Neonatal and Pediatric Respiratory Care 2026/2027 | Brian K. Walsh 5th
Edition Study Guide, Respiratory Therapy Exam Prep, Practice Questions
with Answers & Rationales, Neonatal Respiratory Physiology, Pediatric
Assessment, Oxygen Therapy, Airway Management, Surfactant Therapy,
CPAP, Mechanical Ventilation, Respiratory Pharmacology, Neonatal
Pulmonary Disorders, Asthma, Cystic Fibrosis & Pediatric Critical Care
Question 1: A nurse is assessing a neonate with respiratory distress. Which sign
is most indicative of increased work of breathing?
A. Respiratory rate of 40 breaths/min
B. Nasal flaring and intercostal retractions
C. Heart rate of 120 beats/min
D. Oxygen saturation of 95% on room air
CORRECT ANSWER: B. Nasal flaring and intercostal retractions
Rationale: Nasal flaring and intercostal retractions are classic signs of increased
work of breathing in neonates, reflecting the use of accessory muscles. A
respiratory rate of 40 is within normal limits for a neonate. Heart rate and oxygen
saturation alone do not directly indicate increased work of breathing.
Question 2: Which condition is characterized by a "ground-glass" appearance on
chest radiograph in a premature neonate?
A. Transient tachypnea of the newborn
B. Meconium aspiration syndrome
C. Respiratory distress syndrome
D. Bronchopulmonary dysplasia
CORRECT ANSWER: C. Respiratory distress syndrome
Rationale: Respiratory distress syndrome (RDS) in premature neonates is caused
by surfactant deficiency and presents with a diffuse ground-glass appearance and
air bronchograms on chest radiograph. Transient tachypnea shows fluid in
fissures, meconium aspiration shows patchy infiltrates, and BPD shows
hyperinflation and fibrosis.
Question 3: A nurse is preparing to administer surfactant to a neonate. Which
route is correct?
A. Intravenous
B. Intramuscular
,C. Intratracheal
D. Subcutaneous
CORRECT ANSWER: C. Intratracheal
Rationale: Surfactant is administered directly into the trachea via an endotracheal
tube to reach the alveoli. Intravenous, intramuscular, and subcutaneous routes
are not effective for surfactant delivery.
Question 4: Which pediatric respiratory disorder is most commonly caused by
respiratory syncytial virus (RSV)?
A. Croup
B. Epiglottitis
C. Bronchiolitis
D. Asthma
CORRECT ANSWER: C. Bronchiolitis
Rationale: Bronchiolitis is most commonly caused by RSV and typically affects
infants under 2 years. Croup is usually viral (parainfluenza), epiglottitis is bacterial
(Haemophilus influenzae type b), and asthma is a chronic inflammatory condition.
Question 5: A child with asthma is prescribed a peak flow meter. What is the
primary purpose of this device?
A. To measure oxygen saturation
B. To assess airway obstruction
C. To deliver bronchodilator medication
D. To monitor carbon dioxide levels
CORRECT ANSWER: B. To assess airway obstruction
Rationale: A peak flow meter measures the peak expiratory flow rate, which
reflects the degree of airway obstruction. It does not measure oxygen saturation,
deliver medication, or monitor carbon dioxide.
Question 6: Which ventilator mode delivers a preset tidal volume with each
breath, regardless of the patient's inspiratory effort?
A. Pressure support ventilation
B. Synchronized intermittent mandatory ventilation
,C. Assist-control ventilation
D. Continuous positive airway pressure
CORRECT ANSWER: C. Assist-control ventilation
Rationale: In assist-control ventilation, a preset tidal volume is delivered with
each breath, whether triggered by the patient or the ventilator. Pressure support
assists spontaneous breaths, SIMV delivers mandatory breaths at set intervals,
and CPAP provides continuous positive pressure without mandatory breaths.
Question 7: A nurse is caring for a neonate receiving nasal CPAP. Which
complication is most important to monitor for?
A. Hyperglycemia
B. Nasal septum necrosis
C. Hypertension
D. Hyperkalemia
CORRECT ANSWER: B. Nasal septum necrosis
Rationale: Nasal CPAP can cause pressure necrosis of the nasal septum if the
interface is not properly fitted or rotated. Hyperglycemia, hypertension, and
hyperkalemia are not direct complications of nasal CPAP.
