NURS 535 Pediatrics Test 2 Actual Exam 2026/2027 |
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SECTION 1: PEDIATRIC RESPIRATORY DISORDERS (15 Questions)
Case Study 1: Asthma Exacerbation
Scenario: A 7-year-old child presents to the ED with severe respiratory distress. Respiratory rate
40, O2 sat 88% on room air, wheezing throughout lung fields, using accessory muscles, speaking
in words only.
Q1: What is the priority nursing intervention?
A. Obtain a detailed history
B. Administer oxygen and nebulized albuterol
C. Start an IV line
D. Prepare for chest x-ray
Correct Answer: B. [CORRECT]
Rationale: In acute asthma exacerbation, the priority is addressing hypoxemia and
bronchospasm. Oxygen should be administered immediately, followed by rapid-acting
bronchodilators (albuterol).
Q2: Which finding indicates this child is experiencing status asthmaticus?
A. Respiratory rate of 28 breaths per minute
B. Peak expiratory flow 70% of predicted
C. Silent chest with minimal air movement
D. Speaking in complete sentences
Correct Answer: C. [CORRECT]
Rationale: Status asthmaticus is a life-threatening emergency characterized by absent or
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minimal breath sounds (silent chest) due to severe bronchospasm and air trapping, indicating
impending respiratory failure.
Q3: After initial treatment, the child's condition worsens with decreased breath sounds,
bradycardia, and lethargy. What is the priority action?
A. Continue current treatments
B. Prepare for intubation and ICU transfer
C. Increase oxygen flow
D. Repeat albuterol
Correct Answer: B. [CORRECT]
Rationale: Decreasing breath sounds (silent chest), bradycardia, and lethargy indicate impending
respiratory failure. Immediate preparation for intubation and ICU transfer is required.
Q4: A 6-month-old infant is admitted with bronchiolitis caused by respiratory syncytial virus
(RSV). Which nursing intervention is most appropriate?
A. Place the infant in a supine position with head flat
B. Administer aspirin for fever control
C. Provide humidified oxygen and suction as needed
D. Encourage oral feeding to maintain nutrition
Correct Answer: C. [CORRECT]
Rationale: RSV bronchiolitis management includes humidified oxygen to maintain saturation
>90%, nasal suctioning to clear secretions, and maintaining hydration. Aspirin is contraindicated
in children due to Reye syndrome risk.
Q5: Which clinical manifestation distinguishes epiglottitis from croup?
A. Barking cough
B. Sudden onset with high fever, dysphagia, and tripod positioning
C. Gradual onset with low-grade fever
D. Subglottic narrowing on x-ray
Correct Answer: B. [CORRECT]
Rationale: Epiglottitis presents with sudden onset, high fever, dysphagia, drooling, anxiety, and
tripod positioning (sitting upright with neck extended). Croup has gradual onset, low-grade fever,
and barking cough.
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Q6: A 3-year-old is diagnosed with bacterial pneumonia. Which assessment finding requires
immediate intervention?
A. Respiratory rate 32 breaths per minute
B. Nasal flaring and intercostal retractions
C. Temperature 38.5°C (101.3°F)
D. Nonproductive cough
Correct Answer: B. [CORRECT]
Rationale: Nasal flaring and intercostal retractions indicate severe respiratory distress and
increased work of breathing, requiring immediate oxygen therapy and possible respiratory
support.
Q7: [SATA] Which interventions are appropriate for a child with cystic fibrosis? Select all that
apply.
A. Pancreatic enzyme replacement with meals
B. High-fat, high-calorie diet
C. Chest physiotherapy twice daily
D. Prolonged exposure to other children with CF
E. Bronchodilator therapy before chest physiotherapy
F. Strict fluid restriction
Correct Answers: A, B, C, E. [CORRECT]
Rationale: Cystic fibrosis management includes pancreatic enzymes for malabsorption, high-
calorie/high-fat diet for nutritional support, chest physiotherapy for secretion clearance, and
bronchodilators before CPT. Cross-infection between CF patients is avoided, and adequate
hydration is essential to thin secretions.
Q8: A toddler is brought to the ED after choking on a peanut. The child is coughing forcefully
and able to cry. What is the priority nursing action?
A. Perform abdominal thrusts immediately
B. Encourage the child to continue coughing and monitor closely
C. Perform a blind finger sweep of the mouth
D. Prepare for immediate intubation
Correct Answer: B. [CORRECT]
Rationale: Effective cough and ability to cry indicate a partial airway obstruction with good air
exchange. The child should be encouraged to continue coughing while being monitored closely.
Interventions are reserved for complete obstruction or ineffective cough.