NCLEX Practice Exam for Pediatric Nursing: Respiratory Disorders

Practice Mode – Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam.

Exam Mode – Questions and choices are randomly arranged, time limit of 1min  per question, answers and grade will be revealed after finishing the exam.

Text Mode – Text version of the exam

1. Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child?

1. Pulmonary secretions are abnormally thick.
2. Elevated levels of potassium are found in the sweat.
3. CF is an autosomal dominant hereditary disorder.
4. Obstruction of the endocrine glands occurs.

2. Veronica’s parents were told that their daughter needs ribavirin (Virazole). This drug is used to treat which of the following?

1. Cystic fibrosis
2. Otitis media
3. Respiratory syncytial virus (RSV)
4. Bronchitis

3. Beta-adrenergic agonists such as albuterol are given to Reggie, a child with asthma. Such drugs are administered primarily to do which of the following?

1. Dilate the bronchioles
2. Reduce secondary infections
3. Decrease postnasal drip
4. Reduce airway inflammation

4. Alice is rushed to the emergency department during an acute, severe prolonged asthma attack and is unresponsive to usual treatment. The condition is referred to as which of the following?

1. Status asthmaticus
2. Reactive airway disease
3. Intrinsic asthma
4. Extrinsic asthma

5. Which of the following infants is least probable to develop sudden infant death syndrome (SIDS)?

1. Baby Angela who was premature
2. A sibling of Baby Angie who died of SIDS
3. Baby Gabriel with prenatal drug exposure
4. Baby Gabby who sleeps on his back

6. Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would Nurse Nica expect to assess?

1. Mild cough
2. Slight fever
3. Chest pain
4. Bulging fontanel

7. Baby Melody is a neonate who has a very low-birth-weight. Nurse Josie carefully monitors inspiratory pressure and oxygen (O2) concentration to prevent which of the following? 

1. Meconium aspiration syndrome
2. Bronchopulmonary dysplasia (BPD)
3. Respiratory syncytial virus (RSV)
4. Respiratory distress syndrome (RDS)

8. Archie who weighs 44 lb has been given an order for amoxicillin 500 mg b.i.d. The drug text notes that the daily dose of amoxicillin is 50 mg/kg/day in two divided doses. What dose in milligrams is safest for this child?

1. 1000 mg
2. 750 mg
3. 500 mg
4. 250 mg

9. The Andrews family has been taking good care of their youngest, Archie, who was diagnosed with asthma. Which of the following statements indicate a need for further home care teaching?

1. “He should increase his fluid intake regularly to thin secretions.”
2. “We’ll make sure that he avoids exercise to prevent attacks.”
3. “He is to use his bronchodilator inhaler before the steroid inhaler.”
4. “We need to identify what things trigger his attacks.”

10. Which of the following instructions should Nurse Cheryl include in her teaching plan for the parents of Reggie with otitis media?

1. Placing the child in the supine position to bottle-feed
2. Giving prescribed amoxicillin (Amoxil) on an empty stomach
3. Cleaning the inside of the ear canals with cotton swabs
4. Avoiding contact with people who have upper respiratory tract infections

11. Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions?

1. Bronchiolitis
2. Laryngotracheobronchitis (LTB)
3. Epiglottitis
4. Pneumonia

12. Which of the following respiratory conditions is always considered a medical emergency?

1. Asthma
2. Cystic fibrosis (CF)
3. Epiglottiditis
4. Laryngotracheobronchitis (LTB)

13. When assessing a child’s cultural background, the nurse in charge should keep in mind that:

1. Heritage dictates a group’s shared values
2. Physical characteristics mark the child as part of a particular culture
3. Cultural background usually has little bearing on a family’s health practices
4. Behavioral patterns are passed from one generation to the next

14. Which of the following is the best method for performing a physical examination on a toddler

1. From head to toe
2. Distally to proximally
3. From abdomen to toes, the to head
4. From least to most intrusive

15. Nurse Veronica is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature?

1. Nasopharynx
2. Eustachian tubes
3. External ear canal
4. Tympanic membrane

Answers and Rationale

1. Answer: A. Pulmonary secretions are abnormally thick.

• A: CF is identified by abnormally thick pulmonary secretions.
• B: Diagnosis of CF is based on elevated chloride levels detected in sweat.
• C: It is a chronic, inherited disorder, particularly an autosomal recessive hereditary disorder concerning the exocrine, not endocrine glands.
• D: The thick mucus blocks the exocrine glands.

2. Answer: C. Respiratory syncytial virus (RSV)

• C: Ribavirin is an antiviral medication used for treating RSV infection and for children with RSV who are compromised (such as children with bronchopulmonary dysplasia or heart disease).
• A,B,D: The drug is not used to treat bronchiolitis, otitis media, or CF.

