Asthma is a chronic respiratory condition that affects the airways in the lungs. In acute asthma exacerbation, airway obstruction and inflammation impair ventilation, leading to hypoxemia and, if severe, hypercapnia.

Rationale for correct answer:
2.ABGis the most important test to assess severity of asthma exacerbation. Early stages of the disease result in ↓ PaO₂, and ↓ PaCO₂ from hyperventilation. Late/severe stages cause ↓ PaO₂, ↑ PaCO₂ from respiratory failure. This provides guidance for oxygen therapy and need for escalation such as intubation.

Rationale for incorrect answers:

1. Complete blood count (CBC)may detect infection or eosinophilia, but it does not evaluate acute respiratory status.

3. Blood urea nitrogen (BUN)reflects kidney function, unrelated to asthma exacerbation.

4. Partial thromboplastin time (PTT)measures clotting time, not respiratory function.

Take home points

• ABGs are crucial in acute asthma to monitor oxygenation and CO₂ retention.
• Pulse oximetry is a quick bedside tool, but ABG confirms severity.
• Rising PaCO₂ in a child with asthma is a red flag for impending respiratory failure.

Status asthmaticusis a severe, prolonged asthma attack unresponsive to standard treatment such as inhaled β₂-agonists. It is a medical emergency requiring rapid intervention to prevent respiratory failure.

Rationale for correct answer:
4.Knowing when the child’s last dose of medication was administeredprovides essential, time-sensitive information to guide immediate treatment decisions. It helps avoid duplicating doses too soon and identifies whether medications were ineffective or if the attack worsened despite therapy.

Rationale for incorrect answers:

1. Knowing the last time the child ate is relevant if intubation or sedation might be required (aspiration risk), but not the most urgent information in status asthmaticus.

2. Knowing whether the child has been exposed to any of the usual asthma triggers is useful for long-term prevention and management, but not immediately life-saving during the acute crisis.

3. Asking when the child was last admitted to the hospital for asthma provides background history of severity but does not influence urgent management in the current emergency.

Take home points

• In status asthmaticus, always prioritize immediate treatment-related information (last dose of bronchodilators, steroids, or other meds).
• Exposure history and hospitalization history are important for long-term care, but life-saving interventions come first.

Nurses must gather information that directly impacts safe and effective acute management.

Albuterol is a short-acting beta-agonist (SABA)used as a rescue medication during asthma attacks or before exercise to relax airway smooth muscle and relieve bronchospasm. Proper inhaler technique ensures the drug reaches the lower airways effectively.

Rationale for correct answer:

1. “I should administer two quick puffs of the albuterol inhaler using a spacer.”This is an incorrect technique. Parents should wait at least 1 minute between puffsto allow the first dose to dilate the airways, which helps the second puff penetrate deeper into the lungs. Administering “two quick puffs” without waiting decreases medication effectiveness.

Rationale for incorrect answers:
2. “I should always use a spacer when administering the albuterol inhaler.”Spacers help children coordinate inhalation and maximize delivery of medication to the lungs, reducing deposition in the mouth/throat.

3. “I should be sure that my child is in an upright position when administering the inhaler.”Upright positioning optimizes lung expansion and medication delivery to the lower airways.

4. “I should always shake the inhaler before administering a dose.”Shaking ensures the medication is properly mixed for accurate dosing.

Take home points

• Parents should wait at least 1 minute between puffs of albuterol.
• Using a spacer, upright positioning, and shaking the inhaler are all correct practices.
• Nurses must emphasize step-by-step technique to improve asthma control and avoid ineffective medication use.

Asthma is a chronic inflammatory airway diseasecharacterized by bronchoconstriction, airway inflammation, and increased mucus production. During acute symptoms such as wheezing, coughing, or shortness of breath, the immediate priority is to relieve bronchospasmand improve airflow.

Rationale for correct answer:
3.Albuterolis ashort-acting bronchodilatorthat works within minutes to provide rapid relief of acute bronchospasm, wheezing, and dyspnea. It is the first-line treatment for an asthma attack.

Rationale for incorrect answers:

1. Prednisoneis a corticosteroid used for longer-term control of inflammation in moderate to severe exacerbations but does not provide immediate relief. It can take several hours to days to be effective.

2. Montelukast (Singulair)is a leukotriene receptor antagonist used for long-term asthma control and prevention, not for acute symptom relief.

4. Fluticasone (Flovent)is an inhaled corticosteroid for daily maintenance therapy to reduce airway inflammation. It does not work quickly enough to treat acute attacks.

Take home points

• Albuterol (SABA) is the go-to rescue medication for acute asthma symptoms.
• Corticosteroids (oral or inhaled) are for long-term inflammation control, not acute relief.
• Montelukast is preventive, not a rescue drug.
• Nurses should teach families the difference between rescue medications used for immediate relief and controller medications used for long-term management.

An asthma exacerbation, also called an asthma attackor flare-up, is a sudden worsening of asthma symptoms due to increased inflammation and narrowing of the airways.

Rationale for correct answer:
3.A 9-year-old who is quiet, pale, wheezing bilaterally with SpO₂ 92%: This child is the most critical. Quietness, hypoxemia, and pallorindicate severe obstruction with reduced air entry, suggesting impending respiratory failure. This requires immediate priority intervention such as oxygen, bronchodilator therapy, and possible escalation to advanced airway support.

Rationale for incorrect answers:

1. A 12-month-old, mild cry, pale, diminished breath sounds, SpO₂ 93%: This is concerning but not the most urgent. Diminished breath sounds are worrisome, but SpO₂ is still slightly higher (93%), and the child still has some cry showing air movement.

2. A 5-year-old, complete sentences, pink, wheezing bilaterally, SpO₂ 93%: This child is stable compared to the others. The ability to speak in complete sentencesand normal color indicate adequate air exchange. Wheezing is expected but not immediately life-threatening.

4. A 16-year-old, short sentences, wheezing, sitting upright, SpO₂ 93%: These symptoms indicate moderate distress, but the child is compensating by sitting upright and still moving air with SpO₂ 93%. Not as critical as the quiet 9-year-old with worsening hypoxemia.

Take home points

• Oxygen saturation ≤ 92% signals significant hypoxemia and the need for urgent treatment.
• Prioritization in asthma focuses on recognizing signs of impending respiratory failure: quiet chest, altered mental status, severe retractions, and hypoxemia.
• Always treat the sickest first, not the noisiest. Wheezing children are often moving more air than those who are quiet.

Asthma is a chronic inflammatory airway disorder with air trappingcaused by bronchoconstriction, mucus production, and swelling. Young children often have difficulty with structured breathing techniques such as incentive spirometry. Instead, play-based breathing exercises which helps to mobilize trapped air and improve ventilation.

Rationale for correct answer:
3.Blow a pinwheelis a playful, age-appropriate exercise that helps the child lengthen the expiratory phase, promoting better airway clearance and reducing air trapping.

Rationale for incorrect answers:

1. Using an incentive spirometerrequires a level of cooperation and understanding not expected in a 3-year-old. It is more appropriate for older children and adults.

2. Breathing into a paper bagis not used in asthma; it is sometimes used for hyperventilation due to anxiety. In asthma, this could worsen hypoxemia by limiting oxygen intake.

4. Taking several deep breathswithout a focus on prolonged exhalation does not specifically target the problem of air trapping in asthma.

