FN PEDS EXAM 2 NEWEST ACTUAL EXAM WITH COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
Question 1
Which of the following clinical findings is most characteristic of a child with Pulmonic Stenosis?
A) A machine-like murmur at the left upper sternal border.
B) A harsh, mid-to-late systolic ejection murmur at the upper left sternal border.
C) A holosystolic murmur at the left lower sternal border with a thrill.
D) A soft blowing murmur heard best at the apex.
E) An early diastolic rumble.
Correct Answer: B) A harsh, mid-to-late systolic ejection murmur at the upper left sternal
border.
Rationale: Pulmonic stenosis classically presents with a harsh systolic ejection murmur
heard best at the second intercostal space, left sternal border. It is often associated with
right ventricular hypertrophy and may decrease in intensity with inspiration and increase
with expiration.
Question 2
During an infant physical exam, the FNP notes bounding pulses in the upper extremities and
absent or weak pulses in the femoral region. What diagnosis is suspected?
A) Atrial Septal Defect
B) Ventricular Septal Defect
C) Coarctation of the Aorta
D) Patent Ductus Arteriosus
E) Tetralogy of Fallot
Correct Answer: C) Coarctation of the Aorta
Rationale: Coarctation of the aorta involves a narrowing of the aorta, typically near the
ductus arteriosus. This results in hypertension in the upper extremities (bounding
brachial/radial pulses) and hypotension/hypoperfusion in the lower extremities (weak or
absent femoral pulses).
Question 3
Which of the following is categorized as a "Cyanotic" heart defect?
A) Atrial Septal Defect
B) Ventricular Septal Defect
C) Pulmonic Stenosis
D) Tetralogy of Fallot
E) Patent Ductus Arteriosus
Correct Answer: D) Tetralogy of Fallot
Rationale: Tetralogy of Fallot involves a right-to-left shunt, allowing deoxygenated blood to
bypass the lungs and enter systemic circulation, leading to cyanosis. The other options are
acyanotic defects, typically involving left-to-right shunts.
, 2
Question 4
Which four congenital heart defects are specifically associated with left-to-right shunting?
A) ASD, VSD, AVSD, and PDA
B) TOF, TGA, Tricuspid Atresia, and HLHS
C) Pulmonic Stenosis, Coarctation, ASD, and VSD
D) AVSD, TOF, TGA, and PDA
E) ASD, VSD, HLHS, and Coarctation
Correct Answer: A) ASD, VSD, AVSD, and PDA
Rationale: These four defects allow blood to flow from the higher-pressure left side of the
heart (oxygenated) to the lower-pressure right side (deoxygenated), increasing pulmonary
blood flow without causing immediate cyanosis.
Question 5
A 3-year-old child presents for a well-check. The FNP hears a medium-pitched, systolic
crescendo-decrescendo murmur at the pulmonic area and a widely split S2. The child is thin and
has a history of frequent URIs. What is the most likely diagnosis?
A) Ventricular Septal Defect
B) Atrial Septal Defect
C) Tetralogy of Fallot
D) Mitral Valve Prolapse
E) Coarctation of the Aorta
Correct Answer: B) Atrial Septal Defect
Rationale: ASDs are often asymptomatic in early childhood but may present with easy
fatigue and frequent respiratory infections. The hallmark auscultatory finding is a widely
split S2 and a systolic crescendo-decrescendo murmur at the pulmonic area.
Question 6
A 4-week-old infant presents with a very loud, harsh, high-pitched holosystolic murmur at the
left lower sternal border. The infant is growing well and shows no signs of heart failure. This is
most consistent with:
A) A large VSD
B) A small VSD
C) A PDA
D) Pulmonic Stenosis
E) Tetralogy of Fallot
Correct Answer: B) A small VSD
Rationale: In VSDs, the smaller the hole, the greater the pressure gradient and the
louder/harsher the murmur. Small VSDs produce a high-pitched, grade I-IV holosystolic
murmur, whereas large VSDs produce a lower-pitched murmur and signs of CHF.
