Pediatric Respiratory: Exam 2 - Questions with Correct
Answers
100 questions
1. A large tongue relative to the oral cavity in infants increases the risk that:
A. The infant will breathe faster
B. The infant cannot cry
C. The larynx will descend
D. The tongue will obstruct the airway when muscle tone falls, such as during sedation
Correct Answer: D. The tongue will obstruct the airway when muscle tone falls, such as during
sedation
Rationale: With relaxation, the large tongue falls back and blocks the pharynx, so positioning
and jaw thrust are important in sedated or unconscious children. It does not raise respiratory
rate, prevent crying or move the larynx.
2. A previously agitated child with severe asthma becomes quiet and drowsy while still
struggling to breathe. The nurse should interpret this as:
A. Improvement and successful rest
B. Possible rising carbon dioxide and impending respiratory failure
C. Normal fatigue after crying
D. A side effect of albuterol
Correct Answer: B. Possible rising carbon dioxide and impending respiratory failure
Rationale: Decreased responsiveness in a distressed child suggests hypercapnia or hypoxia and
exhaustion, requiring urgent escalation. Assuming improvement can be fatal, normal fatigue
would not occur with ongoing distress, and albuterol usually causes agitation rather than
drowsiness.
,3. The right main bronchus is shorter, wider and more vertical than the left, so:
A. Aspiration always affects the left lung
B. Breath sounds are louder on the left
C. Aspirated objects and a too-deep endotracheal tube most often enter the right side
D. The left lung is larger
Correct Answer: C. Aspirated objects and a too-deep endotracheal tube most often enter the
right side
Rationale: Its steeper angle makes the right bronchus the usual path for foreign bodies and
malpositioned tubes, causing decreased left-sided breath sounds. Aspiration is not usually
left-sided, and the right lung, with three lobes, is larger.
4. A pulse oximeter reading may be falsely low or unreliable in a child who:
A. Is resting quietly with warm hands
B. Has poor peripheral perfusion or is moving vigorously
C. Has the probe placed correctly on a finger
D. Is breathing room air
Correct Answer: B. Has poor peripheral perfusion or is moving vigorously
Rationale: Poor perfusion, motion, cold extremities and incorrect probe placement interfere
with the signal. A calm, warm child with a correctly placed probe gives the most reliable
readings, and breathing room air does not falsify readings.
5. To obtain an accurate respiratory rate in an infant, the nurse should:
A. Count for a full minute while the infant is quiet, observing the abdomen
B. Count for 10 seconds and multiply by 6
C. Count after the infant has been crying
D. Count only during feeding
Correct Answer: A. Count for a full minute while the infant is quiet, observing the abdomen
Rationale: Infant breathing is irregular and diaphragmatic, so a full minute of observation of
abdominal movement at rest is most accurate. Short counts miss periodic breathing, and crying
or feeding alters the rate.
,6. Infants rely mainly on which muscle for breathing?
A. The sternocleidomastoid
B. The scalene muscles
C. The diaphragm
D. The abdominal oblique muscles
Correct Answer: C. The diaphragm
Rationale: Infants breathe mostly with the diaphragm, so abdominal distension or anything that
limits diaphragm movement can impair ventilation. The sternocleidomastoid and scalenes are
accessory muscles used in distress, and the obliques assist forced expiration.
7. Head bobbing in an infant with respiratory illness indicates:
A. Normal neck control development
B. A seizure
C. Use of accessory neck muscles due to increased work of breathing
D. Ear pain
Correct Answer: C. Use of accessory neck muscles due to increased work of breathing
Rationale: Head bobbing occurs when the scalene and sternocleidomastoid muscles help
breathing in a tired infant, a sign of significant distress. It is not related to developmental head
control, seizure activity or otalgia.
8. Supraclavicular and suprasternal retractions, compared with subcostal retractions, generally
suggest:
A. More severe respiratory distress or upper airway obstruction
B. Milder respiratory distress
C. Normal breathing
D. Abdominal pathology
Correct Answer: A. More severe respiratory distress or upper airway obstruction
Rationale: Retractions that extend upward to the neck reflect very high negative pressure,
often from upper airway obstruction or severe disease. Mild distress usually shows only
subcostal or intercostal retractions, and these signs are not normal or abdominal in origin.
, 9. Which finding makes group A streptococcal pharyngitis more likely than a viral sore throat?
A. Runny nose, cough and hoarseness
B. Conjunctivitis and diarrhea
C. Gradual onset with sneezing
D. Sudden fever, tonsillar exudate, tender anterior cervical nodes and absence of cough
Correct Answer: D. Sudden fever, tonsillar exudate, tender anterior cervical nodes and
absence of cough
Rationale: Strep typically causes abrupt sore throat, fever, exudate and tender nodes without
cold symptoms. Cough, runny nose, hoarseness, conjunctivitis and diarrhea point toward a viral
cause.
10. Honey should not be given for cough to a child younger than 12 months because of the risk
of:
A. Tooth decay only
B. Allergic rhinitis
C. Lactose intolerance
D. Infant botulism
Correct Answer: D. Infant botulism
Rationale: Honey can contain Clostridium botulinum spores that young infants cannot clear,
causing botulism. For children over 1 year, a small amount of honey may ease cough. Tooth
decay, rhinitis and lactose intolerance are not the concern.
11. A child with a cold should be seen promptly if the parent notices:
A. Clear runny nose
B. Sneezing
C. Mild cough on day 3
D. Fast or labored breathing, poor fluid intake, or decreased urination
Correct Answer: D. Fast or labored breathing, poor fluid intake, or decreased urination
Rationale: Labored breathing and dehydration signal complications that need evaluation. Clear
discharge, sneezing and mild early cough are expected features of a cold.
