Pediatric Nurse Exam Pediatric Nurse Respiratory and Cardiovascular Disorders 1 — Questions and Answers
Question 1: Which medication is the first-line treatment for an acute asthma exacerbation in a pediatric patient?
- Inhaled corticosteroids (e.g., fluticasone)
- Short-acting beta-2 agonists (e.g., albuterol) (Correct answer)
- Leukotriene modifiers (e.g., montelukast)
- Long-acting beta-2 agonists (e.g., salmeterol)
Correct answer: Short-acting beta-2 agonists (e.g., albuterol)
Short-acting beta-2 agonists like albuterol are the first-line bronchodilators for acute asthma exacerbations due to their rapid onset and ability to quickly relieve bronchospasm.
Question 2: A 3-month-old infant with confirmed RSV bronchiolitis is admitted with wheezing, tachypnea, and poor feeding. What is the priority nursing intervention?
- Administer ribavirin antiviral therapy
- Begin broad-spectrum antibiotics immediately
- Maintain airway patency and closely monitor respiratory status (Correct answer)
- Perform vigorous chest physiotherapy every 2 hours
Correct answer: Maintain airway patency and closely monitor respiratory status
RSV bronchiolitis management is primarily supportive; ensuring airway patency and monitoring respiratory status are the highest priorities as infants can deteriorate rapidly.
Question 3: A child presents to the ED with a barking cough and mild inspiratory stridor at rest, consistent with mild-to-moderate croup. Which intervention is first-line?
- Nebulized racemic epinephrine and 2-4 hours of observation
- Heliox therapy via face mask
- Immediate endotracheal intubation for airway protection
- A single dose of oral or IM dexamethasone (Correct answer)
Correct answer: A single dose of oral or IM dexamethasone
Dexamethasone is the first-line treatment for mild-to-moderate croup because it reduces subglottic edema through its anti-inflammatory effect and has a prolonged duration of action.
Question 4: Which clinical presentation best distinguishes epiglottitis from croup in a febrile child?
- Barking (seal-like) cough and low-grade fever
- Inspiratory stridor with a hoarse voice and gradual onset
- Tripod positioning, drooling, and high fever without cough (Correct answer)
- Subglottic narrowing visible on lateral neck X-ray
Correct answer: Tripod positioning, drooling, and high fever without cough
Epiglottitis classically presents with tripod positioning (leaning forward on hands), drooling due to inability to swallow, and high fever without the barking cough seen in croup.
Question 5: Which nursing intervention is most important for a hospitalized child with cystic fibrosis (CF) to prevent pulmonary complications?
- Restrict fluid intake to reduce secretion volume
- Limit all physical activity to prevent bronchospasm
- Administer inhaled corticosteroids twice daily as prescribed
- Perform chest physiotherapy and airway clearance techniques regularly (Correct answer)
Correct answer: Perform chest physiotherapy and airway clearance techniques regularly
Chest physiotherapy and airway clearance techniques mobilize the thick, viscous mucus characteristic of CF, reducing the risk of infection, atelectasis, and progressive lung damage.
Question 6: A toddler presents with sudden onset of choking and coughing, followed by unilateral decreased breath sounds on the right side. What is the most likely diagnosis?
- RSV bronchiolitis with mucus plugging
- Epiglottitis with supraglottic obstruction
- Foreign body aspiration lodged in the right mainstem bronchus (Correct answer)
- Community-acquired bilateral pneumonia
Correct answer: Foreign body aspiration lodged in the right mainstem bronchus
The sudden onset of choking with unilateral decreased breath sounds strongly suggests foreign body aspiration, as the object commonly lodges in the right mainstem bronchus due to its more vertical angle.
Question 7: Which oxygen delivery device provides the highest concentration of oxygen for a child in severe respiratory distress who is breathing spontaneously?
- Nasal cannula at 6 L/min (up to 44% FiO2)
- Simple face mask (35-60% FiO2)
- Partial non-rebreather mask (60-80% FiO2)
- Non-rebreather mask with reservoir bag (60-95% FiO2) (Correct answer)
Correct answer: Non-rebreather mask with reservoir bag (60-95% FiO2)
A non-rebreather mask with a reservoir bag and one-way valves can deliver up to 95% FiO2 by preventing rebreathing of exhaled air, making it the highest-concentration device for spontaneously breathing patients.
Pediatric Nurse Exam Pediatric Nurse Respiratory and Cardiovascular Disorders 1
Which medication is the first-line treatment for an acute asthma exacerbation in a pediatric patient?