NSG 3600 Exam 2 – Pediatric Nursing: Cardiac Defects, Respiratory Failure, Infectious Disease, Growth
Parameters, Medication Calculations, Child Maltreatment, and Emergency Prioritization – Galen
2026/2027.
Questions 1–150 (Multiple Answers with Rationale)
Congenital Heart Defects – Clinical Scenarios (1–25)
1. A newborn with a prenatal diagnosis of hypoplastic left heart syndrome (HLHS) is born at term.
Which immediate interventions are indicated? (Select all that apply)
A) Prostaglandin E1 infusion initiated immediately
B) Maintain oxygen saturation >95%
C) Avoid hyperoxia (keep saturations 75-85%)
D) Prepare for Norwood procedure within first weeks of life
E) Indomethacin to close PDA
Answer: A, C, D
Rationale: HLHS is ductal-dependent. PGE1 keeps PDA open. Hyperoxia is harmful; target saturations
are lower. Indomethacin would close PDA and be fatal.
2. A 4-month-old with a large VSD presents with poor weight gain, tachypnea, and hepatomegaly.
Which medications are likely to be ordered? (Select all that apply)
A) Digoxin
B) Furosemide
C) Captopril
D) Prostaglandin E1
E) Spironolactone
Answer: A, B, C, E
Rationale: CHF management includes digoxin (inotrope), diuretics (furosemide, spironolactone), and
afterload reduction (ACE inhibitor). PGE1 is for ductal-dependent lesions, not VSD.
3. Which assessment findings differentiate tetralogy of Fallot (ToF) from a large VSD? (Select all that
apply)
A) Cyanosis with crying or feeding
B) Hypercyanotic "Tet" spells relieved by knee-to-chest
C) Systolic ejection murmur at left sternal border
D) Normal oxygen saturation at all times
E) Boot-shaped heart on chest x-ray
Answer: A, B, C, E
Rationale: ToF causes cyanosis and spells; boot-shaped heart. Large VSD is acyanotic initially, with
CHF, not spells.
,4. A 2-day-old infant has femoral pulses that are weak compared to brachial pulses. Blood pressure
is 85/50 in the right arm and 55/30 in the right leg. Which defects are possible? (Select all that
apply)
A) Coarctation of the aorta
B) Interrupted aortic arch
C) Hypoplastic left heart syndrome
D) Small VSD
E) Pulmonary stenosis
Answer: A, B, C
Rationale: Diminished femoral pulses and lower extremity hypotension are classic for coarctation or
interrupted arch. HLHS also presents with poor lower body perfusion.
5. A child with a history of Kawasaki disease and coronary artery aneurysms is now 2 years post-
diagnosis. Which long-term follow-up is indicated? (Select all that apply)
A) Lifelong cardiology follow-up
B) Serial echocardiograms every 1-2 years
C) Aspirin indefinitely if aneurysms persist
D) No further follow-up needed
E) Stress testing before sports participation
Answer: A, B, C, E
Rationale: Coronary aneurysms require lifelong monitoring, antiplatelet therapy, and activity
limitations/sports clearance.
6. A newborn with transposition of the great arteries (TGA) has severe cyanosis. Which interventions
are priority? (Select all that apply)
A) Prostaglandin E1 infusion
B) 100% oxygen via face mask
C) Balloon atrial septostomy (Rashkind procedure)
D) Indomethacin
E) Prepare for arterial switch operation
Answer: A, C, E
Rationale: PGE1 maintains mixing. Balloon atrial septostomy creates an atrial septal defect for mixing.
Surgical arterial switch is definitive. Oxygen does not correct TGA.
7. A 6-month-old with unrepaired tetralogy of Fallot is crying and becomes acutely cyanotic with
hyperpnea. Which immediate nursing actions are appropriate? (Select all that apply)
A) Place the infant in a knee-to-chest position
B) Administer morphine sulfate as ordered
C) Provide 100% oxygen
D) Lay the infant flat supine
E) Prepare for emergency surgical repair
Answer: A, B, C
Rationale: Knee-to-chest increases SVR, reducing right-to-left shunt. Morphine decreases pulmonary
outflow tract spasm. Oxygen treats hypoxia. Supine worsens spell.