Answers
100 questions
1. A large tongue relative to the oral cavity in infants increases the risk that:
A. The infant will breathe faster
B. The infant cannot cry
C. The larynx will descend
D. The tongue will obstruct the airway when muscle tone falls, such as during sedation
Correct Answer: D. The tongue will obstruct the airway when muscle tone falls, such as during
sedation
Rationale: With relaxation, the large tongue falls back and blocks the pharynx, so positioning
and jaw thrust are important in sedated or unconscious children. It does not raise respiratory
rate, prevent crying or move the larynx.
2. A previously agitated child with severe asthma becomes quiet and drowsy while still
struggling to breathe. The nurse should interpret this as:
A. Improvement and successful rest
B. Possible rising carbon dioxide and impending respiratory failure
C. Normal fatigue after crying
D. A side effect of albuterol
Correct Answer: B. Possible rising carbon dioxide and impending respiratory failure
Rationale: Decreased responsiveness in a distressed child suggests hypercapnia or hypoxia and
exhaustion, requiring urgent escalation. Assuming improvement can be fatal, normal fatigue
would not occur with ongoing distress, and albuterol usually causes agitation rather than
drowsiness.
,3. The right main bronchus is shorter, wider and more vertical than the left, so:
A. Aspiration always affects the left lung
B. Breath sounds are louder on the left
C. Aspirated objects and a too-deep endotracheal tube most often enter the right side
D. The left lung is larger
Correct Answer: C. Aspirated objects and a too-deep endotracheal tube most often enter the
right side
Rationale: Its steeper angle makes the right bronchus the usual path for foreign bodies and
malpositioned tubes, causing decreased left-sided breath sounds. Aspiration is not usually
left-sided, and the right lung, with three lobes, is larger.
4. A pulse oximeter reading may be falsely low or unreliable in a child who:
A. Is resting quietly with warm hands
B. Has poor peripheral perfusion or is moving vigorously
C. Has the probe placed correctly on a finger
D. Is breathing room air
Correct Answer: B. Has poor peripheral perfusion or is moving vigorously
Rationale: Poor perfusion, motion, cold extremities and incorrect probe placement interfere
with the signal. A calm, warm child with a correctly placed probe gives the most reliable
readings, and breathing room air does not falsify readings.
5. To obtain an accurate respiratory rate in an infant, the nurse should:
A. Count for a full minute while the infant is quiet, observing the abdomen
B. Count for 10 seconds and multiply by 6
C. Count after the infant has been crying
D. Count only during feeding
Correct Answer: A. Count for a full minute while the infant is quiet, observing the abdomen
Rationale: Infant breathing is irregular and diaphragmatic, so a full minute of observation of
abdominal movement at rest is most accurate. Short counts miss periodic breathing, and crying
or feeding alters the rate.
,6. Infants rely mainly on which muscle for breathing?
A. The sternocleidomastoid
B. The scalene muscles
C. The diaphragm
D. The abdominal oblique muscles
Correct Answer: C. The diaphragm
Rationale: Infants breathe mostly with the diaphragm, so abdominal distension or anything that
limits diaphragm movement can impair ventilation. The sternocleidomastoid and scalenes are
accessory muscles used in distress, and the obliques assist forced expiration.
7. Head bobbing in an infant with respiratory illness indicates:
A. Normal neck control development
B. A seizure
C. Use of accessory neck muscles due to increased work of breathing
D. Ear pain
Correct Answer: C. Use of accessory neck muscles due to increased work of breathing
Rationale: Head bobbing occurs when the scalene and sternocleidomastoid muscles help
breathing in a tired infant, a sign of significant distress. It is not related to developmental head
control, seizure activity or otalgia.
8. Supraclavicular and suprasternal retractions, compared with subcostal retractions, generally
suggest:
A. More severe respiratory distress or upper airway obstruction
B. Milder respiratory distress
C. Normal breathing
D. Abdominal pathology
Correct Answer: A. More severe respiratory distress or upper airway obstruction
Rationale: Retractions that extend upward to the neck reflect very high negative pressure,
often from upper airway obstruction or severe disease. Mild distress usually shows only
subcostal or intercostal retractions, and these signs are not normal or abdominal in origin.
, 9. Which finding makes group A streptococcal pharyngitis more likely than a viral sore throat?
A. Runny nose, cough and hoarseness
B. Conjunctivitis and diarrhea
C. Gradual onset with sneezing
D. Sudden fever, tonsillar exudate, tender anterior cervical nodes and absence of cough
Correct Answer: D. Sudden fever, tonsillar exudate, tender anterior cervical nodes and
absence of cough
Rationale: Strep typically causes abrupt sore throat, fever, exudate and tender nodes without
cold symptoms. Cough, runny nose, hoarseness, conjunctivitis and diarrhea point toward a viral
cause.
10. Honey should not be given for cough to a child younger than 12 months because of the risk
of:
A. Tooth decay only
B. Allergic rhinitis
C. Lactose intolerance
D. Infant botulism
Correct Answer: D. Infant botulism
Rationale: Honey can contain Clostridium botulinum spores that young infants cannot clear,
causing botulism. For children over 1 year, a small amount of honey may ease cough. Tooth
decay, rhinitis and lactose intolerance are not the concern.
11. A child with a cold should be seen promptly if the parent notices:
A. Clear runny nose
B. Sneezing
C. Mild cough on day 3
D. Fast or labored breathing, poor fluid intake, or decreased urination
Correct Answer: D. Fast or labored breathing, poor fluid intake, or decreased urination
Rationale: Labored breathing and dehydration signal complications that need evaluation. Clear
discharge, sneezing and mild early cough are expected features of a cold.
