COMPREHENSIVE NURSING EXAMINATION:
ACUTE LARYNGOTRACHEOBRONCHITIS
(CROUP)
200 Clinical-Grade Practice Questions with Comprehensive Rationales
Focus: Pediatric Nursing, Respiratory Management, and Emergency
Interventions
Question 1: A nurse is caring for a toddler who has acute
laryngotracheobronchitis (croup). Which of the following interventions
should the nurse include in the plan of care?
A) Administer warm mist vapor from a humidifier in the room.
B) Administer a single dose of oral dexamethasone as prescribed.
C) Prepare the child for immediate endotracheal intubation.
D) Encourage frequent forceful coughing exercises.
Correct Answer & Rationale:
B) Administer a single dose of oral dexamethasone as prescribed.
Rationale: Corticosteroids (such as oral dexamethasone) are the
cornerstone of medical therapy for acute laryngotracheobronchitis
(croup) to reduce subglottic edema. Cool mist is typically preferred
over warm mist. Intubation is reserved for severe, refractory airway
obstruction, not routine care. Forced coughing is ineffective and can
exacerbate airway irritation and distress.
Question 2: A nurse in the emergency department is evaluating a 2-
year-old child with suspected croup. Which clinical manifestation is
most characteristic of this condition?
, A) Inspiratory stridor and a barky, seal-like cough
B) High fever, drooling, and severe dysphagia
C) Wheezing on expiration and a productive mucus cough
D) Intercostal retractions with asymmetric breath sounds
Correct Answer & Rationale:
A) Inspiratory stridor and a barky, seal-like cough
Rationale: Croup (acute laryngotracheobronchitis) is classically
characterized by inspiratory stridor, a barky seal-like cough, and
hoarseness resulting from subglottic inflammation and edema.
Drooling and high fever are hallmark signs of epiglottitis. Expiratory
wheezing is more indicative of asthma or bronchiolitis.
Question 3: The mother of a toddler with mild croup asks the nurse
what she can do at home if the child wakes up with a barking cough
during the night. Which instruction is best?
A) Take the child outside into the cool, night air or open the freezer
door.
B) Place the child in a tightly closed, hot steam-filled bathroom.
C) Administer over-the-counter cough suppressant syrup
immediately.
D) Force the child to drink large volumes of cold milk.
Correct Answer & Rationale:
A) Take the child outside into the cool, night air or open the freezer
door.
Rationale: Exposure to cool, humid night air or opening a freezer
, door (cool mist/air) often helps reduce mucosal edema of the upper
airway in children with croup through vasoconstriction. Hot steam
bathrooms are no longer recommended due to scalding risks and lack
of superior efficacy. Cough suppressants are contraindicated in
young children with respiratory infections.
Question 4: A nurse is caring for a toddler hospitalized with severe
croup. Which assessment finding indicates impending airway
obstruction?
A) Mild tachypnea and clear breath sounds
B) Increased restlessness, lethargy, and intercostal retractions
C) Strong, loud cry and pink mucous membranes
D) Bradycardia and bradypnea
Correct Answer & Rationale:
B) Increased restlessness, lethargy, and intercostal retractions
Rationale: Restlessness, anxiety, and lethargy are key signs of
hypoxia resulting from airway narrowing and obstruction. As
respiratory fatigue sets in, the child may progress from tachypnea
and retractions to lethargy, decreased responsiveness, and cyanosis.
Bradycardia in a child with respiratory distress is an ominous sign of
impending cardiac arrest.
Question 5: An emergency department nurse is preparing to administer
nebulized epinephrine to a toddler with moderate-to-severe croup. What
is the primary mechanism of action of this medication?
A) Systemic bronchodilation of the terminal bronchioles
, B) Mucolytic breakdown of thick mucus plugs
C) Alpha-adrenergic vasoconstriction reducing subglottic mucosal
edema
D) Suppression of the central cough center in the medulla
Correct Answer & Rationale:
C) Alpha-adrenergic vasoconstriction reducing subglottic mucosal
edema
Rationale: Nebulized racemic epinephrine exerts a local alpha-
adrenergic agonist effect that causes mucosal vasoconstriction,
rapidly decreasing subglottic edema and relieving upper airway
obstruction in croup.
Question 6: A nurse is monitoring a toddler who received racemic
epinephrine for severe croup. What is the most important post-treatment
nursing action?
A) Discharge the child immediately if stridor resolves.
B) Monitor the child closely for at least 2 to 4 hours for potential
rebound stridor.
C) Administer a second dose of epinephrine routinely 10 minutes
later.
D) Keep NPO (nothing by mouth) for 12 hours following treatment.
Correct Answer & Rationale:
B) Monitor the child closely for at least 2 to 4 hours for potential
rebound stridor.