Question 8: Which clinical finding is most consistent with epiglottitis in a child?
A. Barking cough
B. Drooling and tripod positioning
C. Wheezing and prolonged expiration
D. Inspiratory stridor that worsens with crying
CORRECT ANSWER: B. Drooling and tripod positioning
Rationale: Epiglottitis presents with the classic triad of drooling, dysphagia, and
distress, often with tripod positioning to maintain airway patency. Barking cough
suggests croup, wheezing suggests asthma or bronchiolitis, and stridor worsening
with crying can occur in various upper airway obstructions.
Question 9: A nurse is suctioning a pediatric patient with a tracheostomy. Which
action is appropriate?
, A. Suction for 15 seconds continuously
B. Instill normal saline before suctioning
C. Apply suction only while withdrawing the catheter
D. Use the largest catheter that fits the tracheostomy
CORRECT ANSWER: C. Apply suction only while withdrawing the catheter
Rationale: Suction should be applied only during catheter withdrawal to minimize
mucosal trauma and hypoxia. Suctioning should be limited to 5-10 seconds,
normal saline instillation is not routinely recommended, and the catheter should
be no more than half the diameter of the tracheostomy tube.
Question 10: Which medication is a short-acting beta-2 agonist used for acute
bronchospasm in pediatric asthma?
A. Fluticasone
B. Montelukast
C. Albuterol
D. Prednisone
CORRECT ANSWER: C. Albuterol
Rationale: Albuterol is a short-acting beta-2 agonist that provides rapid
bronchodilation for acute asthma symptoms. Fluticasone is an inhaled
corticosteroid, montelukast is a leukotriene modifier, and prednisone is a
systemic corticosteroid.
Question 11: A neonate is diagnosed with meconium aspiration syndrome.
Which intervention is most appropriate immediately after birth?
A. Immediate intubation and suctioning
B. Administration of surfactant
C. Initiation of high-frequency oscillatory ventilation
D. Oral suctioning before delivery of the shoulders
CORRECT ANSWER: D. Oral suctioning before delivery of the shoulders
Rationale: For meconium-stained amniotic fluid, current guidelines recommend
suctioning the mouth and nose before delivery of the shoulders if the neonate is
Edition Study Guide, Respiratory Therapy Exam Prep, Practice Questions
with Answers & Rationales, Neonatal Respiratory Physiology, Pediatric
Assessment, Oxygen Therapy, Airway Management, Surfactant Therapy,
CPAP, Mechanical Ventilation, Respiratory Pharmacology, Neonatal
Pulmonary Disorders, Asthma, Cystic Fibrosis & Pediatric Critical Care
Question 1: A nurse is assessing a neonate with respiratory distress. Which sign
is most indicative of increased work of breathing?
A. Respiratory rate of 40 breaths/min
B. Nasal flaring and intercostal retractions
C. Heart rate of 120 beats/min
D. Oxygen saturation of 95% on room air
CORRECT ANSWER: B. Nasal flaring and intercostal retractions
Rationale: Nasal flaring and intercostal retractions are classic signs of increased
work of breathing in neonates, reflecting the use of accessory muscles. A
respiratory rate of 40 is within normal limits for a neonate. Heart rate and oxygen
saturation alone do not directly indicate increased work of breathing.
Question 2: Which condition is characterized by a "ground-glass" appearance on
chest radiograph in a premature neonate?
A. Transient tachypnea of the newborn
B. Meconium aspiration syndrome
C. Respiratory distress syndrome
D. Bronchopulmonary dysplasia
CORRECT ANSWER: C. Respiratory distress syndrome
Rationale: Respiratory distress syndrome (RDS) in premature neonates is caused
by surfactant deficiency and presents with a diffuse ground-glass appearance and
air bronchograms on chest radiograph. Transient tachypnea shows fluid in
fissures, meconium aspiration shows patchy infiltrates, and BPD shows
hyperinflation and fibrosis.
Question 3: A nurse is preparing to administer surfactant to a neonate. Which
route is correct?
A. Intravenous
B. Intramuscular
,C. Intratracheal
D. Subcutaneous
CORRECT ANSWER: C. Intratracheal
Rationale: Surfactant is administered directly into the trachea via an endotracheal
tube to reach the alveoli. Intravenous, intramuscular, and subcutaneous routes
are not effective for surfactant delivery.
