NSG 3600 Exam 2 – Pediatric Nursing: Congenital Heart Defects, Respiratory Distress, Infectious
Diseases, Growth Milestones, Medication Safety, Child Abuse, and Prioritized Care – Updated
2026/2027.
Questions 1–150 (Multiple Answers with Rationale)
Congenital Heart Defects – Advanced (1–25)
1. Which congenital heart defects typically present with congestive heart failure in the first few
weeks of life? (Select all that apply)
A) Large ventricular septal defect (VSD)
B) Small atrial septal defect (ASD)
C) Patent ductus arteriosus (PDA) in a premature infant
D) Coarctation of the aorta with severe narrowing
E) Tetralogy of Fallot (mild form)
Answer: A, C, D
Rationale: Large VSD, moderate/large PDA, and severe coarctation cause early CHF. Small ASD is often
asymptomatic. Mild ToF may not cause early failure.
2. A newborn with suspected coarctation of the aorta has which blood pressure findings? (Select all
that apply)
A) Higher systolic BP in right arm than right leg
B) Lower systolic BP in arms than legs
C) Equal BP in all four extremities
D) Upper extremity hypertension
E) Lower extremity hypotension
Answer: A, D, E
Rationale: Coarctation causes upper extremity hypertension and lower extremity hypotension or
diminished pulses, so BP is higher in arms.
3. Which medications are used to manage congestive heart failure in infants with congenital heart
defects? (Select all that apply)
A) Digoxin
B) Furosemide (Lasix)
C) Spironolactone (Aldactone)
D) Captopril (ACE inhibitor)
E) Albuterol
Answer: A, B, C, D
Rationale: Digoxin (inotrope), furosemide (diuretic), spironolactone (potassium-sparing diuretic), and
captopril (afterload reduction) are CHF mainstays. Albuterol is not for CHF.
,4. A child with tetralogy of Fallot is scheduled for surgical repair. Preoperative nursing care
includes? (Select all that apply)
A) Maintaining adequate hydration
B) Placing in knee-to-chest position during hypercyanotic spells
C) Avoiding unnecessary procedures that cause crying
D) Administering prostaglandin E1 continuously
E) Monitoring oxygen saturation continuously
Answer: A, B, C, E
Rationale: PGE1 is for ductal-dependent lesions (e.g., HLHS), not ToF. Hydration, knee-to-chest,
minimizing distress, and monitoring are key.
5. Which assessment findings suggest a child with a VSD is developing Eisenmenger syndrome
(reversal of shunt to right-to-left)? (Select all that apply)
A) Central cyanosis
B) Clubbing of fingers
C) Disappearance of the loud VSD murmur
D) Increased exercise tolerance
E) Polycythemia (elevated hematocrit)
Answer: A, B, C, E
Rationale: Eisenmenger syndrome: pulmonary hypertension causes shunt reversal → cyanosis,
clubbing, murmur may soften, polycythemia. Exercise tolerance decreases.
6. A newborn with hypoplastic left heart syndrome (HLHS) is started on prostaglandin E1. The nurse
should monitor for which adverse effects? (Select all that apply)
A) Apnea
B) Hypotension
C) Fever
D) Bradycardia
E) Seizures
Answer: A, B, C, D
Rationale: PGE1 adverse effects: apnea (most common, may require intubation), hypotension, fever,
bradycardia, flushing.
7. Postoperative nursing care for a child after a Norwood procedure (HLHS) includes? (Select all that
apply)
A) Maintaining strict fluid balance
B) Monitoring for low cardiac output syndrome
C) Keeping oxygen saturation above 95% at all times
D) Administering sedatives to reduce oxygen demand
E) Monitoring for chylothorax (chest tube output)
Answer: A, B, D, E
Rationale: After Norwood, target saturations are typically 75-85% (not high). High oxygen can be
harmful. Fluid balance, low cardiac output, sedation, and chylothorax monitoring are critical.
