Bronchiolitis and RSV are leading infant respiratory illnesses the CPN emphasizes. Drill the assessment, supportive-care, and isolation scenarios below, each with a full rationale.
Question 1
A nurse is planning morning care for an 18-month-old toddler admitted for respiratory syncytial virus. Which intervention must be performed in the treatment room rather than the bed?
- A) Administering oral antipyretics for a low-grade fever.
- B) Performing a routine apical pulse and assessment.
- C) Changing a heavily soiled diaper and bed linens.
- D) Suctioning the nasopharynx with a deep catheter.✓
Show rationale
To effectively maintain the bed as a safe zone, nurses must differentiate between routine care and invasive procedures. For an 18-month-old toddler, nasopharynx suctioning is highly distressing and invasive, making it the only procedure listed that should be performed in the treatment room. Option D is correct because moving the child prevents them from associating their crib with the trauma of deep suctioning. Option A is incorrect because administering oral medications is a routine, non-painful intervention that is perfectly acceptable in the bed. Option B is incorrect as routine assessments and vital signs should be done in the resting space to promote comfort. Option C is incorrect because diaper changes are standard daily care activities that do not require the use of a specialized treatment room.
Question 2
The child life specialist suggests a therapy dog visit for a 5-year-old with respiratory syncytial virus who is currently on contact and droplet precautions. Which response is correct?
- A) Allow the dog to enter if it remains six feet away.
- B) Permit the visit if the handler wears full personal protective equipment.
- C) Prohibit the visit because isolation precautions contraindicate animal-assisted therapy sessions.✓
- D) Approve the visit provided the dog is wiped with chlorhexidine wipes.
Show rationale
Patients requiring transmission-based isolation precautions, such as contact and droplet precautions for RSV, are strictly excluded from animal-assisted therapy. The therapy animal's fur can act as a fomite, carrying viral particles from the isolated patient's room to other vulnerable patients or staff in the hospital. Prohibiting the visit is the only safe action. Keeping the dog six feet away does not eliminate the risk of droplet contamination or environmental fomite transfer. Having the handler wear PPE does not protect the dog's fur from contamination. Wiping the dog with chlorhexidine is ineffective for viral decontamination and unsafe for the animal.
Question 3
A 7-month-old infant receiving high-flow nasal cannula therapy for bronchiolitis develops thick, tenacious secretions and mild epistaxis. Which action should the nurse take to address these findings?
- A) Increase the system flow rate by two liters.
- B) Assess the humidifier temperature and the water level.✓
- C) Administer a hypertonic saline nebulizer to the infant.
- D) Decrease the fraction of inspired oxygen by half.
Show rationale
When managing a pediatric patient on a high-flow nasal cannula, it is critical to ensure the delivery of heated and humidified gas. This prevents mucosal damage, heat loss, and the drying of respiratory secretions. The presence of epistaxis and thick secretions in this infant strongly indicates a failure in the humidification system. Assessing the humidifier temperature and water level is the most appropriate action to correct the root cause. Increasing the flow rate (A) would only worsen the mucosal trauma by delivering more dry gas. While a hypertonic saline nebulizer (C) might temporarily help mobilize secretions, it ignores the underlying equipment failure causing the issue. Decreasing the fraction of inspired oxygen (D) does not address the humidity deficit and could compromise the infant's respiratory status.
Question 4
A 4-year-old is transferring from the PICU to the pediatric floor after three days of mechanical ventilation for RSV bronchiolitis. The parents express intense worry about moving to a room with less visible nursing staff. Which action best addresses the parents' concern during the handoff process?
- A) Introduce the receiving floor nurse and explain the updated intermittent monitoring plan.✓
- B) Reassure them that the child is completely stable and requires minimal observation.
- C) Request the PICU charge nurse to allow a delayed transfer until tomorrow.
- D) Provide a detailed written pamphlet about the pediatric floor's daily rounding schedule.