Question 4: Which pediatric respiratory disorder is most commonly caused by
respiratory syncytial virus (RSV)?
A. Croup
B. Epiglottitis
C. Bronchiolitis
D. Asthma
CORRECT ANSWER: C. Bronchiolitis
Rationale: Bronchiolitis is most commonly caused by RSV and typically affects
infants under 2 years. Croup is usually viral (parainfluenza), epiglottitis is bacterial
(Haemophilus influenzae type b), and asthma is a chronic inflammatory condition.
Question 5: A child with asthma is prescribed a peak flow meter. What is the
primary purpose of this device?
A. To measure oxygen saturation
B. To assess airway obstruction
C. To deliver bronchodilator medication
D. To monitor carbon dioxide levels
CORRECT ANSWER: B. To assess airway obstruction
Rationale: A peak flow meter measures the peak expiratory flow rate, which
reflects the degree of airway obstruction. It does not measure oxygen saturation,
deliver medication, or monitor carbon dioxide.
Question 6: Which ventilator mode delivers a preset tidal volume with each
breath, regardless of the patient's inspiratory effort?
A. Pressure support ventilation
B. Synchronized intermittent mandatory ventilation
,C. Assist-control ventilation
D. Continuous positive airway pressure
CORRECT ANSWER: C. Assist-control ventilation
Rationale: In assist-control ventilation, a preset tidal volume is delivered with
each breath, whether triggered by the patient or the ventilator. Pressure support
assists spontaneous breaths, SIMV delivers mandatory breaths at set intervals,
and CPAP provides continuous positive pressure without mandatory breaths.
Question 7: A nurse is caring for a neonate receiving nasal CPAP. Which
complication is most important to monitor for?
A. Hyperglycemia
B. Nasal septum necrosis
C. Hypertension
D. Hyperkalemia
CORRECT ANSWER: B. Nasal septum necrosis
Rationale: Nasal CPAP can cause pressure necrosis of the nasal septum if the
interface is not properly fitted or rotated. Hyperglycemia, hypertension, and
hyperkalemia are not direct complications of nasal CPAP.
Question 8: Which clinical finding is most consistent with epiglottitis in a child?
A. Barking cough
B. Drooling and tripod positioning
C. Wheezing and prolonged expiration
D. Inspiratory stridor that worsens with crying
CORRECT ANSWER: B. Drooling and tripod positioning
Rationale: Epiglottitis presents with the classic triad of drooling, dysphagia, and
distress, often with tripod positioning to maintain airway patency. Barking cough
suggests croup, wheezing suggests asthma or bronchiolitis, and stridor worsening
with crying can occur in various upper airway obstructions.
Question 9: A nurse is suctioning a pediatric patient with a tracheostomy. Which
action is appropriate?
, A. Suction for 15 seconds continuously
B. Instill normal saline before suctioning
C. Apply suction only while withdrawing the catheter
D. Use the largest catheter that fits the tracheostomy
CORRECT ANSWER: C. Apply suction only while withdrawing the catheter
Rationale: Suction should be applied only during catheter withdrawal to minimize
mucosal trauma and hypoxia. Suctioning should be limited to 5-10 seconds,
normal saline instillation is not routinely recommended, and the catheter should
be no more than half the diameter of the tracheostomy tube.
Question 10: Which medication is a short-acting beta-2 agonist used for acute
bronchospasm in pediatric asthma?
A. Fluticasone
B. Montelukast
C. Albuterol
D. Prednisone
CORRECT ANSWER: C. Albuterol
Rationale: Albuterol is a short-acting beta-2 agonist that provides rapid
bronchodilation for acute asthma symptoms. Fluticasone is an inhaled
corticosteroid, montelukast is a leukotriene modifier, and prednisone is a
systemic corticosteroid.
Question 11: A neonate is diagnosed with meconium aspiration syndrome.
Which intervention is most appropriate immediately after birth?
A. Immediate intubation and suctioning
B. Administration of surfactant
C. Initiation of high-frequency oscillatory ventilation
D. Oral suctioning before delivery of the shoulders
CORRECT ANSWER: D. Oral suctioning before delivery of the shoulders
Rationale: For meconium-stained amniotic fluid, current guidelines recommend
suctioning the mouth and nose before delivery of the shoulders if the neonate is