Take home points

• Age-appropriate, play-based breathing exercises (e.g., blowing bubbles, blowing a pinwheel) are best for young children with asthma.
• The goal is to prolong exhalation and help mobilize trapped air.
• Structured devices like incentive spirometry are best reserved for older, cooperative children.
• Never use techniques that limit oxygen intake (like paper bag breathing) in asthma.

Asthma is a chronic inflammatory airway disorder with air trappingcaused by bronchoconstriction, mucus production, and swelling. Asthma can be triggered by environmental allergens such as dust mites, pet dander, mold, and pollen. Preventive management focuses on allergen avoidance in the home environment.

Rationale for correct answer:
4.“Avoid purchasing upholstered furniture.”Upholstered furniture collects dust and allergens, which can worsen asthma symptoms. Choosing non-upholstered, easy-to-clean furniture helps maintain a more allergy-free environment.

Rationale for incorrect answers:

1. “Use a humidifier in your child’s room.”Humidifiers can actually promote mold growth and dust mites, which are common asthma triggers. A dehumidifier may be more appropriate in damp environments.

2. “Have your carpet cleaned chemically once a month.”Carpet cleaning chemicals may irritate airways. Instead, minimizing carpet use and vacuuming with a HEPA filter vacuum is better for asthma management.

3. “Wash household pets weekly.”While washing pets may temporarily reduce dander, it does not eliminate exposure. The best approach is to keep pets out of the child’s bedroom and limit close contact if pet dander is a known trigger.

Take home points

• Best environmental control for asthma: limit dust-collecting items (upholstered furniture, heavy drapes, stuffed animals).
• Humidifiers and strong chemicals should be avoided as they can worsen symptoms.
• HEPA filters, regular cleaning, and minimizing carpet use are better strategies.
• Nurses should educate parents that asthma control involves both medication adherence and environmental allergen reduction.

Status asthmaticusis a severe, life-threatening asthma exacerbation that does not respond to standard bronchodilator therapy. Unlike typical asthma attacks, it is continuous, progressive, and can lead to respiratory failure if not treated promptly in an emergency setting.

Rationale for correct answer:
4.Status asthmaticus is characterized by persistent bronchospasm and airway obstructiondespite treatment with short-acting bronchodilators, requiring emergency interventions such as IV medications, oxygen therapy, or mechanical ventilation.

Rationale for incorrect answers:

1. Several attacks per monthindicate moderate persistent asthma, not status asthmaticus.

2. Less than six attacks per yearindicate mild intermittent asthma, not status asthmaticus.

3. While partial nonresponse may occur in severe asthma, status asthmaticus is defined by complete or nearly complete lack of responseand constant symptoms, making option 4 more precise.

Take home points

• Status asthmaticus is a medical emergency requiring immediate intervention.
• Key distinguishing feature: persistent symptoms unrelieved by usual therapy.
• Early recognition and treatment prevent respiratory failure and hypoxia.
• Nurses should monitor oxygen saturation, respiratory effort, and response to therapy continuously.

Cystic fibrosis (CF) is a genetic disorderthat primarily affects the lungs and digestive system, but can impact other organs as well. CF is caused by mutations in the CFTR gene, which regulates the movement of salt and water in and out of cells. These mutations lead to the production of thick, sticky mucus that clogs airways and ducts in various organs.

Rationale for correct answer:

1. Assess the child’s peak expiratory flow: Measuring PEF is the first action because it gives critical information about the child’s current respiratory status and helps prioritize care. Immediate assessment guides whether quick-relief medications or emergency interventions are needed.

Rationale for incorrect answers:
2.Educate the child to avoid triggers: Education is important for long-term asthma management, but it does not address the acute respiratory distress the child is experiencing.

3. Transport the child to the emergency department: Transport may be necessary if severe symptoms persist or worsen, but initial assessment is required to determine the severity and urgency.

4. Notify the child’s parents of his condition: Parental notification is important, but the child’s respiratory status takes priority. Immediate assessment ensures timely intervention.

Take home points

• In children with asthma, airway assessment is the priority during acute symptoms.
• Peak expiratory flow is a simple, objective measure of airway obstruction.
• Nurses must act rapidly to assess, intervene with quick-relief medications, and escalate care if needed.
• Education on triggers and long-term management follows stabilization.

A metered-dose inhaler (MDI)delivers a precise dose of bronchodilator directly to the lungs. It is a handheld device that delivers a precise amount of medication directly to the lungs in the form of a mist or aerosol. Proper technique is critical to ensure maximum drug delivery and therapeutic effect.

Rationale for correct answer:
3.Exhaling fullyempties the lungs, allowing for maximum inhalation of the medication when the MDI is actuated. Proper timing between exhalation and inhalation ensures optimal delivery to the lower airways.

Rationale for incorrect answers:

1. The MDI must be shakento mix the medication and propellant before each dose.

2. The recommended wait time between puffsof the same bronchodilator is usually about 1 minute, not 10 seconds, to allow the first dose to take effect.

4. The canister is pressed once per puff, not continuously for 30 seconds. Holding it down for an extended time is not necessary and can waste medication.

Take home points

• Proper MDI technique involves shaking the inhaler, exhaling fully, actuating while inhaling slowly, holding breath 5–10 seconds, and waiting 1–2 minutes between puffs if a second dose is prescribed.
• Teaching children the correct technique improves drug delivery, asthma control, and reduces side effects.
• Use of a spacer is recommended for children to ensure better deposition of medication in the lungs.

Cystic fibrosis (CF)is an autosomal recessive disorder affecting the exocrine glands. Thick secretions obstruct the pancreatic ducts, preventing digestive enzymes from reaching the intestines. This results in malabsorption of fats and proteins, leading to steatorrheaand azotorrhea, that is, foul-smelling stools with undigested protein.

Rationale for correct answer:

2. Excessive steatorrhea and azotorrhea indicate that pancreatic enzymes are not being adequately delivered to the intestines. This strongly suggests that the child is either missing doses, taking them incorrectly, or underdosed.Compliance with enzyme replacement is critical to prevent growth failure and nutritional deficiencies in CF.

Rationale for incorrect answers:

1. Vitamin noncomplianceleads to deficiencies (A, D, E, K) but does not directly cause steatorrhea and azotorrhea.

3. A high-fat dietalone does not cause these findings if enzymes are taken as prescribed. Enzyme therapy allows CF patients to tolerate high-calorie, high-fat diets.

4. High fiber intakemay cause bloating or gas, but it does not cause fat and protein malabsorption.

Take home points

• Steatorrhea and azotorrhea results from inadequate pancreatic enzyme therapy in CF.
• Pancreatic enzyme replacement must be taken with all meals and snacks.
• Fat-soluble vitamin supplementation is important but does not directly prevent malabsorption symptoms.
• Nutritional management in CF includes a high-calorie, high-protein, high-fat diet with enzyme supplementation.

Cystic fibrosis (CF) is caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR gene). This gene controls the movement of salt and water in and out of cells. This leads to the production of thick, sticky mucus instead of thin, slippery secretions.

Rationale for correct answer:

4.If one parent has CF, that is, two defective genes and the other is a carrier, that is one defective gene there is a 50% chancethe child will have CF since the child inherits one defective gene from each parent. There is also a 50% chancethe child will be a carrier by inheriting one defective gene from the CF parent and one normal gene from the carrier parent.

Rationale for incorrect answers:

1. CF is an autosomal-dominant trait passed on from the child’s motheris incorrect because CF is autosomal recessive, not dominant.

