COMPREHENSIVE PROFESSIONAL NURSING
EXAMINATION
Cystic Fibrosis Home Respiratory Management &
Chest Physiotherapy
200 Clinical Questions with Detailed Rationales for Pediatric Nursing
Mastery
Domain 1: Fundamentals of Chest Physiotherapy & Postural Drainage
Question 1: A nurse is teaching the parents of a school-age child
with cystic fibrosis about home chest physiotherapy (CPT). Which
instruction regarding postural drainage positioning for the lower
posterior basal segments is most accurate? (Clinical Item #1)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #1: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
,Question 2: During a home CPT session for a child with cystic
fibrosis, the parent asks about the ideal hand shape for manual
percussion. Which response by the nurse is correct? (Clinical Item
#2)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #2: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
Question 3: A nurse is reviewing the schedule for home CPT with
the parents of an 8-year-old child with cystic fibrosis. When should
the nurse recommend scheduling these treatments daily? (Clinical
Item #3)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
, Rationale for Item #3: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
Question 4: An educator observes a parent performing CPT on a
child with cystic fibrosis. Which observation indicates a need for
immediate re-instruction? (Clinical Item #4)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #4: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
Question 5: When teaching parents about percussion force and
frequency during CPT, the nurse should emphasize which of the
following principles? (Clinical Item #5)
A. Place the child in a flat supine position with a small pillow under
the knees.
, B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #5: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
Question 6: A school-age child with cystic fibrosis experiences mild
hemoptysis during postural drainage. What is the priority nursing
instruction for the parents? (Clinical Item #6)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #6: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
EXAMINATION
Cystic Fibrosis Home Respiratory Management &
Chest Physiotherapy
200 Clinical Questions with Detailed Rationales for Pediatric Nursing
Mastery
Domain 1: Fundamentals of Chest Physiotherapy & Postural Drainage
Question 1: A nurse is teaching the parents of a school-age child
with cystic fibrosis about home chest physiotherapy (CPT). Which
instruction regarding postural drainage positioning for the lower
posterior basal segments is most accurate? (Clinical Item #1)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #1: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
,Question 2: During a home CPT session for a child with cystic
fibrosis, the parent asks about the ideal hand shape for manual
percussion. Which response by the nurse is correct? (Clinical Item
#2)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #2: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
Question 3: A nurse is reviewing the schedule for home CPT with
the parents of an 8-year-old child with cystic fibrosis. When should
the nurse recommend scheduling these treatments daily? (Clinical
Item #3)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
, Rationale for Item #3: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
Question 4: An educator observes a parent performing CPT on a
child with cystic fibrosis. Which observation indicates a need for
immediate re-instruction? (Clinical Item #4)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #4: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
Question 5: When teaching parents about percussion force and
frequency during CPT, the nurse should emphasize which of the
following principles? (Clinical Item #5)
A. Place the child in a flat supine position with a small pillow under
the knees.
, B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #5: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
Question 6: A school-age child with cystic fibrosis experiences mild
hemoptysis during postural drainage. What is the priority nursing
instruction for the parents? (Clinical Item #6)
A. Place the child in a flat supine position with a small pillow under
the knees.
B. Elevate the foot of the bed 30 degrees (Trendelenburg position)
with the child lying on their abdomen.
C. Position the child sitting upright leaning forward 45 degrees.
D. Place the child in a side-lying position with the head elevated 60
degrees.
Rationale for Item #6: Drainage of the lower posterior basal
segments requires the foot of the bed to be elevated (Trendelenburg
position) with the child prone or side-lying to allow gravity to drain
mucus from the lower lobes toward the central airways. Upper lobes
require upright or semi-Fowler positions, whereas lower lobes
require head-down tilts.
