Respiratory therapists are known for diagnosing and treating adults, but they must also provide care for neonatal and pediatric patients. This involves learning the key differences in how the respiratory system develops and functions at various stages in life.

It also means that respiratory therapy students must develop an understanding of this topic. In this guide, we’ve listed some sample TMC practice questions on neonatal and pediatric respiratory care.

This can help you practice and prepare for the real-life questions that will be featured on the licensure exam offered by the NBRC.

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Note: We didn’t include the correct answers on this page so that you can test your knowledge. If you want to see the correct answers (with detailed rationales), just simply download the digital study guide.

Neonatal and Pediatric Sample TMC Practice Questions:

1. You were called by the physician to obtain a capillary blood sample. Which of the following is true regarding this sample type?
A. The sample must be drawn from the first drop of surface blood
B. The puncture normally is performed on the ball of the foot
C. The sample pH and PCO2 correlate well with standard ABG results
D. To obtain the sample, you need to milk the puncture site

2. While assisting with the delivery of a newborn infant, the doctor asks you to obtain an Apgar score. Which of the following is considered a normal score?
A. 1-4
B. 4-7
C. 7-10
D. 10-13

3. You are called for the assessment of a child in the emergency department. It has been noted that the child has stridor. Which of the following conditions would you expect?
A. Croup
B. Asthma
C. Pneumonia
D. Cystic fibrosis

4. You are called to the NICU for the assessment of a premature infant. The infant is receiving positive pressure ventilation and exhibits the following: acute respiratory distress, hypotension, and asymmetrical chest motion. Which of the following procedures would you initially recommend?
A. An arterial blood gas
B. A chest radiograph
C. A capillary heal stick
D. Chest transillumination

5. Upon assessment, you note that an infant patient with bradycardia is having spells of apnea. Which of the following would you recommend?
A. Surfactant
B. Nasal CPAP
C. An aerosolized bronchodilator
D. Mechanical ventilation

6. You are needed in the NICU to help with the intubation of an infant. While gathering supplies, which of the following laryngoscope blades would you select?
A. Miller
B. Macintosh
C. Guedel
D. Berman

7. A 4-year-old child has been admitted to the emergency department with wheezing and stridor. An AP x-ray shows an area of prominent subglottic edema but the lateral neck X-ray appears normal. Which of the following is the most likely problem?
A. Cystic fibrosis
B. Foreign body
C. Epiglottitis
D. Croup

8. A 2-year-old child is showing signs of a severe asthma attack. The physician orders a bronchodilator that is available in both MDI and SVN doses. Which of the following would be the best delivery system for this drug to this patient?
A. An SVN using the “blow by” technique
B. An MDI with a holding chamber and mask
C. A small volume nebulizer with a mouthpiece
D. A breath-actuated MDI with mask

9. Which of the following could be a potential problem when using a nebulizer to deliver gas to an infant that is in an oxyhood?
A. Increased potential for CO2 accumulation
B. The production of harmful noise levels
C. Difficulty in maintaining adequate humidification
D. Difficulty in maintaining a stable high FiO2

10. You were called to assess an infant in the NICU. While observing the infant’s chest configuration, you note that it is the same size in both the AP and the lateral dimensions. This would indicate that the infant has which of the following?
A. A normal chest
B. Lordosis
C. Pectus excavatum
D. Pulmonary emphysema with air trapping

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11. While evaluating a pediatric patient, upon entering the room, you hear a harsh, high-pitched sound on the child’s inspiration. Which of the following is most likely the cause of this finding?
A. The sounds are bronchovesicular
B. The sounds are bronchial
C. The sounds are tracheal
D. The sounds are stridorous

12. The nurse calls and requests for you to suction a pediatric patient with excess secretions. What is the normal range of negative pressure that should be used when suctioning the child?
A. -60 to -80 mm Hg
B. -80 to -100 mm Hg
C. -100 to -120 mm Hg
D. -150 to -200 mm Hg

13. Which of the following patients is the best candidate for high-frequency oscillation ventilation?
A. A child with severe hypercapnia
B. A neonate with refractory hypoxemia
C. An adult with refractory hypoxemia
D. An adult with status asthmaticus

