COMPREHENSIVE PROFESSIONAL NURSING
CERTIFICATION EXAMINATION
Pediatric Emergency Care, Airway Management, and Advanced Clinical
Practice • 200 Questions with Detailed Rationales
Acute Epiglottitis & Airway Emergency
Question 1: A nurse is assessing a toddler who has acute epiglottitis.
Which of the following actions must the nurse avoid performing?
A. Administering humidified oxygen via blow-by
B. Inspecting the throat using a tongue depressor
C. Keeping the child in a position of comfort
D. Ensuring emergency intubation equipment is at the bedside
Correct Answer: B
Rationale: Inspecting the throat with a tongue depressor or
attempting to visualize the pharynx in a child with suspected
epiglottitis can trigger sudden, reflex laryngospasm, resulting in
complete and immediate airway obstruction. All emergency airway
equipment must be ready, oxygen provided gently without agitation,
and the child maintained in a position of comfort.
,Question 2: A 3-year-old child presents to the emergency department
with drooling, dysphagia, dysphonia, and a muffled voice. The child is
sitting upright and leaning forward (tripod position). What is the
immediate priority nursing action?
A. Obtain an immediate throat culture
B. Prepare for immediate insertion of an IV line
C. Ensure emergency airway equipment is immediately available and
keep the child calm
D. Place the child supine for a physical examination
Correct Answer: C
Rationale: The child exhibits classic signs of acute epiglottitis. The
immediate priority is maintaining airway safety by keeping
emergency airway equipment at hand and minimizing agitation.
Agitation or crying can precipitate total airway obstruction.
Question 3: Which of the following pathogens is the most common
cause of acute epiglottitis in unimmunized children?
A. Respiratory Syncytial Virus (RSV)
B. Haemophilus influenzae type b (Hib)
C. Streptococcus pneumoniae
D. Bordetella pertussis
Correct Answer: B
Rationale: Haemophilus influenzae type b (Hib) was historically the
primary cause of acute epiglottitis. With the widespread
implementation of the Hib conjugate vaccine, the incidence has
dramatically declined, but it remains the classic etiologic agent tested
in board examinations.
,Question 4: A nurse is caring for a toddler with suspected epiglottitis
who suddenly develops complete airway obstruction. Which equipment
should be immediately prioritized at the bedside?
A. Suction catheter and oxygen mask
B. Tracheostomy tray and emergency intubation equipment
C. Nebulized epinephrine kit
D. Large-bore intravenous cannulation set
Correct Answer: B
Rationale: When complete airway obstruction occurs due to
epiglottitis, endotracheal intubation can be extremely difficult due to
edematous epiglottic swelling. A tracheostomy tray and surgical
airway equipment must be immediately accessible alongside pediatric
intubation gear.
Question 5: Which clinical manifestation differentiates acute epiglottitis
from acute laryngotracheobronchitis (croup)?
A. Presence of a barking cough
B. High fever, drooling, and absence of spontaneous cough
C. Gradual onset over several days
D. Inspiratory stridor that worsens at night
Correct Answer: B
Rationale: Acute epiglottitis presents with a rapid onset of high
fever, severe sore throat, drooling (due to inability to swallow
secretions), dysphonia, and absence of a barking cough. Croup
typically presents with a hallmark barking cough, low-grade fever,
and gradual onset.
, Pediatric Respiratory Emergencies & Croup
Question 6: A nurse is caring for a 2-year-old child with acute
laryngotracheobronchitis (croup). Which of the following findings
should the nurse expect during the assessment?
A. Drooling and muffled voice
B. Barking cough and inspiratory stridor
C. Wheezing and prolonged expiration
D. Asymmetrical chest expansion and dullness on percussion
Correct Answer: B
Rationale: Croup (laryngotracheobronchitis) is characterized by
subglottic inflammation causing a characteristic barking cough,
hoarseness, and inspiratory stridor, often worsening at night.
Question 7: A child with moderate croup is admitted to the pediatric
unit. Which medication should the nurse anticipate administering first?
A. Intravenous antibiotics
B. Nebulized racemic epinephrine
C. Inhaled beta-2 agonists
D. Oral antihistamines
Correct Answer: B
Rationale: Nebulized racemic epinephrine provides rapid mucosal
vasoconstriction, reducing subglottic edema in moderate-to-severe
croup. Corticosteroids (such as dexamethasone) are also
administered for anti-inflammatory effects.
