NSG 3600 Exam 2 Practice Exam: Pediatric
Cardiac & Respiratory Nursing Exam with
questions and well verified answers actual!!!!!
2026
CARDIAC SECTION (Questions 1-45)
Question 1: A 6-month-old infant with congestive heart failure (CHF) is prescribed digoxin. Which
assessment finding requires the nurse to HOLD the dose and notify the provider?
• A) Apical heart rate of 92 bpm
• B) Respiratory rate of 40 breaths/min
• C) Weight gain of 15 grams since yesterday
• D) Oxygen saturation of 94% on room air
✅ Correct Answer: A
Rationales for ALL options:
• A) CORRECT: Digoxin is contraindicated if infant HR <90-100 bpm due to risk of severe
bradycardia or heart block. This requires holding the dose and notifying the provider.
• B) Incorrect: A respiratory rate of 40/min is within normal limits for a 6-month-old (30-60 bpm).
Tachypnea in CHF would typically be >60/min.
• C) Incorrect: A 15-gram weight gain is minimal and expected with growth. Significant fluid
retention in CHF would show rapid weight gain (e.g., >30g/day).
• D) Incorrect: 94% SpO₂ is acceptable for an infant with CHF; intervention is typically needed if
<90-92% depending on baseline.
Question 2: The nurse is caring for a child post-cardiac catheterization via the femoral artery. Which
intervention is the PRIORITY in the first hour?
• A) Encourage oral fluids to prevent dehydration
, • B) Assess the catheterization site for bleeding or hematoma
• C) Administer prescribed analgesics for groin discomfort
• D) Allow the child to bend the affected leg for comfort
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: While hydration is important, it is not the priority over assessing for life-
threatening complications like hemorrhage.
• B) CORRECT: The femoral access site is at high risk for bleeding, hematoma, or
pseudoaneurysm. Frequent assessment (every 15 min initially) is critical to detect complications
early.
• C) Incorrect: Pain management is important but secondary to ensuring hemodynamic stability
and site integrity.
• D) Incorrect: The affected leg must remain straight for 4-6 hours to prevent disruption of the
arterial puncture site and bleeding.
Question 3: A toddler is diagnosed with Kawasaki disease. Which finding indicates the child is entering
the subacute phase and at highest risk for coronary artery aneurysms?
• A) High fever lasting 5 days
• B) Desquamation of fingers and toes
• C) Bilateral conjunctival injection
• D) Strawberry tongue and cracked lips
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: Prolonged fever (>5 days) is characteristic of the acute phase, not the subacute
phase when aneurysm risk peaks.
• B) CORRECT: Desquamation (peeling) of extremities occurs in the subacute phase (days 14-21),
coinciding with peak risk for coronary artery complications.
• C) Incorrect: Conjunctival injection is an acute phase sign (first 1-2 weeks), not indicative of
subacute progression.
• D) Incorrect: Oral changes like strawberry tongue occur in the acute phase and help diagnose
the disease initially.
,Question 4: Which parental statement indicates understanding of home care for a child with a
ventricular septal defect (VSD)?
• A) "We will limit his fluids to prevent fluid overload."
• B) "We should give extra calories because he tires easily during feeds."
• C) "We need to keep him on strict bed rest to conserve energy."
• D) "We will avoid all immunizations until his heart is repaired."
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: Fluid restriction is not routine for uncomplicated VSD; adequate hydration
supports cardiac output. Restriction is reserved for severe CHF.
• B) CORRECT: Infants with VSD have increased metabolic demands and fatigue easily. High-
calorie formulas or frequent small feeds support growth.
• C) Incorrect: Activity restriction is individualized; most children with small VSDs tolerate normal
activity. Complete bed rest is unnecessary and developmentally harmful.
• D) Incorrect: Immunizations are CRITICAL for children with congenital heart disease to prevent
infections like RSV or influenza that could worsen cardiac status.
Question 5: A child with rheumatic fever is prescribed penicillin. The nurse explains that long-term
antibiotic prophylaxis is primarily to prevent:
• A) Recurrent streptococcal pharyngitis triggering additional cardiac damage
• B) Development of antibiotic resistance in community pathogens
• C) Secondary bacterial endocarditis during dental procedures
• D) Progression of existing valvular damage to heart failure
✅ Correct Answer: A
Rationales for ALL options:
• A) CORRECT: Rheumatic fever is an autoimmune response to Group A Strep. Prophylaxis
prevents recurrent strep infections that could trigger further carditis and valve damage.