, 3
Question 7
Which of the following is a symptom of Congestive Heart Failure (CHF) in an infant with a large
Ventricular Septal Defect?
A) Bradycardia
B) Increased appetite
C) Poor feedings and tires easily
D) Hypertension in the legs
E) Hyperactivity
Correct Answer: C) Poor feedings and tires easily
Rationale: Infants with CHF from a large VSD exhibit signs of poor cardiac output and
pulmonary congestion, including tachypnea, tachycardia, diaphoresis during feeds, and
failure to thrive because they lack the energy to complete a feeding.
Question 8
A child with Trisomy 21 is diagnosed with an Atrioventricular Septal Defect (AVSD). What is
the expected management for a complete AVSD?
A) Watchful waiting until age 10
B) Immediate coil insertion in the first week
C) Surgical repair by 6 months of age
D) No treatment, as it usually closes spontaneously
E) Propranolol therapy only
Correct Answer: C) Surgical repair by 6 months of age
Rationale: Complete AVSD is strongly associated with Down Syndrome (Trisomy 21).
Because it involves a large communication between all four chambers, symptoms of CHF
progress rapidly, necessitated surgical correction within the first 6 months of life.
Question 9
What is the characteristic sound of a Patent Ductus Arteriosus (PDA) heard after the first few
weeks of life?
A) A musical, vibratory murmur
B) A harsh, blowing holosystolic murmur
C) A harsh, rumbling, machinery-like murmur
D) A soft, early systolic click
E) A single, loud S2
Correct Answer: C) A harsh, rumbling, machinery-like murmur
Rationale: The PDA murmur is classically described as "machinery-like" because it is a
continuous murmur (heard in both systole and diastole) as blood flows from the high-
pressure aorta to the lower-pressure pulmonary artery throughout the cardiac cycle.
Question 10
A 4-month-old infant experiences a "TET spell" characterized by sudden cyanosis and dyspnea
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
Question 1
Which of the following clinical findings is most characteristic of a child with Pulmonic Stenosis?
A) A machine-like murmur at the left upper sternal border.
B) A harsh, mid-to-late systolic ejection murmur at the upper left sternal border.
C) A holosystolic murmur at the left lower sternal border with a thrill.
D) A soft blowing murmur heard best at the apex.
E) An early diastolic rumble.
Correct Answer: B) A harsh, mid-to-late systolic ejection murmur at the upper left sternal
border.
Rationale: Pulmonic stenosis classically presents with a harsh systolic ejection murmur
heard best at the second intercostal space, left sternal border. It is often associated with
right ventricular hypertrophy and may decrease in intensity with inspiration and increase
with expiration.
Question 2
During an infant physical exam, the FNP notes bounding pulses in the upper extremities and
absent or weak pulses in the femoral region. What diagnosis is suspected?
A) Atrial Septal Defect
B) Ventricular Septal Defect
C) Coarctation of the Aorta
D) Patent Ductus Arteriosus
E) Tetralogy of Fallot
Correct Answer: C) Coarctation of the Aorta
Rationale: Coarctation of the aorta involves a narrowing of the aorta, typically near the
ductus arteriosus. This results in hypertension in the upper extremities (bounding
brachial/radial pulses) and hypotension/hypoperfusion in the lower extremities (weak or
absent femoral pulses).
Question 3
Which of the following is categorized as a "Cyanotic" heart defect?
A) Atrial Septal Defect
B) Ventricular Septal Defect
C) Pulmonic Stenosis
D) Tetralogy of Fallot
E) Patent Ductus Arteriosus
Correct Answer: D) Tetralogy of Fallot
Rationale: Tetralogy of Fallot involves a right-to-left shunt, allowing deoxygenated blood to
bypass the lungs and enter systemic circulation, leading to cyanosis. The other options are
acyanotic defects, typically involving left-to-right shunts.
