,Galen NSG 3600 Exam 2 – Children's Health
(2026) Actual Q&A PDF
1. The nurse is assessing a newborn and notes a loud, continuous “machinery” murmur at the left
upper sternal border, bounding pulses, and a wide pulse pressure. Which congenital heart defect does
the nurse suspect?
A) Ventricular septal defect
B) Patent ductus arteriosus
C) Coarctation of the aorta
D) Tetralogy of Fallot
Correct Answer: Patent ductus arteriosus
Rationale: PDA presents with a continuous machinery‑like murmur, bounding pulses, and wide pulse
pressure due to continuous runoff from the aorta to the pulmonary artery. VSD produces a
holosystolic murmur; coarctation shows BP discrepancy; TOF is cyanotic with a systolic ejection
murmur.
2. A 36‑hour‑old infant has a blood pressure of 96/25 mm Hg and bounding peripheral pulses. The
nurse recognizes these findings as classic for which defect?
A) Coarctation of the aorta
B) Atrial septal defect
C) Patent ductus arteriosus
D) Pulmonary stenosis
Correct Answer: Patent ductus arteriosus
Rationale: Wide pulse pressure (96/25) and bounding pulses are hallmark signs of PDA caused by
continuous blood flow from the aorta into the pulmonary artery during systole and diastole.
Coarctation causes upper‑extremity hypertension with weak femoral pulses, not bounding pulses.
,3. The nurse is performing a cardiac assessment on a child with suspected coarctation of the aorta.
Which finding supports this diagnosis?
A) Higher blood pressure in the right arm than in the right leg
B) Continuous machinery murmur at the left upper sternal border
C) Central cyanosis that worsens with crying
D) Hypercyanotic spells relieved by knee‑chest position
Correct Answer: Higher blood pressure in the right arm than in the right leg
Rationale: Coarctation of the aorta obstructs blood flow to the lower body, causing higher BP in the
upper extremities compared to the lower extremities. A machinery murmur suggests PDA; cyanosis
and hypercyanotic spells are characteristic of TOF.
4. Which of the following is NOT a component of Tetralogy of Fallot?
A) Pulmonary stenosis
B) Ventricular septal defect
C) Left ventricular hypertrophy
D) Overriding aorta
Correct Answer: Left ventricular hypertrophy
Rationale: Tetralogy of Fallot consists of four defects: pulmonary stenosis, ventricular septal defect,
overriding aorta, and right ventricular hypertrophy. Left ventricular hypertrophy is not a component;
the right ventricle hypertrophies due to increased workload from the obstruction.
5. During a hypercyanotic “Tet spell,” the nurse places the infant in which position to improve
pulmonary blood flow?
A) Supine with legs elevated
B) Knee‑chest position
C) High‑Fowler’s position
D) Left lateral recumbent
, Correct Answer: Knee‑chest position
Rationale: Knee‑chest position increases systemic vascular resistance, which reduces right‑to‑left
shunting and forces more blood into the pulmonary artery, improving oxygenation. Supine and
high‑Fowler’s positions do not provide this hemodynamic benefit.
6. A child with Tetralogy of Fallot develops polycythemia. The nurse understands this is:
A) A side effect of digoxin therapy
B) A compensatory response to chronic hypoxia
C) A sign of worsening heart failure
D) An indication of iron‑deficiency anemia
Correct Answer: A compensatory response to chronic hypoxia
Rationale: Chronic hypoxia in cyanotic heart disease stimulates the bone marrow to produce more red
blood cells, leading to polycythemia. This increases blood viscosity and the risk of thromboembolism.
It is not related to digoxin, heart failure, or iron deficiency.
7. The nurse is preparing to administer digoxin to a 3‑month‑old infant with heart failure. Which
action is required before administration?
A) Check the infant’s temperature
B) Assess the apical pulse for one full minute
C) Obtain a blood pressure
D) Measure oxygen saturation
Correct Answer: Assess the apical pulse for one full minute
Rationale: Digoxin slows conduction through the AV node. The nurse must count the apical pulse for a
full minute before administering; the dose is held if the heart rate is below the prescribed parameter
(e.g., <90‑100 bpm in an infant). Temperature and SpO₂ are not required before digoxin.
