PNR 204/PNR204 Exam 3 V1 | Pediatric
Nursing Q&A with Rationale | Fortis
College
1. A nurse is caring for a 4-year-old child diagnosed with laryngotracheobronchitis (croup).
Which of the following clinical manifestations should the nurse expect to observe?
A. High-pitched expiratory wheezing and productive cough
B. Barking cough and inspiratory stridor
C. Silent chest and severe intercostal retractions
D. Sudden onset of high fever and drooling
Correct Answer: B
Expert Explanation: Laryngotracheobronchitis, or croup, is characterized by inflammation
of the larynx and trachea which results in a distinct barking cough. Inspiratory stridor
occurs due to the narrowing of the airway as the child breathes in against the
inflammation. This condition is typically viral and managed with cool mist or nebulized
racemic epinephrine if severe.
2. A nurse is assessing a child with suspected epiglottitis. Which of the following actions
should the nurse avoid performing?
A. Placing the child in an upright position
B. Examining the throat with a tongue depressor
,C. Administering humidified oxygen
D. Monitoring oxygen saturation levels
Correct Answer: B
Expert Explanation: Examining the throat of a child with suspected epiglottitis using a
tongue depressor can trigger a sudden laryngospasm and complete airway obstruction.
This is a medical emergency that requires immediate intubation equipment to be at the
bedside. The nurse must prioritize keeping the child calm and in a position of comfort until
the airway is secured.
3. A 10-year-old child with asthma is being discharged. The nurse is teaching the child how to
use a peak flow meter. What does the ‘green zone’ on the meter indicate?
A. The child is having a severe asthma attack
B. The child should use a rescue inhaler immediately
C. The asthma is well-controlled and the child can perform normal activities
D. The child’s lung function is at 50% of their personal best
Correct Answer: C
Expert Explanation: The green zone on a peak flow meter typically represents 80% to
100% of the child’s personal best lung function. This indicates that the asthma is under
good control and no changes to the daily medication regimen are required. Consistent
monitoring helps families recognize when a child is entering the yellow or red zones, which
necessitate intervention.
,4. A nurse is providing teaching to the parents of an infant with Cystic Fibrosis. Which
instruction regarding pancreatic enzyme administration is correct?
A. Give the enzymes once daily in the morning
B. Administer enzymes with every meal and snack
C. Only give enzymes if the child has a fatty stool
D. Mix the enzymes into a large bottle of warm milk
Correct Answer: B
Expert Explanation: Children with Cystic Fibrosis require pancreatic enzymes with all
meals and snacks to facilitate the digestion and absorption of fats, proteins, and
carbohydrates. Because their pancreatic ducts are often blocked by thick mucus, they
cannot naturally release these enzymes into the duodenum. Failure to provide enzymes
consistently results in malabsorption, steatorrhea, and poor weight gain.
5. Which of the following congenital heart defects is characterized by a ‘machine-like’
murmur heard at the upper left sternal border?
A. Ventricular Septal Defect (VSD)
B. Atrial Septal Defect (ASD)
C. Coarctation of the Aorta
D. Patent Ductus Arteriosus (PDA)
Correct Answer: D
, Expert Explanation: A Patent Ductus Arteriosus (PDA) is a condition where the fetal shunt
between the pulmonary artery and the aorta fails to close after birth. The continuous
‘machine-like’ murmur is the hallmark clinical sign of this defect due to the flow of blood
from the high-pressure aorta to the lower-pressure pulmonary artery. Management may
include Indomethacin administration or surgical ligation if the ductus does not close on its
own.
6. A nurse is assessing an infant with Tetralogy of Fallot who suddenly becomes cyanotic and
dyspneic. Which action should the nurse take first?
A. Administer 100% oxygen via face mask
B. Obtain a full set of vital signs
C. Prepare for immediate administration of morphine
D. Place the infant in the knee-chest position
Correct Answer: D
Expert Explanation: The knee-chest position is the priority intervention for a ‘tet spell’ in
a child with Tetralogy of Fallot. This position increases systemic vascular resistance, which
helps to decrease the right-to-left shunt across the ventricular septal defect. Improving
oxygenation during these acute cyanotic episodes is crucial for preventing potential
neurological complications.
