Pediatric Respiratory Disorders (Croup, RSV) Practice Questions
18 free Pediatric Respiratory Disorders (Croup, RSV) practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which diagnosis is most likely for a 2-year-old child presenting at night with a sudden onset “barky” cough, hoarse voice, and inspiratory stridor that worsens when agitated?
- A Acute epiglottitis
- B Acute asthma exacerbation
- C Viral croup (laryngotracheobronchitis)
- D Foreign body aspiration into the airway
Correct answer: Viral croup (laryngotracheobronchitis)
Viral croup is characterised by the classic triad of hoarseness, barky cough, and inspiratory stridor, especially in children aged about 6 months to 3 years.
In the outpatient or emergency setting for a child with mild croup (stridor only when upset, no distress at rest), which treatment is recommended for all patients?
- A Nebulised albuterol
- B Oral or intramuscular dexamethasone
- C Routine antibiotics
- D High-flow nasal cannula oxygen only
Correct answer: Oral or intramuscular dexamethasone
Guidelines recommend a dose of corticosteroid (commonly dexamethasone) for children with croup of any severity to reduce symptom duration and hospital visits.
What is a key nursing priority in the care of a hospitalised infant with RSV bronchiolitis?
- A Cool mist therapy alone
- B Nebulised racemic epinephrine plus a steroid
- C A course of oral antibiotics
- D Immediate endotracheal intubation in all cases
Correct answer: Nebulised racemic epinephrine plus a steroid
Nursing care for bronchiolitis emphasises airway clearance (nasal suctioning), hydration, minimal handling (to reduce work of breathing), and monitoring respiratory status.
A child with moderate to severe croup (continuous stridor, retractions, hypoxia) would likely need which additional intervention?
- A Restricting fluids strictly to 50% of maintenance
- B Frequent nasal suctioning and clustered care to reduce fatigue
- C Routine chest physiotherapy for every infant
- D Starting broad-spectrum antibiotics immediately
Correct answer: Frequent nasal suctioning and clustered care to reduce fatigue
In moderate/severe croup, nebulised epinephrine is used to rapidly decrease airway swelling, and steroids are still given. Supportive care remains central.
Which of the following is not generally recommended as routine therapy for typical bronchiolitis due to Respiratory syncytial virus (RSV)?
- A Supplemental oxygen for saturation < 90%
- B Nasal saline and suctioning of secretions
- C Routine bronchodilator (albuterol) therapy
- D Adequate hydration and minimal handling
Correct answer: Routine bronchodilator (albuterol) therapy
Evidence shows that routine bronchodilators or steroids do not improve outcomes in typical RSV bronchiolitis; management is primarily supportive.
Which sign in an infant with suspected bronchiolitis should prompt urgent attention and possible escalation of care?
- A Mild wheeze while feeding well with O₂ saturation of 97%
- B Nasal congestion with a mild intermittent cough
- C Apnoea episodes over 15 seconds or bradycardia with desaturation
- D Occasional dry cough occurring only at night
Correct answer: Apnoea episodes over 15 seconds or bradycardia with desaturation
Apnoeas, bradycardia and desaturation in an infant with bronchiolitis are red flags for severe disease and need urgent intervention.
A child with croup is brought by parents for home care. Which of the following instructions is most appropriate?
- A Encourage vigorous activity and chest pounding to clear the airway
- B Provide cool or moist air and keep the child calm
- C Use cough suppressants and OTC decongestants freely at home
- D Delay seeking care even if stridor develops while at rest
Correct answer: Provide cool or moist air and keep the child calm
Airway obstruction in croup worsens with agitation/crying, so calming the child and providing cool/moist air are useful supportive measures while treatment is ongoing.
Which of the following is most likely in a child with croup?
- A Drooling, muffled voice and a tripod sitting posture
- B Barky cough, hoarseness and inspiratory stridor at night
- C Persistent expiratory wheeze with a prior asthma history
- D Sudden onset without any cough in an older school child
Correct answer: Barky cough, hoarseness and inspiratory stridor at night
Croup classic presentation includes the “seal-like” barky cough, hoarseness and inspiratory stridor, especially in young children. Drooling and tripod posture suggest epiglottitis or other airway emergency.
During RSV season, which preventive measure is recommended for children at high risk (e.g., premature infants, congenital heart disease)?
- A Routine broad-spectrum antibiotic prophylaxis all season
- B Monoclonal antibody (palivizumab) prophylaxis in eligible infants
- C Inhaled or systemic corticosteroids to prevent RSV infection
- D Scheduled chest physiotherapy in all infants before the season
Correct answer: Monoclonal antibody (palivizumab) prophylaxis in eligible infants
High-risk infants may receive palivizumab prophylaxis to reduce severe RSV hospitalisation, according to guidelines.
In the management of bronchiolitis, what is the typical approach to diagnostic imaging and routine testing?
