HESI RN Case Study: Congenital Heart Disease | Practice
Questions & Verified Answers | High-Scoring Nursing Review
1. A newborn with a significant ventricular septal defect is most likely to develop which finding as
pulmonary blood flow increases?
A. Tachypnea and feeding intolerance
B. Decreased respiratory rate
C. Unilateral absent breath sounds
D. Severe bradycardia
Answer: A. Tachypnea and feeding intolerance
2. Which assessment finding is most concerning for heart failure in an infant with congenital heart
disease?
A. Strong peripheral pulses
B. Warm hands and feet
C. Increased appetite
D. Poor feeding with diaphoresis
Answer: D. Poor feeding with diaphoresis
3. Why can an infant with heart failure become fatigued during feeding?
A. Sucking increases metabolic demand
B. Feeding requires no energy
C. Milk decreases oxygen consumption
D. Infants have larger cardiac reserves
Answer: A. Sucking increases metabolic demand
4. Which nursing assessment best evaluates peripheral perfusion in an infant with congenital heart
disease?
A. Bowel sounds only
B. Capillary refill and peripheral pulses
C. Visual acuity
D. Pupil size
Answer: B. Capillary refill and peripheral pulses
5. An infant with a left-to-right shunt is at greatest risk for which complication if pulmonary blood flow
becomes excessive?
A. Decreased pulmonary circulation
B. Immediate complete heart block
C. Cerebral edema
D. Pulmonary congestion
Answer: D. Pulmonary congestion
6. Which parent statement indicates understanding of energy-conserving feeding for an infant with
heart failure?
A. I will allow frequent rest periods during feeds.
B. I will avoid monitoring breathing.
Page 1
, C. I will force the infant to finish every bottle.
D. I will make every feeding as long as possible.
Answer: A. I will allow frequent rest periods during feeds.
7. Which finding is commonly associated with increased work of breathing in an infant?
A. Nasal flaring
B. Dry sclera
C. Decreased respiratory effort
D. Bradykinesia
Answer: A. Nasal flaring
8. What is the priority nursing action when an infant with congenital heart disease develops acute
respiratory distress?
A. Place the infant flat without assessment
B. Assess airway and breathing and provide prescribed oxygen/support
C. Offer a large feeding
D. Delay assessment until feeding is finished
Answer: B. Assess airway and breathing and provide prescribed oxygen/support
9. Which measurement is particularly useful when evaluating feeding tolerance in an infant with heart
failure?
A. Hair length
B. Oxygen saturation and respiratory response
C. Visual acuity
D. Head circumference after every swallow
Answer: B. Oxygen saturation and respiratory response
10. Which interprofessional team member is especially helpful when feeding problems are related to
breastfeeding technique?
A. Respiratory equipment vendor
B. Pathology assistant
C. Radiology technician
D. Certified lactation consultant
Answer: D. Certified lactation consultant
11. Which finding in an infant with heart failure should the nurse recognize as a possible sign of
decreased cardiac output?
A. Brisk peripheral perfusion
B. Improved feeding endurance
C. Increased urine output
D. Cool extremities and delayed capillary refill
Answer: D. Cool extremities and delayed capillary refill
12. An infant with congenital heart disease has tachypnea during a feeding. What should the nurse do
first?
A. Continue feeding to prevent hunger
B. Place the infant flat and leave the room
C. Offer a larger volume
D. Pause the feeding and assess respiratory status
Answer: D. Pause the feeding and assess respiratory status
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,13. Which position may improve oxygenation in a cyanotic child during an acute hypercyanotic
episode?
A. Prone position with the neck flexed
B. Flat supine position only
C. Trendelenburg position
D. Knee-chest position in an appropriate infant or child
Answer: D. Knee-chest position in an appropriate infant or child
14. Why can the knee-chest position help during a hypercyanotic episode associated with tetralogy of
Fallot?
A. It stops the heart from beating rapidly.
B. It decreases systemic vascular resistance.
C. It eliminates all cardiac shunts.
D. It increases systemic vascular resistance and can improve pulmonary blood flow.
Answer: D. It increases systemic vascular resistance and can improve pulmonary blood flow.
15. Which medication class is commonly used to reduce fluid overload in pediatric heart failure?
A. Diuretics
B. Topical anesthetics
C. Antacids
D. Antihistamines
Answer: A. Diuretics
16. A nurse administers a prescribed digoxin dose to an infant. Which assessment is important before
administration?
A. Hair color
B. Bowel sounds only
C. Apical heart rate and medication-specific parameters
D. Pupil symmetry only
Answer: C. Apical heart rate and medication-specific parameters
17. Which finding may indicate digoxin toxicity in a child?
A. Increased appetite only
B. Improved activity
C. Vomiting with bradycardia or rhythm changes
D. Warm skin only
Answer: C. Vomiting with bradycardia or rhythm changes
18. What is the best reason to monitor daily weight in a child with heart failure?
A. Weight replaces all other assessments.
B. It diagnoses every congenital defect.
C. It measures oxygen saturation.
D. Small weight changes can reflect fluid retention or loss.
Answer: D. Small weight changes can reflect fluid retention or loss.