3. Answer: A. Dilate the bronchioles

• A: Beta-adrenergic agonists, such as albuterol, are highly effective bronchodilators and are used to dilate the narrow airways associated with asthma.
• B: Antibiotics are used to prevent secondary infection.
• C: Decongestants may be given to decrease postnasal drip.
• D: Corticosteroids may be used for their anti-inflammatory effect.

4. Answer: A. Status asthmaticus

• A: Status asthmaticus is an acute, prolonged, severe asthma attack that is unresponsive to usual treatment. Typically, the child requires hospitalization.
• B: Reactive airway disease is another general term for asthma.
• C: Intrinsic is a term used to denote internal precipitating factors, such as viruses.
• D: Extrinsic is a term used to denote external precipitating factors, such as allergens.

5. Answer: D. Baby Gabby who sleeps on his back

• D: Infants who sleep on their back are least likely to develop SIDS. However, SIDS has been associated with infants who sleep on their abdomens.
• A,B,C: Being premature, having a sibling who died of SIDS, and being prenatally exposed to drugs all place the infant at high risk for developing SIDS.

6. Answer: C. Chest pain

• C: Older children with pneumococcal pneumonia may complain of chest pain.
• A,B: A mild cough and slight fever are commonly assessed with viral pneumonia.
• D: A bulging fontanel may be seen in infants with meningitis or increased intracranial pressure.

7. Answer: B. Bronchopulmonary dysplasia (BPD)

• B: Close monitoring of inspiratory pressure and O₂ concentration is necessary to prevent BPD, which is related to the use of high inspiratory pressures and O₂concentrations especially in very low-birth-weight and extremely low-birth-weight neonates with lung disorders.
• A: Meconium aspiration syndrome is a respiratory disorder created by the aspiration of meconium in perinatal period.
• C: RSV is a group of viruses that cause respiratory tract infections, such as bronchiolitis and pneumonia.
• D: RDS, a disorder caused by lack of surfactant, usually is found in premature neonates.

8. Answer: C. 500 mg

• C: First, calculate the child’s weight in kg: 44/2.2 = 20 kg. Then calculate the appropriate daily dose according to the drug text: 50 mg/kg/day = 50 mg x 20 kg = 1,000 mg/day. the abbreviation b.i.d. means twice daily; therefore 1,000 divided by 2 equals 500 mg.

9. Answer: B. “We’ll make sure that he avoids exercise to prevent attacks.”

• B: Additional teaching is needed if the family states that the child with asthma should avoid exercise to prevent attacks. Children with asthma should be encouraged to exercise as tolerated.
• A,C,D: Identifying triggers, using a bronchodilator inhaler before a steroid inhaler, and increasing fluid intake are appropriate measures to be included in a home care teaching program for the child with asthma and his family.

10. Answer: D. Avoiding contact with people who have upper respiratory tract infections

• D: Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection.
• A: A bottle-fed child should be fed in an upright position because feeding the child in the supine position may actually precipitate otitis by allowing the formula to pool in the pharyngeal cavity.
• B: Amoxicillin, when prescribed, should be given with food to prevent stomach upset.
• C: Cotton swabs can cause injuries such as tympanic perforation. They may be used to clean the outer ear, but they should never be inserted into the ear canal.

11. Answer: C. Epiglottitis

• C: Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis.
• A: Bronchiolitis is usually caused by Respiratory Syncytial Virus (RSV).
• B: Acute LTB is of viral origin.
• D: The most common bacterial organisms causing pneumonia in children are pneumococci, streptococci, and staphylococci.

12. Answer: C. Epiglottiditis

• C: Epiglottiditis, acute and severe inflammation of the epiglottis, is always considered an acute medical emergency because it can lead to acute, life-threatening airway obstruction.
• A: Asthma is a chronic disease; however, status asthmaticus and acute attacks require prompt treatment.
• B: CF is a chronic disease and is not considered an emergency.
• D: Acute LTB requires close observation for airway obstruction, but this condition is not always an emergency.

13. Answer: D. Behavioral patterns are passed from one generation to the next

• D: A family’s behavioral patterns and values are passed from one generation to the next.
• A: Although heritage plays a role in culture, it does not dictate a group’s shared values and its effect on culture is weaker than that of behavioral patterns.
• B: Physical characteristics do not indicate a child’s culture.
• C: Cultural background commonly plays a major role in determining a family’s health practices.

14. Answer: Answer: D. From least to most intrusive

• D: When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive.
• A: Starting at the head or abdomen is intrusive and should be avoided.
• B: Proceeding from distal to proximal is inappropriate at any age.

15. Answer: B. Eustachian tubes

• B: In a child, Eustachian tubes are short and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media.
• A,C,D: The nasopharynx, tympanic membrane, external ear canal have no unusual features that would predispose a child to otitis media.