CERTIFICATION EXAMINATION
Pediatric Emergency Care, Airway Management, and Advanced Clinical
Practice • 200 Questions with Detailed Rationales
Acute Epiglottitis & Airway Emergency
Question 1: A nurse is assessing a toddler who has acute epiglottitis.
Which of the following actions must the nurse avoid performing?
A. Administering humidified oxygen via blow-by
B. Inspecting the throat using a tongue depressor
C. Keeping the child in a position of comfort
D. Ensuring emergency intubation equipment is at the bedside
Correct Answer: B
Rationale: Inspecting the throat with a tongue depressor or
attempting to visualize the pharynx in a child with suspected
epiglottitis can trigger sudden, reflex laryngospasm, resulting in
complete and immediate airway obstruction. All emergency airway
equipment must be ready, oxygen provided gently without agitation,
and the child maintained in a position of comfort.
,Question 2: A 3-year-old child presents to the emergency department
with drooling, dysphagia, dysphonia, and a muffled voice. The child is
sitting upright and leaning forward (tripod position). What is the
immediate priority nursing action?
A. Obtain an immediate throat culture
B. Prepare for immediate insertion of an IV line
C. Ensure emergency airway equipment is immediately available and
keep the child calm
D. Place the child supine for a physical examination
Correct Answer: C
Rationale: The child exhibits classic signs of acute epiglottitis. The
immediate priority is maintaining airway safety by keeping
emergency airway equipment at hand and minimizing agitation.
Agitation or crying can precipitate total airway obstruction.
Question 3: Which of the following pathogens is the most common
cause of acute epiglottitis in unimmunized children?
A. Respiratory Syncytial Virus (RSV)
B. Haemophilus influenzae type b (Hib)
C. Streptococcus pneumoniae
D. Bordetella pertussis
Correct Answer: B
Rationale: Haemophilus influenzae type b (Hib) was historically the
primary cause of acute epiglottitis. With the widespread
implementation of the Hib conjugate vaccine, the incidence has
dramatically declined, but it remains the classic etiologic agent tested
in board examinations.
,Question 4: A nurse is caring for a toddler with suspected epiglottitis
who suddenly develops complete airway obstruction. Which equipment
should be immediately prioritized at the bedside?
A. Suction catheter and oxygen mask
B. Tracheostomy tray and emergency intubation equipment
C. Nebulized epinephrine kit
D. Large-bore intravenous cannulation set
Correct Answer: B
Rationale: When complete airway obstruction occurs due to
epiglottitis, endotracheal intubation can be extremely difficult due to
edematous epiglottic swelling. A tracheostomy tray and surgical
airway equipment must be immediately accessible alongside pediatric
intubation gear.
Question 5: Which clinical manifestation differentiates acute epiglottitis
from acute laryngotracheobronchitis (croup)?
A. Presence of a barking cough
B. High fever, drooling, and absence of spontaneous cough
C. Gradual onset over several days
D. Inspiratory stridor that worsens at night
Correct Answer: B
Rationale: Acute epiglottitis presents with a rapid onset of high
fever, severe sore throat, drooling (due to inability to swallow
secretions), dysphonia, and absence of a barking cough. Croup
typically presents with a hallmark barking cough, low-grade fever,
and gradual onset.
, Pediatric Respiratory Emergencies & Croup
Question 6: A nurse is caring for a 2-year-old child with acute
laryngotracheobronchitis (croup). Which of the following findings
should the nurse expect during the assessment?
A. Drooling and muffled voice
B. Barking cough and inspiratory stridor
C. Wheezing and prolonged expiration
D. Asymmetrical chest expansion and dullness on percussion
Correct Answer: B
Rationale: Croup (laryngotracheobronchitis) is characterized by
subglottic inflammation causing a characteristic barking cough,
hoarseness, and inspiratory stridor, often worsening at night.
Question 7: A child with moderate croup is admitted to the pediatric
unit. Which medication should the nurse anticipate administering first?
A. Intravenous antibiotics
B. Nebulized racemic epinephrine
C. Inhaled beta-2 agonists
D. Oral antihistamines
Correct Answer: B
Rationale: Nebulized racemic epinephrine provides rapid mucosal
vasoconstriction, reducing subglottic edema in moderate-to-severe
croup. Corticosteroids (such as dexamethasone) are also
administered for anti-inflammatory effects.