(2026) Actual Q&A PDF
1. The nurse is assessing a newborn and notes a loud, continuous “machinery” murmur at the left
upper sternal border, bounding pulses, and a wide pulse pressure. Which congenital heart defect does
the nurse suspect?
A) Ventricular septal defect
B) Patent ductus arteriosus
C) Coarctation of the aorta
D) Tetralogy of Fallot
Correct Answer: Patent ductus arteriosus
Rationale: PDA presents with a continuous machinery‑like murmur, bounding pulses, and wide pulse
pressure due to continuous runoff from the aorta to the pulmonary artery. VSD produces a
holosystolic murmur; coarctation shows BP discrepancy; TOF is cyanotic with a systolic ejection
murmur.
2. A 36‑hour‑old infant has a blood pressure of 96/25 mm Hg and bounding peripheral pulses. The
nurse recognizes these findings as classic for which defect?
A) Coarctation of the aorta
B) Atrial septal defect
C) Patent ductus arteriosus
D) Pulmonary stenosis
Correct Answer: Patent ductus arteriosus
Rationale: Wide pulse pressure (96/25) and bounding pulses are hallmark signs of PDA caused by
continuous blood flow from the aorta into the pulmonary artery during systole and diastole.
Coarctation causes upper‑extremity hypertension with weak femoral pulses, not bounding pulses.
,3. The nurse is performing a cardiac assessment on a child with suspected coarctation of the aorta.
Which finding supports this diagnosis?
A) Higher blood pressure in the right arm than in the right leg
B) Continuous machinery murmur at the left upper sternal border
C) Central cyanosis that worsens with crying
D) Hypercyanotic spells relieved by knee‑chest position
Correct Answer: Higher blood pressure in the right arm than in the right leg
Rationale: Coarctation of the aorta obstructs blood flow to the lower body, causing higher BP in the
upper extremities compared to the lower extremities. A machinery murmur suggests PDA; cyanosis
and hypercyanotic spells are characteristic of TOF.
4. Which of the following is NOT a component of Tetralogy of Fallot?
A) Pulmonary stenosis
B) Ventricular septal defect
C) Left ventricular hypertrophy
D) Overriding aorta
Correct Answer: Left ventricular hypertrophy
Rationale: Tetralogy of Fallot consists of four defects: pulmonary stenosis, ventricular septal defect,
overriding aorta, and right ventricular hypertrophy. Left ventricular hypertrophy is not a component;
the right ventricle hypertrophies due to increased workload from the obstruction.
5. During a hypercyanotic “Tet spell,” the nurse places the infant in which position to improve
pulmonary blood flow?
A) Supine with legs elevated
B) Knee‑chest position
C) High‑Fowler’s position
D) Left lateral recumbent
, Correct Answer: Knee‑chest position
Rationale: Knee‑chest position increases systemic vascular resistance, which reduces right‑to‑left
shunting and forces more blood into the pulmonary artery, improving oxygenation. Supine and
high‑Fowler’s positions do not provide this hemodynamic benefit.
6. A child with Tetralogy of Fallot develops polycythemia. The nurse understands this is:
A) A side effect of digoxin therapy
B) A compensatory response to chronic hypoxia
C) A sign of worsening heart failure
D) An indication of iron‑deficiency anemia
Correct Answer: A compensatory response to chronic hypoxia
Rationale: Chronic hypoxia in cyanotic heart disease stimulates the bone marrow to produce more red
blood cells, leading to polycythemia. This increases blood viscosity and the risk of thromboembolism.
It is not related to digoxin, heart failure, or iron deficiency.
7. The nurse is preparing to administer digoxin to a 3‑month‑old infant with heart failure. Which
action is required before administration?
A) Check the infant’s temperature
B) Assess the apical pulse for one full minute
C) Obtain a blood pressure
D) Measure oxygen saturation
Correct Answer: Assess the apical pulse for one full minute
Rationale: Digoxin slows conduction through the AV node. The nurse must count the apical pulse for a
full minute before administering; the dose is held if the heart rate is below the prescribed parameter
(e.g., <90‑100 bpm in an infant). Temperature and SpO₂ are not required before digoxin.