2. CF is an autosomal-dominant trait passed on from the child’s fatheris inaccurate since inheritance is not dominant.

3. The child of parents who are both carriers having a 50% chance of acquiring CFis incorrect. If both parents are carriers 25% chance the child will have CF, 50% chance the child will be a carrier, and 25% chance the child will be unaffected.

Take home points

• CF is autosomal recessive. A child must inherit two defective CF genes to have the disease.
• Two carrier parents: 25% affected, 50% carrier, 25% unaffected.
• One parent with CF and one carrier parent: 50% affected, 50% carrier.
• Genetic counseling is important for families with a history of CF.

Cystic fibrosis (CF) causes thick, sticky mucus that clogs the airways and predisposes the child to respiratory infections. Chest physiotherapy (CPT)is used to mobilize secretions and improve airway clearance. Timing of CPT is important to optimize effectiveness and reduce complications such as vomiting or aspiration.

Rationale for correct answer:

1.Performing CPT 30 minutes before feedingis correct because airway clearance prior to eating reduces the risk of vomiting or aspirationduring therapy. It also helps open the airways, which improves oxygenation and overall tolerance of feeds.

Rationale for incorrect answers:
2.CPT is performed before suctioning, not after. CPT helps loosen secretions, and suctioning may then be used afterward if needed to clear mobilized mucus.
3.Performing CPT 30 minutes after feedingis incorrect because it increases the risk of regurgitation, vomiting, and aspiration, especially in infants.
4.CPT should not be limited to times of congestion or coughing. It is a routine, daily therapyto maintain airway clearance and prevent mucus plugging.

Take home points

• CPT should be scheduled before meals to minimize aspiration risk.
• Airway clearance therapy is a routine part of CF management, not just during illness.
• CPT helps loosen secretions, and suctioning may follow if secretions are not effectively expelled.
• Timing airway clearance correctly supports nutrition and lung function in infants with CF.

Infants with cystic fibrosis (CF) have increased energy requirementsbecause of the extra work of breathing and chronic lung infections. They also experience malabsorption of fats and proteins due to pancreatic enzyme insufficiency.

Rationale for correct answer:
3. A higher-calorie formulais appropriate because infants with CF need more calories than healthy infants to meet growth requirements. This ensures they receive enough energy to compensate for malabsorption and increased metabolic demands. Pancreatic enzymes are also given with feeds to aid digestion.

Rationale for incorrect answers:

1.Increasing fruits and vegetablesdoes not meet the high-calorie and high-protein needs of an infant with CF. While they are healthy foods, they are not calorie-dense enough to support growth in CF.

2.Advancing to whole cow’s milkbefore age 12 months is inappropriate. Infants under 1 year should receive breast milk or formula; cow’s milk lacks adequate iron and essential nutrients and may increase the risk of anemia.

4.Increasing carbohydrate intakealone is not sufficient. Infants with CF need balanced nutrition with adequate protein and fatto support tissue growth and energy needs.

Take home points

• Infants with CF need higher-calorie diets due to malabsorption and increased metabolic demands.
• Pancreatic enzymes must be given with feeds to aid digestion and nutrient absorption.
• Cow’s milk is not recommended before 12 months of age.
• Nutritional care in CF focuses on high-calorie, high-protein, high-fat foods once the child is on solids.

Cystic fibrosis (CF) causes thick, sticky mucus that clogs the airways and predisposes the child to respiratory infections. It is a genetic, multisystem disorderthat primarily affects the lungs and digestive system.

Rationale for correct answer:
2.A double lung transplant can improverespiratory functionand quality of life, allowing the child to live longer. However, it does not correct the underlying genetic defect, so problems with digestion, pancreatic insufficiency, and other CF complications persist.

Rationale for incorrect answers:

1.Lung transplant doesnot cure CF; the genetic defect remains, and other organ complications continue.

3. Transplantation cannotreverse multisystem damagesuch as pancreatic insufficiency, liver disease, and infertility. These issues remain lifelong.

4.While transplantation may prolong life, it should not be described as the only chancefor survival or framed in terms of a specific milestone (like college graduation). This may create unrealistic expectations.

Take home points

• Lung transplantation improves survival in CF patients with end-stage lung disease but is not a cure.
• CF remains a multisystem disease; pancreatic and gastrointestinal issues persist after transplant.
• Families should be counseled about realistic expectations and ongoing care needs after transplant.
• Genetic counseling and continued multidisciplinary support remain essential in CF management.

Cystic fibrosis (CF) is a genetic disorder that causes thick, sticky mucus production in the airways, leading to airway obstruction, inflammation, and infections. It is a genetic, multisystem disorder that primarily affects the lungs and digestive system.

Rationale for correct answer:
4.Wheezing respirationsare an early sign of airway obstruction due to mucus plugging in children with CF. Parents should be taught that recurrent wheezing is one of the first respiratory manifestations.

Rationale for incorrect answers:

1. Abarrel-shaped chestdevelops later in the disease from chronic air trapping and hyperinflation of the lungs. It is not an early sign.

2. Achronic productive coughis more typical in later stages, once recurrent lung infections and persistent mucus buildup have progressed.

3. Bronchiectasis, an irreversible dilation and damage of bronchi, is a long-term complication of repeated lung infections, not an early finding.

Take home points

• Early respiratory signs of CF include wheezing and recurrent respiratory infections.
• Progressive signs include chronic cough, barrel chest, and digital clubbing.
• Parents should report persistent wheezing, frequent cough, or recurrent infections early for prompt intervention.
• Early airway clearance therapy helps reduce progression of lung damage.

Children with cystic fibrosis (CF) often develop gastrointestinal complications due to thick, sticky mucus secretions that block the intestines. Constipation is common and is usually managed with oral stool softeners or osmotic laxatives.

Rationale for correct answer:
3.MiraLAX (polyethylene glycol)is commonly prescribed for constipation in children with CF because it draws water into the stool, making it easier to pass. It is safe for long-term use and effective in relieving constipation caused by thick mucus secretions.

Rationale for incorrect answers:

1. Surgery isnot the first-line treatmentfor constipation in CF. Surgery is only considered for severe complications such as distal intestinal obstructive syndrome (DIOS)that does not respond to medical management.

2.IV fluidsmay be given if the child is dehydrated but are not the primary treatment for constipation. Hydration helps, but medications like MiraLAX are typically needed.

4.A clear liquid dietmay temporarily ease symptoms in severe obstruction but is not standard treatment for routine constipation in CF. Adequate nutrition is essential for growth and health.

Take home points

• Constipation in CF is usually managed with osmotic laxatives like MiraLAX.
• Surgery is reserved for severe, non-resolving intestinal obstruction (DIOS).
• Adequate hydration and enzyme therapy also help prevent constipation.
• GI symptoms in CF require ongoing monitoring to prevent complications.

Cystic fibrosis (CF) is a chronic, progressive genetic disorder affecting multiple systems, primarily the lungs and gastrointestinal tract. Therapeutic management focuses on maintaining adequate nutrition, promoting airway clearance, preventing infections, encouraging activity, and supporting adherence to prescribed therapies to improve quality of life and extend survival.

Rationale for correct answers:

1. Ahigh-protein, high-calorie dietis necessary because CF patients have increased metabolic demands and malabsorption due to pancreatic enzyme insufficiency.

