CPEN Respiratory Emergencies 4 — Questions and Answers
Question 1: Which capnography waveform pattern is most consistent with severe bronchospasm in an intubated child?
- Flat line (no waveform)
- Normal square wave
- Shark fin (upsloping plateau) (Correct answer)
- Cleft in the plateau
Correct answer: Shark fin (upsloping plateau)
The 'shark fin' pattern on capnography indicates incomplete exhalation due to bronchospasm, causing a prolonged, upsloping expiratory phase.
Question 2: A 4-year-old is found apneic. After 2 rescue breaths fail to produce chest rise, the next step is:
- Begin chest compressions
- Attempt to ventilate again with head repositioned (Correct answer)
- Perform blind finger sweep of the mouth
- Proceed directly to intubation
Correct answer: Attempt to ventilate again with head repositioned
If initial rescue breaths do not produce chest rise, the head-tilt/chin-lift should be repositioned before a second attempt, as poor positioning is the most common cause.
Question 3: For a 2-year-old (10 kg) in status asthmaticus requiring magnesium sulfate, the correct IV dose is:
- 25–50 mg/kg (max 2 g) (Correct answer)
- 1–2 mg/kg (max 50 mg)
- 5–10 mg/kg (max 500 mg)
- 0.1 mg/kg (max 5 mg)
Correct answer: 25–50 mg/kg (max 2 g)
IV magnesium sulfate for pediatric asthma is dosed at 25–75 mg/kg (max 2 g) infused over 20–30 minutes.
Question 4: Which clinical sign BEST indicates impending respiratory failure in an infant with bronchiolitis?
- Nasal flaring
- Intermittent grunting
- Apneic episodes (Correct answer)
- Mild intercostal retractions
Correct answer: Apneic episodes
Apneic episodes indicate exhaustion and central respiratory compromise — a sign of impending respiratory failure requiring immediate intervention.
Question 5: A 9-year-old with cystic fibrosis presents with acute hemoptysis, fever, and increased sputum. The PRIORITY nursing action is:
- Position the patient with the affected side down (Correct answer)
- Administer nebulized hypertonic saline
- Obtain IV access and administer antibiotics
- Prepare for immediate bronchoscopy
Correct answer: Position the patient with the affected side down
Positioning the patient with the bleeding (affected) lung down prevents blood from flooding the contralateral lung and maintains ventilation.
Question 6: Which parameter is the MOST sensitive early indicator of respiratory decompensation in a pediatric patient?
- Oxygen saturation drop below 90%
- Rising respiratory rate (tachypnea) (Correct answer)
- Cyanosis of the lips
- Bradycardia
Correct answer: Rising respiratory rate (tachypnea)
Tachypnea is the earliest compensatory response to hypoxia and hypercarbia, appearing before SpO2 drops or visible cyanosis develops.
Question 7: Racemic epinephrine administered to a child with croup requires a minimum observation period of how long after treatment?
- 30 minutes
- 1 hour
- 2 hours (Correct answer)
- 4 hours
Correct answer: 2 hours
Children must be observed for a minimum of 2 hours after racemic epinephrine due to the risk of rebound airway edema as the medication wears off.
CPEN Respiratory Emergencies 4
Which capnography waveform pattern is most consistent with severe bronchospasm in an intubated child?