, 2
Question 4
Which four congenital heart defects are specifically associated with left-to-right shunting?
A) ASD, VSD, AVSD, and PDA
B) TOF, TGA, Tricuspid Atresia, and HLHS
C) Pulmonic Stenosis, Coarctation, ASD, and VSD
D) AVSD, TOF, TGA, and PDA
E) ASD, VSD, HLHS, and Coarctation
Correct Answer: A) ASD, VSD, AVSD, and PDA
Rationale: These four defects allow blood to flow from the higher-pressure left side of the
heart (oxygenated) to the lower-pressure right side (deoxygenated), increasing pulmonary
blood flow without causing immediate cyanosis.
Question 5
A 3-year-old child presents for a well-check. The FNP hears a medium-pitched, systolic
crescendo-decrescendo murmur at the pulmonic area and a widely split S2. The child is thin and
has a history of frequent URIs. What is the most likely diagnosis?
A) Ventricular Septal Defect
B) Atrial Septal Defect
C) Tetralogy of Fallot
D) Mitral Valve Prolapse
E) Coarctation of the Aorta
Correct Answer: B) Atrial Septal Defect
Rationale: ASDs are often asymptomatic in early childhood but may present with easy
fatigue and frequent respiratory infections. The hallmark auscultatory finding is a widely
split S2 and a systolic crescendo-decrescendo murmur at the pulmonic area.
Question 6
A 4-week-old infant presents with a very loud, harsh, high-pitched holosystolic murmur at the
left lower sternal border. The infant is growing well and shows no signs of heart failure. This is
most consistent with:
A) A large VSD
B) A small VSD
C) A PDA
D) Pulmonic Stenosis
E) Tetralogy of Fallot
Correct Answer: B) A small VSD
Rationale: In VSDs, the smaller the hole, the greater the pressure gradient and the
louder/harsher the murmur. Small VSDs produce a high-pitched, grade I-IV holosystolic
murmur, whereas large VSDs produce a lower-pitched murmur and signs of CHF.
, 3
Question 7
Which of the following is a symptom of Congestive Heart Failure (CHF) in an infant with a large
Ventricular Septal Defect?
A) Bradycardia
B) Increased appetite
C) Poor feedings and tires easily
D) Hypertension in the legs
E) Hyperactivity
Correct Answer: C) Poor feedings and tires easily
Rationale: Infants with CHF from a large VSD exhibit signs of poor cardiac output and
pulmonary congestion, including tachypnea, tachycardia, diaphoresis during feeds, and
failure to thrive because they lack the energy to complete a feeding.
Question 8
A child with Trisomy 21 is diagnosed with an Atrioventricular Septal Defect (AVSD). What is
the expected management for a complete AVSD?
A) Watchful waiting until age 10
B) Immediate coil insertion in the first week
C) Surgical repair by 6 months of age
D) No treatment, as it usually closes spontaneously
E) Propranolol therapy only
Correct Answer: C) Surgical repair by 6 months of age
Rationale: Complete AVSD is strongly associated with Down Syndrome (Trisomy 21).
Because it involves a large communication between all four chambers, symptoms of CHF
progress rapidly, necessitated surgical correction within the first 6 months of life.
Question 9
What is the characteristic sound of a Patent Ductus Arteriosus (PDA) heard after the first few
weeks of life?
A) A musical, vibratory murmur
B) A harsh, blowing holosystolic murmur
C) A harsh, rumbling, machinery-like murmur
D) A soft, early systolic click
E) A single, loud S2
Correct Answer: C) A harsh, rumbling, machinery-like murmur
Rationale: The PDA murmur is classically described as "machinery-like" because it is a
continuous murmur (heard in both systole and diastole) as blood flows from the high-
pressure aorta to the lower-pressure pulmonary artery throughout the cardiac cycle.
Question 10
A 4-month-old infant experiences a "TET spell" characterized by sudden cyanosis and dyspnea