3. Exerciseimproves lung function, enhances airway clearance, strengthens respiratory muscles, and promotes overall health.

4. Minimizing pulmonary complicationsis a cornerstone of CF management. This includes chest physiotherapy, airway clearance techniques, antibiotics, and vaccinations.

5. Medication complianceis critical for effectiveness of therapies such as pancreatic enzymes, fat-soluble vitamins, bronchodilators, mucolytics, antibiotics, and CFTR modulators.

Rationale for incorrect answers:
2.While CF patients require high-calorie and nutrient-rich diets, recommending a specifically high-fat, high-carbohydrate dietis misleading. Fat and carbohydrate intake should be balanced with protein, with pancreatic enzymes given to aid digestion. The emphasis is on high-calorie, high-protein nutrition, not excessive fat/carbs alone.

Take home points

• CF management requires a multidisciplinary approach (nutrition, respiratory therapy, medications).
• High-protein, high-calorie diets with enzyme supplementation support growth and development.
• Daily airway clearance + exercise improves lung function and reduces complications.
• Long-term survival depends heavily on adherence to prescribed therapies and consistent medical follow-up.

The sweat chloride testis the gold standard for diagnosing cystic fibrosis (CF). CF causes defective chloride transport across epithelial cells, leading to abnormally salty sweat. Elevated chloride levels in sweat confirm the diagnosis.

Rationale for correct answer:
3. Asweat chloride level ≥60 mEq/Lis a positive diagnostic indicator of CF in children and adults. This finding strongly supports CF when clinical features are present.

Rationale for incorrect answers:

1. 30 mEq/Lis below the diagnostic threshold. In infants under 6 months, values ≥30 mEq/L are considered suspicious but not diagnostic.

2. 25 mEq/Lis normal and does not indicate CF.

4. 50 mEq/Lis considered borderline/suspicious but not diagnostic. Additional testing (genetic testing or repeat sweat chloride test) would be required.

Take home points

• Sweat chloride level ≥60 mEq/L is diagnostic for CF.
• The sweat chloride test is most accurate when performed at a certified CF center.

Cystic fibrosis (CF) is a genetic disorderthat affects the lungs, digestive system, and other organs by causing the body to produce thick, sticky mucus. CF is caused by mutations in the CFTR gene, which regulates salt and water movement in and out of cells. These mutations disrupt the function of the CFTR protein, leading to mucus buildup.

Rationale for correct answer:
4.Meconium ileusoccurs in newborns with CF due to viscous intestinal secretions,and it may present as abdominal distention, failure to pass meconium within the first 24–48 hours, and bilious vomiting. Early recognition is crucial for prompt surgical or medical intervention.

Rationale for incorrect answers:

1. While CF can later cause intestinal blockages or constipation, it is not typically an early neonatal sign.

2. Decreased appetitemay occur later due to malabsorption, but it is not an early sign in newborns.

3.CF is not associated with elevated albumin levels. Instead, malabsorption can lead to hypoalbuminemiaover time.

Take home points

• Meconium ileus is a hallmark early sign of CF in newborns.
• Newborns with delayed meconium passage or abdominal distention should be evaluated for CF.
• Early detection allows for timely management of nutrition, pancreatic enzymes, and respiratory care.
• Newborn screening and sweat chloride testing confirm the diagnosis.

Children with cystic fibrosis (CF)often have pancreatic insufficiency, leading to malabsorption of fats and proteins. Pancreatic enzyme supplements are essential to improve digestion and nutrient absorption. Proper timing and dosing of enzymes are critical to maximize their effectiveness.

Rationale for correct answer:
4.Pancreatic enzymes should be taken with every meal and snackto ensure that food is properly digested, reduce steatorrhea, and promote adequate growth and nutrition.

Rationale for incorrect answers:

1. Many CF pancreatic enzyme capsules contain microbeads or microspheresthat can be sprinkled on soft foodsif the client cannot swallow capsules whole.

2. Crushing enzymes can destroy the enteric coating, making them ineffective and potentially irritating to the stomach.

3. While frequent meals and snacks are appropriate for nutrition, this alone does not address enzyme administration, which is the key point.

Take home points

• Administer pancreatic enzymes with all meals and snacks for proper digestion.
• Do not crush or chew enzyme capsules/microbeads unless specifically formulated to be sprinkled on soft food.
• Encourage a high-calorie, high-fat, high-protein diet to meet nutritional needs.
• Monitor stool characteristics and growth to assess enzyme effectiveness.

Cystic fibrosis (CF) is a genetic disorderthat affects the lungs, digestive system, and other organs by causing the body to produce thick, sticky mucus. CF is caused by mutations in the CFTR gene, which regulates salt and water movement in and out of cells. These mutations disrupt the function of the CFTR protein, leading to mucus buildup.

Rationale for correct answer:
3.Chest physiotherapy (CPT)helps mobilize and clear secretions, improving airway clearance, lung function, and oxygenation. CPT is a primary therapy for CF. Regular sessions help prevent mucus plugging, reduce infection risk, and improve breathing.

Rationale for incorrect answers:

1. Exercise isencouragedin children with CF because it helps loosen mucus and maintain cardiopulmonary fitness.

2. Coughing is anatural mechanism for clearing mucus. Suppressants may worsen airway obstruction. Antihistamines are not routinely indicated unless allergies are present.

4. Bronchodilatorsare typically given before CPTto open airways, making airway clearance more effective.

Take home points

• Chest physiotherapy 2–4 times daily is essential in CF care.
• Administer bronchodilators before CPT to enhance mucus clearance.
• Encourage regular physical activity to support lung health.
• Avoid suppressing cough; coughing is an important mechanism for airway clearance.

Cystic fibrosis (CF) is a genetic disorderthat affects the lungs, digestive system, and other organs by causing the body to produce thick, sticky mucus. CF is caused by mutations in the CFTR gene, which regulates salt and water movement in and out of cells. These mutations disrupt the function of the CFTR protein, leading to mucus buildup.

Rationale for correct answer:

1. Cystic fibrosis (CF) is an autosomal recessive genetic disorder.Both parents must be carriers of the CF gene for a child to be affected. Genetic counselingprovides information on inheritance patterns, carrier status, and reproductive risks, helping families make informed decisions about future pregnancies.

Rationale for incorrect answers:
2.If both parents are carriers, the chance for a completely unaffected childis 25%, not 50%.

3. The chance of having an affected childwhen both parents are carriers is 25%, not 50%.

4. The chance of a child being a carrieris 50%, not 25%.

Take home points

• CF is autosomal recessive, meaning both parents must carry the gene for a child to be affected.
• Carrier status and inheritance risks should be discussed with a genetic counselor before future pregnancies.
• Understanding genetic risk helps parents plan and access prenatal testing or assisted reproductive options.
• Counseling provides psychosocial support in addition to medical information.

Children with cystic fibrosis (CF) often have pancreatic insufficiency, which leads to malabsorption of fat-soluble vitamins. Supplementation is necessary to prevent deficiencies, maintain growth, support immune function, and promote bone health.

Rationale for correct answers:

1. Vitamin Ais essential for vision, skin integrity, and immune function. Fat malabsorption in CF can lead to deficiency.

3. Vitamin Dsupports calcium absorption and bone health. Children with CF are at risk for rickets and poor bone mineralization.

