COMPREHENSIVE PROFESSIONAL EXAMINATION:
NURSING CARE OF THE INFANT WITH RSV
BRONCHIOLITIS
200 Clinical Questions with Comprehensive Rationales & Correct
Answers
Domain 1: Pathophysiology & Etiology
Question 1: (Prioritizing Airway Clearance) Which nursing
intervention should the nurse prioritize first for an infant admitted
with acute RSV bronchiolitis and thick nasal secretions? (Case
variation #1)
A. Administering a dose of racemic epinephrine via nebulizer
B. Performing gentle, strategic suctioning of the nares and
nasopharynx prior to feeds
C. Placing the infant in a flat, supine position to promote relaxation
D. Performing deep endotracheal suctioning every hour routinely
Correct Answer: B
Rationale: Infants are obligate nasal breathers. Gentle saline drops
and bulb or catheter suctioning of the nares before feeds and as
needed clear the airway and reduce work of breathing.
Question 2: (Oxygen Therapy Monitoring) An infant with RSV
bronchiolitis is receiving humidified low-flow oxygen via nasal
cannula. Which oxygen saturation target is generally appropriate
for this infant? (Case variation #2)
, A. Maintain SpO2 between 88% and 92%
B. Maintain SpO2 strictly at 100% using high-flow nasal cannula
C. Keep SpO2 above 90% during active periods and sleep
D. Withhold oxygen unless SpO2 drops below 80%
Correct Answer: C
Rationale: Current clinical guidelines recommend maintaining
oxygen saturation >90% for infants with bronchiolitis while avoiding
unnecessary hyperoxia and prolonged oxygen exposure.
Question 3: (Infection Control Precautions) An infant with
confirmed RSV is placed in a multi-bed unit. Which type of
transmission-based precautions must the nurse implement? (Case
variation #3)
A. Airborne precautions with a negative pressure room and N95
respirators
B. Droplet and contact precautions, including gown, gloves, and
strict hand hygiene
C. Standard precautions only, as RSV is exclusively bloodborne
D. Protective environment with positive airflow filtration
Correct Answer: B
Rationale: RSV is spread primarily via contact with infectious
secretions or fomites and large respiratory droplets. Contact and
droplet precautions, along with meticulous hand hygiene, prevent
nosocomial spread.
,Question 4: (Hydration & Nutrition) A 6-month-old infant with
RSV bronchiolitis has a respiratory rate of 72 breaths/min and
moderate retractions. Which feeding method is safest? (Case
variation #4)
A. Continue unrestricted oral bottle feedings regardless of
respiratory rate
B. Switch immediately to total parenteral nutrition (TPN) via
central line
C. Suspend oral feeds and provide IV fluids or NG/ND tube
feeding when tachypnea (RR > 60-70) increases aspiration risk
D. Force oral electrolyte solutions every 15 minutes
Correct Answer: C
Rationale: Infants with tachypnea (respiratory rate > 60-70
breaths/min) are at high risk for aspiration and fatigue when feeding
orally. IV hydration or small, frequent nasogastric/nasoduodenal
tube feeds are indicated.
Question 5: (Suctioning Technique) When performing
nasopharyngeal suctioning on an infant with RSV, what is the
maximum recommended negative pressure and duration per pass to
prevent complications? (Case variation #5)
A. Pressure of 120-150 mmHg for up to 15 seconds per pass
B. Pressure of 80-100 mmHg in infants, limiting suction duration
to 5 seconds per pass with adequate hyperoxygenation between
passes
, C. Continuous high suction applied during insertion and
withdrawal
D. No pressure limit as long as secretions are thick
Correct Answer: B
Rationale: Excessive suction pressure or prolonged passes (>5-10
seconds) can cause mucosal trauma, bleeding, hypoxia, and vagal-
induced bradycardia in infants.
Question 6: (Palivizumab (Synagis) Administration) Which infant is
the primary candidate for prophylactic monthly intramuscular
injections of palivizumab during RSV season? (Case variation #6)
A. A healthy 12-month-old infant born at term with no medical
history
B. An infant born before 29 weeks of gestation or with chronic
lung disease of prematurity / congenital heart disease
C. Any child admitted to the hospital with active RSV infection to
treat symptoms
D. All children under 5 years old attending daycare facilities
Correct Answer: B
Rationale: Palivizumab is a monoclonal antibody indicated for
passive immunoprophylaxis in high-risk infants, such as those born
prematurely (<29 weeks) or with chronic lung disease/congenital
heart disease.
