: B. Pancreatic insufficiency impairs fat digestion, so increased intake compensates for
malabsorption
Exocrine pancreatic insufficiency in CF leads to fat malabsorption and steatorrhea, requiring increased caloric
and fat intake along with enzyme replacement. Fat does not reduce airway inflammation (A) or mucus
viscosity (C), and delayed gastric emptying (D) is not the goal.
3. Which finding on a pediatric respiratory assessment is most consistent with a cystic
fibrosis exacerbation and should be documented as a priority concern?
[ ] A. Respiratory rate of 22 with mild subcostal retractions and SpO2 94% on room air
[ ] B. Clear breath sounds with occasional cough after activity
[ ] C. Bilateral coarse crackles with increased work of breathing and SpO2 89% on room air
[ ] D. Respiratory rate of 18 with no retractions and SpO2 98% on room air
CORRECT: C. Bilateral coarse crackles with increased work of breathing and SpO2 89% on room air
Coarse crackles, increased work of breathing, and hypoxemia (SpO2 <90%) indicate a significant
exacerbation requiring immediate intervention. Mild retractions with SpO2 94% (A) are concerning but less
urgent, and clear breath sounds (B, D) suggest stability.
HIGHP - Page 2 of 48
,4. A provider orders airway clearance therapy for a child with cystic fibrosis. Which
intervention should the nurse anticipate as the priority before chest physiotherapy?
[ ] A. Administer a bronchodilator 15-20 minutes before therapy
[ ] B. Perform postural drainage in the Trendelenburg position immediately after meals
[ ] C. Withhold pancreatic enzymes until after therapy
[ ] D. Encourage the child to drink 8 oz of water immediately before therapy
CORRECT: A. Administer a bronchodilator 15-20 minutes before therapy
A bronchodilator given 15-20 minutes before chest physiotherapy optimizes airway opening and mucus
clearance. Postural drainage should not be performed immediately after meals (B). Enzymes are unrelated
(C), and drinking large volumes immediately before therapy (D) may increase discomfort and reflux risk.
5. A child with cystic fibrosis has a sweat chloride test result of 58 mmol/L. How should
the nurse interpret this finding?
[ ] A. Normal; CF is excluded
[ ] B. Intermediate; further testing such as genetic analysis is indicated
[ ] C. Diagnostic of cystic fibrosis
[ ] D. Invalid; the test must be repeated after 24 hours
CORRECT: B. Intermediate; further testing such as genetic analysis is indicated
Sweat chloride values of 30-59 mmol/L are intermediate and require additional evaluation, often genetic
testing. Values 60 mmol/L are diagnostic (C), values <30 mmol/L are normal (A), and the test is not
invalidated by a single intermediate result (D).
6. A child with cystic fibrosis is prescribed dornase alfa. Which statement by the caregiver
indicates correct understanding of the medication?
[ ] A. It will help thin the mucus in the lungs so it can be coughed out more easily.
[ ] B. It will replace the pancreatic enzymes my child is missing.
[ ] C. It will prevent the need for chest physiotherapy.
[ ] D. It will cure the underlying genetic defect.
CORRECT: A. It will help thin the mucus in the lungs so it can be coughed out more easily.
Dornase alfa is a recombinant DNase that cleaves extracellular DNA in mucus, reducing viscosity and
improving clearance. It does not replace enzymes (B), eliminate the need for airway clearance (C), or correct
the genetic defect (D).
7. When documenting a focused respiratory assessment for a child with cystic fibrosis,
which entry is most appropriate and complete?
[ ] A. Lungs clear to auscultation bilaterally; no cough; respiratory effort even and unlabored.
[ ] B. Coarse crackles in bilateral bases; mild subcostal retractions; productive cough with thick,
HIGHP - Page 3 of 48
, tenacious sputum; SpO2 92% on room air.
[ ] C. Diminished breath sounds on the right; tracheal deviation to the left; absent breath sounds on the
right.
[ ] D. Wheezing throughout all lung fields; prolonged expiratory phase; use of accessory muscles.
CORRECT: B. Coarse crackles in bilateral bases; mild subcostal retractions; productive cough with
thick, tenacious sputum; SpO2 92% on room air.
Option B accurately captures the hallmark findings of a CF exacerbation: coarse crackles, retractions,
productive cough with thick sputum, and hypoxemia. Option A is incomplete for an exacerbation, C describes
pneumothorax, and D is more consistent with asthma.
8. A child with cystic fibrosis is admitted with a pulmonary exacerbation. Which nursing
diagnosis should be prioritized in the care plan?
[ ] A. Imbalanced nutrition: less than body requirements related to malabsorption
[ ] B. Ineffective airway clearance related to increased mucus viscosity and retention
[ ] C. Risk for impaired skin integrity related to decreased mobility
[ ] D. Anxiety related to hospitalization and unfamiliar environment
CORRECT: B. Ineffective airway clearance related to increased mucus viscosity and retention
Ineffective airway clearance is the priority because it directly addresses the immediate respiratory
compromise. Nutrition (A) and anxiety (D) are important but secondary, and skin integrity (C) is not the priority
in this acute respiratory context.