4. Vitamin Eis an antioxidantimportant for protecting cell membranes and preventing hemolytic anemia.

5. Vitamin Kis necessary for blood clotting.Deficiency can lead to bleeding disorders in children with CF.

Rationale for incorrect answers:
2.Vitamin Cis water-solubleand generally not deficient in CF if the child consumes a normal diet. Supplementation is not routinely required.

6. Vitamin B12is also water-soluble, and routine supplementation is usually unnecessary unless a deficiency is diagnosed.

Take home points

• Children with CF require daily supplementation of fat-soluble vitamins (A, D, E, K) due to malabsorption.
• Monitoring growth, bone health, and coagulation status helps ensure supplementation is effective.
• Caregivers should understand that water-soluble vitamins are generally obtained through diet, while fat-soluble vitamins need supplementation.
• Supplements should be given with meals containing fat to enhance absorption.

Cystic fibrosis (CF)is a genetic disorder affecting exocrine glands, resulting in thick, sticky mucus in the lungs, pancreas, and other organs. Children with CF are also prone to recurrent respiratory infections due to mucus buildup and impaired airway clearance.

Rationale for correct answer:

1. Salty skin on the lips or skinis a classic early sign of cystic fibrosis, especially in children with a history of frequent respiratory infections. This warrants evaluation by the primary health-care provider and confirmatory testing such as a sweat chloride test.

Rationale for incorrect answers:
2.Asthmacauses wheezing, coughing, and shortness of breath but does not cause salty-tasting skin.

3. Bronchiolitisis an acute viral infection of the lower respiratory tract in infants, causing cough, wheezing, and congestion. Salty skin is not a feature.

4. Pharyngitisinvolves sore throat, fever, and inflammation of the pharynx, and does not cause salty-tasting skin.

Take home points

• Salty-tasting skin is a hallmark early sign of CF and should prompt further evaluation.
• Recurrent respiratory infections in infancy increase suspicion for CF.
• The sweat chloride test is the standard diagnostic tool.

Early diagnosis allows initiation of airway clearance, nutritional support, and infection prevention strategies.

Bronchopulmonary dysplasia (BPD)is a chronic lung disease of infancy, often seen in premature infants requiring prolonged ventilation or oxygen therapy. These infants frequently need home oxygen, tracheostomy care, and close monitoring. They are highly susceptible to respiratory infections, hypoxemia, and complications with high altitude.

Rationale for correct answer:
3.Camping trip to Yellowstone National Park:Yellowstone is at a high altitude, which has lower oxygen levels in the air. An infant with BPD on home oxygen is at high risk of severe hypoxemia and respiratory distress in such environments. Travel to high-altitude areas is contraindicated until the infant’s respiratory status is stable and cleared by the healthcare team.

Rationale for incorrect answers:

1. Calling the pediatrician if fever or increased secretions: These are early signs of infection or tracheostomy complications, and prompt medical evaluation is necessary.

2. Loosely covering the tracheostomy with a bib during feeding/outside:A loose cover protects the airway from food particles, wind, and debris without blocking airflow.

4. Notifying the power company about home oxygen use:This ensures the family has priority in case of a power outage since home oxygen is life-sustaining equipment.

Take home points

• Infants with BPD on home oxygen should not be exposed to high altitudes without medical clearance.
• Parents should be taught infection prevention, safe tracheostomy care, and oxygen safety.
• Backup power planning and emergency contacts are essential for families using home oxygen.
• Nurses must carefully assess caregiver understanding before discharge to ensure safety at home.

Bronchopulmonary dysplasia (BPD)is a chronic lung disease that primarily affects premature neonates who require prolonged ventilatory support or high concentrations of oxygen. It results from lung injury due to mechanical ventilation, oxygen toxicity, and inflammation, leading to impaired alveolar development, fibrosis, and airway remodeling.

Rationale for correct answer:
2.Exposure to high positive airway pressure and high oxygen concentrations during the first weeks of life can damage immature lungs and interfere with alveolar growth, leading to BPD.

Rationale for incorrect answers:

1. Bronchiolitisis an acute viral infectionof the lower respiratory tract, not caused by ventilatory support or oxygen therapy.

3. Asthmais a chronic inflammatory airway disease, usually diagnosed later in childhood, not directly caused by neonatal ventilatory support.

4. Cystic fibrosisis a genetic disorder caused by mutations in the CFTR gene, unrelated to ventilatory support or oxygen exposure.

Take home points

• Neonates exposed to high oxygen and positive pressure ventilation are at increased risk for BPD.
• BPD involves chronic lung inflammation, airway remodeling, and impaired alveolarization.
• Preventive strategies include gentle ventilation, minimizing oxygen exposure, and early surfactant therapy.

Infants with bronchopulmonary dysplasia (BPD)have immature lungs with decreased compliance and impaired gas exchange. They are at risk for respiratory distress and failure. Key signs of acute respiratory compromiseinclude tachypnea, retractions, nasal flaring, grunting, and changes in oxygen saturation. Early recognition and prompt reporting are critical to prevent further deterioration.

Rationale for correct answer:
3.Respiratory rate greater than 60 breaths/minute with moderate sub-sternal retractions indicates increased work of breathing and possible hypoxemiadespite oxygen therapy. Immediate reporting is necessary because the infant may require escalation of respiratory supportor additional interventions to prevent respiratory failure.

Rationale for incorrect answers:

1. Pulse oximetry of 94% while receiving oxygen by nasal cannula is slightly lower than normal but generally acceptable for a BPD infant on supplemental oxygen; can be monitored, not emergent.

2. Decreased intake with last feedingis concerning for hydration/nutrition but not an immediate life-threatening issue; can be managed with feeding adjustments and monitoring.

4. Sleeping more than 3 hours at a time is normal for young infants; not an indication of acute respiratory compromise.

Take home points

• Tachypnea and retractions are early warning signs of respiratory distress in infants with BPD.
• Nurses should report changes in respiratory effort immediately, even if oxygen saturation is only mildly affected.
• Monitoring oxygen saturation, respiratory rate, retractions, and overall work of breathing is essential for infants with chronic lung disease.
• Prompt intervention can prevent progression to respiratory failure.

Bronchopulmonary dysplasia (BPD)is a chronic lung disease resulting from lung injury in premature infants. Impaired gas exchange occurs due to alveolar damage, inflammation, and mucus accumulation, leading to hypoxemia and increased work of breathing. Nursing care focuses on optimizing oxygenation and ventilation.

Rationale for correct answer:

1. Chest physiotherapyhelps mobilize secretions, improve airway clearance, and enhance ventilation, directly addressing impaired gas exchange. This intervention reduces atelectasis and facilitates better oxygenation.

Rationale for incorrect answers:
2.Enteral feedingssupport nutrition, which is important for growth, but they do not directly improve gas exchange.

3. Developmental activitiessupport neurodevelopment, but are secondary to airway and respiratory support in prioritization.

4. Bondingis important for psychosocial development, but it does not directly address impaired gas exchange.

Take home points

• Nursing interventions for impaired gas exchange in BPD should focus on airway clearance, oxygen therapy, and respiratory monitoring.
• Chest physiotherapy is a key intervention to remove secretions and improve alveolar ventilation.
• Supportive care (nutrition, developmental activities, and bonding) is important but secondary to ensuring adequate oxygenation.
• Continuous monitoring of respiratory rate, oxygen saturation, and work of breathing is essential to evaluate intervention effectiveness.

Allergiesare immune-mediated reactions to environmental antigens (allergens) such as pollen, dust, or pet dander. Coldsare viral infections that produce variable symptoms such as congestion, runny nose, and sometimes fever, usually resolving within 7–10 days.

