HESI Pediatric Respiratory Disorders
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Section 1: Upper Respiratory Tract Disorders (Questions 1–20)
1. A 4-year-old presents with harsh barking cough, inspiratory stridor, and
low-grade fever. Symptoms worsen at night. What is the priority intervention?
• A. Prepare for immediate intubation
• B. Administer racemic epinephrine and dexamethasone
• C. Start broad-spectrum antibiotics
• D. Obtain a lateral neck X-ray
Rationale: This describes moderate to severe croup (laryngotracheobronchitis).
Racemic epinephrine reduces mucosal edema rapidly; dexamethasone prevents
rebound. Antibiotics are ineffective (viral etiology). X-ray may delay treatment.
2. A 2-month-old has nasal flaring, grunting, and apnea episodes. RSV
bronchiolitis is suspected. Which finding indicates the need for ICU transfer?
• A. Oxygen saturation 91% on room air
• B. Apnea with bradycardia
• C. Respiratory rate of 55 breaths/min
• D. Mild intercostal retractions
Rationale: Apnea with bradycardia in young infants (especially <6 weeks) signals
severe respiratory failure and risk of cardiopulmonary arrest. Requires ICU
monitoring and possible ventilatory support.
, 3. Which assessment finding differentiates bacterial tracheitis from severe
croup?
• A. Gradual onset over 2–3 days
• B. Absence of fever
• C. Barking cough that improves with humidity
• D. High fever, toxic appearance, and copious purulent secretions
Rationale: Bacterial tracheitis presents with high fever, toxicity, and thick purulent
secretions; croup is viral, low-grade fever, and responds to mist/steroids. Tracheitis
requires IV antibiotics and airway clearance.
4. A 7-year-old has sore throat, fever, dysphagia, and muffled voice. On exam:
trismus, “hot potato” voice, and unilateral tonsillar bulge. What should the
nurse do first?
• A. Throat culture
• B. Oral amoxicillin
• C. Avoid throat manipulation and prepare for ENT consult
• D. Administer IV dexamethasone
Rationale: Signs point to peritonsillar abscess. Manipulating the throat (swab,
exam) can rupture the abscess or cause laryngospasm. ENT drainage needed.
Steroids may be adjunctive but not first.
5. A 9-month-old with RSV bronchiolitis has respiratory rate 70, heart rate
190, and nasal flaring. Which nursing action is priority?
• A. Initiate high-flow nasal cannula (HFNC)
• B. Suction nares deeply every hour
• C. Administer albuterol nebulizer
• D. Place in prone position
Rationale: HFNC provides heated, humidified oxygen and positive distending
pressure, reducing work of breathing. Deep suctioning can cause vagal response.
Albuterol is not standard in bronchiolitis per 2026 AAP guidelines.
6. A 5-year-old has suspected epiglottitis. Which action is contraindicated?
Exam||Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Section 1: Upper Respiratory Tract Disorders (Questions 1–20)
1. A 4-year-old presents with harsh barking cough, inspiratory stridor, and
low-grade fever. Symptoms worsen at night. What is the priority intervention?
• A. Prepare for immediate intubation
• B. Administer racemic epinephrine and dexamethasone
• C. Start broad-spectrum antibiotics
• D. Obtain a lateral neck X-ray
Rationale: This describes moderate to severe croup (laryngotracheobronchitis).
Racemic epinephrine reduces mucosal edema rapidly; dexamethasone prevents
rebound. Antibiotics are ineffective (viral etiology). X-ray may delay treatment.
2. A 2-month-old has nasal flaring, grunting, and apnea episodes. RSV
bronchiolitis is suspected. Which finding indicates the need for ICU transfer?
• A. Oxygen saturation 91% on room air
• B. Apnea with bradycardia
• C. Respiratory rate of 55 breaths/min
• D. Mild intercostal retractions
Rationale: Apnea with bradycardia in young infants (especially <6 weeks) signals
severe respiratory failure and risk of cardiopulmonary arrest. Requires ICU
monitoring and possible ventilatory support.
, 3. Which assessment finding differentiates bacterial tracheitis from severe
croup?
• A. Gradual onset over 2–3 days
• B. Absence of fever
• C. Barking cough that improves with humidity
• D. High fever, toxic appearance, and copious purulent secretions
Rationale: Bacterial tracheitis presents with high fever, toxicity, and thick purulent
secretions; croup is viral, low-grade fever, and responds to mist/steroids. Tracheitis
requires IV antibiotics and airway clearance.
4. A 7-year-old has sore throat, fever, dysphagia, and muffled voice. On exam:
trismus, “hot potato” voice, and unilateral tonsillar bulge. What should the
nurse do first?
• A. Throat culture
• B. Oral amoxicillin
• C. Avoid throat manipulation and prepare for ENT consult
• D. Administer IV dexamethasone
Rationale: Signs point to peritonsillar abscess. Manipulating the throat (swab,
exam) can rupture the abscess or cause laryngospasm. ENT drainage needed.
Steroids may be adjunctive but not first.
5. A 9-month-old with RSV bronchiolitis has respiratory rate 70, heart rate
190, and nasal flaring. Which nursing action is priority?
• A. Initiate high-flow nasal cannula (HFNC)
• B. Suction nares deeply every hour
• C. Administer albuterol nebulizer
• D. Place in prone position
Rationale: HFNC provides heated, humidified oxygen and positive distending
pressure, reducing work of breathing. Deep suctioning can cause vagal response.
Albuterol is not standard in bronchiolitis per 2026 AAP guidelines.
6. A 5-year-old has suspected epiglottitis. Which action is contraindicated?
