1
HESI Pediatric Respiratory Exam
Bank: Bronchiolitis, Distress Signs
& Nursing Care Q&A
Table of Contents
Subtopic 1: Recognition and Early Assessment of Pediatric Respiratory
Distress............................................................................................................2
Subtopic 2: Bronchiolitis Pathophysiology and Risk Factors...........................10
Subtopic 3: Clinical Presentation and Symptom Progression in Bronchiolitis. 18
Subtopic 4: Diagnostic Approaches and Clinical Decision-Making.................27
Subtopic 5: Nursing Management and Supportive Interventions in
Bronchiolitis...................................................................................................35
, 2
Subtopic 1: Recognition and Early Assessment
of Pediatric Respiratory Distress
Question 1:
A 6-month-old infant presents to the ED with nasal flaring, intercostal
retractions, and a respiratory rate of 70/min. Which of the following best
describes the infant's condition?
A. Mild upper respiratory tract infection
B. Normal variation for age
C. Moderate to severe respiratory distress
D. Hyperventilation due to crying
Correct Answer: C. Moderate to severe respiratory distress
Rationale: A respiratory rate >60/min with nasal flaring and retractions
indicates significant respiratory distress requiring immediate intervention.
Question 2:
Which sign is an early indicator of respiratory distress in infants?
A. Cyanosis
B. Tachypnea
C. Bradypnea
D. Grunting
Correct Answer: B. Tachypnea
Rationale: Tachypnea is one of the earliest and most sensitive signs of
respiratory distress before other compensatory mechanisms like grunting or
cyanosis appear.
, 3
Question 3:
Which of the following respiratory sounds is most concerning in a 3-month-
old with bronchiolitis?
A. Occasional sneezing
B. Audible expiratory wheezing with nasal flaring
C. Soft inspiratory breath sounds
D. Rhonchi in upper lobes
Correct Answer: B. Audible expiratory wheezing with nasal flaring
Rationale: Audible wheezing with nasal flaring suggests lower airway
obstruction and increased work of breathing.
Question 4:
What is the best position to place a 2-month-old infant in respiratory distress
to ease breathing?
A. Supine
B. Semi-Fowler’s position
C. Trendelenburg
D. Prone
Correct Answer: B. Semi-Fowler’s position
Rationale: Semi-Fowler’s promotes lung expansion and reduces the work of
breathing in infants.
Question 5:
In assessing a child with suspected bronchiolitis, which symptom would
indicate worsening respiratory status?
A. Runny nose
, 4
B. Grunting on expiration
C. Mild cough
D. Clear lung sounds
Correct Answer: B. Grunting on expiration
Rationale: Grunting is a compensatory mechanism for impaired oxygenation
and indicates worsening distress.
Question 6:
Which of the following assessment findings in a 1-year-old indicates the need
for immediate intervention?
A. Mild nasal congestion
B. Respiratory rate of 40/min
C. Head bobbing with each breath
D. Crying with feeding
Correct Answer: C. Head bobbing with each breath
Rationale: Head bobbing is a late sign of respiratory distress signaling
exhaustion and poor oxygenation.
Question 7:
Which oxygen saturation level in a 4-month-old with bronchiolitis requires
urgent intervention?
A. 95% on room air
B. 88% on room air
C. 92% on room air
D. 96% on nasal cannula
HESI Pediatric Respiratory Exam
Bank: Bronchiolitis, Distress Signs
& Nursing Care Q&A
Table of Contents
Subtopic 1: Recognition and Early Assessment of Pediatric Respiratory
Distress............................................................................................................2
Subtopic 2: Bronchiolitis Pathophysiology and Risk Factors...........................10
Subtopic 3: Clinical Presentation and Symptom Progression in Bronchiolitis. 18
Subtopic 4: Diagnostic Approaches and Clinical Decision-Making.................27
Subtopic 5: Nursing Management and Supportive Interventions in
Bronchiolitis...................................................................................................35
, 2
Subtopic 1: Recognition and Early Assessment
of Pediatric Respiratory Distress
Question 1:
A 6-month-old infant presents to the ED with nasal flaring, intercostal
retractions, and a respiratory rate of 70/min. Which of the following best
describes the infant's condition?
A. Mild upper respiratory tract infection
B. Normal variation for age
C. Moderate to severe respiratory distress
D. Hyperventilation due to crying
Correct Answer: C. Moderate to severe respiratory distress
Rationale: A respiratory rate >60/min with nasal flaring and retractions
indicates significant respiratory distress requiring immediate intervention.
Question 2:
Which sign is an early indicator of respiratory distress in infants?
A. Cyanosis
B. Tachypnea
C. Bradypnea
D. Grunting
Correct Answer: B. Tachypnea
Rationale: Tachypnea is one of the earliest and most sensitive signs of
respiratory distress before other compensatory mechanisms like grunting or
cyanosis appear.
, 3
Question 3:
Which of the following respiratory sounds is most concerning in a 3-month-
old with bronchiolitis?
A. Occasional sneezing
B. Audible expiratory wheezing with nasal flaring
C. Soft inspiratory breath sounds
D. Rhonchi in upper lobes
Correct Answer: B. Audible expiratory wheezing with nasal flaring
Rationale: Audible wheezing with nasal flaring suggests lower airway
obstruction and increased work of breathing.
Question 4:
What is the best position to place a 2-month-old infant in respiratory distress
to ease breathing?
A. Supine
B. Semi-Fowler’s position
C. Trendelenburg
D. Prone
Correct Answer: B. Semi-Fowler’s position
Rationale: Semi-Fowler’s promotes lung expansion and reduces the work of
breathing in infants.
Question 5:
In assessing a child with suspected bronchiolitis, which symptom would
indicate worsening respiratory status?
A. Runny nose
, 4
B. Grunting on expiration
C. Mild cough
D. Clear lung sounds
Correct Answer: B. Grunting on expiration
Rationale: Grunting is a compensatory mechanism for impaired oxygenation
and indicates worsening distress.
Question 6:
Which of the following assessment findings in a 1-year-old indicates the need
for immediate intervention?
A. Mild nasal congestion
B. Respiratory rate of 40/min
C. Head bobbing with each breath
D. Crying with feeding
Correct Answer: C. Head bobbing with each breath
Rationale: Head bobbing is a late sign of respiratory distress signaling
exhaustion and poor oxygenation.
Question 7:
Which oxygen saturation level in a 4-month-old with bronchiolitis requires
urgent intervention?
A. 95% on room air
B. 88% on room air
C. 92% on room air
D. 96% on nasal cannula