8. A child with a Fontan circulation (single ventricle) is admitted with dehydration. Which
complications are the nurse most concerned about? (Select all that apply)
,A) Thromboembolism
B) Decreased cardiac output
C) Pleural effusion
D) Hypertension
E) Polycythemia
Answer: A, B, C
Rationale: Fontan circulation is passive and preload-dependent. Dehydration causes low cardiac
output, increased clotting risk, and effusions. Hypertension is not typical.
9. A premature infant (28 weeks) has a hemodynamically significant PDA. Which treatments are
appropriate? (Select all that apply)
A) Indomethacin IV
B) Fluid restriction
C) Surgical ligation if medical therapy fails
D) Prostaglandin E1
E) High-dose caffeine
Answer: A, B, C
Rationale: Indomethacin or ibuprofen closes PDA. Fluid restriction reduces pulmonary overcirculation.
Surgery for failure. PGE1 keeps PDA open – contraindicated.
10. Which congenital heart defects present with differential cyanosis (lower body cyanosis with pink
upper body)? (Select all that apply)
A) Transposition of the great arteries
B) Coarctation of the aorta with PDA
C) Hypoplastic left heart syndrome
D) Truncus arteriosus
E) Total anomalous pulmonary venous return
Answer: B
Rationale: Differential cyanosis (pink upper, blue lower) occurs when a PDA connects to a coarctation,
allowing oxygenated blood to upper body. Other defects cause generalized cyanosis.
11. A child with a VSD and pulmonary hypertension develops sudden cyanosis and clubbing. The
nurse suspects? (Select all that apply)
A) Eisenmenger syndrome (reversal of shunt)
B) Improvement in the VSD
C) Need for closure of VSD
D) Right-to-left shunting
E) Polycythemia
Answer: A, D, E
Rationale: Eisenmenger syndrome is reversal from left-to-right to right-to-left shunt due to pulmonary
hypertension, causing cyanosis, clubbing, and polycythemia.
12. A 2-week-old with poor feeding, tachypnea, and a gallop rhythm is diagnosed with coarctation
of the aorta. Which additional defects are commonly associated? (Select all that apply)
A) Bicuspid aortic valve
B) VSD
C) Mitral valve abnormalities
, D) Pulmonary stenosis
E) Atrial septal defect
Answer: A, B, C, E
Rationale: Coarctation is associated with bicuspid aortic valve (>50%), VSD, mitral stenosis, and ASD.
Isolated pulmonary stenosis is not typically associated.
13. A child with a history of Kawasaki disease has a normal echocardiogram 6 weeks after diagnosis.
The nurse should advise? (Select all that apply)
A) No further follow-up needed
B) Continue low-dose aspirin for 6-8 weeks
C) Repeat echocardiogram at 6-12 months
D) Avoid live vaccines for 11 months
E) Resume all activities without restriction
Answer: B, C, D
Rationale: Even with normal early echo, follow-up echo at 6-12 months is recommended. Aspirin
continues for 6-8 weeks. Live vaccines delayed 11 months.
14. A newborn with suspected coarctation of the aorta has a preductal and postductal oxygen
saturation difference. What is the expected finding? (Select all that apply)
A) Preductal (right hand) saturation 95%
B) Postductal (foot) saturation 85%
C) Preductal and postductal equal
D) Preductal lower than postductal
E) Postductal higher than preductal
Answer: A, B
Rationale: Preductal (right arm) has higher saturation; postductal (lower body) is lower due to mixing
from PDA with deoxygenated blood.
15. A 4-year-old with tetralogy of Fallot is scheduled for elective repair. Preoperative teaching for
the child should include? (Select all that apply)
A) Use a doll to demonstrate procedures
B) Explain using simple terms ("fix the hole in your heart")
C) Assure the child that nothing will hurt
D) Allow the child to handle a mask and stethoscope
E) Avoid discussing the hospital until the day of surgery
Answer: A, B, D
Rationale: Age-appropriate preparation: play therapy, simple terms, and handling equipment. Do not
promise no pain; prepare in advance.
16. A child with a bidirectional Glenn shunt (stage 2 palliation for single ventricle) has a sudden
increase in cyanosis. Which actions should the nurse take? (Select all that apply)
A) Assess for signs of superior vena cava (SVC) obstruction
B) Check for dehydration
C) Place in supine position
D) Administer fluids as ordered
E) Prepare for echocardiogram
Answer: A, B, D, E
Parameters, Medication Calculations, Child Maltreatment, and Emergency Prioritization – Galen
2026/2027.