7. Which clinical finding is most characteristic of a child with Coarctation of the Aorta?
A. Weak or absent femoral pulses
Nursing Q&A with Rationale | Fortis
College
1. A nurse is caring for a 4-year-old child diagnosed with laryngotracheobronchitis (croup).
Which of the following clinical manifestations should the nurse expect to observe?
A. High-pitched expiratory wheezing and productive cough
B. Barking cough and inspiratory stridor
C. Silent chest and severe intercostal retractions
D. Sudden onset of high fever and drooling
Correct Answer: B
Expert Explanation: Laryngotracheobronchitis, or croup, is characterized by inflammation
of the larynx and trachea which results in a distinct barking cough. Inspiratory stridor
occurs due to the narrowing of the airway as the child breathes in against the
inflammation. This condition is typically viral and managed with cool mist or nebulized
racemic epinephrine if severe.
2. A nurse is assessing a child with suspected epiglottitis. Which of the following actions
should the nurse avoid performing?
A. Placing the child in an upright position
B. Examining the throat with a tongue depressor
,C. Administering humidified oxygen
D. Monitoring oxygen saturation levels
Correct Answer: B
Expert Explanation: Examining the throat of a child with suspected epiglottitis using a
tongue depressor can trigger a sudden laryngospasm and complete airway obstruction.
This is a medical emergency that requires immediate intubation equipment to be at the
bedside. The nurse must prioritize keeping the child calm and in a position of comfort until
the airway is secured.
3. A 10-year-old child with asthma is being discharged. The nurse is teaching the child how to
use a peak flow meter. What does the ‘green zone’ on the meter indicate?
A. The child is having a severe asthma attack
B. The child should use a rescue inhaler immediately
C. The asthma is well-controlled and the child can perform normal activities
D. The child’s lung function is at 50% of their personal best
Correct Answer: C
Expert Explanation: The green zone on a peak flow meter typically represents 80% to
100% of the child’s personal best lung function. This indicates that the asthma is under
good control and no changes to the daily medication regimen are required. Consistent
monitoring helps families recognize when a child is entering the yellow or red zones, which
necessitate intervention.
,4. A nurse is providing teaching to the parents of an infant with Cystic Fibrosis. Which
instruction regarding pancreatic enzyme administration is correct?
A. Give the enzymes once daily in the morning
B. Administer enzymes with every meal and snack
C. Only give enzymes if the child has a fatty stool
D. Mix the enzymes into a large bottle of warm milk
Correct Answer: B
Expert Explanation: Children with Cystic Fibrosis require pancreatic enzymes with all
meals and snacks to facilitate the digestion and absorption of fats, proteins, and
carbohydrates. Because their pancreatic ducts are often blocked by thick mucus, they
cannot naturally release these enzymes into the duodenum. Failure to provide enzymes
consistently results in malabsorption, steatorrhea, and poor weight gain.
5. Which of the following congenital heart defects is characterized by a ‘machine-like’
murmur heard at the upper left sternal border?
A. Ventricular Septal Defect (VSD)
B. Atrial Septal Defect (ASD)
C. Coarctation of the Aorta
D. Patent Ductus Arteriosus (PDA)
Correct Answer: D
, Expert Explanation: A Patent Ductus Arteriosus (PDA) is a condition where the fetal shunt
between the pulmonary artery and the aorta fails to close after birth. The continuous
‘machine-like’ murmur is the hallmark clinical sign of this defect due to the flow of blood
from the high-pressure aorta to the lower-pressure pulmonary artery. Management may
include Indomethacin administration or surgical ligation if the ductus does not close on its
own.
6. A nurse is assessing an infant with Tetralogy of Fallot who suddenly becomes cyanotic and
dyspneic. Which action should the nurse take first?
A. Administer 100% oxygen via face mask
B. Obtain a full set of vital signs
C. Prepare for immediate administration of morphine
D. Place the infant in the knee-chest position
Correct Answer: D
Expert Explanation: The knee-chest position is the priority intervention for a ‘tet spell’ in
a child with Tetralogy of Fallot. This position increases systemic vascular resistance, which
helps to decrease the right-to-left shunt across the ventricular septal defect. Improving
oxygenation during these acute cyanotic episodes is crucial for preventing potential
neurological complications.
7. Which clinical finding is most characteristic of a child with Coarctation of the Aorta?
A. Weak or absent femoral pulses