Rationale for correct answer:
4.Sneezing in allergies occursrepetitively and predictably, often in response to exposure to a specific allergen, distinguishing it from the intermittent or variable sneezing seen in viral colds.

Rationale for incorrect answers:

1. Skin testsare used to identify allergens, not viral infections. Colds are diagnosed clinically based on symptoms.

2. Allergies do not causefever. Fever suggests an infectious process, such as a cold or flu.

3. Itchingis typical of allergies, not viral colds. Colds may cause nasal congestion or discharge but not persistent itching.

Take home points

• Allergies produce predictable, consistent, and non-infectious symptoms such as sneezing, nasal/eye itching, and clear rhinorrhea.
• Colds are caused by viruses and usually present with variable symptoms and possible fever.
• Diagnostic tests like skin testing or IgE levels can confirm allergies.
• Nurses should educate caregivers on differentiating allergy symptoms from infections to guide appropriate management.

Obstructive sleep apnea (OSA) in children is a sleep-related breathing disorder where the upper airway becomes partially or completely blocked during sleep, causing repeated pauses in breathing throughout the night. The child may snore loudly, gasp, or stop breathing briefly, then resume with a snort or choke.

Rationale for correct answer:
4. Continuous positive airway pressure (CPAP) maintains positive airway pressure, which keeps alveoli and the upper airway patentduring sleep, improving oxygenation and reducing apneic events in clients with OSA.

Rationale for incorrect answers:

1. CPAPdoes not provide ventilation; it does not initiate breaths. It only maintains airway patency. Ventilators or BiPAP are used for assisted ventilation.

2. CPAP maintains positive pressure and may actually increase intrathoracic pressure slightly. Its goal is not to reduce it.

3. CPAP provides air at room concentration or supplemental oxygenif added, but the primary purpose is airway patency, not high oxygen delivery.

Take home points

• CPAP is first-line therapy for obstructive sleep apnea, particularly in adults and children with significant airway obstruction.
• The device prevents airway and alveolar collapse, improving oxygenation and sleep quality.
• Nurses should educate clients on proper mask fit, cleaning, and adherence to therapy.
• CPAP does not replace spontaneous breathing; it supports airway patency only.

A peak expiratory flow (PEF) metermeasures the maximum speed of expiration and is used to monitor airway obstruction in asthma. Daily use helps detect early changes in lung function before symptoms appear, allowing timely intervention and prevention of exacerbations.

Rationale for correct answer:

1. “My peak flow meter can tell me if an asthma episode might be coming, even though I might still be feeling okay.”The peak flow meter is an early warning tool. A decrease from the child’s personal best can indicate worsening airway obstruction before overt symptoms, prompting action according to the asthma action plan.

Rationale for incorrect answers:
2.“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.

3. “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.

4. “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.

Take home points

• Peak flow meters detect early airway obstruction, even before symptoms appear.
• Proper technique: reset to zero, deep breath in, blow out as hard and fast as possible, repeat three times, record the highest value.
• Peak flow readings guide asthma action plans for timely medication adjustments.

Daily use helps prevent severe attacks but does not replace prescribed medications or other asthma management strategies.

Cystic fibrosis (CF) affects the pancreas, leading to pancreatic enzyme insufficiencyand malabsorption of fats and proteins. This can cause nutritional deficiencies, steatorrhea (fatty stools), and poor growth. Proper nutrition with high-calorie, high-fat diets and enzyme supplementationis essential, especially during respiratory infections that increase metabolic demand.

Rationale for correct answers:

1. Frothy, foul-smelling stoolsindicates steatorrhea caused by fat malabsorption, suggesting the child may need enzyme dose adjustment or dietary counseling.

5. Children with CF require high-calorie, high-fat dietsto maintain growth and meet increased energy needs. A low-fat, low-calorie diet is inappropriate and increases the risk of malnutrition and poor growth.

Rationale for incorrect answers:
2.Weight remaining unchanged from yesterdaydoes not necessarily concerning in acute illness; short-term weight changes may not reflect chronic nutritional status.

3. Consuming 80% of breakfastis an acceptable intake for a hospitalized child. Indicates reasonable appetite.

4. Eating three snacks every dayis a positive behavior for caloric intake. Encouraged in CF nutrition plans.

Take home points

• Steatorrhea (frothy, foul-smelling stools) indicates inadequate fat absorption — assess enzyme use and dietary intake.
• Children with CF need high-calorie, high-fat diets; low-calorie diets are inappropriate.
• Nutrition counseling is essential to support growth, maintain weight, and meet increased metabolic demands during illness.
• Nurses should monitor stool characteristics, dietary intake, and weight trends for early identification of gastrointestinal complications.

Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants, often following premature birth with prolonged oxygen therapy and mechanical ventilation. The primary pathophysiology involves alveolar damage, decreased lung compliance, and ventilation-perfusion mismatch, which can lead to hypoxemia and hypercapnia.

Rationale for correct answer:
3.Impaired gas exchange: The highest priority in nursing care is to ensure adequate oxygenation and ventilation. Without effective gas exchange, all other body systems are compromised. Interventions may include oxygen therapy, monitoring SpO₂, positioning, and respiratory support as needed.

Rationale for incorrect answers:

1. 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.

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

4. 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.

Take home points

• Airway and breathing always take priority over nutrition or fluid management in infants with chronic lung disease.
• Nursing interventions should focus on monitoring respiratory status, optimizing oxygenation, and minimizing work of breathing.
• Once the infant is stable, attention can shift to nutrition, fluid balance, and developmental care.
• ABCs (Airway, Breathing, Circulation) guide prioritization in critical pediatric care.

Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants, often following premature birth with prolonged oxygen therapy and mechanical ventilation. The primary pathophysiology involves alveolar damage, decreased lung compliance, and ventilation-perfusion mismatch, which can lead to hypoxemia and hypercapnia.

Rationale for correct answer:
3. Structured routinesensure that the infant receives adequate rest, nutrition, and care while minimizing unnecessary stress and energy expenditure, which is crucial for infants with compromised lungs.

Rationale for incorrect answers:

1. 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.

2. 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.

4. 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.

Take home points

• Scheduled care helps conserve energy in infants with BPD.
• Balance rest, nutrition, and developmental activities to support growth and prevent fatigue.
• Oxygen therapy should always be maintained during all interventions.
• Nurses should plan care to minimize stress and optimize respiratory function while promoting normal development.

Bronchopulmonary dysplasia (BPD)is a chronic lung disease seen in premature infantswho required prolonged oxygen therapy or mechanical ventilation. The disease results in alveolar damage, airway inflammation, and impaired gas exchange, which manifest as increased work of breathing, tachypnea, and dyspnea.

Rationale for correct answer:
2.Infants and children with BPD often show rapid breathing, labored breathing, nasal flaring, retractions, and use of accessory musclesdue to compromised lung function and decreased oxygenation.

Rationale for incorrect answers:

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

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

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

Take home points

• Tachypnea and dyspnea are hallmark signs of BPD and should guide nursing assessments.
• Nurses should monitor respiratory rate, effort, oxygen saturation, and work of breathing closely.
• Early identification of respiratory compromise allows timely interventions such as oxygen therapy, suctioning, and positioning to optimize ventilation.
• Supportive care should include nutrition, rest, and developmentally appropriate handling to minimize additional stress on the lungs.