8. Which congenital heart defects are considered "ductal-dependent" (require PGE1 to keep PDA
open)? (Select all that apply)
A) Hypoplastic left heart syndrome
,B) Coarctation of the aorta with interruption of the aortic arch
C) Transposition of the great arteries with intact septum
D) Small VSD
E) Pulmonary atresia
Answer: A, B, C, E
Rationale: Ductal-dependent lesions include those with inadequate pulmonary or systemic blood flow
(HLHS, pulmonary atresia, severe coarctation, TGA). Small VSD is not ductal-dependent.
9. A child with a right-to-left shunt has which arterial blood gas finding? (Select all that apply)
A) Hypoxemia not improved by 100% oxygen
B) Hyperoxemia
C) PaO2 significantly increases with oxygen
D) Hypercapnia
E) Normal PaO2 on room air
Answer: A, D
Rationale: Right-to-left shunt causes hypoxemia that does NOT correct with 100% oxygen.
Hypercapnia may occur from poor pulmonary blood flow.
10. A 4-month-old with a large VSD has poor weight gain. Which feeding strategies are
appropriate? (Select all that apply)
A) Small, frequent feedings (every 2-3 hours)
B) High-calorie formula (24-30 kcal/oz)
C) Allow unlimited feeding time without breaks
D) Use a soft, preemie nipple to reduce effort
E) Nasogastric tube feedings if fatigue is severe
Answer: A, B, D, E
Rationale: Unlimited feeding without rest increases fatigue and calorie expenditure. Small frequent
feeds, high-calorie formula, low-effort nipples, and NG if needed are correct.
11. Which signs indicate a child with a congenital heart defect is in decompensated heart failure
requiring escalation of care? (Select all that apply)
A) Gallop rhythm (S3)
B) Hepatomegaly
C) Increased urine output
D) Cool extremities with weak pulses
E) Lethargy and poor feeding
Answer: A, B, D, E
Rationale: Decompensated CHF: S3 gallop, hepatomegaly, poor perfusion (cool extremities, weak
pulses), lethargy, oliguria (not increased urine output).
12. A child with a history of Kawasaki disease with coronary aneurysms is on low-dose aspirin. The
parent reports fever and rash. Which additional medications should be avoided? (Select all that
apply)
A) Ibuprofen
B) Acetaminophen
C) Naproxen
D) Other NSAIDs
, E) Antibiotics
Answer: A, C, D
Rationale: Aspirin plus other NSAIDs/ibuprofen/naproxen increases risk of GI bleeding and Reye
syndrome. Acetaminophen is safe. Antibiotics are unrelated.
13. A neonate with transposition of the great arteries (TGA) presents with severe cyanosis. Which
immediate interventions are indicated? (Select all that apply)
A) Prostaglandin E1 infusion
B) Indomethacin
C) Balloon atrial septostomy (Rashkind procedure)
D) 100% oxygen (will not help but given)
E) Immediate discharge to home
Answer: A, C, D
Rationale: TGA is ductal-dependent; PGE1 and balloon atrial septostomy create mixing. Oxygen does
not correct mixing defect. Indomethacin closes PDA and is contraindicated.
14. Total anomalous pulmonary venous return (TAPVR) is classified as which type of shunt? (Select
all that apply)
A) Acyanotic
B) Cyanotic
C) Left-to-right shunt
D) Right-to-left shunt (depending on obstruction)
E) Obstructive defect
Answer: B, D, E
Rationale: TAPVR is cyanotic with right-to-left shunt; if obstructed, it presents as severe cyanosis and
respiratory distress in infancy.
15. A child with truncus arteriosus (single great vessel) has which associated findings? (Select all
that apply)
A) Cyanosis varying with pulmonary blood flow
B) Loud systolic murmur
C) Bounding pulses
D) Congestive heart failure in early infancy
E) Normal oxygen saturation
Answer: A, B, C, D
Rationale: Truncus arteriosus causes mixing of blood with variable cyanosis, CHF from high pulmonary
flow, bounding pulses, and a loud murmur.
16. Which diagnostic tests confirm a diagnosis of coarctation of the aorta? (Select all that apply)
A) Echocardiogram
B) Chest x-ray (rib notching in older children)
C) MRI angiography
D) Cardiac catheterization with pressure gradients
E) Sweat chloride test
Answer: A, B, C, D
Rationale: Echocardiogram is first-line. Rib notching on CXR (collateral vessels). MRI and cath with
gradient confirm. Sweat chloride is for CF.