Show rationale
Transfer anxiety is common for parents leaving the intensive care environment. Introducing the receiving nurse and explaining the new monitoring plan directly addresses their fear of decreased visibility by providing relational reassurance. Reassuring them the child needs minimal observation minimizes their valid concerns and can damage trust. Delaying the transfer is inappropriate for a medically ready patient and disrupts hospital flow. Providing a pamphlet is passive and lacks the personal engagement needed during a stressful handoff.
Question 5
A 6-month-old infant with RSV is in respiratory arrest with a heart rate of 88 bpm. The nurse initiates bag-valve-mask ventilation, but notes minimal chest rise and increasing abdominal distension.
- A) Insert an appropriately sized oral airway adjunct immediately.
- B) Place a small towel beneath the infant's shoulders.✓
- C) Increase the peak inspiratory pressure of each breath.
- D) Transition immediately to a two person bag technique.
Show rationale
When managing a 6-month-old infant requiring bag-valve-mask ventilation, achieving a neutral sniffing position is crucial. Because infants have a prominent occiput, laying them flat often causes neck flexion, which obstructs the airway and leads to minimal chest rise and gastric inflation. Placing a small towel under the shoulders aligns the airway axes perfectly. Option A is incorrect because while an oral airway might help with tongue displacement, it doesn't fix the underlying anatomical flexion caused by the large occiput. Option C is dangerous; increasing pressure when the airway is misaligned forces more air into the stomach, worsening abdominal distension. Option D is a great strategy for a poor mask seal, but it doesn't correct the primary positional obstruction. Always optimize airway positioning before escalating to higher pressures or advanced adjuncts.
Question 6
A nurse assumes care of an 11-month-old infant admitted for bronchiolitis. During the initial room assessment, the nurse notices two loose syringe caps resting on the bedside table within the child's reach. The parents are asleep on the couch. What is the most appropriate nursing action?
- A) Discard the loose syringe caps immediately into the waste receptacle.✓
- B) Place the loose syringe caps securely inside the medication drawer.
- C) Wake the parents to explain the risk of choking hazards.
- D) Move the loose syringe caps to a high out-of-reach shelf.
Show rationale
The best action is to immediately remove the hazard by discarding the caps in the waste receptacle. Infants at this age actively explore their environment by placing objects in their mouths, making small medical supplies a significant choking risk. Discarding them completely eliminates the hazard. Placing them in a medication drawer (Option B) or on a high shelf (Option D) retains unnecessary trash in the room, which could inadvertently fall or be accessed later. Waking the parents to explain the risk (Option C) is a good secondary educational intervention, but the immediate priority must always be the physical removal of the choking hazard to ensure the infant's absolute safety.
Question 7
A nurse conducts bedside handoff for a 6-month-old with bronchiolitis on high-flow nasal cannula. The mother frequently interrupts the report to ask questions about the discharge timeline and feeding schedule.
- A) Ask the mother to hold questions until the report finishes.
- B) Incorporate the mother's questions into the structured handoff process.✓
- C) Move the handoff to the hallway to maintain clinical focus.
- D) Give the mother a written summary to review independently later.
Show rationale
Bedside reporting aims to partner with families. Incorporating their questions validates their role, addresses their anxieties, and improves patient safety. Asking them to wait (A) or giving them written summaries instead of dialogue (D) discourages active engagement and diminishes family-centered care. Moving to the hallway (C) entirely eliminates the family from the process and prevents the oncoming nurse from visualizing the infant's respiratory status.
Question 8
A 10-month-old admitted for RSV bronchiolitis was initially fussy with a heart rate of 160 bpm. The infant is now lethargic, with a heart rate of 180 bpm, BP 68/40, and weak brachial pulses. What is the most appropriate interpretation and action?
- A) Prepare for rapid intubation due to impending respiratory failure.
- B) Administer a fluid bolus for decompensated hypotensive clinical shock.✓
- C) Administer IV epinephrine for severe compensated cardiogenic clinical shock.