14. A neonate has severe hypoxemia due to persistent pulmonary hypertension. In order to treat the patient, the doctor ordered inhaled nitric oxide. What starting dose would you recommend for this patient?
A. 2%
B. 2 ppm
C. 20 ppm
D. 200 ppm

15. A newborn 28-week gestational age neonate is being treated in an oxygen hood with an FiO2 of 50%. The physician believes that the patient has infant respiratory distress syndrome. The following blood gas results were obtained from an umbilical artery sample:
pH 7.36
PaCO2 38 mm Hg
HCO3 25 mEq/L
BE 0 mEq/L
PaO2 46 mm Hg
Based on the results, what should you recommend?
A. Start nasal CPAP at 5-8 cm H2O
B. Increase the oxygen hood concentration to 100%
C. Intubate and begin mechanical ventilation with PEEP
D. Obtain a chest X-ray to look for a pneumothorax

16. A 3-year-old boy has arrived to the emergency department having an asthma attack. Which of the following drugs would you NOT recommend for the initial management of an acute asthma attack for a child?
A. Epinephrine
B. Albuterol (Proventil)
C. Terbutaline (Brethaire)
D. Cromolyn sodium (Intal)

17. While performing a full code blue on a 5-year-old pediatric patient that is in respiratory arrest, you should bag-mask ventilation at a rate of what?
A. 6-12 breaths/min
B. 12-20 breaths/min
C. 20-25 breaths/min
D. 25-30 breaths/min

18. An infant that was born prematurely has a low Apgar score and needs immediate resuscitation and chest compressions. Which of the following statements about chest compressions during neonatal resuscitation is correct?
A. Compressions should exceed 1/2 the AP chest diameter
B. Compressions should be delivered on the top third of the sternum
C. The compression to ventilation ratio should be 3:1
D. Compressions and ventilations should be delivered simultaneously

19. A premature newborn infant with an Apgar score of 3 is showing signs of hypoxemia, grunting, and intercostal retractions. Which of the following would you recommend?
A. Suction the neonate
B. Nebulize albuterol
C. Provide supplemental oxygen
D. Instill surfactant into the airway

20. An 8-year-old child is in need of immediate intubation and mechanical ventilation. Which of the following endotracheal tube sizes would you select for this patient?
A. 4.0 mm
B. 5.0 mm
C. 6.0 mm
D. 7.0 mm

21. You are needed to assist with the intubation of a premature infant. Which laryngoscope blade would you recommend?
A. Miller blade number 0
B. Miller blade number 2
C. MacIntosh blade number 0
D. MacIntosh blade number 1

22. While treating a 3-month-old infant, you note that she has periods of apnea that result in bradycardia and cyanosis. Which of the following medications would you recommend?
A. Albuterol
B. Lidocaine
C. Neostigmine
D. Caffeine citrate

23. A neonate that has meconium aspiration syndrome is receiving mechanical ventilation. If you were to increase the pressure limit, this would increase the risk of which of the following?
A. Pneumothorax
B. Oxygen toxicity
C. Tracheoesophageal fistula
D. Retinopathy of prematurity

24. Which of the following signs would indicate that an infant has an increased work of breathing?
A. Pallor
B. Nasal flaring
C. Digital clubbing
D. Acrocyanosis

25. A child is admitted with the following symptoms:
Fever
Difficulty swallowing
Drooling
Stridor
A lateral neck x-ray was taken and showed supraglottic swelling. Which of the following is the most likely diagnosis?
A. Croup
B. Asthma
C. Epiglottitis
D. Foreign body obstruction

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26. The physician asks for you to evaluate a newborn infant’s condition. The normal vital signs for a term newborn include all of the following EXCEPT:
A. Heart rate of 132 beats/min
B. Respiratory rate of 20 breaths/min
C. Blood pressure of 62/40 mmHg
D. Rectal temperature of 35.9 degrees C

27. You are called to assist with the delivery of a high-risk infant. After being evaluated, the infant is given a five-minute Apgar score of 8. What should you recommend at this time?
A. Give the infant supplemental oxygen
B. Begin bag/mask rescue breathing on the infant
C. Give the infant to the mother for bonding
D. Give the mother supplemental oxygen

