Pediatric Respiratory: Practice Test 1 (Units 1-7) - Questions
with Correct Answers
100 questions
1. Cyanosis in a child with respiratory illness is considered:
A. An early and reliable sign of mild hypoxemia
B. A sign of good perfusion
C. A sign seen only in children with heart disease
D. A late sign of hypoxemia
Correct Answer: D. A late sign of hypoxemia
Rationale: Central cyanosis appears only when a large amount of hemoglobin is desaturated, so
it is a late finding, and anemia can mask it. It is not an early sign, does not reflect good
perfusion, and occurs with severe respiratory disease too.
2. Normal end-tidal carbon dioxide in a child with healthy lungs is approximately:
A. 10 to 20 mm Hg
B. 60 to 80 mm Hg
C. 90 to 100 mm Hg
D. 35 to 45 mm Hg
Correct Answer: D. 35 to 45 mm Hg
Rationale: End-tidal carbon dioxide normally closely approximates arterial PaCO2, about 35 to
45 mm Hg. Lower values suggest hyperventilation or poor perfusion, while higher values
indicate hypoventilation. Ninety to 100 resembles a normal PaO2, not carbon dioxide.
,3. When taking a respiratory history for a child, an essential environmental question is:
A. The child's favorite color
B. The number of television channels in the home
C. Whether anyone in the home smokes or vapes
D. The parent's shoe size
Correct Answer: C. Whether anyone in the home smokes or vapes
Rationale: Secondhand smoke and vapor exposure increase the risk of respiratory infections,
asthma and ear infections, so they are key history items. The other questions are irrelevant to
respiratory health.
4. Fever increases respiratory rate in children because:
A. Higher temperature raises metabolic rate and carbon dioxide production
B. Fever narrows the airways
C. Fever lowers oxygen consumption
D. Fever decreases carbon dioxide production
Correct Answer: A. Higher temperature raises metabolic rate and carbon dioxide production
Rationale: Each degree of fever increases metabolic demand, so breathing speeds up to remove
extra carbon dioxide. This is why rates should be reassessed after fever control. Fever does not
narrow airways and increases rather than lowers oxygen use.
5. The WHO uses fast breathing as a sign of pneumonia. For a child aged 12 months to 5 years,
fast breathing is a rate of:
A. 20 or more breaths per minute
B. 60 or more breaths per minute
C. 40 or more breaths per minute
D. 30 or more breaths per minute
Correct Answer: C. 40 or more breaths per minute
Rationale: WHO thresholds are 60 or more for infants under 2 months, 50 or more for 2 to 12
months, and 40 or more for 1 to 5 years. A threshold of 20 or 30 would label normal children as
tachypneic, and 60 applies to young infants.
,6. A chest radiograph in a child with respiratory illness is used mainly to:
A. Diagnose every viral infection
B. Replace clinical assessment in all children
C. Measure oxygen saturation
D. Identify findings such as consolidation, hyperinflation, effusion or a foreign body
Correct Answer: D. Identify findings such as consolidation, hyperinflation, effusion or a
foreign body
Rationale: Radiographs show structural findings that guide care, but many viral illnesses are
diagnosed clinically without imaging. They do not replace assessment or measure saturation.
7. Digital clubbing in a child with a respiratory condition suggests:
A. An acute viral cold
B. A recent ear infection
C. Normal variation in all children
D. Chronic hypoxemia, as seen in conditions such as cystic fibrosis
Correct Answer: D. Chronic hypoxemia, as seen in conditions such as cystic fibrosis
Rationale: Clubbing develops over months to years in chronic lung or heart disease with
hypoxemia. It does not appear in acute colds or ear infections and is not a normal finding.
8. Expiratory grunting in an infant is best explained as:
A. A sign of normal digestion
B. A response to pain only
C. A sound produced by the tongue
D. Exhaling against a partly closed glottis to keep alveoli open by creating end-expiratory
pressure
Correct Answer: D. Exhaling against a partly closed glottis to keep alveoli open by creating
end-expiratory pressure
Rationale: Grunting generates positive pressure at the end of expiration that helps prevent
alveolar collapse, so it signals significant lower airway or alveolar disease. It is not digestive, not
merely a pain response, and not produced by the tongue.
, 9. In a child with respiratory distress, the first vital sign change is usually:
A. Bradycardia
B. Hypotension
C. Tachypnea
D. Cyanosis
Correct Answer: C. Tachypnea
Rationale: Children compensate early by breathing faster, so tachypnea is usually the earliest
sign. Bradycardia, hypotension and cyanosis are late signs of decompensation.
10. A respiratory assessment of an adolescent should include confidential questions about:
A. Smoking, vaping and substance inhalation
B. Only their favorite sports
C. Only their parents' smoking
D. Their school grades only
Correct Answer: A. Smoking, vaping and substance inhalation
Rationale: Adolescents may begin smoking, vaping or inhaling substances, which affects
respiratory health, and they answer more honestly in private. Asking only about sports, parents
or grades misses these risks.