Diseases, Growth Milestones, Medication Safety, Child Abuse, and Prioritized Care – Updated
2026/2027.
Questions 1–150 (Multiple Answers with Rationale)
Congenital Heart Defects – Advanced (1–25)
1. Which congenital heart defects typically present with congestive heart failure in the first few
weeks of life? (Select all that apply)
A) Large ventricular septal defect (VSD)
B) Small atrial septal defect (ASD)
C) Patent ductus arteriosus (PDA) in a premature infant
D) Coarctation of the aorta with severe narrowing
E) Tetralogy of Fallot (mild form)
Answer: A, C, D
Rationale: Large VSD, moderate/large PDA, and severe coarctation cause early CHF. Small ASD is often
asymptomatic. Mild ToF may not cause early failure.
2. A newborn with suspected coarctation of the aorta has which blood pressure findings? (Select all
that apply)
A) Higher systolic BP in right arm than right leg
B) Lower systolic BP in arms than legs
C) Equal BP in all four extremities
D) Upper extremity hypertension
E) Lower extremity hypotension
Answer: A, D, E
Rationale: Coarctation causes upper extremity hypertension and lower extremity hypotension or
diminished pulses, so BP is higher in arms.
3. Which medications are used to manage congestive heart failure in infants with congenital heart
defects? (Select all that apply)
A) Digoxin
B) Furosemide (Lasix)
C) Spironolactone (Aldactone)
D) Captopril (ACE inhibitor)
E) Albuterol
Answer: A, B, C, D
Rationale: Digoxin (inotrope), furosemide (diuretic), spironolactone (potassium-sparing diuretic), and
captopril (afterload reduction) are CHF mainstays. Albuterol is not for CHF.
,4. A child with tetralogy of Fallot is scheduled for surgical repair. Preoperative nursing care
includes? (Select all that apply)
A) Maintaining adequate hydration
B) Placing in knee-to-chest position during hypercyanotic spells
C) Avoiding unnecessary procedures that cause crying
D) Administering prostaglandin E1 continuously
E) Monitoring oxygen saturation continuously
Answer: A, B, C, E
Rationale: PGE1 is for ductal-dependent lesions (e.g., HLHS), not ToF. Hydration, knee-to-chest,
minimizing distress, and monitoring are key.
5. Which assessment findings suggest a child with a VSD is developing Eisenmenger syndrome
(reversal of shunt to right-to-left)? (Select all that apply)
A) Central cyanosis
B) Clubbing of fingers
C) Disappearance of the loud VSD murmur
D) Increased exercise tolerance
E) Polycythemia (elevated hematocrit)
Answer: A, B, C, E
Rationale: Eisenmenger syndrome: pulmonary hypertension causes shunt reversal → cyanosis,
clubbing, murmur may soften, polycythemia. Exercise tolerance decreases.
6. A newborn with hypoplastic left heart syndrome (HLHS) is started on prostaglandin E1. The nurse
should monitor for which adverse effects? (Select all that apply)
A) Apnea
B) Hypotension
C) Fever
D) Bradycardia
E) Seizures
Answer: A, B, C, D
Rationale: PGE1 adverse effects: apnea (most common, may require intubation), hypotension, fever,
bradycardia, flushing.
7. Postoperative nursing care for a child after a Norwood procedure (HLHS) includes? (Select all that
apply)
A) Maintaining strict fluid balance
B) Monitoring for low cardiac output syndrome
C) Keeping oxygen saturation above 95% at all times
D) Administering sedatives to reduce oxygen demand
E) Monitoring for chylothorax (chest tube output)
Answer: A, B, D, E
Rationale: After Norwood, target saturations are typically 75-85% (not high). High oxygen can be
harmful. Fluid balance, low cardiac output, sedation, and chylothorax monitoring are critical.
8. Which congenital heart defects are considered "ductal-dependent" (require PGE1 to keep PDA
open)? (Select all that apply)
A) Hypoplastic left heart syndrome
,B) Coarctation of the aorta with interruption of the aortic arch
C) Transposition of the great arteries with intact septum
D) Small VSD
E) Pulmonary atresia
Answer: A, B, C, E
Rationale: Ductal-dependent lesions include those with inadequate pulmonary or systemic blood flow
(HLHS, pulmonary atresia, severe coarctation, TGA). Small VSD is not ductal-dependent.