- D) Prepare for synchronized cardioversion due to unstable supraventricular tachycardia.
Show rationale
The transition from compensated to decompensated shock is marked by a failure of compensatory mechanisms, leading to hypotension and inadequate organ perfusion. For an infant, a systolic blood pressure below 70 mmHg is hypotensive. Combined with lethargy and weak central pulses, this indicates decompensated shock requiring immediate fluid resuscitation. Option A is incorrect as the primary acute issue is perfusion failure, not just respiratory decline. Option C is incorrect because epinephrine is not the first-line therapy for hypovolemic shock. Option D is incorrect because the heart rate is below the typical threshold for infant SVT.
Question 9
A 6-month-old infant with bronchiolitis has a respiratory rate of 68/min and a temperature of 39.2°C (102.6°F). The infant's daily weight shows a 150-gram decrease over 24 hours despite adequate IV fluid intake. What is the most accurate interpretation of this weight trend?
- A) High insensible fluid loss necessitates adjusting the current hydration plan.✓
- B) Poor renal perfusion necessitates administering an immediate intravenous fluid bolus.
- C) High metabolic demand necessitates initiating peripheral parenteral nutrition therapy today.
- D) Poor gastrointestinal absorption necessitates changing the current enteral formula composition.
Show rationale
Fever and tachypnea significantly increase insensible fluid losses through the skin and respiratory tract. The weight loss despite adequate IV intake indicates a negative fluid balance driven by these unmeasured losses. Adjusting the hydration plan addresses the root cause. A fluid bolus is for acute hypovolemia, not gradual insensible loss. Parenteral nutrition and formula changes do not address the primary fluid deficit caused by respiratory and evaporative losses.
Question 10
A 4-month-old infant is admitted with bronchiolitis and a respiratory rate of 68 breaths/min. The infant is receiving high-flow nasal cannula therapy. The nurse is planning care for the shift. Which delegation to the UAP is appropriate?
- A) Administer two ounces of expressed breast milk orally.
- B) Obtain a complete set of vital signs hourly.
- C) Weigh all wet diapers to record output accurately.✓
- D) Adjust the nasal cannula prongs if they dislodge.
Show rationale
The correct answer is weighing diapers because this is a routine, non-invasive task that does not require nursing assessment. Option A is incorrect because an infant with a respiratory rate over 60 is at high risk for aspiration and should not be fed orally by a UAP. Option B is incorrect because the infant is on high-flow oxygen and is considered unstable, meaning vital signs require clinical judgment. Option D is incorrect because adjusting oxygen delivery devices falls outside the UAP's scope of practice.
Question 11
A 4-month-old infant is admitted with severe retractions, tachypnea, and copious clear nasal secretions testing positive for respiratory syncytial virus. Which isolation setup is most appropriate for this patient?
- A) Require a private room and use of gown, gloves, and mask.✓
- B) Require a private room and use of gown, gloves, and N95.
- C) Require a negative pressure room and use of gown and gloves.
- D) Require a negative pressure room and use of gown and mask.
Show rationale
Respiratory syncytial virus (RSV) is transmitted via large droplets and direct contact with infectious secretions. Therefore, contact and droplet precautions are indicated, which require a private room, gown, gloves, and a surgical mask. An N95 respirator and a negative pressure room are unnecessary because RSV is not transmitted via airborne micro-aerosols. Using only a gown and gloves or omitting the mask leaves the nurse vulnerable to droplet transmission during close patient care.
Question 12
The nurse is initiating high-flow nasal cannula therapy for an 8-kg infant admitted with severe RSV bronchiolitis. Which initial setting is most appropriate for this patient?
- A) Initiate the flow rate at 8 liters per minute.
- B) Initiate the flow rate at 12 liters per minute.
- C) Initiate the flow rate at 16 liters per minute.✓
- D) Initiate the flow rate at 24 liters per minute.