19. Which laboratory value may need monitoring when a child receives a loop diuretic?
A. Bilirubin only
B. Amylase only
C. Hemoglobin A1c only
D. Potassium
Page 3
, Answer: D. Potassium
20. Which finding after cardiac catheterization requires immediate nursing attention?
A. Bleeding or a diminished distal pulse in the affected extremity
B. A request for a snack
C. Mild boredom
D. Normal capillary refill
Answer: A. Bleeding or a diminished distal pulse in the affected extremity
21. What is the priority assessment after femoral cardiac catheterization?
A. Hearing
B. Visual fields
C. Hair distribution
D. Distal pulses, color, temperature, and capillary refill
Answer: D. Distal pulses, color, temperature, and capillary refill
22. Why may the affected leg be kept relatively straight after femoral catheterization?
A. To improve appetite.
B. To reduce the risk of bleeding from the access site.
C. To increase intracranial pressure.
D. To prevent all arrhythmias.
Answer: B. To reduce the risk of bleeding from the access site.
23. Which parent statement after cardiac catheterization indicates a need for further teaching?
A. I will follow the discharge instructions.
B. I will monitor the site as instructed.
C. I will report persistent bleeding from the site.
D. I can ignore a cold or pale foot.
Answer: D. I can ignore a cold or pale foot.
24. Which assessment is most important when caring for a child with a newly placed central line after
cardiac surgery?
A. Avoid all vital signs.
B. Monitor the site, vital signs, and signs of infection or complications.
C. Check hair growth.
D. Measure visual acuity every hour.
Answer: B. Monitor the site, vital signs, and signs of infection or complications.
25. Which sign can indicate infection after cardiac surgery?
A. Improved appetite
B. Normal temperature
C. Fever with increasing redness or drainage at the incision
D. Clean, dry incision
Answer: C. Fever with increasing redness or drainage at the incision
26. Which intervention reduces energy expenditure in an infant with heart failure?
A. Extend feeding times indefinitely.
B. Perform unnecessary procedures frequently.
C. Cluster care and allow adequate rest periods.
D. Encourage continuous crying.
Answer: C. Cluster care and allow adequate rest periods.
Page 4
Questions & Verified Answers | High-Scoring Nursing Review
1. A newborn with a significant ventricular septal defect is most likely to develop which finding as
pulmonary blood flow increases?
A. Tachypnea and feeding intolerance
B. Decreased respiratory rate
C. Unilateral absent breath sounds
D. Severe bradycardia
Answer: A. Tachypnea and feeding intolerance
2. Which assessment finding is most concerning for heart failure in an infant with congenital heart
disease?
A. Strong peripheral pulses
B. Warm hands and feet
C. Increased appetite
D. Poor feeding with diaphoresis
Answer: D. Poor feeding with diaphoresis
3. Why can an infant with heart failure become fatigued during feeding?
A. Sucking increases metabolic demand
B. Feeding requires no energy
C. Milk decreases oxygen consumption
D. Infants have larger cardiac reserves
Answer: A. Sucking increases metabolic demand
4. Which nursing assessment best evaluates peripheral perfusion in an infant with congenital heart
disease?
A. Bowel sounds only
B. Capillary refill and peripheral pulses
C. Visual acuity
D. Pupil size
Answer: B. Capillary refill and peripheral pulses
5. An infant with a left-to-right shunt is at greatest risk for which complication if pulmonary blood flow
becomes excessive?
A. Decreased pulmonary circulation
B. Immediate complete heart block
C. Cerebral edema
D. Pulmonary congestion
Answer: D. Pulmonary congestion
6. Which parent statement indicates understanding of energy-conserving feeding for an infant with
heart failure?
A. I will allow frequent rest periods during feeds.
B. I will avoid monitoring breathing.
Page 1
, C. I will force the infant to finish every bottle.
D. I will make every feeding as long as possible.
Answer: A. I will allow frequent rest periods during feeds.
7. Which finding is commonly associated with increased work of breathing in an infant?
A. Nasal flaring
B. Dry sclera
C. Decreased respiratory effort
D. Bradykinesia
Answer: A. Nasal flaring
8. What is the priority nursing action when an infant with congenital heart disease develops acute
respiratory distress?
A. Place the infant flat without assessment
B. Assess airway and breathing and provide prescribed oxygen/support
C. Offer a large feeding
D. Delay assessment until feeding is finished
Answer: B. Assess airway and breathing and provide prescribed oxygen/support
9. Which measurement is particularly useful when evaluating feeding tolerance in an infant with heart
failure?