Questions 1–150 (Multiple Answers with Rationale)
Congenital Heart Defects – Clinical Scenarios (1–25)
1. A newborn with a prenatal diagnosis of hypoplastic left heart syndrome (HLHS) is born at term.
Which immediate interventions are indicated? (Select all that apply)
A) Prostaglandin E1 infusion initiated immediately
B) Maintain oxygen saturation >95%
C) Avoid hyperoxia (keep saturations 75-85%)
D) Prepare for Norwood procedure within first weeks of life
E) Indomethacin to close PDA
Answer: A, C, D
Rationale: HLHS is ductal-dependent. PGE1 keeps PDA open. Hyperoxia is harmful; target saturations
are lower. Indomethacin would close PDA and be fatal.
2. A 4-month-old with a large VSD presents with poor weight gain, tachypnea, and hepatomegaly.
Which medications are likely to be ordered? (Select all that apply)
A) Digoxin
B) Furosemide
C) Captopril
D) Prostaglandin E1
E) Spironolactone
Answer: A, B, C, E
Rationale: CHF management includes digoxin (inotrope), diuretics (furosemide, spironolactone), and
afterload reduction (ACE inhibitor). PGE1 is for ductal-dependent lesions, not VSD.
3. Which assessment findings differentiate tetralogy of Fallot (ToF) from a large VSD? (Select all that
apply)
A) Cyanosis with crying or feeding
B) Hypercyanotic "Tet" spells relieved by knee-to-chest
C) Systolic ejection murmur at left sternal border
D) Normal oxygen saturation at all times
E) Boot-shaped heart on chest x-ray
Answer: A, B, C, E
Rationale: ToF causes cyanosis and spells; boot-shaped heart. Large VSD is acyanotic initially, with
CHF, not spells.
,4. A 2-day-old infant has femoral pulses that are weak compared to brachial pulses. Blood pressure
is 85/50 in the right arm and 55/30 in the right leg. Which defects are possible? (Select all that
apply)
A) Coarctation of the aorta
B) Interrupted aortic arch
C) Hypoplastic left heart syndrome
D) Small VSD
E) Pulmonary stenosis
Answer: A, B, C
Rationale: Diminished femoral pulses and lower extremity hypotension are classic for coarctation or
interrupted arch. HLHS also presents with poor lower body perfusion.
5. A child with a history of Kawasaki disease and coronary artery aneurysms is now 2 years post-
diagnosis. Which long-term follow-up is indicated? (Select all that apply)
A) Lifelong cardiology follow-up
B) Serial echocardiograms every 1-2 years
C) Aspirin indefinitely if aneurysms persist
D) No further follow-up needed
E) Stress testing before sports participation
Answer: A, B, C, E
Rationale: Coronary aneurysms require lifelong monitoring, antiplatelet therapy, and activity
limitations/sports clearance.
6. A newborn with transposition of the great arteries (TGA) has severe cyanosis. Which interventions
are priority? (Select all that apply)
A) Prostaglandin E1 infusion
B) 100% oxygen via face mask
C) Balloon atrial septostomy (Rashkind procedure)
D) Indomethacin
E) Prepare for arterial switch operation
Answer: A, C, E
Rationale: PGE1 maintains mixing. Balloon atrial septostomy creates an atrial septal defect for mixing.
Surgical arterial switch is definitive. Oxygen does not correct TGA.
7. A 6-month-old with unrepaired tetralogy of Fallot is crying and becomes acutely cyanotic with
hyperpnea. Which immediate nursing actions are appropriate? (Select all that apply)
A) Place the infant in a knee-to-chest position
B) Administer morphine sulfate as ordered
C) Provide 100% oxygen
D) Lay the infant flat supine
E) Prepare for emergency surgical repair
Answer: A, B, C
Rationale: Knee-to-chest increases SVR, reducing right-to-left shunt. Morphine decreases pulmonary
outflow tract spasm. Oxygen treats hypoxia. Supine worsens spell.