11. See-saw (paradoxical) breathing, in which the chest sinks while the abdomen rises, signals:
A. Severe respiratory distress and possible impending respiratory failure
B. Normal infant breathing
C. Mild nasal congestion
D. Recovery from illness
Correct Answer: A. Severe respiratory distress and possible impending respiratory failure
Rationale: When the chest is drawn in as the diaphragm descends, the child is working very
hard with a compliant chest wall and may be tiring. It is not a normal pattern, is out of
proportion to simple congestion, and is not a sign of recovery.
with Correct Answers
100 questions
1. Cyanosis in a child with respiratory illness is considered:
A. An early and reliable sign of mild hypoxemia
B. A sign of good perfusion
C. A sign seen only in children with heart disease
D. A late sign of hypoxemia
Correct Answer: D. A late sign of hypoxemia
Rationale: Central cyanosis appears only when a large amount of hemoglobin is desaturated, so
it is a late finding, and anemia can mask it. It is not an early sign, does not reflect good
perfusion, and occurs with severe respiratory disease too.
2. Normal end-tidal carbon dioxide in a child with healthy lungs is approximately:
A. 10 to 20 mm Hg
B. 60 to 80 mm Hg
C. 90 to 100 mm Hg
D. 35 to 45 mm Hg
Correct Answer: D. 35 to 45 mm Hg
Rationale: End-tidal carbon dioxide normally closely approximates arterial PaCO2, about 35 to
45 mm Hg. Lower values suggest hyperventilation or poor perfusion, while higher values
indicate hypoventilation. Ninety to 100 resembles a normal PaO2, not carbon dioxide.
,3. When taking a respiratory history for a child, an essential environmental question is:
A. The child's favorite color
B. The number of television channels in the home
C. Whether anyone in the home smokes or vapes
D. The parent's shoe size
Correct Answer: C. Whether anyone in the home smokes or vapes
Rationale: Secondhand smoke and vapor exposure increase the risk of respiratory infections,
asthma and ear infections, so they are key history items. The other questions are irrelevant to
respiratory health.
4. Fever increases respiratory rate in children because:
A. Higher temperature raises metabolic rate and carbon dioxide production
B. Fever narrows the airways
C. Fever lowers oxygen consumption
D. Fever decreases carbon dioxide production
Correct Answer: A. Higher temperature raises metabolic rate and carbon dioxide production
Rationale: Each degree of fever increases metabolic demand, so breathing speeds up to remove
extra carbon dioxide. This is why rates should be reassessed after fever control. Fever does not
narrow airways and increases rather than lowers oxygen use.
5. The WHO uses fast breathing as a sign of pneumonia. For a child aged 12 months to 5 years,
fast breathing is a rate of:
A. 20 or more breaths per minute
B. 60 or more breaths per minute
C. 40 or more breaths per minute
D. 30 or more breaths per minute
Correct Answer: C. 40 or more breaths per minute
Rationale: WHO thresholds are 60 or more for infants under 2 months, 50 or more for 2 to 12
months, and 40 or more for 1 to 5 years. A threshold of 20 or 30 would label normal children as
tachypneic, and 60 applies to young infants.
,6. A chest radiograph in a child with respiratory illness is used mainly to:
A. Diagnose every viral infection
B. Replace clinical assessment in all children
C. Measure oxygen saturation
D. Identify findings such as consolidation, hyperinflation, effusion or a foreign body
Correct Answer: D. Identify findings such as consolidation, hyperinflation, effusion or a
foreign body
Rationale: Radiographs show structural findings that guide care, but many viral illnesses are
diagnosed clinically without imaging. They do not replace assessment or measure saturation.
7. Digital clubbing in a child with a respiratory condition suggests:
A. An acute viral cold
B. A recent ear infection
C. Normal variation in all children
D. Chronic hypoxemia, as seen in conditions such as cystic fibrosis
Correct Answer: D. Chronic hypoxemia, as seen in conditions such as cystic fibrosis
Rationale: Clubbing develops over months to years in chronic lung or heart disease with
hypoxemia. It does not appear in acute colds or ear infections and is not a normal finding.
8. Expiratory grunting in an infant is best explained as:
A. A sign of normal digestion
B. A response to pain only
C. A sound produced by the tongue
D. Exhaling against a partly closed glottis to keep alveoli open by creating end-expiratory
pressure
Correct Answer: D. Exhaling against a partly closed glottis to keep alveoli open by creating
end-expiratory pressure
Rationale: Grunting generates positive pressure at the end of expiration that helps prevent
alveolar collapse, so it signals significant lower airway or alveolar disease. It is not digestive, not
merely a pain response, and not produced by the tongue.
, 9. In a child with respiratory distress, the first vital sign change is usually:
A. Bradycardia
B. Hypotension
C. Tachypnea
D. Cyanosis
Correct Answer: C. Tachypnea
Rationale: Children compensate early by breathing faster, so tachypnea is usually the earliest
sign. Bradycardia, hypotension and cyanosis are late signs of decompensation.
10. A respiratory assessment of an adolescent should include confidential questions about:
A. Smoking, vaping and substance inhalation
B. Only their favorite sports
C. Only their parents' smoking
D. Their school grades only
Correct Answer: A. Smoking, vaping and substance inhalation
Rationale: Adolescents may begin smoking, vaping or inhaling substances, which affects
respiratory health, and they answer more honestly in private. Asking only about sports, parents
or grades misses these risks.
11. See-saw (paradoxical) breathing, in which the chest sinks while the abdomen rises, signals:
A. Severe respiratory distress and possible impending respiratory failure
B. Normal infant breathing
C. Mild nasal congestion
D. Recovery from illness
Correct Answer: A. Severe respiratory distress and possible impending respiratory failure
Rationale: When the chest is drawn in as the diaphragm descends, the child is working very
hard with a compliant chest wall and may be tiring. It is not a normal pattern, is out of
proportion to simple congestion, and is not a sign of recovery.
