NSG 3600 Exam 2 – Children’s Health: Congenital Heart Defects, Respiratory Emergencies, Kawasaki
Disease, Cystic Fibrosis, Asthma, CHF Management, Medications, and Nursing Prioritization – Latest
2026/2027 Update.
Questions 1–150 (Multiple Answers with Rationale)
Congenital Heart Defects (Acyanotic & Cyanotic)
1. Which of the following are acyanotic congenital heart defects? (Select all that apply)
A) Tetralogy of Fallot
B) Atrial septal defect (ASD)
C) Ventricular septal defect (VSD)
D) Hypoplastic left heart syndrome
E) Patent ductus arteriosus (PDA)
Answer: B, C, E
Rationale: ASD, VSD, and PDA are acyanotic (left-to-right shunts). ToF and HLHS are cyanotic (right-to-
left shunts).
2. A newborn has a loud, harsh holosystolic murmur at the left sternal border with a palpable thrill.
Which defects are possible? (Select all that apply)
A) Small ASD
B) Large VSD
C) Mild pulmonary stenosis
D) Tetralogy of Fallot
E) Coarctation of the aorta
Answer: B, D
Rationale: Large VSD and ToF produce a harsh murmur with thrill. Small ASD is often silent or has soft
murmur. Coarctation may have murmur but not typically harsh with thrill.
3. Which medications are used to close a patent ductus arteriosus (PDA) pharmacologically? (Select
all that apply)
A) Prostaglandin E1 (PGE1)
B) Indomethacin
C) Ibuprofen
D) Digoxin
E) Furosemide
Answer: B, C
Rationale: Indomethacin and ibuprofen are prostaglandin inhibitors that close a PDA. PGE1 keeps the
PDA open; digoxin and furosemide treat CHF but do not close the PDA.
,4. A child with coarctation of the aorta is likely to have which assessment findings? (Select all that
apply)
A) Bounding femoral pulses
B) Decreased or absent femoral pulses
C) Higher blood pressure in arms than legs
D) Higher blood pressure in legs than arms
E) Headaches in older children
Answer: B, C, E
Rationale: Coarctation causes diminished/absent femoral pulses, upper extremity hypertension (higher
BP in arms), and headaches from increased cerebral perfusion pressure.
5. Tetralogy of Fallot (ToF) includes which four anatomical defects? (Select all that apply)
A) Pulmonary stenosis
B) Ventricular septal defect (VSD)
C) Overriding aorta
D) Left ventricular hypertrophy
E) Right ventricular hypertrophy
Answer: A, B, C, E
Rationale: ToF consists of pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy
(not left).
6. During a hypercyanotic "Tet spell," which nursing actions are appropriate? (Select all that apply)
A) Place the child in a knee-to-chest position
B) Administer 100% oxygen
C) Give morphine as ordered
D) Lay the child flat supine
E) Prepare for immediate surgical repair
Answer: A, B, C
Rationale: Knee-to-chest position increases systemic vascular resistance, reducing right-to-left
shunting. Oxygen and morphine decrease hypoxia and anxiety. Supine position worsens the spell.
7. Hypoplastic left heart syndrome (HLHS) in a newborn requires which immediate interventions?
(Select all that apply)
A) Prostaglandin E1 (PGE1) infusion
B) Indomethacin administration
C) Surgical palliation (Norwood procedure)
D) Strict fluid restriction
E) Digoxin as first-line therapy
Answer: A, C
Rationale: PGE1 keeps the ductus arteriosus open to maintain systemic blood flow. Surgical palliation
(Norwood) is definitive. Indomethacin would close the PDA and be fatal.
8. Signs of congestive heart failure (CHF) in an infant include which of the following? (Select all that
apply)
A) Improved feeding and weight gain
B) Tachypnea and retractions
C) Diaphoresis during feeding
,D) Hepatomegaly
E) Peripheral edema
Answer: B, C, D, E
Rationale: CHF causes poor feeding (not improved), tachypnea, sweating, hepatomegaly, and edema
due to fluid overload and decreased cardiac output.
9. Digoxin toxicity in a child presents with which clinical manifestations? (Select all that apply)
A) Bradycardia
B) Tachycardia
C) Nausea and vomiting
D) Hyperkalemia
E) Visual changes (in older children)
Answer: A, C, E
Rationale: Toxicity causes bradycardia, GI symptoms (nausea/vomiting), and visual disturbances
(yellow/green halos). Hypokalemia, not hyperkalemia, increases toxicity risk.
10. Before administering digoxin to an infant, the nurse must check which parameters? (Select all
that apply)
A) Apical pulse for 1 full minute
B) Respiratory rate
C) Blood pressure
D) Serum potassium level (if available)
E) Recent weight
Answer: A, D
Rationale: Hold digoxin if HR <90-100 bpm in infants; hypokalemia increases toxicity risk. Weight
helps calculate dose but is not a pre-administration safety check.