8. A child with a Fontan circulation (single ventricle) is admitted with dehydration. Which
complications are the nurse most concerned about? (Select all that apply)
,A) Thromboembolism
B) Decreased cardiac output
C) Pleural effusion
D) Hypertension
E) Polycythemia
Answer: A, B, C
Rationale: Fontan circulation is passive and preload-dependent. Dehydration causes low cardiac
output, increased clotting risk, and effusions. Hypertension is not typical.
9. A premature infant (28 weeks) has a hemodynamically significant PDA. Which treatments are
appropriate? (Select all that apply)
A) Indomethacin IV
B) Fluid restriction
C) Surgical ligation if medical therapy fails
D) Prostaglandin E1
E) High-dose caffeine
Answer: A, B, C
Rationale: Indomethacin or ibuprofen closes PDA. Fluid restriction reduces pulmonary overcirculation.
Surgery for failure. PGE1 keeps PDA open – contraindicated.
10. Which congenital heart defects present with differential cyanosis (lower body cyanosis with pink
upper body)? (Select all that apply)
A) Transposition of the great arteries
B) Coarctation of the aorta with PDA
C) Hypoplastic left heart syndrome
D) Truncus arteriosus
E) Total anomalous pulmonary venous return
Answer: B
Rationale: Differential cyanosis (pink upper, blue lower) occurs when a PDA connects to a coarctation,
allowing oxygenated blood to upper body. Other defects cause generalized cyanosis.
11. A child with a VSD and pulmonary hypertension develops sudden cyanosis and clubbing. The
nurse suspects? (Select all that apply)
A) Eisenmenger syndrome (reversal of shunt)
B) Improvement in the VSD
C) Need for closure of VSD
D) Right-to-left shunting
E) Polycythemia
Answer: A, D, E
Rationale: Eisenmenger syndrome is reversal from left-to-right to right-to-left shunt due to pulmonary
hypertension, causing cyanosis, clubbing, and polycythemia.
12. A 2-week-old with poor feeding, tachypnea, and a gallop rhythm is diagnosed with coarctation
of the aorta. Which additional defects are commonly associated? (Select all that apply)
A) Bicuspid aortic valve
B) VSD
C) Mitral valve abnormalities
, D) Pulmonary stenosis
E) Atrial septal defect
Answer: A, B, C, E
Rationale: Coarctation is associated with bicuspid aortic valve (>50%), VSD, mitral stenosis, and ASD.
Isolated pulmonary stenosis is not typically associated.
13. A child with a history of Kawasaki disease has a normal echocardiogram 6 weeks after diagnosis.
The nurse should advise? (Select all that apply)
A) No further follow-up needed
B) Continue low-dose aspirin for 6-8 weeks
C) Repeat echocardiogram at 6-12 months
D) Avoid live vaccines for 11 months
E) Resume all activities without restriction
Answer: B, C, D
Rationale: Even with normal early echo, follow-up echo at 6-12 months is recommended. Aspirin
continues for 6-8 weeks. Live vaccines delayed 11 months.
14. A newborn with suspected coarctation of the aorta has a preductal and postductal oxygen
saturation difference. What is the expected finding? (Select all that apply)
A) Preductal (right hand) saturation 95%
B) Postductal (foot) saturation 85%
C) Preductal and postductal equal
D) Preductal lower than postductal
E) Postductal higher than preductal
Answer: A, B
Rationale: Preductal (right arm) has higher saturation; postductal (lower body) is lower due to mixing
from PDA with deoxygenated blood.
15. A 4-year-old with tetralogy of Fallot is scheduled for elective repair. Preoperative teaching for
the child should include? (Select all that apply)
A) Use a doll to demonstrate procedures
B) Explain using simple terms ("fix the hole in your heart")
C) Assure the child that nothing will hurt
D) Allow the child to handle a mask and stethoscope
E) Avoid discussing the hospital until the day of surgery
Answer: A, B, D
Rationale: Age-appropriate preparation: play therapy, simple terms, and handling equipment. Do not
promise no pain; prepare in advance.
16. A child with a bidirectional Glenn shunt (stage 2 palliation for single ventricle) has a sudden
increase in cyanosis. Which actions should the nurse take? (Select all that apply)
A) Assess for signs of superior vena cava (SVC) obstruction
B) Check for dehydration
C) Place in supine position
D) Administer fluids as ordered
E) Prepare for echocardiogram
Answer: A, B, D, E
