PEARS Recognizing Respiratory Emergencies 3 — Questions and Answers
Question 1: In the PEARS primary assessment, which element of the respiratory exam evaluates the child's ability to maintain adequate gas exchange?
- Respiratory rate
- Breath sounds
- Pulse oximetry (SpO2) (Correct answer)
- Presence of retractions
Correct answer: Pulse oximetry (SpO2)
Pulse oximetry reflects oxygenation status and is the primary indicator of adequate gas exchange during respiratory assessment.
Question 2: A 5-year-old is found unresponsive with agonal gasps occurring every 8–10 seconds. How should this breathing be classified?
- Adequate breathing requiring monitoring only
- Normal slow breathing for an unconscious child
- Absent or ineffective breathing requiring rescue breaths (Correct answer)
- Mild respiratory distress
Correct answer: Absent or ineffective breathing requiring rescue breaths
Agonal gasps are ineffective and do not support oxygenation; the child requires immediate rescue breathing.
Question 3: Which position best opens the airway of an unresponsive infant without suspected cervical spine injury?
- Hyperextended neck position
- Neutral sniffing position (Correct answer)
- Flexed neck position
- Semi-prone recovery position
Correct answer: Neutral sniffing position
The neutral sniffing position aligns the airway axes optimally in infants without cervical injury.
Question 4: A child in respiratory failure due to bronchiolitis is receiving blow-by oxygen but remains cyanotic with SpO2 of 78%. What is the most appropriate next intervention?
- Increase blow-by oxygen flow rate
- Apply a non-rebreather mask
- Begin bag-mask ventilation (Correct answer)
- Administer nebulized albuterol
Correct answer: Begin bag-mask ventilation
SpO2 of 78% with cyanosis despite supplemental oxygen indicates respiratory failure requiring immediate bag-mask ventilation.
Question 5: Which respiratory rate would be considered tachypneic for a 10-year-old child?
- 18 breaths/min
- 22 breaths/min
- 26 breaths/min (Correct answer)
- 14 breaths/min
Correct answer: 26 breaths/min
A respiratory rate above 20 breaths/min in a 10-year-old is considered tachypneic and warrants further assessment.
Question 6: A 7-month-old presents with 3 days of rhinorrhea and now has subcostal retractions, expiratory wheezing, and SpO2 of 91%. Which diagnosis is most consistent?
- Croup
- Epiglottitis
- Bronchiolitis (Correct answer)
- Pneumonia
Correct answer: Bronchiolitis
Bronchiolitis typically presents in infants under 2 years with viral URI prodrome followed by lower airway wheezing and retractions.
Question 7: During the initial assessment of a child with respiratory distress, which finding most directly indicates the need for immediate intervention?
- Respiratory rate of 30/min
- SpO2 of 91% on room air (Correct answer)
- Mild nasal flaring
- Occasional cough
Correct answer: SpO2 of 91% on room air
SpO2 below 94% indicates inadequate oxygenation and requires immediate oxygen therapy or ventilatory support.
PEARS Recognizing Respiratory Emergencies 3
In the PEARS primary assessment, which element of the respiratory exam evaluates the child's ability to maintain adequate gas exchange?