N4410 Exam 2025 Latest Questions with
complete solutions
Respiratory assessment
HISTORY!
-allergies
-environment (smoking/air quality)
-recurrent respiratory illness or colds/sore throat
-respiratory dysfunction at birth
-growth and development
-nutrition (poor = slow grower)
-poor weight gain
-genetics (family hx, cystic fibrosis, lung cancer, chronic lung disease)
Predisposing factors respiratory issues
-breathing (obligate, diaphragm)
-tongue
-lungs/structure (smaller/immature)
-airway (narrower)
-higher oxygen demand
Why is oxygen demand higher in children?
,due to smaller alveoli that are less elastic
Obligate breathing
-only through nose
-first 4-6wks. infants can only breath through nose
-cannot automatically open mouth if nose is obstructs
-mucus build up in nose affects breathing
Diaphragmatic breathing
-uses diaphragm, nose, and mouth
-occurs around 7 y/o
Do children easily fall into respiratory distress? What does respiratory distress occur
before?
yes, due to cross infection, decreased immunity, increased exposure, and structure/function of
lungs.
respiratory distress always occurs before cardiac distress
Basic respiratory assessment
-appearance
-behavior/physical S/S
-chest/thorax assessment
-ear, nose, mouth
-lung sounds
,-RR
-pulse ox
Appearance of respiratory issues
-leaning forward (tripod position) to enlarge chest for more air to get in
-pursing lips when exhaling
-nasal flaring
-retractions (substernal, suprasternal, intracostal, subcostal)
-drooling
-breathing through mouth (d/t blockage of nasal passage)
-bare chest!!! (symmetry and retractions)
Why can drooling occur for altered respiratory function?
somewhere in the upper respiratory there is an occlusion preventing appropriate swallowing
What is the number one indicator of respiratory status?
respiratory rate
infants: 28-60
toddler: 20-30
preschool: 20-28
What is normal pulse ox?
, 92% or higher
Airway sounds of respiratory compromise
-stridor (upper airway)
-grunting (lower airway)
-clubbing (chronic compromise)
Stridor
-upper airway
-sign of acute compromise
-whistle on inspiration or exhale
Grunting
-lower airway
-short deep, hoarse sounds on expiration
-trapped air pushing out
-acute compromise
What is the first sign of respiratory issue in infants and children?
tachypnea
What retractions are most common? Which are most concerning?
common: subcostal and substernal
concerning: supresternal and intercostal
Asthma pathophysiology
complete solutions
Respiratory assessment
HISTORY!
-allergies
-environment (smoking/air quality)
-recurrent respiratory illness or colds/sore throat
-respiratory dysfunction at birth
-growth and development
-nutrition (poor = slow grower)
-poor weight gain
-genetics (family hx, cystic fibrosis, lung cancer, chronic lung disease)
Predisposing factors respiratory issues
-breathing (obligate, diaphragm)
-tongue
-lungs/structure (smaller/immature)
-airway (narrower)
-higher oxygen demand
Why is oxygen demand higher in children?
,due to smaller alveoli that are less elastic
Obligate breathing
-only through nose
-first 4-6wks. infants can only breath through nose
-cannot automatically open mouth if nose is obstructs
-mucus build up in nose affects breathing
Diaphragmatic breathing
-uses diaphragm, nose, and mouth
-occurs around 7 y/o
Do children easily fall into respiratory distress? What does respiratory distress occur
before?
yes, due to cross infection, decreased immunity, increased exposure, and structure/function of
lungs.
respiratory distress always occurs before cardiac distress
Basic respiratory assessment
-appearance
-behavior/physical S/S
-chest/thorax assessment
-ear, nose, mouth
-lung sounds
,-RR
-pulse ox
Appearance of respiratory issues
-leaning forward (tripod position) to enlarge chest for more air to get in
-pursing lips when exhaling
-nasal flaring
-retractions (substernal, suprasternal, intracostal, subcostal)
-drooling
-breathing through mouth (d/t blockage of nasal passage)
-bare chest!!! (symmetry and retractions)
Why can drooling occur for altered respiratory function?
somewhere in the upper respiratory there is an occlusion preventing appropriate swallowing
What is the number one indicator of respiratory status?
respiratory rate
infants: 28-60
toddler: 20-30
preschool: 20-28
What is normal pulse ox?
, 92% or higher
Airway sounds of respiratory compromise
-stridor (upper airway)
-grunting (lower airway)
-clubbing (chronic compromise)
Stridor
-upper airway
-sign of acute compromise
-whistle on inspiration or exhale
Grunting
-lower airway
-short deep, hoarse sounds on expiration
-trapped air pushing out
-acute compromise
What is the first sign of respiratory issue in infants and children?
tachypnea
What retractions are most common? Which are most concerning?
common: subcostal and substernal
concerning: supresternal and intercostal
Asthma pathophysiology
