,NSG 3600 Exam 2 | Pediatric Nursing |
Galen College | 26/27|Guaranteed Pass
1. A nurse is assessing an infant with suspected heart failure. Which finding is an early indicator of
fluid overload in this population?
A) Decreased urine output
B) Weight gain
C) Peripheral edema
D) Distended neck veins
Correct Answer: Weight gain
Rationale: In infants, weight gain is the most sensitive and earliest indicator of fluid retention and
worsening heart failure, often occurring before other signs such as peripheral edema or pulmonary
congestion. Decreased urine output, peripheral edema, and distended neck veins are also signs of
fluid overload but are generally later findings in infants.
2. The parent of a child with a congenital heart defect asks the nurse why their child becomes cyanotic
during crying episodes. Which pathophysiologic response provides the best explanation?
A) Increased pulmonary blood flow
B) Decreased systemic vascular resistance
C) Increased right-to-left shunting
D) Decreased pulmonary vascular resistance
Correct Answer: Increased right-to-left shunting
Rationale: During crying, increased intrathoracic pressure can decrease pulmonary blood flow and
increase right-to-left shunting in children with cyanotic defects, leading to transient desaturation and
cyanosis. Systemic vascular resistance typically increases, not decreases, and pulmonary blood flow is
reduced, not increased.
,3. A nurse is assessing a newborn with a suspected congenital heart defect. Which finding is most
suggestive of a cyanotic defect?
A) Bounding peripheral pulses
B) Oxygen saturation of 85% on room air
C) Hepatomegaly
D) Systolic murmur
Correct Answer: Oxygen saturation of 85% on room air
Rationale: Cyanotic defects involve right-to-left shunting, which allows deoxygenated blood to enter
the systemic circulation, resulting in hypoxemia with SpO2 levels typically below 90%. Bounding
pulses are more characteristic of acyanotic defects such as PDA, and hepatomegaly may indicate heart
failure. Murmurs can be present in both types of defects.
4. A nurse is providing discharge teaching to the parent of an infant with a congenital heart defect.
Which parental statement indicates a correct understanding of feeding management?
A) "I will feed my baby when she is calm and not crying."
B) "I will use a soft nipple with a large hole to make feeding easier."
C) "I will stop feeding if my baby becomes fatigued."
D) "I will feed my baby in a semi-upright position."
Correct Answer: "I will use a soft nipple with a large hole to make feeding easier."
Rationale: Infants with congenital heart defects often tire easily during feeding. A soft nipple with a
larger hole reduces the effort required to suck, helping the infant receive adequate nutrition before
fatigue occurs. Feeding when calm, stopping if fatigued, and using a semi-upright position are all
appropriate feeding strategies.
5. A nurse is caring for a child immediately after a cardiac catheterization via the femoral artery.
Which assessment finding requires immediate intervention?
A) The affected leg is warm and pink
B) The pedal pulse on the affected side is weaker than on the unaffected side
, C) The child reports mild discomfort at the insertion site
D) The dressing is dry and intact
Correct Answer: The pedal pulse on the affected side is weaker than on the unaffected side
Rationale: A weaker or absent pedal pulse on the affected side may indicate arterial thrombosis or
occlusion, a serious complication of cardiac catheterization requiring immediate intervention.
Warmth, mild discomfort, and an intact dressing are expected findings.
6. A nurse is assessing a child with tetralogy of Fallot who is squatting. Which physiologic effect of
squatting improves the child's condition?
A) Decreases systemic vascular resistance
B) Increases right-to-left shunting
C) Increases pulmonary blood flow
D) Decreases venous return to the heart
Correct Answer: Increases pulmonary blood flow
Rationale: Squatting increases systemic vascular resistance, which reduces the right-to-left shunt and
forces more blood into the pulmonary circulation, thereby improving oxygenation. Squatting does not
decrease systemic vascular resistance or increase right-to-left shunting.
7. A nurse is caring for an infant diagnosed with patent ductus arteriosus (PDA). The healthcare
provider prescribes indomethacin. What is the therapeutic action of this medication?
A) It increases prostaglandin levels to maintain ductal patency
B) It inhibits prostaglandin synthesis to promote ductal closure
C) It dilates the pulmonary vessels to decrease pressure
D) It increases cardiac contractility to improve perfusion
Correct Answer: It inhibits prostaglandin synthesis to promote ductal closure
Galen College | 26/27|Guaranteed Pass
1. A nurse is assessing an infant with suspected heart failure. Which finding is an early indicator of
fluid overload in this population?
A) Decreased urine output
B) Weight gain
C) Peripheral edema
D) Distended neck veins
Correct Answer: Weight gain
Rationale: In infants, weight gain is the most sensitive and earliest indicator of fluid retention and
worsening heart failure, often occurring before other signs such as peripheral edema or pulmonary
congestion. Decreased urine output, peripheral edema, and distended neck veins are also signs of
fluid overload but are generally later findings in infants.
2. The parent of a child with a congenital heart defect asks the nurse why their child becomes cyanotic
during crying episodes. Which pathophysiologic response provides the best explanation?
A) Increased pulmonary blood flow
B) Decreased systemic vascular resistance
C) Increased right-to-left shunting
D) Decreased pulmonary vascular resistance
Correct Answer: Increased right-to-left shunting
Rationale: During crying, increased intrathoracic pressure can decrease pulmonary blood flow and
increase right-to-left shunting in children with cyanotic defects, leading to transient desaturation and
cyanosis. Systemic vascular resistance typically increases, not decreases, and pulmonary blood flow is
reduced, not increased.
,3. A nurse is assessing a newborn with a suspected congenital heart defect. Which finding is most
suggestive of a cyanotic defect?
A) Bounding peripheral pulses
B) Oxygen saturation of 85% on room air
C) Hepatomegaly
D) Systolic murmur
Correct Answer: Oxygen saturation of 85% on room air
Rationale: Cyanotic defects involve right-to-left shunting, which allows deoxygenated blood to enter
the systemic circulation, resulting in hypoxemia with SpO2 levels typically below 90%. Bounding
pulses are more characteristic of acyanotic defects such as PDA, and hepatomegaly may indicate heart
failure. Murmurs can be present in both types of defects.
4. A nurse is providing discharge teaching to the parent of an infant with a congenital heart defect.
Which parental statement indicates a correct understanding of feeding management?
A) "I will feed my baby when she is calm and not crying."
B) "I will use a soft nipple with a large hole to make feeding easier."
C) "I will stop feeding if my baby becomes fatigued."
D) "I will feed my baby in a semi-upright position."
Correct Answer: "I will use a soft nipple with a large hole to make feeding easier."
Rationale: Infants with congenital heart defects often tire easily during feeding. A soft nipple with a
larger hole reduces the effort required to suck, helping the infant receive adequate nutrition before
fatigue occurs. Feeding when calm, stopping if fatigued, and using a semi-upright position are all
appropriate feeding strategies.
5. A nurse is caring for a child immediately after a cardiac catheterization via the femoral artery.
Which assessment finding requires immediate intervention?
A) The affected leg is warm and pink
B) The pedal pulse on the affected side is weaker than on the unaffected side
, C) The child reports mild discomfort at the insertion site
D) The dressing is dry and intact
Correct Answer: The pedal pulse on the affected side is weaker than on the unaffected side
Rationale: A weaker or absent pedal pulse on the affected side may indicate arterial thrombosis or
occlusion, a serious complication of cardiac catheterization requiring immediate intervention.
Warmth, mild discomfort, and an intact dressing are expected findings.
6. A nurse is assessing a child with tetralogy of Fallot who is squatting. Which physiologic effect of
squatting improves the child's condition?
A) Decreases systemic vascular resistance
B) Increases right-to-left shunting
C) Increases pulmonary blood flow
D) Decreases venous return to the heart
Correct Answer: Increases pulmonary blood flow
Rationale: Squatting increases systemic vascular resistance, which reduces the right-to-left shunt and
forces more blood into the pulmonary circulation, thereby improving oxygenation. Squatting does not
decrease systemic vascular resistance or increase right-to-left shunting.
7. A nurse is caring for an infant diagnosed with patent ductus arteriosus (PDA). The healthcare
provider prescribes indomethacin. What is the therapeutic action of this medication?
A) It increases prostaglandin levels to maintain ductal patency
B) It inhibits prostaglandin synthesis to promote ductal closure
C) It dilates the pulmonary vessels to decrease pressure
D) It increases cardiac contractility to improve perfusion
Correct Answer: It inhibits prostaglandin synthesis to promote ductal closure