NURSING CARE OF THE INFANT WITH RSV
BRONCHIOLITIS
200 Clinical Questions with Comprehensive Rationales & Correct
Answers
Domain 1: Pathophysiology & Etiology
Question 1: (Prioritizing Airway Clearance) Which nursing
intervention should the nurse prioritize first for an infant admitted
with acute RSV bronchiolitis and thick nasal secretions? (Case
variation #1)
A. Administering a dose of racemic epinephrine via nebulizer
B. Performing gentle, strategic suctioning of the nares and
nasopharynx prior to feeds
C. Placing the infant in a flat, supine position to promote relaxation
D. Performing deep endotracheal suctioning every hour routinely
Correct Answer: B
Rationale: Infants are obligate nasal breathers. Gentle saline drops
and bulb or catheter suctioning of the nares before feeds and as
needed clear the airway and reduce work of breathing.
Question 2: (Oxygen Therapy Monitoring) An infant with RSV
bronchiolitis is receiving humidified low-flow oxygen via nasal
cannula. Which oxygen saturation target is generally appropriate
for this infant? (Case variation #2)
, A. Maintain SpO2 between 88% and 92%
B. Maintain SpO2 strictly at 100% using high-flow nasal cannula
C. Keep SpO2 above 90% during active periods and sleep
D. Withhold oxygen unless SpO2 drops below 80%
Correct Answer: C
Rationale: Current clinical guidelines recommend maintaining
oxygen saturation >90% for infants with bronchiolitis while avoiding
unnecessary hyperoxia and prolonged oxygen exposure.
Question 3: (Infection Control Precautions) An infant with
confirmed RSV is placed in a multi-bed unit. Which type of
transmission-based precautions must the nurse implement? (Case
variation #3)
A. Airborne precautions with a negative pressure room and N95
respirators
B. Droplet and contact precautions, including gown, gloves, and
strict hand hygiene
C. Standard precautions only, as RSV is exclusively bloodborne
D. Protective environment with positive airflow filtration
Correct Answer: B
Rationale: RSV is spread primarily via contact with infectious
secretions or fomites and large respiratory droplets. Contact and
droplet precautions, along with meticulous hand hygiene, prevent
nosocomial spread.
,Question 4: (Hydration & Nutrition) A 6-month-old infant with
RSV bronchiolitis has a respiratory rate of 72 breaths/min and
moderate retractions. Which feeding method is safest? (Case
variation #4)
A. Continue unrestricted oral bottle feedings regardless of
respiratory rate
B. Switch immediately to total parenteral nutrition (TPN) via
central line
C. Suspend oral feeds and provide IV fluids or NG/ND tube
feeding when tachypnea (RR > 60-70) increases aspiration risk
D. Force oral electrolyte solutions every 15 minutes
Correct Answer: C
Rationale: Infants with tachypnea (respiratory rate > 60-70
breaths/min) are at high risk for aspiration and fatigue when feeding
orally. IV hydration or small, frequent nasogastric/nasoduodenal
tube feeds are indicated.
Question 5: (Suctioning Technique) When performing
nasopharyngeal suctioning on an infant with RSV, what is the
maximum recommended negative pressure and duration per pass to
prevent complications? (Case variation #5)
A. Pressure of 120-150 mmHg for up to 15 seconds per pass
B. Pressure of 80-100 mmHg in infants, limiting suction duration
to 5 seconds per pass with adequate hyperoxygenation between
passes
, C. Continuous high suction applied during insertion and
withdrawal
D. No pressure limit as long as secretions are thick
Correct Answer: B
Rationale: Excessive suction pressure or prolonged passes (>5-10
seconds) can cause mucosal trauma, bleeding, hypoxia, and vagal-
induced bradycardia in infants.
Question 6: (Palivizumab (Synagis) Administration) Which infant is
the primary candidate for prophylactic monthly intramuscular
injections of palivizumab during RSV season? (Case variation #6)
A. A healthy 12-month-old infant born at term with no medical
history
B. An infant born before 29 weeks of gestation or with chronic
lung disease of prematurity / congenital heart disease
C. Any child admitted to the hospital with active RSV infection to
treat symptoms
D. All children under 5 years old attending daycare facilities
Correct Answer: B
Rationale: Palivizumab is a monoclonal antibody indicated for
passive immunoprophylaxis in high-risk infants, such as those born
prematurely (<29 weeks) or with chronic lung disease/congenital
heart disease.