Rationale: Because the duration of action of nebulized epinephrine is
relatively short (typically 2 hours), children must be monitored
ACUTE LARYNGOTRACHEOBRONCHITIS
(CROUP)
200 Clinical-Grade Practice Questions with Comprehensive Rationales
Focus: Pediatric Nursing, Respiratory Management, and Emergency
Interventions
Question 1: A nurse is caring for a toddler who has acute
laryngotracheobronchitis (croup). Which of the following interventions
should the nurse include in the plan of care?
A) Administer warm mist vapor from a humidifier in the room.
B) Administer a single dose of oral dexamethasone as prescribed.
C) Prepare the child for immediate endotracheal intubation.
D) Encourage frequent forceful coughing exercises.
Correct Answer & Rationale:
B) Administer a single dose of oral dexamethasone as prescribed.
Rationale: Corticosteroids (such as oral dexamethasone) are the
cornerstone of medical therapy for acute laryngotracheobronchitis
(croup) to reduce subglottic edema. Cool mist is typically preferred
over warm mist. Intubation is reserved for severe, refractory airway
obstruction, not routine care. Forced coughing is ineffective and can
exacerbate airway irritation and distress.
Question 2: A nurse in the emergency department is evaluating a 2-
year-old child with suspected croup. Which clinical manifestation is
most characteristic of this condition?
, A) Inspiratory stridor and a barky, seal-like cough
B) High fever, drooling, and severe dysphagia
C) Wheezing on expiration and a productive mucus cough
D) Intercostal retractions with asymmetric breath sounds
Correct Answer & Rationale:
A) Inspiratory stridor and a barky, seal-like cough
Rationale: Croup (acute laryngotracheobronchitis) is classically
characterized by inspiratory stridor, a barky seal-like cough, and
hoarseness resulting from subglottic inflammation and edema.
Drooling and high fever are hallmark signs of epiglottitis. Expiratory
wheezing is more indicative of asthma or bronchiolitis.
Question 3: The mother of a toddler with mild croup asks the nurse
what she can do at home if the child wakes up with a barking cough
during the night. Which instruction is best?
A) Take the child outside into the cool, night air or open the freezer
door.
B) Place the child in a tightly closed, hot steam-filled bathroom.
C) Administer over-the-counter cough suppressant syrup
immediately.
D) Force the child to drink large volumes of cold milk.
Correct Answer & Rationale:
A) Take the child outside into the cool, night air or open the freezer
door.
Rationale: Exposure to cool, humid night air or opening a freezer
, door (cool mist/air) often helps reduce mucosal edema of the upper
airway in children with croup through vasoconstriction. Hot steam
bathrooms are no longer recommended due to scalding risks and lack
of superior efficacy. Cough suppressants are contraindicated in
young children with respiratory infections.
Question 4: A nurse is caring for a toddler hospitalized with severe
croup. Which assessment finding indicates impending airway
obstruction?
A) Mild tachypnea and clear breath sounds
B) Increased restlessness, lethargy, and intercostal retractions
C) Strong, loud cry and pink mucous membranes
D) Bradycardia and bradypnea
Correct Answer & Rationale:
B) Increased restlessness, lethargy, and intercostal retractions
Rationale: Restlessness, anxiety, and lethargy are key signs of
hypoxia resulting from airway narrowing and obstruction. As
respiratory fatigue sets in, the child may progress from tachypnea
and retractions to lethargy, decreased responsiveness, and cyanosis.
Bradycardia in a child with respiratory distress is an ominous sign of
impending cardiac arrest.
Question 5: An emergency department nurse is preparing to administer
nebulized epinephrine to a toddler with moderate-to-severe croup. What
is the primary mechanism of action of this medication?
A) Systemic bronchodilation of the terminal bronchioles
, B) Mucolytic breakdown of thick mucus plugs
C) Alpha-adrenergic vasoconstriction reducing subglottic mucosal
edema
D) Suppression of the central cough center in the medulla
Correct Answer & Rationale:
C) Alpha-adrenergic vasoconstriction reducing subglottic mucosal
edema
Rationale: Nebulized racemic epinephrine exerts a local alpha-
adrenergic agonist effect that causes mucosal vasoconstriction,
rapidly decreasing subglottic edema and relieving upper airway
obstruction in croup.
Question 6: A nurse is monitoring a toddler who received racemic
epinephrine for severe croup. What is the most important post-treatment
nursing action?
A) Discharge the child immediately if stridor resolves.
B) Monitor the child closely for at least 2 to 4 hours for potential
rebound stridor.
C) Administer a second dose of epinephrine routinely 10 minutes
later.
D) Keep NPO (nothing by mouth) for 12 hours following treatment.
Correct Answer & Rationale:
B) Monitor the child closely for at least 2 to 4 hours for potential
rebound stridor.
Rationale: Because the duration of action of nebulized epinephrine is
relatively short (typically 2 hours), children must be monitored