11. Which congenital heart defects typically present with cyanosis in the first few days of life? (Select
all that apply)
A) Small VSD
B) Tetralogy of Fallot (severe form)
C) Hypoplastic left heart syndrome
D) Atrial septal defect
E) Transposition of the great arteries
Answer: B, C, E
Rationale: Severe ToF, HLHS, and transposition of the great arteries cause early cyanosis. Small VSD
and ASD are acyanotic.
12. Which findings suggest a child with a congenital heart defect is developing heart failure? (Select
all that apply)
A) Increased appetite
B) Tachypnea at rest
C) Crackles on lung auscultation
D) Gallop rhythm (S3)
E) Weight loss
Answer: B, C, D, E
, Rationale: Heart failure causes tachypnea, crackles (pulmonary edema), S3 gallop, and poor weight
gain or weight loss, not increased appetite.
13. Postoperative care for a child after cardiac catheterization includes? (Select all that apply)
A) Keep the affected leg straight
B) Apply pressure to the insertion site if bleeding
C) Encourage ambulation immediately
D) Monitor distal pulses and temperature
E) Sandbag over the site as ordered
Answer: A, B, D, E
Rationale: Keep leg straight, monitor distal pulses, apply pressure/sandbag. Ambulation is delayed for
4-6 hours.
14. Which dietary modifications are appropriate for an infant with CHF? (Select all that apply)
A) Small, frequent feedings
B) High-calorie formula
C) Fluid restriction as ordered
D) Low-sodium formula
E) Feeding via nasogastric tube if fatigue is severe
Answer: A, B, C, D, E
Rationale: All help reduce cardiac workload, prevent fluid overload, and ensure adequate nutrition
despite fatigue.
15. Which murmurs are characteristic of specific congenital heart defects? (Select all that apply)
A) Continuous "machinery" murmur – PDA
B) Harsh holosystolic murmur – VSD
C) Soft, blowing systolic murmur – Small ASD
D) Late systolic murmur – Coarctation
E) Systolic ejection murmur – Pulmonary stenosis
Answer: A, B, C, E
Rationale: PDA: continuous; VSD: harsh holosystolic; small ASD: soft systolic; pulmonary stenosis:
systolic ejection. Coarctation does not have a classic late systolic murmur.
Kawasaki Disease (16–25)
16. Kawasaki disease diagnostic criteria require fever for at least 5 days plus how many of the
following five clinical signs?
A) 2 of 5
B) 3 of 5
C) 4 of 5
D) 5 of 5
E) 1 of 5
Answer: C – 4 of 5
Rationale: Classic criteria: fever ≥5 days + 4 of 5 principal clinical features.
Disease, Cystic Fibrosis, Asthma, CHF Management, Medications, and Nursing Prioritization – Latest
2026/2027 Update.
Questions 1–150 (Multiple Answers with Rationale)
Congenital Heart Defects (Acyanotic & Cyanotic)
1. Which of the following are acyanotic congenital heart defects? (Select all that apply)
A) Tetralogy of Fallot
B) Atrial septal defect (ASD)
C) Ventricular septal defect (VSD)
D) Hypoplastic left heart syndrome
E) Patent ductus arteriosus (PDA)
Answer: B, C, E
Rationale: ASD, VSD, and PDA are acyanotic (left-to-right shunts). ToF and HLHS are cyanotic (right-to-
left shunts).
2. A newborn has a loud, harsh holosystolic murmur at the left sternal border with a palpable thrill.
Which defects are possible? (Select all that apply)
A) Small ASD
B) Large VSD
C) Mild pulmonary stenosis
D) Tetralogy of Fallot
E) Coarctation of the aorta
Answer: B, D
Rationale: Large VSD and ToF produce a harsh murmur with thrill. Small ASD is often silent or has soft
murmur. Coarctation may have murmur but not typically harsh with thrill.
3. Which medications are used to close a patent ductus arteriosus (PDA) pharmacologically? (Select
all that apply)
A) Prostaglandin E1 (PGE1)
B) Indomethacin
C) Ibuprofen
D) Digoxin
E) Furosemide
Answer: B, C
Rationale: Indomethacin and ibuprofen are prostaglandin inhibitors that close a PDA. PGE1 keeps the
PDA open; digoxin and furosemide treat CHF but do not close the PDA.
,4. A child with coarctation of the aorta is likely to have which assessment findings? (Select all that
apply)
A) Bounding femoral pulses
B) Decreased or absent femoral pulses
C) Higher blood pressure in arms than legs
D) Higher blood pressure in legs than arms
E) Headaches in older children
Answer: B, C, E
Rationale: Coarctation causes diminished/absent femoral pulses, upper extremity hypertension (higher
BP in arms), and headaches from increased cerebral perfusion pressure.
5. Tetralogy of Fallot (ToF) includes which four anatomical defects? (Select all that apply)
A) Pulmonary stenosis
B) Ventricular septal defect (VSD)
C) Overriding aorta
D) Left ventricular hypertrophy
E) Right ventricular hypertrophy
Answer: A, B, C, E
Rationale: ToF consists of pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy
(not left).