- A Order routine chest x-rays and viral testing in every case
- B Limit testing in typical cases; image only atypical presentations
- C Obtain a mandatory complete blood count in every affected infant
- D Perform a routine CT scan for all children with RSV infection
Correct answer: Limit testing in typical cases; image only atypical presentations
Guidelines advise against routine imaging or excessive testing in classic bronchiolitis unless there are signs indicating other diagnoses or complications.
A 3-year-old child with recurrent croup episodes (3–4 nights each winter) presents for evaluation. Which aspect should the nurse emphasise?
- A Reassure that each episode routinely requires oral antibiotics
- B Assess triggers and irritants; teach home care and when to seek help
- C Recommend home nebuliser therapy without physician consultation
- D Reassure that recurrent croup is benign and needs no follow-up
Correct answer: Assess triggers and irritants; teach home care and when to seek help
Recurrent croup may warrant evaluation of airway anomalies or environmental triggers; education on home care and when to escalate is critical.
An infant hospitalised with RSV bronchiolitis has O₂ saturation of 88% on room air. The nurse’s next action should be:
- A Discharge the infant home with verbal supportive-care instructions
- B Give humidified oxygen to keep saturation 90% and monitor effort
- C Offer only oral fluids and continue passive room-air observation
- D Start empiric intravenous antibiotics for the viral infection now
Correct answer: Give humidified oxygen to keep saturation 90% and monitor effort
Hypoxia (O₂ sat < 90%) in bronchiolitis indicates the need for supplemental oxygen and close monitoring. Supportive care with oxygen is primary.
For a child with croup, what is the major benefit of early corticosteroid administration?
- A It immediately cures the underlying viral upper-airway infection
- B It shortens symptoms and reduces return visits and hospital stay
- C It reliably replaces the need for nebulised epinephrine in croup
- D It reduces antibiotic use but has no effect on airway obstruction
Correct answer: It shortens symptoms and reduces return visits and hospital stay
Corticosteroids like dexamethasone have been shown to improve symptom resolution and reduce the need for further care in croup.
A toddler with bronchiolitis remains adequately fed and oxygenated, with O₂ sat 95% on room air, mild wheeze and no dehydration. According to many pathways, what is the likely next step?
- A Admit for intravenous fluids and elective mechanical ventilation
- B Manage as an outpatient with supportive home care and follow-up
- C Start high-dose systemic corticosteroids before discharge home
- D Give nebulised albuterol every hour despite only mild wheeze
Correct answer: Manage as an outpatient with supportive home care and follow-up
When an infant with bronchiolitis is stable (adequate oral intake, acceptable sat, mild work of breathing) outpatient management with education is appropriate.
Which of the following is a red-flag sign in a child with croup that requires immediate escalation?
- A A barky cough that is present only when the child is upset
- B Stridor at rest with cyanosis, drooling or severe retractions
- C Mild intermittent hoarseness without any stridor at any time
- D An occasional faint expiratory wheeze heard only during sleep
Correct answer: Stridor at rest with cyanosis, drooling or severe retractions
Stridor at rest, cyanosis, drooling and severe retractions indicate airway compromise and the need for urgent intervention in croup.
In nursing care for an infant with RSV, which infection-control measure is most important in the hospital setting?
- A No isolation is required because RSV spreads only through food
- B Standard hand hygiene plus contact precautions for the infant
- C Use a face mask alone and skip routine hand washing between care
- D Give prophylactic antibiotics to all siblings of the affected child
Correct answer: Standard hand hygiene plus contact precautions for the infant
RSV is highly transmissible via droplets and contact; hand hygiene and contact precautions (isolate or cohort RSV infants) are key.
Which statement is true regarding mist/humidified air in croup and bronchiolitis?
- A It is strongly evidence-based and replaces steroids and epinephrine
- B It has limited evidence but may give comfort; not first-line therapy
- C It is harmful and is therefore contraindicated in both conditions
- D It reliably cures bronchiolitis entirely without other treatment
Correct answer: It has limited evidence but may give comfort; not first-line therapy
Using cool or humidified air may help comfort the child, but evidence is limited and it does not replace recommended therapies (steroids, epinephrine for croup; supportive care for bronchiolitis).
A 7-month-old infant with RSV is feeding poorly, has tachypnoea and signs of dehydration. What is an appropriate nursing priority?
- A Restrict all fluids and simply wait for spontaneous improvement
- B Start IV or nasogastric hydration if oral intake is insufficient
- C Ignore intake since hydration is never a concern in bronchiolitis
- D Administer bronchodilators only and provide no hydration support
Correct answer: Start IV or nasogastric hydration if oral intake is insufficient
In infants with bronchiolitis who are feeding poorly and show dehydration risk, hydration support (IV or NG) and close monitoring are important as part of supportive care.