A. Hair length
B. Oxygen saturation and respiratory response
C. Visual acuity
D. Head circumference after every swallow
Answer: B. Oxygen saturation and respiratory response
10. Which interprofessional team member is especially helpful when feeding problems are related to
breastfeeding technique?
A. Respiratory equipment vendor
B. Pathology assistant
C. Radiology technician
D. Certified lactation consultant
Answer: D. Certified lactation consultant
11. Which finding in an infant with heart failure should the nurse recognize as a possible sign of
decreased cardiac output?
A. Brisk peripheral perfusion
B. Improved feeding endurance
C. Increased urine output
D. Cool extremities and delayed capillary refill
Answer: D. Cool extremities and delayed capillary refill
12. An infant with congenital heart disease has tachypnea during a feeding. What should the nurse do
first?
A. Continue feeding to prevent hunger
B. Place the infant flat and leave the room
C. Offer a larger volume
D. Pause the feeding and assess respiratory status
Answer: D. Pause the feeding and assess respiratory status
Page 2
,13. Which position may improve oxygenation in a cyanotic child during an acute hypercyanotic
episode?
A. Prone position with the neck flexed
B. Flat supine position only
C. Trendelenburg position
D. Knee-chest position in an appropriate infant or child
Answer: D. Knee-chest position in an appropriate infant or child
14. Why can the knee-chest position help during a hypercyanotic episode associated with tetralogy of
Fallot?
A. It stops the heart from beating rapidly.
B. It decreases systemic vascular resistance.
C. It eliminates all cardiac shunts.
D. It increases systemic vascular resistance and can improve pulmonary blood flow.
Answer: D. It increases systemic vascular resistance and can improve pulmonary blood flow.
15. Which medication class is commonly used to reduce fluid overload in pediatric heart failure?
A. Diuretics
B. Topical anesthetics
C. Antacids
D. Antihistamines
Answer: A. Diuretics
16. A nurse administers a prescribed digoxin dose to an infant. Which assessment is important before
administration?
A. Hair color
B. Bowel sounds only
C. Apical heart rate and medication-specific parameters
D. Pupil symmetry only
Answer: C. Apical heart rate and medication-specific parameters
17. Which finding may indicate digoxin toxicity in a child?
A. Increased appetite only
B. Improved activity
C. Vomiting with bradycardia or rhythm changes
D. Warm skin only
Answer: C. Vomiting with bradycardia or rhythm changes
18. What is the best reason to monitor daily weight in a child with heart failure?
A. Weight replaces all other assessments.
B. It diagnoses every congenital defect.
C. It measures oxygen saturation.
D. Small weight changes can reflect fluid retention or loss.
Answer: D. Small weight changes can reflect fluid retention or loss.
19. Which laboratory value may need monitoring when a child receives a loop diuretic?
A. Bilirubin only
B. Amylase only
C. Hemoglobin A1c only
D. Potassium
Page 3
, Answer: D. Potassium
20. Which finding after cardiac catheterization requires immediate nursing attention?
A. Bleeding or a diminished distal pulse in the affected extremity
B. A request for a snack
C. Mild boredom
D. Normal capillary refill
Answer: A. Bleeding or a diminished distal pulse in the affected extremity
21. What is the priority assessment after femoral cardiac catheterization?
A. Hearing
B. Visual fields
C. Hair distribution
D. Distal pulses, color, temperature, and capillary refill
Answer: D. Distal pulses, color, temperature, and capillary refill
22. Why may the affected leg be kept relatively straight after femoral catheterization?
A. To improve appetite.
B. To reduce the risk of bleeding from the access site.
C. To increase intracranial pressure.
D. To prevent all arrhythmias.
Answer: B. To reduce the risk of bleeding from the access site.
23. Which parent statement after cardiac catheterization indicates a need for further teaching?
A. I will follow the discharge instructions.
B. I will monitor the site as instructed.
C. I will report persistent bleeding from the site.
D. I can ignore a cold or pale foot.
Answer: D. I can ignore a cold or pale foot.
24. Which assessment is most important when caring for a child with a newly placed central line after
cardiac surgery?
A. Avoid all vital signs.
B. Monitor the site, vital signs, and signs of infection or complications.
C. Check hair growth.
D. Measure visual acuity every hour.
Answer: B. Monitor the site, vital signs, and signs of infection or complications.
25. Which sign can indicate infection after cardiac surgery?
A. Improved appetite
B. Normal temperature
C. Fever with increasing redness or drainage at the incision
D. Clean, dry incision
Answer: C. Fever with increasing redness or drainage at the incision
26. Which intervention reduces energy expenditure in an infant with heart failure?
A. Extend feeding times indefinitely.
B. Perform unnecessary procedures frequently.
C. Cluster care and allow adequate rest periods.
D. Encourage continuous crying.
Answer: C. Cluster care and allow adequate rest periods.
Page 4
