Pediatric Respiratory: Exam 1 - Questions with Correct
Answers
100 questions
1. Pulse oximetry may overestimate oxygenation in a child with:
A. Mild nasal congestion
B. Normal hemoglobin
C. Carbon monoxide poisoning
D. Low fever
Correct Answer: C. Carbon monoxide poisoning
Rationale: Carboxyhemoglobin absorbs light like oxyhemoglobin, so the oximeter reads falsely
high despite poor oxygen delivery. Nasal congestion, normal hemoglobin and low fever do not
cause this error.
2. The normal resting respiratory rate of a healthy newborn is approximately:
A. 30 to 60 breaths per minute
B. 12 to 20 breaths per minute
C. 60 to 90 breaths per minute
D. 8 to 12 breaths per minute
Correct Answer: A. 30 to 60 breaths per minute
Rationale: Newborns normally breathe about 30 to 60 times a minute. Twelve to 20 is the adult
range, rates persistently above 60 suggest tachypnea, and 8 to 12 would be dangerously slow.
,3. A child with respiratory distress who sits leaning forward with hands on the knees is in the:
A. Recovery position
B. Trendelenburg position
C. Fowler position for comfort only
D. Tripod position, which helps maximize airway opening and accessory muscle use
Correct Answer: D. Tripod position, which helps maximize airway opening and accessory
muscle use
Rationale: The tripod position stabilizes the shoulders so accessory muscles can help breathing
and is a sign of significant distress. The recovery position is for unconscious patients,
Trendelenburg is head-down, and the child's posture is not mere comfort.
4. Stridor heard on inspiration usually indicates obstruction of the:
A. Small bronchioles
B. Alveoli
C. Pleural space
D. Upper airway, at or above the larynx
Correct Answer: D. Upper airway, at or above the larynx
Rationale: Inspiratory stridor arises from narrowing at or above the glottis, where the airway
collapses during inspiration. Bronchiolar narrowing causes wheeze, alveolar disease causes
crackles, and pleural problems cause friction rubs or decreased sounds.
5. Young infants are described as preferential nasal breathers, so the nurse knows that:
A. Mouth breathing is their main route from birth
B. Nasal congestion can cause significant respiratory distress and feeding difficulty
C. Nasal secretions never affect oxygenation
D. Nasal suctioning is contraindicated
Correct Answer: B. Nasal congestion can cause significant respiratory distress and feeding
difficulty
Rationale: Infants under about 4 to 6 months breathe mainly through the nose, so blocked
nostrils can cause distress and trouble feeding. They do not readily switch to mouth breathing.
Gentle suctioning is a key way to relieve the obstruction.
,6. When positioning an infant to open the airway, the nurse should place the head in a:
A. Fully hyperextended position
B. Sharply flexed position with chin on chest
C. Rotated position facing the shoulder
D. Neutral sniffing position, avoiding hyperextension
Correct Answer: D. Neutral sniffing position, avoiding hyperextension
Rationale: The large occiput tends to flex the neck, so a small roll under the shoulders and a
neutral sniffing position keep the soft trachea open. Hyperextension or flexion can kink the
airway, and rotation does not open it.
7. Early in an asthma attack, an arterial blood gas commonly shows:
A. A high PaCO2 from the start
B. A high bicarbonate
C. A pH below 7.0
D. A low PaCO2 from hyperventilation
Correct Answer: D. A low PaCO2 from hyperventilation
Rationale: Rapid breathing early in an attack blows off carbon dioxide. A normal or rising PaCO2
in a tachypneic child signals fatigue and impending failure. High bicarbonate and severe
acidemia are not typical early findings.
8. When auscultating a child's lungs, the nurse should:
A. Compare corresponding areas on the right and left sides, listening through a full breath at
each site
B. Listen only over the trachea
C. Listen through clothing for speed
D. Listen only on the back while the child cries
Correct Answer: A. Compare corresponding areas on the right and left sides, listening through
a full breath at each site
Rationale: Side-to-side comparison detects asymmetry such as decreased sounds from
consolidation, a foreign body or effusion. Listening only at the trachea misses lung fields,
clothing muffles sounds, and crying distorts breath sounds.
, 9. A teen with sore throat who is given amoxicillin develops a diffuse rash and is later diagnosed
with mononucleosis. The nurse understands that:
A. The teen has a lifelong penicillin allergy
B. The rash proves strep infection
C. The rash means measles
D. Rash after amoxicillin is common in Epstein-Barr virus infection and is not necessarily a true
penicillin allergy
Correct Answer: D. Rash after amoxicillin is common in Epstein-Barr virus infection and is not
necessarily a true penicillin allergy
Rationale: Many patients with EBV develop a rash after amoxicillin, and it usually does not
mean a lasting allergy, although evaluation is needed. It does not prove strep infection or
measles.
10. A school nurse notes several children with sore throat, fever and exudate. To reduce spread,
the most important action is:
A. Close the school for a month
B. Promote hand hygiene, discourage sharing cups, and refer symptomatic children for testing
C. Give everyone antibiotics
D. Ignore it as viral
Correct Answer: B. Promote hand hygiene, discourage sharing cups, and refer symptomatic
children for testing
Rationale: Strep spreads by droplets and shared items, so hygiene and testing symptomatic
children limit outbreaks. Mass antibiotics and closures are not standard, and ignoring possible
strep risks complications.