9. Which statement by a caregiver of a child with cystic fibrosis indicates a need for
further teaching about infection control?
[ ] A. We will keep our child away from other children with cystic fibrosis at school.
[ ] B. We will ensure our child receives all recommended immunizations, including influenza.
[ ] C. We will use a separate nebulizer for each family member.
[ ] D. We will encourage our child to attend large indoor gatherings to build immunity.
CORRECT: D. We will encourage our child to attend large indoor gatherings to build immunity.
Children with CF should avoid crowded indoor environments due to increased risk of respiratory infections,
especially with pathogens like Pseudomonas and Burkholderia. Avoiding contact with other CF patients (A),
staying current on vaccines (B), and using separate nebulizers (C) are appropriate.
10. A child with cystic fibrosis presents with a chronic productive cough and recurrent
respiratory infections. The nurse anticipates which finding on the shadow health focused
exam that best reflects the underlying pathophysiology of CF?
[ ] A. Increased sweat chloride concentration above 60 mmol/L
[ ] B. Elevated serum immunoglobulin E (IgE) levels
HIGHP - Page 4 of 48
Focused Exam: Cystic Fibrosis | Complete
Subjective & Objective Data, Respiratory
Assessment, Documentation, Care Plan &
Clinical Reasoning | 2026/2027 Updated
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
147 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam evaluates application-level mastery of the Shadow Health Pediatrics Focused Exam for a pediatric
client with cystic fibrosis, integrating complete subjective and objective data collection, respiratory
assessment, clinical documentation, care planning, and clinical reasoning. Items span pathophysiology,
respiratory and GI manifestations, diagnostic testing, pharmacologic and airway-clearance management,
nutrition, infection control, and patient/family education.
STUDY GUIDE
Recommended duration: 75 minutes. Passing target: 75% (minimum); 90%+ recommended for A-level
mastery.
HIGHP - Page 1 of 48
,1. A pediatric client with cystic fibrosis is admitted with a pulmonary exacerbation. Which
set of assessment findings best reflects the underlying pathophysiology of the disease?
[ ] A. Increased anterior-posterior chest diameter, hyperresonance to percussion, and decreased tactile
fremitus
[ ] B. Inspiratory stridor, barky cough, and diminished breath sounds at the lung bases
[ ] C. Fine crackles at the bases, dullness to percussion, and increased tactile fremitus
[ ] D. Wheezing throughout all lung fields, prolonged expiration, and a barrel-shaped chest
CORRECT: A. Increased anterior-posterior chest diameter, hyperresonance to percussion, and
decreased tactile fremitus
CF causes hyperinflation from air trapping, producing barrel chest, hyperresonance, and decreased fremitus.
Fine crackles with dullness and increased fremitus (C) suggest consolidation, not CF. Stridor and barky
cough (B) suggest croup, and diffuse wheezing (D) is more consistent with asthma.
2. A child with cystic fibrosis is prescribed a high-calorie, high-fat diet. Which rationale
best supports this prescription?
[ ] A. Fat provides essential fatty acids that reduce pulmonary inflammation
[ ] B. Pancreatic insufficiency impairs fat digestion, so increased intake compensates for malabsorption
[ ] C. High-fat foods decrease mucus viscosity in the airways
[ ] D. Fat slows gastric emptying, improving pancreatic enzyme efficacy
CORRECT: B. Pancreatic insufficiency impairs fat digestion, so increased intake compensates for
malabsorption
Exocrine pancreatic insufficiency in CF leads to fat malabsorption and steatorrhea, requiring increased caloric
and fat intake along with enzyme replacement. Fat does not reduce airway inflammation (A) or mucus
viscosity (C), and delayed gastric emptying (D) is not the goal.
3. Which finding on a pediatric respiratory assessment is most consistent with a cystic
fibrosis exacerbation and should be documented as a priority concern?
[ ] A. Respiratory rate of 22 with mild subcostal retractions and SpO2 94% on room air
[ ] B. Clear breath sounds with occasional cough after activity
[ ] C. Bilateral coarse crackles with increased work of breathing and SpO2 89% on room air
[ ] D. Respiratory rate of 18 with no retractions and SpO2 98% on room air
CORRECT: C. Bilateral coarse crackles with increased work of breathing and SpO2 89% on room air
Coarse crackles, increased work of breathing, and hypoxemia (SpO2 <90%) indicate a significant
exacerbation requiring immediate intervention. Mild retractions with SpO2 94% (A) are concerning but less
urgent, and clear breath sounds (B, D) suggest stability.
HIGHP - Page 2 of 48
,4. A provider orders airway clearance therapy for a child with cystic fibrosis. Which
intervention should the nurse anticipate as the priority before chest physiotherapy?
