ATI Pediatrics | Pediatric Cardiac Conditions (Congenital Heart
Defects) Practice Pack 2026/2027 Questions |Answers |Rationales
1. Which of the following is considered a cyanotic congenital heart defect?
A. Ventricular Septal Defect (VSD)
B. Atrial Septal Defect (ASD)
C. Tetralogy of Fallot (TOF)
D. Patent Ductus Arteriosus (PDA)
Answer: C
Rationale: Tetralogy of Fallot is a cyanotic defect involving right-to-left shunting, whereas
VSD, ASD, and PDA are acyanotic defects involving left-to-right shunting.
2. A nurse is assessing an infant with a suspected Patent Ductus Arteriosus
(PDA). What type of murmur should the nurse expect to hear?
A. Systolic ejection murmur
B. Continuous machinery-like murmur
C. Diastolic murmur
D. Holosystolic murmur at the left lower sternal border
Answer: B
Rationale: A continuous machinery-like murmur is the classic auscultatory finding for a
Patent Ductus Arteriosus (PDA).
,3. An infant with heart failure is receiving Digoxin. For which of the following
signs should the nurse withhold the medication and notify the provider?
A. Heart rate of 110 bpm
B. Apical pulse of 80 bpm
C. Increased urine output
D. Respiratory rate of 40 bpm
Answer: B
Rationale: For an infant, Digoxin is typically held if the apical pulse is less than 90 bpm. 80
bpm is below this threshold.
4. Which medication is commonly administered to keep the ductus arteriosus
open in newborns with certain cyanotic heart defects?
A. Prostaglandin E1
B. Ibuprofen
C. Indomethacin
D. Furosemide
Answer: A
Rationale: Prostaglandin E1 is used to maintain the patency of the ductus arteriosus, while
Indomethacin or Ibuprofen are used to close it.
5. A child is diagnosed with Coarctation of the Aorta. Which assessment finding
is most characteristic of this condition?
A. Cyanosis of the upper extremities
B. Bounding pulses in the lower extremities
C. Clubbing of the fingers and toes
D. Higher blood pressure in the arms than in the legs
Answer: D
, Rationale: Coarctation of the aorta involves narrowing of the aorta, leading to high blood
pressure and bounding pulses in the arms and low blood pressure or weak pulses in the
legs.
6. What are the four components of Tetralogy of Fallot?
A. ASD, VSD, Pulmonary Stenosis, Overriding Aorta
B. VSD, Aortic Stenosis, Overriding Aorta, Right Ventricular Hypertrophy
C. PDA, VSD, Overriding Aorta, Left Ventricular Hypertrophy
D. VSD, Pulmonary Stenosis, Overriding Aorta, Right Ventricular Hypertrophy
Answer: D
Rationale: The four defects in TOF are VSD, Pulmonary Stenosis, Overriding Aorta, and
Right Ventricular Hypertrophy.
7. A toddler with Tetralogy of Fallot becomes acutely cyanotic and hyperpneic.
Which action should the nurse take first?
A. Administer 100% oxygen via mask
B. Place the child in the knee-chest position
C. Prepare for immediate intubation
D. Administer Morphine Sulfate IV
Answer: B
Rationale: The knee-chest position is the first intervention for a ‘Tet spell’ as it increases
systemic vascular resistance and improves oxygenation.
8. A child is in the acute phase of Kawasaki Disease. Which clinical manifestation
should the nurse expect?
A. Peeling of the skin on fingers and toes
B. Joint pain and stiffness
C. High fever unresponsive to antipyretics
D. Gradual resolution of all symptoms
Answer: C
Defects) Practice Pack 2026/2027 Questions |Answers |Rationales
1. Which of the following is considered a cyanotic congenital heart defect?
A. Ventricular Septal Defect (VSD)
B. Atrial Septal Defect (ASD)
C. Tetralogy of Fallot (TOF)
D. Patent Ductus Arteriosus (PDA)
Answer: C
Rationale: Tetralogy of Fallot is a cyanotic defect involving right-to-left shunting, whereas
VSD, ASD, and PDA are acyanotic defects involving left-to-right shunting.
2. A nurse is assessing an infant with a suspected Patent Ductus Arteriosus
(PDA). What type of murmur should the nurse expect to hear?
A. Systolic ejection murmur
B. Continuous machinery-like murmur
C. Diastolic murmur
D. Holosystolic murmur at the left lower sternal border
Answer: B
Rationale: A continuous machinery-like murmur is the classic auscultatory finding for a
Patent Ductus Arteriosus (PDA).
,3. An infant with heart failure is receiving Digoxin. For which of the following
signs should the nurse withhold the medication and notify the provider?
A. Heart rate of 110 bpm
B. Apical pulse of 80 bpm
C. Increased urine output
D. Respiratory rate of 40 bpm
Answer: B
Rationale: For an infant, Digoxin is typically held if the apical pulse is less than 90 bpm. 80
bpm is below this threshold.
4. Which medication is commonly administered to keep the ductus arteriosus
open in newborns with certain cyanotic heart defects?
A. Prostaglandin E1
B. Ibuprofen
C. Indomethacin
D. Furosemide
Answer: A
Rationale: Prostaglandin E1 is used to maintain the patency of the ductus arteriosus, while
Indomethacin or Ibuprofen are used to close it.
5. A child is diagnosed with Coarctation of the Aorta. Which assessment finding
is most characteristic of this condition?
A. Cyanosis of the upper extremities
B. Bounding pulses in the lower extremities
C. Clubbing of the fingers and toes
D. Higher blood pressure in the arms than in the legs
Answer: D
, Rationale: Coarctation of the aorta involves narrowing of the aorta, leading to high blood
pressure and bounding pulses in the arms and low blood pressure or weak pulses in the
legs.
6. What are the four components of Tetralogy of Fallot?
A. ASD, VSD, Pulmonary Stenosis, Overriding Aorta
B. VSD, Aortic Stenosis, Overriding Aorta, Right Ventricular Hypertrophy
C. PDA, VSD, Overriding Aorta, Left Ventricular Hypertrophy
D. VSD, Pulmonary Stenosis, Overriding Aorta, Right Ventricular Hypertrophy
Answer: D
Rationale: The four defects in TOF are VSD, Pulmonary Stenosis, Overriding Aorta, and
Right Ventricular Hypertrophy.
7. A toddler with Tetralogy of Fallot becomes acutely cyanotic and hyperpneic.
Which action should the nurse take first?
A. Administer 100% oxygen via mask
B. Place the child in the knee-chest position
C. Prepare for immediate intubation
D. Administer Morphine Sulfate IV
Answer: B
Rationale: The knee-chest position is the first intervention for a ‘Tet spell’ as it increases
systemic vascular resistance and improves oxygenation.
8. A child is in the acute phase of Kawasaki Disease. Which clinical manifestation
should the nurse expect?
A. Peeling of the skin on fingers and toes
B. Joint pain and stiffness
C. High fever unresponsive to antipyretics
D. Gradual resolution of all symptoms
Answer: C