Show rationale
When initiating high-flow nasal cannula therapy for an infant with severe bronchiolitis, the standard initial flow rate is typically calculated at 2 L/kg/min. This specific rate provides adequate flow to effectively wash out nasopharyngeal dead space and generate a mild positive end-expiratory pressure that splints the airways open. For an 8-kg infant, this calculation equals 16 liters per minute. Initiating the therapy at 8 liters per minute (A) provides only 1 L/kg/min, which is likely insufficient to relieve the work of breathing in severe distress. Initiating the flow at 12 liters per minute (B) is also subtherapeutic for the initial stabilization phase. Conversely, initiating at 24 liters per minute (D) exceeds standard pediatric safety limits and significantly increases the risk of barotrauma or severe gastric distension.
Question 13
A 4-month-old with bronchiolitis received oral acetaminophen for a FLACC score of 6. Sixty minutes later, the FLACC score remains 5, and the infant is continuously pulling at the right ear. What is the most appropriate action?
- A) Administer a scheduled dose of intravenous ibuprofen.
- B) Evaluate the tympanic membrane for otitis media.✓
- C) Swaddle the infant and provide a soothing pacifier.
- D) Increase the frequency of the oral acetaminophen dosing.
Show rationale
Oral acetaminophen peaks in approximately one hour. When pain remains high despite peak medication effect and new focal symptoms emerge, the nurse must assess for a new pain etiology, such as acute otitis media. Option A is incorrect because intravenous ibuprofen is not indicated as a primary step before assessment. Option C ignores the new focal symptom that requires a clinical evaluation. Option D is unsafe as it violates safe dosing intervals and increases the risk of hepatotoxicity.
Question 14
An infant born at 25 weeks gestation is receiving monthly palivizumab injections for respiratory syncytial virus prophylaxis. The parents report they missed the scheduled January dose due to a transportation issue, and they are now presenting to the clinic in mid-February. Which action is most appropriate for the nurse practitioner to take?
- A) Administer the missed dose now and resume monthly scheduling.✓
- B) Skip the missed dose and give the next scheduled injection.
- C) Administer a double dose now to ensure adequate protection.
- D) Discontinue the injections since the series was significantly interrupted.
Show rationale
When an infant is receiving a multi-dose series of palivizumab for prophylaxis and experiences a delay in administration the standard protocol is to administer the missed dose as soon as possible. After giving the delayed dose the provider should then reset the schedule and continue administering subsequent doses every twenty-eight to thirty days until the season ends or the maximum of five doses is reached. Option B is incorrect because skipping a dose leaves the infant with inadequate serum antibody levels during a high-risk time of the year. Option C is incorrect because palivizumab is dosed strictly by weight and giving a double dose is not safe or approved to compensate for a delay. Option D is incorrect because an interrupted prophylaxis schedule does not require discontinuation and partial protection is still highly beneficial.
Question 15
A nurse is discussing a 9-month-old infant admitted for bronchiolitis during interdisciplinary rounds. The nurse notes the infant's inability to sit unsupported or bear weight on their legs. Which interdisciplinary referral is most appropriate?
- A) Recommend a speech therapy consult for developmental delays.
- B) Recommend an occupational therapy consult for motor delays.
- C) Recommend a physical therapy consult for gross motor delay.✓
- D) Recommend a pediatric neurology consult for developmental delay.
Show rationale
The inability to sit unsupported or bear weight at nine months indicates a delay in gross motor skills, which falls directly under the scope of physical therapy. Physical therapists focus on large muscle movements, core strength, and mobility milestones. Occupational therapy is a near-miss distractor; while they address motor delays, their primary focus in infants is on fine motor skills, such as the pincer grasp, and sensory processing. Speech therapy focuses on communication, babbling, and feeding mechanics, none of which are highlighted as deficits in this scenario. A pediatric neurology consult might eventually be warranted if a central nervous system pathology is suspected, but the immediate, standard intervention for an isolated gross motor delay is a physical therapy evaluation.
