PEDS NURSING EXAMS SET 2025/2026 QUESTIONS WITH
ANSWERS MARKED A+
✔✔A 3-month-old infant has a hypercyanotic spell. The nurse's first action should be
which of the following?
a. Assess for neurologic defects.
b. Prepare family for imminent death.
c. Begin cardiopulmonary resuscitation.
d. Place child in the knee-chest position. - ✔✔ANS: D
The first action is to place the infant in the knee-chest position. Blow-by oxygen may be
indicated. Neurologic defects are unlikely. Preparing the family for imminent death or
beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed
for airway, breathing, and circulation. Often, calming the child and administering oxygen
and morphine can alleviate the hypercyanotic spell.
✔✔A cardiac defect that allows blood to shunt from the (high pressure) left side of the
heart to the (lower pressure) right side can result in:
a. cyanosis.
b. congestive heart failure.
c. decreased pulmonary blood flow.
d. bounding pulses in upper extremities. - ✔✔ANS: B
As blood is shunted into the right side of the heart, there is increased pulmonary blood
flow and the child is at high risk for congestive heart failure. Cyanosis usually occurs in
defects with decreased pulmonary blood flow. Bounding upper extremity pulses are a
manifestation of coarctation of the aorta.
✔✔Ventricular septal defect has the following blood flow pattern:
a. Mixed blood flow
b. Increased pulmonary blood flow
c. Decreased pulmonary blood flow
d. Obstruction to blood flow from ventricles - ✔✔ANS: B
The opening in the septal wall allows for blood to flow from the higher pressure left
ventricle into the lower pressure right ventricle. This left-to-right shunt creates increased
pulmonary blood flow. The shunt is one way, from high pressure to lower pressure;
oxygenated and unoxygenated blood do not mix. The outflow of blood from the
ventricles is not affected by the septal defect.
✔✔The physician suggests that surgery be performed for patent ductus arteriosus
(PDA) to prevent which of the following complications?
a. Hypoxemia
b. Right-to-left shunt of blood
,c. Decreased workload on left side of heart
d. Pulmonary vascular congestion - ✔✔ANS: D
In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary
vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular
congestion. Hypoxemia usually results from defects with mixed blood flow and
decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure
would stop this. There is increased workload on the left side of the heart with a PDA.
✔✔Which of the following defects results in obstruction to blood flow?
a. Aortic stenosis
b. Tricuspid atresia
c. Atrial septal defect
d. Transposition of the great arteries - ✔✔ANS: A
Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood
flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and
pulmonary vascular congestion. Tricuspid atresia results in decreased pulmonary blood
flow. The atrial septal defect results in increased pulmonary blood flow. Transposition of
the great arteries results in mixed blood flow.
✔✔Which of the following structural defects constitute tetralogy of Fallot?
a. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
c. Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy
d. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular
hypertrophy - ✔✔ANS: A
Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal
defect, overriding aorta, and right ventricular hypertrophy.
✔✔The parents of a 3-year-old child with congenital heart disease are afraid to let their
child play with other children because of possible overexertion. The nurse's reply should
include which of the following?
a. Parents can meet all the child's needs.
b. Child needs opportunities to play with peers.
c. Constant parental supervision is needed to avoid overexertion.
d. Child needs to understand that peers' activities are too strenuous. - ✔✔ANS: B
The child needs opportunities for social development. Children are able to regulate and
limit their activities based on their energy level. Parents must be encouraged to seek
appropriate social activities for the child, especially before kindergarten. The child needs
to have activities that foster independence.
, ✔✔Which of the following should the nurse consider when preparing a school-age child
and the family for heart surgery?
a. Unfamiliar equipment should not be shown.
b. Let child hear the sounds of a cardiac monitor, including alarms.
c. Explain that an endotracheal tube will not be needed if the surgery goes well.
d. Discussion of postoperative discomfort and interventions is not necessary before the
procedure. - ✔✔ANS: B
The child and family should be exposed to the sights and sounds of the intensive care
unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The
family and child should make the decision about a tour of the unit if it is an option. The
child should be shown unfamiliar equipment and its use demonstrated on a doll.
Carefully prepare the child for the postoperative experience, including intravenous lines,
incision, endotracheal tube, expected discomfort, and management strategies.