Infants with bronchopulmonary dysplasia (BPD)have immature lungs and decreased respiratory reserve. Frequent handling and stimulation can increase oxygen demand and cause overstimulation, leading to hypoxemia, respiratory distress.

Rationale for correct answer:
3.Cyanosisindicates inadequate oxygenation, often a result of overstimulation or increased work of breathing. It is a serious sign that requires immediate intervention, such as pausing stimulation, providing supplemental oxygen, or repositioning.

Rationale for incorrect answers:

1. Increased alertnessis normal behavior and may indicate a healthy response to interaction rather than overstimulation.

2. Good eye contactis a positive developmental response and not a sign of respiratory distress or overstimulation.

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

Take home points

• Infants with BPD need frequent rest periods to conserve energy and maintain oxygenation.
• Cyanosis, nasal flaring, retractions, and tachypnea are early signs of overstimulation and hypoxemia.
• Nurses should pace care, minimize handling, and cluster interventions to reduce stress.
• Immediate action is required if cyanosis occurs to ensure airway patency and adequate oxygen delivery.

Bronchopulmonary dysplasia (BPD)is a chronic lung disease primarily affecting premature infantswho required mechanical ventilation or high oxygen therapy. BPD is classified into four stagesbased on radiographic and clinical findings.

Rationale for correct answer:
4.During the initial stage of BPD, infants often present with signs of respiratory distress syndrome (RDS), such as tachypnea, retractions, grunting, and diffuse lung infiltrates on X-ray, before the development of chronic lung changes.

Rationale for incorrect answers:

1. Interstitial fibrosisis a feature of later stages of BPD, indicating chronic lung injury and scarring.

2. Signs of emphysemaoccur in advanced stages due to alveolar overdistension and chronic lung injury.

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

Take home points

• The early stage of BPD resembles RDS, requiring interventions similar to RDS management.
• Recognizing early-stage BPD is critical to prevent progression to chronic lung disease.
• Later stages show hyperexpansion, emphysema, and interstitial fibrosis, which indicate chronic structural damage.
• Nurses should monitor for respiratory distress, oxygen needs, and radiographic changes to guide appropriate care.

Bronchopulmonary dysplasia (BPD)is a chronic lung disease resulting from lung injury in premature infants. Impaired gas exchange occurs due to alveolar damage, inflammation, and mucus accumulation, leading to hypoxemia and increased work of breathing.

Rationale for correct answer:
2.Tracheostomy is indicated when prolonged mechanical ventilation is necessaryand the infant cannot maintain adequate oxygenation or ventilation independently. It facilitates chronic respiratory support and allows the infant to transition to home care if stable.

Rationale for incorrect answers:

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

3. Gastrostomy tube placementdoes not require a tracheostomy; feeding tubes and tracheostomy are separate interventions.

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

Take home points

• Tracheostomy is primarily indicated for long-term ventilator support in infants with BPD who cannot be weaned safely.
• It reduces risks associated with prolonged endotracheal intubation, such as subglottic stenosis and airway trauma.
• Care involves airway suctioning, tracheostomy tube care, and infection prevention.
• Nurses play a key role in monitoring respiratory status, maintaining airway patency, and educating caregivers for home care.

Bronchopulmonary dysplasia (BPD)is a chronic lung disease resulting from lung injury in premature infants. Impaired gas exchange occurs due to alveolar damage, inflammation, and mucus accumulation, leading to hypoxemia and increased work of breathing.

Rationale for correct answer:
3.The decline in oxygen saturation from 96% to 87%, along with anxiety and restlessness, suggests partial airway obstruction, likely from secretions. Immediate suctioningcan restore airway patency and improve oxygenation.

Rationale for incorrect answers:

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

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

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

Take home points

• In infants with BPD and tracheostomy, sudden drops in oxygen saturation require assessment for airway obstruction first.
• Priority interventions focus on clearing the airway before supportive measures such as oxygen or medications.
• Nurses must be skilled in tracheostomy suctioning, monitoring oxygen saturation, and recognizing early signs of respiratory distress.

Cystic fibrosis (CF)is a chronic, multisystem disorder affecting the lungs, pancreas, and digestive system. Home care focuses on airway clearance, infection prevention, nutrition, and appropriate physical activity to maintain health and prevent complications.

Rationale for correct answers:

1. “We will perform chest physiotherapy and postural drainage four times a day.”Regular chest physiotherapy and postural drainage help mobilize secretions, prevent infection, and maintain lung function.

2. “We will keep our child home from school if there are any reportable communicable diseases in the school.”Children with CF have compromised pulmonary function and are at higher risk for complications from infections; avoiding exposure to communicable diseases is critical.

4. “The relay races and swimming at the school picnic next week will be good exercise for her.”Moderate exercise is beneficial for children with CF, improving pulmonary function, endurance, and overall health.

Rationale for incorrect answers:
3.“If her bowel movements are normal and her appetite is good, she does not need her pancreatic enzymes.”Pancreatic enzyme supplementation is required with every meal or snack in children with CF who have pancreatic insufficiency, regardless of bowel movement or appetite status.

5. “My child will not need any special dietary intake.”Children with CF need a high-calorie, high-protein, high-fat diet to meet increased energy demands and compensate for malabsorption.

Take home points

• Home care for CF includes regular airway clearance, infection prevention, appropriate exercise, and optimal nutrition.
• Pancreatic enzymes must be taken with all meals/snacks if pancreatic insufficiency is present.
• Caregivers should understand the importance of balancing activity with rest and preventing exposure to infections.
• Education should reinforce daily adherence to treatment and monitoring for signs of infection or nutritional issues.

Cystic fibrosis (CF) is a genetic, multisystem diseasethat primarily affects the lungs and pancreas. Adolescents with CF may experience delayed puberty, reproductive challenges, and risk of diabetes. Education about the disease helps adolescents and their families understand expectations and self-management.

Rationale for correct answers:

1. Delayed pubertyis common in females with CF due to malnutrition and chronic illness, which can slow growth and development.

2. Cystic fibrosis-related diabetes (CFRD)can develop during adolescence due to pancreatic damage, and screening should begin around age 10.

4. With appropriate education and support, adolescents with CF can have normal sexual relationships, although fertility may be affected, particularly in males.

Rationale for incorrect answers:
3. Fertility can beimpaired, especially in males, and pregnancy in females with CF requires careful planning and monitoring due to health risks.

5. CF is an autosomal recessive disorder, so both males and females can inherit and carry the gene.

6. CF is progressive, and respiratory treatment frequency usually remains high or may increaseover time; it is rarely decreased.

Take home points

• Adolescents with CF may experience delayed puberty and growth delays.
• CFRD screening is essential starting around age 10.
• With education and support, normal social and sexual relationships are possible, but fertility may be affected.
• CF management remains intensive throughout life, and treatment adherence is critical.

Asthma exacerbationscan lead to airway obstruction, causing hypoventilation and carbon dioxide retention. Respiratory acidosis occurs when the lungs fail to remove CO₂ effectively, leading to low pH and elevated PCO₂. Prompt recognition and treatment are essential to prevent respiratory failure.

Rationale for correct answer:
3.The ABG shows pH 7.30 which is acidic (normal 7.35–7.45), PCO₂ 56 mm Hg which is elevated (normal 35–45 mm Hg), and HCO₃⁻ 25 mEq/L is within normal ranges (22–26 mEq/L). This pattern indicates acuterespiratory acidosis, caused by hypoventilation from airway obstruction during an asthma attack.