• B) Incorrect: While antibiotic stewardship is important, prophylaxis duration (often until age 21
or longer) is based on preventing disease recurrence, not resistance concerns.
• C) Incorrect: Endocarditis prophylaxis is separate and only indicated for specific high-risk cardiac
conditions per AHA guidelines—not all rheumatic heart disease.
, • D) Incorrect: Antibiotics do not reverse existing valvular damage; they prevent new
inflammatory episodes that could worsen damage.
Question 6: When assessing an infant with suspected coarctation of the aorta, which finding is MOST
characteristic?
• A) Cyanosis of the lower extremities
• B) Blood pressure higher in arms than legs
• C) Loud systolic murmur at the left sternal border
• D) Tachypnea and diaphoresis during feeding
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: Cyanosis is not typical in isolated coarctation; it suggests mixing lesions like
tetralogy of Fallot.
• B) CORRECT: Coarctation causes obstruction distal to left subclavian artery, resulting in higher
BP/pulses in upper extremities vs. lower extremities—a hallmark sign.
• C) Incorrect: While murmurs may occur, they are not specific. The BP differential is more
diagnostic.
• D) Incorrect: Feeding difficulties occur in many CHF lesions but are not specific to coarctation.
Question 7: A child with tetralogy of Fallot becomes acutely cyanotic and agitated during crying. The
nurse's FIRST action should be to:
• A) Administer morphine sulfate as prescribed
• B) Place the child in knee-chest position
• C) Apply 100% oxygen via non-rebreather mask
• D) Prepare for emergency intubation
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: Morphine may be used to reduce infundibular spasm but is not the first
intervention; positioning is immediate and non-invasive.
• B) CORRECT: Knee-chest position increases systemic vascular resistance, reducing right-to-left
shunting and improving pulmonary blood flow—first-line for "tet spells."
Cardiac & Respiratory Nursing Exam with
questions and well verified answers actual!!!!!
2026
CARDIAC SECTION (Questions 1-45)
Question 1: A 6-month-old infant with congestive heart failure (CHF) is prescribed digoxin. Which
assessment finding requires the nurse to HOLD the dose and notify the provider?
• A) Apical heart rate of 92 bpm
• B) Respiratory rate of 40 breaths/min
• C) Weight gain of 15 grams since yesterday
• D) Oxygen saturation of 94% on room air
✅ Correct Answer: A
Rationales for ALL options:
• A) CORRECT: Digoxin is contraindicated if infant HR <90-100 bpm due to risk of severe
bradycardia or heart block. This requires holding the dose and notifying the provider.
• B) Incorrect: A respiratory rate of 40/min is within normal limits for a 6-month-old (30-60 bpm).
Tachypnea in CHF would typically be >60/min.
• C) Incorrect: A 15-gram weight gain is minimal and expected with growth. Significant fluid
retention in CHF would show rapid weight gain (e.g., >30g/day).
• D) Incorrect: 94% SpO₂ is acceptable for an infant with CHF; intervention is typically needed if
<90-92% depending on baseline.
Question 2: The nurse is caring for a child post-cardiac catheterization via the femoral artery. Which
intervention is the PRIORITY in the first hour?
• A) Encourage oral fluids to prevent dehydration
, • B) Assess the catheterization site for bleeding or hematoma
• C) Administer prescribed analgesics for groin discomfort
• D) Allow the child to bend the affected leg for comfort
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: While hydration is important, it is not the priority over assessing for life-
threatening complications like hemorrhage.
• B) CORRECT: The femoral access site is at high risk for bleeding, hematoma, or
pseudoaneurysm. Frequent assessment (every 15 min initially) is critical to detect complications
early.
• C) Incorrect: Pain management is important but secondary to ensuring hemodynamic stability
and site integrity.
• D) Incorrect: The affected leg must remain straight for 4-6 hours to prevent disruption of the
arterial puncture site and bleeding.
