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“When I do my peak flow, it works best if I do three breaths without pausing in between breaths.” Peak flow measurements should be done with a deep inhalation followed by a single, forceful exhalation into the meter. Multiple breaths without pausing would invalidate the reading.

“I always start with the meter reading about halfway up. That way I don’t waste any breath.” The meter should always be set to zero before each attempt to ensure an accurate reading.

“If I use my peak flow meter every day, I will not have an asthma attack.” Using the meter does not prevent asthma attacks; it helps monitor airway status so early interventions can be taken if a decline is detected.

Imbalanced nutrition: Less than body requirements: This is important but secondary to addressing life-threatening respiratory compromise. Nutrition support is necessary once the infant is stable.

Effective breastfeeding: This is a goal/outcome rather than a diagnosis; important for growth and bonding but not immediately life-threatening.

Risk for imbalanced fluid volume: Preventive nursing concern; while fluid management is important, it is not as urgent as impaired gas exchange in an infant with BPD.

Provide frequent playful stimuli: While developmental stimulation is important, frequent stimulation can fatigue the infant, increasing oxygen needs and respiratory distress. Play should be balanced with rest.

Decrease oxygen during feedings: Oxygen should never be decreased during activities or feeding unless specifically ordered by the provider, as infants with BPD are at risk for desaturation.

Place the infant in an open crib: Open cribs may be inappropriate for infants needing thermal support or oxygen therapy. Isolette or semi-enclosed cribs may be preferred until the infant is stable.

BPD is characterized by increased work of breathing, not minimal effort.

Infants with BPD may become irritable or difficult to console due to discomfort, hypoxia, or fatigue from increased respiratory effort.

Hypotension is not a typical early sign of BPD. Blood pressure is usually maintained unless there is severe illness or complications.

Increased alertness is normal behavior and may indicate a healthy response to interaction rather than overstimulation.

Good eye contact is a positive developmental response and not a sign of respiratory distress or overstimulation.

 While lethargy can indicate fatigue or illness, cyanosis is a more immediate indicator of overstimulation and oxygen compromise in BPD.

Interstitial fibrosis is a feature of later stages of BPD, indicating chronic lung injury and scarring.

Signs of emphysema occur in advanced stages due to alveolar overdistension and chronic lung injury.

Hyperexpansion on chest X-ray typically appears in later stages, reflecting chronic air trapping and structural lung changes.

While tracheomalacia can occur in BPD, it is not by itself an indication for tracheostomy unless it causes severe airway obstruction.

Gastrostomy tube placement does not require a tracheostomy; feeding tubes and tracheostomy are separate interventions.

Acute respiratory distress is managed with oxygen, medications, or short-term ventilation, not automatically with tracheostomy unless there is persistent ventilator dependence.

Obtaining arterial blood gases (ABGs) provide information on gas exchange but do not immediately relieve airway obstruction, which is the priority.

 Simply increasing oxygen rate from 30% to 50% will not resolve the underlying obstruction. Oxygen supplementation is supportive but secondary to clearing the airway.

Anxiety and restlessness are likely secondary to hypoxemia, not primary pain. Administering medication without addressing the airway could worsen respiratory compromise.

Metabolic acidosis shows low pH with low HCO₃⁻, which is not present here.

Metabolic alkalosis shows elevated pH and elevated HCO₃⁻; both are not present.

Respiratory alkalosis shows elevated pH and low PCO₂, the opposite of this ABG.

A neonate born at 38 weeks’ gestation receiving 1 to 4 L oxygen during feedings is a term infant and generally has mature lungs, and low-flow oxygen for brief periods does not typically cause BPD.

A premature neonate born at 36 weeks’ gestation receiving supplemental oxygen is a late preterm infant (34–36 weeks) have relatively mature lungs, and short-term oxygen therapy rarely leads to BPD.

A neonate born at 42 weeks’ gestation who requires treatments for respiratory syncytial virus is a post-term infant. Post-term infants may have acute respiratory illness, but they are not at high risk for BPD because their lungs are mature.

Exercise can trigger bronchospasm (exercise-induced asthma), so precautions are necessary.

Limiting activity unnecessarily can negatively impact fitness, socialization, and quality of life.

Swimming is often recommended for children with asthma because warm, humid air reduces airway irritation.

Carpets trap dust, pollen, and other allergens, which can worsen asthma and allergy symptoms.

Basements may have higher humidity and mold, which can increase allergen exposure rather than reduce it.

Cleaning twice a month is insufficient; frequent cleaning, at least weekly, is needed to maintain a low-allergen environment.

The baby must receive a dose of folic acid three times each day: Routine folic acid supplementation is not a primary dietary requirement for CF unless specifically prescribed.

The baby must never consume any milk or milk products: Milk and milk products are not contraindicated; they may be part of the diet as long as pancreatic enzymes are provided to aid digestion.

The baby must receive pancreatic enzymes before bedtime every night: Pancreatic enzymes should be given with every meal and snack, not just at bedtime, to ensure proper digestion of nutrients.

 Lupus is an autoimmune disorder not specifically associated with CF.

Arthritis is not a routine comorbidity in children with CF.

Hyperthyroidism is not linked to CF, and routine screening is not indicated.

“I will stop the enzymes if my child is receiving antibiotics” Antibiotics do not affect enzyme use, and stopping enzymes could lead to malabsorption and nutritional deficiencies.

“I will decrease the dose by half if my child is having frequent, bulky stools” Stopping or reducing enzymes without provider guidance can worsen malabsorption. Stool changes should be reported to the provider for proper dose adjustment.

“Between meals is the best time for me to give the enzymes” Giving enzymes between meals is ineffective, as there is little food to digest; enzymes work only when food is present.

“This will determine if your child is dehydrated.” The sweat test does not evaluate hydration status.

“This will assess whether your child’s sweat glands are functioning.” While sweat is collected during the test, the purpose is not to assess gland function, but to measure chloride concentration for CF diagnosis.

“This will help us to identify the infectious organism.” The sweat test is not a microbiology test and cannot detect infections.