6. During a hypercyanotic "Tet spell," which nursing actions are appropriate? (Select all that apply)
A) Place the child in a knee-to-chest position
B) Administer 100% oxygen
C) Give morphine as ordered
D) Lay the child flat supine
E) Prepare for immediate surgical repair
Answer: A, B, C
Rationale: Knee-to-chest position increases systemic vascular resistance, reducing right-to-left
shunting. Oxygen and morphine decrease hypoxia and anxiety. Supine position worsens the spell.
7. Hypoplastic left heart syndrome (HLHS) in a newborn requires which immediate interventions?
(Select all that apply)
A) Prostaglandin E1 (PGE1) infusion
B) Indomethacin administration
C) Surgical palliation (Norwood procedure)
D) Strict fluid restriction
E) Digoxin as first-line therapy
Answer: A, C
Rationale: PGE1 keeps the ductus arteriosus open to maintain systemic blood flow. Surgical palliation
(Norwood) is definitive. Indomethacin would close the PDA and be fatal.
8. Signs of congestive heart failure (CHF) in an infant include which of the following? (Select all that
apply)
A) Improved feeding and weight gain
B) Tachypnea and retractions
C) Diaphoresis during feeding
,D) Hepatomegaly
E) Peripheral edema
Answer: B, C, D, E
Rationale: CHF causes poor feeding (not improved), tachypnea, sweating, hepatomegaly, and edema
due to fluid overload and decreased cardiac output.
9. Digoxin toxicity in a child presents with which clinical manifestations? (Select all that apply)
A) Bradycardia
B) Tachycardia
C) Nausea and vomiting
D) Hyperkalemia
E) Visual changes (in older children)
Answer: A, C, E
Rationale: Toxicity causes bradycardia, GI symptoms (nausea/vomiting), and visual disturbances
(yellow/green halos). Hypokalemia, not hyperkalemia, increases toxicity risk.
10. Before administering digoxin to an infant, the nurse must check which parameters? (Select all
that apply)
A) Apical pulse for 1 full minute
B) Respiratory rate
C) Blood pressure
D) Serum potassium level (if available)
E) Recent weight
Answer: A, D
Rationale: Hold digoxin if HR <90-100 bpm in infants; hypokalemia increases toxicity risk. Weight
helps calculate dose but is not a pre-administration safety check.
11. Which congenital heart defects typically present with cyanosis in the first few days of life? (Select
all that apply)
A) Small VSD
B) Tetralogy of Fallot (severe form)
C) Hypoplastic left heart syndrome
D) Atrial septal defect
E) Transposition of the great arteries
Answer: B, C, E
Rationale: Severe ToF, HLHS, and transposition of the great arteries cause early cyanosis. Small VSD
and ASD are acyanotic.
12. Which findings suggest a child with a congenital heart defect is developing heart failure? (Select
all that apply)
A) Increased appetite
B) Tachypnea at rest
C) Crackles on lung auscultation
D) Gallop rhythm (S3)
E) Weight loss
Answer: B, C, D, E
, Rationale: Heart failure causes tachypnea, crackles (pulmonary edema), S3 gallop, and poor weight
gain or weight loss, not increased appetite.
13. Postoperative care for a child after cardiac catheterization includes? (Select all that apply)
A) Keep the affected leg straight
B) Apply pressure to the insertion site if bleeding
C) Encourage ambulation immediately
D) Monitor distal pulses and temperature
E) Sandbag over the site as ordered
Answer: A, B, D, E
Rationale: Keep leg straight, monitor distal pulses, apply pressure/sandbag. Ambulation is delayed for
4-6 hours.
14. Which dietary modifications are appropriate for an infant with CHF? (Select all that apply)
A) Small, frequent feedings
B) High-calorie formula
C) Fluid restriction as ordered
D) Low-sodium formula
E) Feeding via nasogastric tube if fatigue is severe
Answer: A, B, C, D, E
Rationale: All help reduce cardiac workload, prevent fluid overload, and ensure adequate nutrition
despite fatigue.
15. Which murmurs are characteristic of specific congenital heart defects? (Select all that apply)
A) Continuous "machinery" murmur – PDA
B) Harsh holosystolic murmur – VSD
C) Soft, blowing systolic murmur – Small ASD
D) Late systolic murmur – Coarctation
E) Systolic ejection murmur – Pulmonary stenosis
Answer: A, B, C, E
Rationale: PDA: continuous; VSD: harsh holosystolic; small ASD: soft systolic; pulmonary stenosis:
systolic ejection. Coarctation does not have a classic late systolic murmur.
Kawasaki Disease (16–25)
16. Kawasaki disease diagnostic criteria require fever for at least 5 days plus how many of the
following five clinical signs?
A) 2 of 5
B) 3 of 5
C) 4 of 5
D) 5 of 5
E) 1 of 5
Answer: C – 4 of 5
Rationale: Classic criteria: fever ≥5 days + 4 of 5 principal clinical features.