Question 3: A toddler is diagnosed with Kawasaki disease. Which finding indicates the child is entering
the subacute phase and at highest risk for coronary artery aneurysms?
• A) High fever lasting 5 days
• B) Desquamation of fingers and toes
• C) Bilateral conjunctival injection
• D) Strawberry tongue and cracked lips
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: Prolonged fever (>5 days) is characteristic of the acute phase, not the subacute
phase when aneurysm risk peaks.
• B) CORRECT: Desquamation (peeling) of extremities occurs in the subacute phase (days 14-21),
coinciding with peak risk for coronary artery complications.
• C) Incorrect: Conjunctival injection is an acute phase sign (first 1-2 weeks), not indicative of
subacute progression.
• D) Incorrect: Oral changes like strawberry tongue occur in the acute phase and help diagnose
the disease initially.
,Question 4: Which parental statement indicates understanding of home care for a child with a
ventricular septal defect (VSD)?
• A) "We will limit his fluids to prevent fluid overload."
• B) "We should give extra calories because he tires easily during feeds."
• C) "We need to keep him on strict bed rest to conserve energy."
• D) "We will avoid all immunizations until his heart is repaired."
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: Fluid restriction is not routine for uncomplicated VSD; adequate hydration
supports cardiac output. Restriction is reserved for severe CHF.
• B) CORRECT: Infants with VSD have increased metabolic demands and fatigue easily. High-
calorie formulas or frequent small feeds support growth.
• C) Incorrect: Activity restriction is individualized; most children with small VSDs tolerate normal
activity. Complete bed rest is unnecessary and developmentally harmful.
• D) Incorrect: Immunizations are CRITICAL for children with congenital heart disease to prevent
infections like RSV or influenza that could worsen cardiac status.
Question 5: A child with rheumatic fever is prescribed penicillin. The nurse explains that long-term
antibiotic prophylaxis is primarily to prevent:
• A) Recurrent streptococcal pharyngitis triggering additional cardiac damage
• B) Development of antibiotic resistance in community pathogens
• C) Secondary bacterial endocarditis during dental procedures
• D) Progression of existing valvular damage to heart failure
✅ Correct Answer: A
Rationales for ALL options:
• A) CORRECT: Rheumatic fever is an autoimmune response to Group A Strep. Prophylaxis
prevents recurrent strep infections that could trigger further carditis and valve damage.
• B) Incorrect: While antibiotic stewardship is important, prophylaxis duration (often until age 21
or longer) is based on preventing disease recurrence, not resistance concerns.
• C) Incorrect: Endocarditis prophylaxis is separate and only indicated for specific high-risk cardiac
conditions per AHA guidelines—not all rheumatic heart disease.
, • D) Incorrect: Antibiotics do not reverse existing valvular damage; they prevent new
inflammatory episodes that could worsen damage.
Question 6: When assessing an infant with suspected coarctation of the aorta, which finding is MOST
characteristic?
• A) Cyanosis of the lower extremities
• B) Blood pressure higher in arms than legs
• C) Loud systolic murmur at the left sternal border
• D) Tachypnea and diaphoresis during feeding
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: Cyanosis is not typical in isolated coarctation; it suggests mixing lesions like
tetralogy of Fallot.
• B) CORRECT: Coarctation causes obstruction distal to left subclavian artery, resulting in higher
BP/pulses in upper extremities vs. lower extremities—a hallmark sign.
• C) Incorrect: While murmurs may occur, they are not specific. The BP differential is more
diagnostic.
• D) Incorrect: Feeding difficulties occur in many CHF lesions but are not specific to coarctation.
Question 7: A child with tetralogy of Fallot becomes acutely cyanotic and agitated during crying. The
nurse's FIRST action should be to:
• A) Administer morphine sulfate as prescribed
• B) Place the child in knee-chest position
• C) Apply 100% oxygen via non-rebreather mask
• D) Prepare for emergency intubation
✅ Correct Answer: B
Rationales for ALL options:
• A) Incorrect: Morphine may be used to reduce infundibular spasm but is not the first
intervention; positioning is immediate and non-invasive.
• B) CORRECT: Knee-chest position increases systemic vascular resistance, reducing right-to-left
shunting and improving pulmonary blood flow—first-line for "tet spells."