[ ] A. Administer a bronchodilator 15-20 minutes before therapy
[ ] B. Perform postural drainage in the Trendelenburg position immediately after meals
[ ] C. Withhold pancreatic enzymes until after therapy
[ ] D. Encourage the child to drink 8 oz of water immediately before therapy
CORRECT: A. Administer a bronchodilator 15-20 minutes before therapy
A bronchodilator given 15-20 minutes before chest physiotherapy optimizes airway opening and mucus
clearance. Postural drainage should not be performed immediately after meals (B). Enzymes are unrelated
(C), and drinking large volumes immediately before therapy (D) may increase discomfort and reflux risk.
5. A child with cystic fibrosis has a sweat chloride test result of 58 mmol/L. How should
the nurse interpret this finding?
[ ] A. Normal; CF is excluded
[ ] B. Intermediate; further testing such as genetic analysis is indicated
[ ] C. Diagnostic of cystic fibrosis
[ ] D. Invalid; the test must be repeated after 24 hours
CORRECT: B. Intermediate; further testing such as genetic analysis is indicated
Sweat chloride values of 30-59 mmol/L are intermediate and require additional evaluation, often genetic
testing. Values 60 mmol/L are diagnostic (C), values <30 mmol/L are normal (A), and the test is not
invalidated by a single intermediate result (D).
6. A child with cystic fibrosis is prescribed dornase alfa. Which statement by the caregiver
indicates correct understanding of the medication?
[ ] A. It will help thin the mucus in the lungs so it can be coughed out more easily.
[ ] B. It will replace the pancreatic enzymes my child is missing.
[ ] C. It will prevent the need for chest physiotherapy.
[ ] D. It will cure the underlying genetic defect.
CORRECT: A. It will help thin the mucus in the lungs so it can be coughed out more easily.
Dornase alfa is a recombinant DNase that cleaves extracellular DNA in mucus, reducing viscosity and
improving clearance. It does not replace enzymes (B), eliminate the need for airway clearance (C), or correct
the genetic defect (D).
7. When documenting a focused respiratory assessment for a child with cystic fibrosis,
which entry is most appropriate and complete?
[ ] A. Lungs clear to auscultation bilaterally; no cough; respiratory effort even and unlabored.
[ ] B. Coarse crackles in bilateral bases; mild subcostal retractions; productive cough with thick,
HIGHP - Page 3 of 48
, tenacious sputum; SpO2 92% on room air.
[ ] C. Diminished breath sounds on the right; tracheal deviation to the left; absent breath sounds on the
right.
[ ] D. Wheezing throughout all lung fields; prolonged expiratory phase; use of accessory muscles.
CORRECT: B. Coarse crackles in bilateral bases; mild subcostal retractions; productive cough with
thick, tenacious sputum; SpO2 92% on room air.
Option B accurately captures the hallmark findings of a CF exacerbation: coarse crackles, retractions,
productive cough with thick sputum, and hypoxemia. Option A is incomplete for an exacerbation, C describes
pneumothorax, and D is more consistent with asthma.
8. A child with cystic fibrosis is admitted with a pulmonary exacerbation. Which nursing
diagnosis should be prioritized in the care plan?
[ ] A. Imbalanced nutrition: less than body requirements related to malabsorption
[ ] B. Ineffective airway clearance related to increased mucus viscosity and retention
[ ] C. Risk for impaired skin integrity related to decreased mobility
[ ] D. Anxiety related to hospitalization and unfamiliar environment
CORRECT: B. Ineffective airway clearance related to increased mucus viscosity and retention
Ineffective airway clearance is the priority because it directly addresses the immediate respiratory
compromise. Nutrition (A) and anxiety (D) are important but secondary, and skin integrity (C) is not the priority
in this acute respiratory context.
9. Which statement by a caregiver of a child with cystic fibrosis indicates a need for
further teaching about infection control?
[ ] A. We will keep our child away from other children with cystic fibrosis at school.
[ ] B. We will ensure our child receives all recommended immunizations, including influenza.
[ ] C. We will use a separate nebulizer for each family member.
[ ] D. We will encourage our child to attend large indoor gatherings to build immunity.
CORRECT: D. We will encourage our child to attend large indoor gatherings to build immunity.
Children with CF should avoid crowded indoor environments due to increased risk of respiratory infections,
especially with pathogens like Pseudomonas and Burkholderia. Avoiding contact with other CF patients (A),
staying current on vaccines (B), and using separate nebulizers (C) are appropriate.
10. A child with cystic fibrosis presents with a chronic productive cough and recurrent
respiratory infections. The nurse anticipates which finding on the shadow health focused
exam that best reflects the underlying pathophysiology of CF?
[ ] A. Increased sweat chloride concentration above 60 mmol/L
[ ] B. Elevated serum immunoglobulin E (IgE) levels
HIGHP - Page 4 of 48