9. A child with a right-to-left shunt has which arterial blood gas finding? (Select all that apply)
A) Hypoxemia not improved by 100% oxygen
B) Hyperoxemia
C) PaO2 significantly increases with oxygen
D) Hypercapnia
E) Normal PaO2 on room air
Answer: A, D
Rationale: Right-to-left shunt causes hypoxemia that does NOT correct with 100% oxygen.
Hypercapnia may occur from poor pulmonary blood flow.
10. A 4-month-old with a large VSD has poor weight gain. Which feeding strategies are
appropriate? (Select all that apply)
A) Small, frequent feedings (every 2-3 hours)
B) High-calorie formula (24-30 kcal/oz)
C) Allow unlimited feeding time without breaks
D) Use a soft, preemie nipple to reduce effort
E) Nasogastric tube feedings if fatigue is severe
Answer: A, B, D, E
Rationale: Unlimited feeding without rest increases fatigue and calorie expenditure. Small frequent
feeds, high-calorie formula, low-effort nipples, and NG if needed are correct.
11. Which signs indicate a child with a congenital heart defect is in decompensated heart failure
requiring escalation of care? (Select all that apply)
A) Gallop rhythm (S3)
B) Hepatomegaly
C) Increased urine output
D) Cool extremities with weak pulses
E) Lethargy and poor feeding
Answer: A, B, D, E
Rationale: Decompensated CHF: S3 gallop, hepatomegaly, poor perfusion (cool extremities, weak
pulses), lethargy, oliguria (not increased urine output).
12. A child with a history of Kawasaki disease with coronary aneurysms is on low-dose aspirin. The
parent reports fever and rash. Which additional medications should be avoided? (Select all that
apply)
A) Ibuprofen
B) Acetaminophen
C) Naproxen
D) Other NSAIDs
, E) Antibiotics
Answer: A, C, D
Rationale: Aspirin plus other NSAIDs/ibuprofen/naproxen increases risk of GI bleeding and Reye
syndrome. Acetaminophen is safe. Antibiotics are unrelated.
13. A neonate with transposition of the great arteries (TGA) presents with severe cyanosis. Which
immediate interventions are indicated? (Select all that apply)
A) Prostaglandin E1 infusion
B) Indomethacin
C) Balloon atrial septostomy (Rashkind procedure)
D) 100% oxygen (will not help but given)
E) Immediate discharge to home
Answer: A, C, D
Rationale: TGA is ductal-dependent; PGE1 and balloon atrial septostomy create mixing. Oxygen does
not correct mixing defect. Indomethacin closes PDA and is contraindicated.
14. Total anomalous pulmonary venous return (TAPVR) is classified as which type of shunt? (Select
all that apply)
A) Acyanotic
B) Cyanotic
C) Left-to-right shunt
D) Right-to-left shunt (depending on obstruction)
E) Obstructive defect
Answer: B, D, E
Rationale: TAPVR is cyanotic with right-to-left shunt; if obstructed, it presents as severe cyanosis and
respiratory distress in infancy.
15. A child with truncus arteriosus (single great vessel) has which associated findings? (Select all
that apply)
A) Cyanosis varying with pulmonary blood flow
B) Loud systolic murmur
C) Bounding pulses
D) Congestive heart failure in early infancy
E) Normal oxygen saturation
Answer: A, B, C, D
Rationale: Truncus arteriosus causes mixing of blood with variable cyanosis, CHF from high pulmonary
flow, bounding pulses, and a loud murmur.
16. Which diagnostic tests confirm a diagnosis of coarctation of the aorta? (Select all that apply)
A) Echocardiogram
B) Chest x-ray (rib notching in older children)
C) MRI angiography
D) Cardiac catheterization with pressure gradients
E) Sweat chloride test
Answer: A, B, C, D
Rationale: Echocardiogram is first-line. Rib notching on CXR (collateral vessels). MRI and cath with
gradient confirm. Sweat chloride is for CF.