Rationale for incorrect answers:

1. Metabolic acidosisshows low pH with low HCO₃⁻, which is not present here.

2. Metabolic alkalosisshows elevated pH and elevated HCO₃⁻; both are not present.

4. Respiratory alkalosisshows elevated pH and low PCO₂, the opposite of this ABG.

Take home points

• ABG interpretation requires assessing pH, PCO₂, and HCO₃⁻ to determine acid-base status.
• In acute asthma exacerbations, watch for CO₂ retention, which signals respiratory acidosis and worsening airway obstruction.
• Early intervention with bronchodilators, oxygen, and monitoring is critical to prevent respiratory failure.

Bronchopulmonary dysplasia (BPD)is a chronic lung disease most common in premature infants who require mechanical ventilation and high concentrations of oxygen. Immature lungs are vulnerable to injury, and prolonged respiratory support can lead to alveolar and airway damage, resulting in BPD.

Rationale for correct answer:
3.Extreme prematurity (≤28 weeks)and prolonged high-pressure ventilationare the primary risk factors for BPD. These factors increase susceptibility to lung injury, inflammation, and chronic oxygen dependence.

Rationale for incorrect answers:

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

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

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

Take home points

• Extreme prematurity and mechanical ventilation are the most significant risk factors for BPD.
• BPD results from lung injury caused by oxygen toxicity and barotrauma.
• Early identification of at-risk neonates allows for preventive strategies, including minimizing ventilator pressures and oxygen exposure.
• Infants with BPD require long-term monitoring for growth, oxygen needs, and respiratory complications.

Children with well-controlled asthma can safely participate in most physical activities and sports, which help improve cardiopulmonary fitness, lung function, and overall health. Proper medication use, warm-up routines, and trigger management allow participation without increasing the risk of asthma exacerbations.

Rationale for correct answer:
4. Exercise isbeneficialfor children with asthma. With adequate control, medication adherence, and monitoring, participation in sports is safe and supports overall physical and emotional well-being.

Rationale for incorrect answers:

1. Exercise cantrigger bronchospasm(exercise-induced asthma), so precautions are necessary.

2. Limiting activity unnecessarilycan negatively impact fitness, socialization, and quality of life.

3. Swimming isoften recommendedfor children with asthma because warm, humid air reduces airway irritation.

Take home points

• Encourage regular physical activity in children with controlled asthma.
• Ensure pre-exercise medication if prescribed (e.g., short-acting bronchodilator).
• Educate on recognizing early signs of asthma during activity.
• Promote inclusion and participation in sports to support physical and psychosocial health.

Asthmain children is a chronic lung condition that causes inflammation and narrowing of the airways, making it difficult to breathe. For children with asthma or allergies, allergen avoidancein the home is critical.

Rationale for correct answer:
4.Foam rubber pillows and synthetic blanketsdo not trap dust mites and allergens like natural fibers do, making them a practical intervention for “allergy-proofing” the child’s sleeping environment.

Rationale for incorrect answers:

1. Carpetstrap dust, pollen, and other allergens, which can worsen asthma and allergy symptoms.

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

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

Take home points

• Use allergen-resistant bedding and synthetic materials to reduce exposure to dust mites and allergens.
• Avoid carpets, upholstered furniture, and natural-fiber pillows that can harbor allergens.
• Combine with frequent cleaning, vacuuming with HEPA filters, and humidity control for optimal asthma management.

Infants with cystic fibrosis (CF)often have pancreatic insufficiency, leading to malabsorption of fats and proteins. To support adequate growth and nutrition, these infants require high-calorie, nutrient-dense, and predigested formulas that are easier to absorb. This helps prevent failure to thrive and supports overall development.

Rationale for correct answer:
4.The baby must consume a predigested formula that is high in calories: Predigested (hydrolyzed) formulas are easier to absorb, and high-calorie content meets the increased energy needs of infants with CF. This is a key component of nutritional management for growth and development.

Rationale for incorrect answers:

1. 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.

2. 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.

3. 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.

Take home points

• Infants with CF require high-calorie, predigested or enzyme-supplemented formulas to meet nutritional needs.
• Pancreatic enzyme therapy should accompany each feeding to enhance nutrient absorption.
• Proper nutrition supports growth, immune function, and overall health in infants with CF.
• Caregiver education should emphasize timing of enzyme administration and monitoring weight gain and growth parameters.

Cystic fibrosis (CF) is a genetic disorderthat primarily affects the lungs and digestive system, but can impact other organs as well. CF is caused by mutations in the CFTR gene, which regulates the movement of salt and water in and out of cells. These mutations lead to the production of thick, sticky mucus that clogs airways and ducts in various organs.

Rationale for correct answer:
4.Children with cystic fibrosis (CF) are at risk for developing cystic fibrosis-related diabetes (CFRD)due to damage to the pancreas, which affects both insulin production and glucose metabolism. Annual screening for diabetes is recommended starting around age 10, even in asymptomatic children, to allow for early detection and management. Early monitoring allows for timely intervention with dietary management, insulin therapy, and glucose monitoringto prevent complications.

Rationale for incorrect answers:

1. Lupusis an autoimmune disorder not specifically associated with CF.

2. Arthritisis not a routine comorbidity in children with CF.

3. Hyperthyroidismis not linked to CF, and routine screening is not indicated.

Take home points

• Children with CF should have annual screening for diabetes starting at 10 years of age.
• CFRD differs from type 1 or type 2 diabetes but requires similar management strategies.
• Early detection helps maintain nutrition, growth, and overall health in children with CF.
• Nurses should educate families on recognizing signs of hyperglycemia, including increased thirst, urination, and weight loss.

Children with cystic fibrosis (CF) often have pancreatic insufficiency, leading to malabsorption of fats, proteins, and carbohydrates. Pancreatic enzyme supplementationis essential to aid digestion and ensure proper nutrition.

Rationale for correct answer:
4.“The enzymes should be given at the beginning of each meal and snack”Administering enzymes with the first bite of food maximizes digestion of nutrients and reduces steatorrhea and malnutrition.

Rationale for incorrect answers:

1. “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.

2. “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.

3. “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.

Take home points

• Pancreatic enzymes are essential for digestion in children with CF and must be given with every meal and snack.
• Proper timing reduces gastrointestinal symptoms such as foul-smelling, greasy stools.
• Parents should never alter the dose without consulting the provider, even if stools appear normal.
• Education should include signs of malabsorption, proper dosing, and administration techniques.

A sweat chloride testis the gold standard for diagnosing cystic fibrosis (CF). CF is a genetic disorder affecting chloride transport across epithelial cells, leading to abnormally salty sweat. A positive newborn screen (elevated IRT) indicates the need for confirmatory testing with a sweat test.

Rationale for correct answer:
4.“This will diagnose whether the infant has cystic fibrosis.”The sweat test directly measures chloride concentration in sweat. Values ≥60 mEq/Lin infants confirm CF, while borderline values require further testing.

Rationale for incorrect answers:

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

2. “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.

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

Take home points

• Sweat chloride test confirms CF after a positive newborn screen.
• Abnormal chloride levels (≥60 mEq/L) indicate cystic fibrosis.
• The test is safe and noninvasive, but requires trained personnel.
• Nurses should educate caregivers on the purpose, procedure, and interpretation of the sweat test.