Answers
100 questions
1. Pulse oximetry may overestimate oxygenation in a child with:
A. Mild nasal congestion
B. Normal hemoglobin
C. Carbon monoxide poisoning
D. Low fever
Correct Answer: C. Carbon monoxide poisoning
Rationale: Carboxyhemoglobin absorbs light like oxyhemoglobin, so the oximeter reads falsely
high despite poor oxygen delivery. Nasal congestion, normal hemoglobin and low fever do not
cause this error.
2. The normal resting respiratory rate of a healthy newborn is approximately:
A. 30 to 60 breaths per minute
B. 12 to 20 breaths per minute
C. 60 to 90 breaths per minute
D. 8 to 12 breaths per minute
Correct Answer: A. 30 to 60 breaths per minute
Rationale: Newborns normally breathe about 30 to 60 times a minute. Twelve to 20 is the adult
range, rates persistently above 60 suggest tachypnea, and 8 to 12 would be dangerously slow.
,3. A child with respiratory distress who sits leaning forward with hands on the knees is in the:
A. Recovery position
B. Trendelenburg position
C. Fowler position for comfort only
D. Tripod position, which helps maximize airway opening and accessory muscle use
Correct Answer: D. Tripod position, which helps maximize airway opening and accessory
muscle use
Rationale: The tripod position stabilizes the shoulders so accessory muscles can help breathing
and is a sign of significant distress. The recovery position is for unconscious patients,
Trendelenburg is head-down, and the child's posture is not mere comfort.
4. Stridor heard on inspiration usually indicates obstruction of the:
A. Small bronchioles
B. Alveoli
C. Pleural space
D. Upper airway, at or above the larynx
Correct Answer: D. Upper airway, at or above the larynx
Rationale: Inspiratory stridor arises from narrowing at or above the glottis, where the airway
collapses during inspiration. Bronchiolar narrowing causes wheeze, alveolar disease causes
crackles, and pleural problems cause friction rubs or decreased sounds.
5. Young infants are described as preferential nasal breathers, so the nurse knows that:
A. Mouth breathing is their main route from birth
B. Nasal congestion can cause significant respiratory distress and feeding difficulty
C. Nasal secretions never affect oxygenation
D. Nasal suctioning is contraindicated
Correct Answer: B. Nasal congestion can cause significant respiratory distress and feeding
difficulty
Rationale: Infants under about 4 to 6 months breathe mainly through the nose, so blocked
nostrils can cause distress and trouble feeding. They do not readily switch to mouth breathing.
Gentle suctioning is a key way to relieve the obstruction.
,6. When positioning an infant to open the airway, the nurse should place the head in a:
A. Fully hyperextended position
B. Sharply flexed position with chin on chest
C. Rotated position facing the shoulder
D. Neutral sniffing position, avoiding hyperextension
Correct Answer: D. Neutral sniffing position, avoiding hyperextension
Rationale: The large occiput tends to flex the neck, so a small roll under the shoulders and a
neutral sniffing position keep the soft trachea open. Hyperextension or flexion can kink the
airway, and rotation does not open it.
7. Early in an asthma attack, an arterial blood gas commonly shows:
A. A high PaCO2 from the start
B. A high bicarbonate
C. A pH below 7.0
D. A low PaCO2 from hyperventilation
Correct Answer: D. A low PaCO2 from hyperventilation
Rationale: Rapid breathing early in an attack blows off carbon dioxide. A normal or rising PaCO2
in a tachypneic child signals fatigue and impending failure. High bicarbonate and severe
acidemia are not typical early findings.
8. When auscultating a child's lungs, the nurse should:
A. Compare corresponding areas on the right and left sides, listening through a full breath at
each site
B. Listen only over the trachea
C. Listen through clothing for speed
D. Listen only on the back while the child cries
Correct Answer: A. Compare corresponding areas on the right and left sides, listening through
a full breath at each site
Rationale: Side-to-side comparison detects asymmetry such as decreased sounds from
consolidation, a foreign body or effusion. Listening only at the trachea misses lung fields,
clothing muffles sounds, and crying distorts breath sounds.
, 9. A teen with sore throat who is given amoxicillin develops a diffuse rash and is later diagnosed
with mononucleosis. The nurse understands that:
A. The teen has a lifelong penicillin allergy
B. The rash proves strep infection
C. The rash means measles
D. Rash after amoxicillin is common in Epstein-Barr virus infection and is not necessarily a true
penicillin allergy
Correct Answer: D. Rash after amoxicillin is common in Epstein-Barr virus infection and is not
necessarily a true penicillin allergy
Rationale: Many patients with EBV develop a rash after amoxicillin, and it usually does not
mean a lasting allergy, although evaluation is needed. It does not prove strep infection or
measles.
10. A school nurse notes several children with sore throat, fever and exudate. To reduce spread,
the most important action is:
A. Close the school for a month
B. Promote hand hygiene, discourage sharing cups, and refer symptomatic children for testing
C. Give everyone antibiotics
D. Ignore it as viral
Correct Answer: B. Promote hand hygiene, discourage sharing cups, and refer symptomatic
children for testing
Rationale: Strep spreads by droplets and shared items, so hygiene and testing symptomatic
children limit outbreaks. Mass antibiotics and closures are not standard, and ignoring possible
strep risks complications.