28. While reviewing the lateral neck radiograph of a 3-year-old boy, you note that there is a clear air column through the upper airway and narrowing of the tracheal air column below the larynx. Which of the following conditions is most likely present?
A. Tonsillitis
B. Aspirated a coin
C. Epiglottitis
D. Laryngotracheobronchitis

29. A 3-day-old boy was brought into the emergency department with his mother after being involved in a motor vehicle accident. The infant is showing signs of respiratory distress with cyanosis and tachycardia, and a pneumothorax is suspected. Which of the following tests would you recommend to confirm this suspicion?
A. Collect an ABG
B. Transillumination
C. Obtain an Apgar score
D. Perform a thoracentesis

30. You collected an ABG on a 30-week gestational age infant that is receiving oxygen via oxyhood at 60%. The results are as follows:
pH 7.36
PaO2 47 torr
PaCO2 44 torr
After reviewing the results, which of the following would you recommend?
A. Nasal CPAP at 4 cm H2O
B. Intubate and provide mechanical ventilation
C. Switch the infant to a nonrebreather mask
D. Increase the oxygen to 70%

31. You were called to help with the treatment of a newborn in the neonatal ICU. The physician states that the infant needs hyperventilation. This form of treatment would be recommended in which of the following types of patients?
A. Meconium aspiration
B. Respiratory distress syndrome
C. Infant with normal lung compliance
D. Persistent newborn pulmonary hypertension

32. A 21-month-old girl with asthma is receiving volume control SIMV mechanical ventilation with an inline small volume nebulizer in place. After the treatment was started, the alarm of the heated humidifier was activated. Which of the following is the most likely cause of this alarm?
A. Low gas temperature
B. Empty water reservoir
C. Clogged expiratory filter
D. Decreased humidity output

33. An arterial blood gas sample needs to be obtained from a newborn infant. The doctor ordered the sample from arterialized capillary blood because the artery would be too difficult to stick. Which of the following sites would you choose to obtain the sample?
A. The fingertip
B. The toe tip
C. The lateral area of the heel
D. The earlobe

34. You were called by the nurse to assist with the assessment of a newborn infant in the NICU. Which of the following signs is an indication that the infant is in respiratory distress?
A. Pallor
B. Cyanosis
C. Grunting
D. Digital clubbing

35. A newborn infant needs immediate resuscitation. While performing chest compressions, how far should the sternum be compressed?
A. At least 2 inches
B. One-half the AP diameter of the chest
C. No more than 0.5 inches
D. One-third of the AP diameter of the chest

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Final Thoughts

As previously mentioned, neonatal and pediatric care involves diagnosing and treating infants and children. It is important for respiratory therapists (and students) to develop an understanding of this topic.

This guide has provided you with some sample TMC practice questions that can help you prepare for the NBRC licensure exam.

If you want to increase your chances of passing the TMC exam on your first (or next) attempt, be sure to check out some of our other helpful resources:

You can join thousands of our other previous students who passed both board exams to earn their RRT credentials. Best of luck, and thanks for reading!

Medical Disclaimer: This content is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you read in this article. We strive for 100% accuracy, but errors may occur, and medications, protocols, and treatment methods may change over time.

References

The following are the sources that were used while doing research for this article:

  • Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
  • Clinical Application of Mechanical Ventilation. 4th ed., Cengage Learning, 2013.
  • Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 6th ed., Mosby, 2015.
  • Mosby’s Respiratory Care Equipment. 10th ed., Mosby, 2017.
  • Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019.
  • Wilkins’ Clinical Assessment in Respiratory Care. 8th ed., Mosby, 2017.
  • Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care. 7th ed., Cengage Learning, 2019.
  • Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.
  • Ruppel’s Manual of Pulmonary Function Testing. 11th ed., Mosby, 2017.
  • Neonatal and Pediatric Respiratory Care. 5th ed., Saunders, 2018.

Medical Disclaimer: The information provided by Respiratory Therapy Zone is for educational and informational purposes only. It should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition.