Shadow Health Pediatrics - Isabella Burgel |
Continuum of Care: Congestive Heart
Failure | Complete Assessment, Subjective
& Objective Data, SBAR, Care Plan & Clinical
Reasoning | 2026/2027 Updated
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam evaluates nursing students on the comprehensive assessment, subjective and objective data
collection, SBAR communication, care planning, and clinical reasoning for pediatric patients with congestive
heart failure, using the Shadow Health virtual patient Isabella Burgel as the exemplar. It covers
pathophysiology, pharmacologic and non-pharmacologic management, family-centered care, and
interprofessional collaboration.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 80% (40/50 correct).
HIGHP - Page 1 of 48
,1. Which congenital heart defect most commonly presents with congestive heart failure in
the first weeks of life due to a large left-to-right shunt?
[ ] A. Tetralogy of Fallot
[ ] B. Ventricular septal defect (VSD)
[ ] C. Transposition of the great arteries
[ ] D. Tricuspid atresia
CORRECT: B. Ventricular septal defect (VSD)
A large VSD causes significant left-to-right shunting, leading to pulmonary overcirculation and heart failure.
Tetralogy of Fallot and tricuspid atresia are cyanotic defects with right-to-left shunting, and transposition of
the great arteries presents with cyanosis, not heart failure from a left-to-right shunt.
2. A mother reports that her infant with heart failure tires easily during feedings and takes
only 1-2 ounces before falling asleep. Which nursing action is most appropriate to
promote adequate nutrition?
[ ] A. Increase the feeding volume by adding cereal to the formula.
[ ] B. Offer continuous nasogastric feedings throughout the day.
[ ] C. Provide smaller, more frequent feedings and use a soft, high-flow nipple.
[ ] D. Withhold feedings until the infant's respiratory rate decreases below 40 breaths/min.
CORRECT: C. Provide smaller, more frequent feedings and use a soft, high-flow nipple.
Smaller, frequent feedings with a soft, high-flow nipple reduce energy expenditure and fatigue during feeding.
Adding cereal may increase caloric density but does not address fatigue; continuous NG feedings are
invasive and not first-line; withholding feedings based on respiratory rate alone is not standard and may
compromise nutrition.
3. When assessing a pediatric patient with heart failure, which set of objective findings is
most consistent with fluid overload?
[ ] A. Weight loss, dry mucous membranes, and sunken fontanelle
[ ] B. Tachycardia, hepatomegaly, and crackles in the lung bases
[ ] C. Bradycardia, hypertension, and peripheral edema
[ ] D. Hypotension, decreased urine output, and poor skin turgor
CORRECT: B. Tachycardia, hepatomegaly, and crackles in the lung bases
Fluid overload in heart failure leads to tachycardia, hepatomegaly (due to venous congestion), and pulmonary
crackles from fluid accumulation. Weight loss and dehydration signs indicate fluid deficit, not overload;
bradycardia and hypertension are not typical; hypotension and poor skin turgor suggest dehydration or shock.
HIGHP - Page 2 of 48
,4. The nurse is preparing to administer digoxin to a pediatric patient with heart failure.
Which assessment finding should prompt the nurse to withhold the dose and notify the
provider?
[ ] A. Heart rate of 110 beats/min in an infant
[ ] B. Serum potassium level of 4.0 mEq/L
[ ] C. Heart rate of 80 beats/min in an infant
[ ] D. Serum digoxin level of 1.0 ng/mL
CORRECT: C. Heart rate of 80 beats/min in an infant
In infants, a heart rate below 90-100 beats/min may indicate digoxin toxicity, and the dose should be withheld.
A heart rate of 110 is within normal limits, potassium of 4.0 is normal, and a digoxin level of 1.0 ng/mL is
therapeutic.
5. Which statement by a parent of a child with heart failure indicates a correct
understanding of home care?
[ ] A. I will weigh my child daily and report a weight gain of more than 1 pound in a day.
[ ] B. I will restrict my child's fluids to less than half of normal intake.
[ ] C. I will give a double dose of diuretic if my child seems more swollen.
[ ] D. I will keep my child on strict bed rest until the next appointment.
CORRECT: A. I will weigh my child daily and report a weight gain of more than 1 pound in a day.
Daily weight monitoring is crucial; a sudden weight gain indicates fluid retention and should be reported. Fluid
restriction is not routinely recommended for all children and should be provider-directed; doubling diuretics is
dangerous; bed rest is not appropriate as activity should be balanced with rest.
6. The nurse is reviewing the medication list for a pediatric patient with heart failure.
Which combination of drugs is most commonly used to reduce afterload and improve
cardiac output?
[ ] A. Furosemide and spironolactone
[ ] B. Digoxin and metoprolol
[ ] C. Captopril and carvedilol
[ ] D. Amiodarone and warfarin
CORRECT: C. Captopril and carvedilol
Angiotensin-converting enzyme inhibitors (e.g., captopril) and beta-blockers (e.g., carvedilol) are used to
reduce afterload and improve cardiac function in heart failure. Diuretics manage fluid overload but do not
primarily reduce afterload; digoxin increases contractility but is not an afterload reducer; amiodarone and
warfarin are for arrhythmias and anticoagulation, not afterload reduction.
HIGHP - Page 3 of 48
, 7. Which SBAR component correctly identifies the 'A' (Assessment) when communicating
with the provider about a pediatric patient with worsening heart failure?
[ ] A. The patient has a history of ventricular septal defect and is on furosemide.
[ ] B. The patient's heart rate is 150, respiratory rate 60, and oxygen saturation 88% on room air.
[ ] C. I think the patient is experiencing fluid overload and needs an adjustment in diuretic therapy.
[ ] D. I am calling because the patient's mother reports increased fussiness and poor feeding.
CORRECT: C. I think the patient is experiencing fluid overload and needs an adjustment in diuretic
therapy.
The 'A' in SBAR is the nurse's assessment or conclusion about the patient's condition. Option C provides the
nurse's clinical judgment. Option A is background, option B is objective data (part of assessment but not the
conclusion), and option D is the situation (reason for calling).
8. When developing a care plan for a pediatric patient with heart failure, which nursing
diagnosis should be prioritized to address the most immediate physiological need?
[ ] A. Activity intolerance related to decreased cardiac output
[ ] B. Impaired gas exchange related to pulmonary congestion
[ ] C. Risk for impaired skin integrity related to edema
[ ] D. Anxiety related to hospitalization
CORRECT: B. Impaired gas exchange related to pulmonary congestion
Impaired gas exchange takes priority because it directly affects oxygenation and can be life-threatening.
Activity intolerance and anxiety are important but less urgent; risk for impaired skin integrity is a potential
problem but not immediately life-threatening.
9. The nurse is teaching a student about the pathophysiology of heart failure in children.
Which statement best explains why infants with heart failure often present with feeding
difficulties?
[ ] A. Increased metabolic demand and fatigue from tachycardia and increased work of breathing.
[ ] B. Decreased gastric motility due to splanchnic vasoconstriction.
[ ] C. Delayed gastric emptying from digoxin therapy.
[ ] D. Increased appetite from corticosteroid administration.
CORRECT: A. Increased metabolic demand and fatigue from tachycardia and increased work of
breathing.
Infants with heart failure have increased metabolic demands due to tachycardia and increased respiratory
effort, leading to fatigue during feeding. Splanchnic vasoconstriction may occur but is not the primary cause;
digoxin does not typically delay gastric emptying; corticosteroids are not standard therapy for heart failure.
HIGHP - Page 4 of 48
Continuum of Care: Congestive Heart
Failure | Complete Assessment, Subjective
& Objective Data, SBAR, Care Plan & Clinical
Reasoning | 2026/2027 Updated
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam evaluates nursing students on the comprehensive assessment, subjective and objective data
collection, SBAR communication, care planning, and clinical reasoning for pediatric patients with congestive
heart failure, using the Shadow Health virtual patient Isabella Burgel as the exemplar. It covers
pathophysiology, pharmacologic and non-pharmacologic management, family-centered care, and
interprofessional collaboration.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 80% (40/50 correct).
HIGHP - Page 1 of 48
,1. Which congenital heart defect most commonly presents with congestive heart failure in
the first weeks of life due to a large left-to-right shunt?
[ ] A. Tetralogy of Fallot
[ ] B. Ventricular septal defect (VSD)
[ ] C. Transposition of the great arteries
[ ] D. Tricuspid atresia
CORRECT: B. Ventricular septal defect (VSD)
A large VSD causes significant left-to-right shunting, leading to pulmonary overcirculation and heart failure.
Tetralogy of Fallot and tricuspid atresia are cyanotic defects with right-to-left shunting, and transposition of
the great arteries presents with cyanosis, not heart failure from a left-to-right shunt.
2. A mother reports that her infant with heart failure tires easily during feedings and takes
only 1-2 ounces before falling asleep. Which nursing action is most appropriate to
promote adequate nutrition?
[ ] A. Increase the feeding volume by adding cereal to the formula.
[ ] B. Offer continuous nasogastric feedings throughout the day.
[ ] C. Provide smaller, more frequent feedings and use a soft, high-flow nipple.
[ ] D. Withhold feedings until the infant's respiratory rate decreases below 40 breaths/min.
CORRECT: C. Provide smaller, more frequent feedings and use a soft, high-flow nipple.
Smaller, frequent feedings with a soft, high-flow nipple reduce energy expenditure and fatigue during feeding.
Adding cereal may increase caloric density but does not address fatigue; continuous NG feedings are
invasive and not first-line; withholding feedings based on respiratory rate alone is not standard and may
compromise nutrition.
3. When assessing a pediatric patient with heart failure, which set of objective findings is
most consistent with fluid overload?
[ ] A. Weight loss, dry mucous membranes, and sunken fontanelle
[ ] B. Tachycardia, hepatomegaly, and crackles in the lung bases
[ ] C. Bradycardia, hypertension, and peripheral edema
[ ] D. Hypotension, decreased urine output, and poor skin turgor
CORRECT: B. Tachycardia, hepatomegaly, and crackles in the lung bases
Fluid overload in heart failure leads to tachycardia, hepatomegaly (due to venous congestion), and pulmonary
crackles from fluid accumulation. Weight loss and dehydration signs indicate fluid deficit, not overload;
bradycardia and hypertension are not typical; hypotension and poor skin turgor suggest dehydration or shock.
HIGHP - Page 2 of 48
,4. The nurse is preparing to administer digoxin to a pediatric patient with heart failure.
Which assessment finding should prompt the nurse to withhold the dose and notify the
provider?
[ ] A. Heart rate of 110 beats/min in an infant
[ ] B. Serum potassium level of 4.0 mEq/L
[ ] C. Heart rate of 80 beats/min in an infant
[ ] D. Serum digoxin level of 1.0 ng/mL
CORRECT: C. Heart rate of 80 beats/min in an infant
In infants, a heart rate below 90-100 beats/min may indicate digoxin toxicity, and the dose should be withheld.
A heart rate of 110 is within normal limits, potassium of 4.0 is normal, and a digoxin level of 1.0 ng/mL is
therapeutic.
5. Which statement by a parent of a child with heart failure indicates a correct
understanding of home care?
[ ] A. I will weigh my child daily and report a weight gain of more than 1 pound in a day.
[ ] B. I will restrict my child's fluids to less than half of normal intake.
[ ] C. I will give a double dose of diuretic if my child seems more swollen.
[ ] D. I will keep my child on strict bed rest until the next appointment.
CORRECT: A. I will weigh my child daily and report a weight gain of more than 1 pound in a day.
Daily weight monitoring is crucial; a sudden weight gain indicates fluid retention and should be reported. Fluid
restriction is not routinely recommended for all children and should be provider-directed; doubling diuretics is
dangerous; bed rest is not appropriate as activity should be balanced with rest.
6. The nurse is reviewing the medication list for a pediatric patient with heart failure.
Which combination of drugs is most commonly used to reduce afterload and improve
cardiac output?
[ ] A. Furosemide and spironolactone
[ ] B. Digoxin and metoprolol
[ ] C. Captopril and carvedilol
[ ] D. Amiodarone and warfarin
CORRECT: C. Captopril and carvedilol
Angiotensin-converting enzyme inhibitors (e.g., captopril) and beta-blockers (e.g., carvedilol) are used to
reduce afterload and improve cardiac function in heart failure. Diuretics manage fluid overload but do not
primarily reduce afterload; digoxin increases contractility but is not an afterload reducer; amiodarone and
warfarin are for arrhythmias and anticoagulation, not afterload reduction.
HIGHP - Page 3 of 48
, 7. Which SBAR component correctly identifies the 'A' (Assessment) when communicating
with the provider about a pediatric patient with worsening heart failure?
[ ] A. The patient has a history of ventricular septal defect and is on furosemide.
[ ] B. The patient's heart rate is 150, respiratory rate 60, and oxygen saturation 88% on room air.
[ ] C. I think the patient is experiencing fluid overload and needs an adjustment in diuretic therapy.
[ ] D. I am calling because the patient's mother reports increased fussiness and poor feeding.
CORRECT: C. I think the patient is experiencing fluid overload and needs an adjustment in diuretic
therapy.
The 'A' in SBAR is the nurse's assessment or conclusion about the patient's condition. Option C provides the
nurse's clinical judgment. Option A is background, option B is objective data (part of assessment but not the
conclusion), and option D is the situation (reason for calling).
8. When developing a care plan for a pediatric patient with heart failure, which nursing
diagnosis should be prioritized to address the most immediate physiological need?
[ ] A. Activity intolerance related to decreased cardiac output
[ ] B. Impaired gas exchange related to pulmonary congestion
[ ] C. Risk for impaired skin integrity related to edema
[ ] D. Anxiety related to hospitalization
CORRECT: B. Impaired gas exchange related to pulmonary congestion
Impaired gas exchange takes priority because it directly affects oxygenation and can be life-threatening.
Activity intolerance and anxiety are important but less urgent; risk for impaired skin integrity is a potential
problem but not immediately life-threatening.
9. The nurse is teaching a student about the pathophysiology of heart failure in children.
Which statement best explains why infants with heart failure often present with feeding
difficulties?
[ ] A. Increased metabolic demand and fatigue from tachycardia and increased work of breathing.
[ ] B. Decreased gastric motility due to splanchnic vasoconstriction.
[ ] C. Delayed gastric emptying from digoxin therapy.
[ ] D. Increased appetite from corticosteroid administration.
CORRECT: A. Increased metabolic demand and fatigue from tachycardia and increased work of
breathing.
Infants with heart failure have increased metabolic demands due to tachycardia and increased respiratory
effort, leading to fatigue during feeding. Splanchnic vasoconstriction may occur but is not the primary cause;
digoxin does not typically delay gastric emptying; corticosteroids are not standard therapy for heart failure.
HIGHP - Page 4 of 48