✔✔Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4o
C (101.1° F). The nurse should do which of the following?
a. Report findings to practitioner.
b. Apply a hypothermia blanket.
c. Keep child warm with blankets.
d. Record temperature on assessment flow sheet. - ✔✔ANS: A
In the first 24 to 48 hours after surgery, the body temperature may increase to 37.8° C
(100° F) as part of the inflammatory response to tissue trauma. If the temperature is
higher or fever continues after this period, it is most likely a sign of an infection, and
immediate investigation is indicated. Hypothermia blanket is not indicated for this level
of temperature. Blankets should be removed from the child to keep the temperature
from increasing. The temperature should be recorded, but the practitioner must be
notified for evaluation.
✔✔The nurse notices that a child is increasingly apprehensive and has tachycardia
after heart surgery. The chest tube drainage is now 8 ml/kg/hr. Which of the following
should be the nurse's initial intervention?
a. Apply warming blankets.
b. Notify the practitioner of these findings.
c. Give additional pain medication per protocol.
d. Encourage child to cough, turn, and deep breathe. - ✔✔ANS: B
The practitioner is notified immediately. Increases of chest tube drainage to more than 3
ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate
postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and
tachycardia may indicate cardiac tamponade—blood or fluid in the pericardial space
constricting the heart—which is a life-threatening complication. Warming blankets are
not indicated at this time. Additional pain medication can be given before the practitioner
drains the fluid, but the notification is the first action. Encouraging the child to cough,
turn, and deep breathe should be deferred until after evaluation by the practitioner.
ANSWERS MARKED A+
✔✔A 3-month-old infant has a hypercyanotic spell. The nurse's first action should be
which of the following?
a. Assess for neurologic defects.
b. Prepare family for imminent death.
c. Begin cardiopulmonary resuscitation.
d. Place child in the knee-chest position. - ✔✔ANS: D
The first action is to place the infant in the knee-chest position. Blow-by oxygen may be
indicated. Neurologic defects are unlikely. Preparing the family for imminent death or
beginning cardiopulmonary resuscitation should be unnecessary. The child is assessed
for airway, breathing, and circulation. Often, calming the child and administering oxygen
and morphine can alleviate the hypercyanotic spell.
✔✔A cardiac defect that allows blood to shunt from the (high pressure) left side of the
heart to the (lower pressure) right side can result in:
a. cyanosis.
b. congestive heart failure.
c. decreased pulmonary blood flow.
d. bounding pulses in upper extremities. - ✔✔ANS: B
As blood is shunted into the right side of the heart, there is increased pulmonary blood
flow and the child is at high risk for congestive heart failure. Cyanosis usually occurs in
defects with decreased pulmonary blood flow. Bounding upper extremity pulses are a
manifestation of coarctation of the aorta.
✔✔Ventricular septal defect has the following blood flow pattern:
a. Mixed blood flow
b. Increased pulmonary blood flow
c. Decreased pulmonary blood flow
d. Obstruction to blood flow from ventricles - ✔✔ANS: B
The opening in the septal wall allows for blood to flow from the higher pressure left
ventricle into the lower pressure right ventricle. This left-to-right shunt creates increased
pulmonary blood flow. The shunt is one way, from high pressure to lower pressure;
oxygenated and unoxygenated blood do not mix. The outflow of blood from the
ventricles is not affected by the septal defect.
✔✔The physician suggests that surgery be performed for patent ductus arteriosus
(PDA) to prevent which of the following complications?
a. Hypoxemia
b. Right-to-left shunt of blood
,c. Decreased workload on left side of heart
d. Pulmonary vascular congestion - ✔✔ANS: D
In PDA, blood flows from the higher pressure aorta into the lower pressure pulmonary
vein, resulting in increased pulmonary blood flow. This creates pulmonary vascular
congestion. Hypoxemia usually results from defects with mixed blood flow and
decreased pulmonary blood flow. The shunt is from left to right in a PDA. The closure
would stop this. There is increased workload on the left side of the heart with a PDA.
✔✔Which of the following defects results in obstruction to blood flow?
a. Aortic stenosis
b. Tricuspid atresia
c. Atrial septal defect
d. Transposition of the great arteries - ✔✔ANS: A
Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood
flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and
pulmonary vascular congestion. Tricuspid atresia results in decreased pulmonary blood
flow. The atrial septal defect results in increased pulmonary blood flow. Transposition of
the great arteries results in mixed blood flow.
✔✔Which of the following structural defects constitute tetralogy of Fallot?
a. Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
b. Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular
hypertrophy
c. Aortic stenosis, ventricular septal defect, overriding aorta, left ventricular hypertrophy
d. Pulmonary stenosis, ventricular septal defect, aortic hypertrophy, left ventricular
hypertrophy - ✔✔ANS: A
Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal
defect, overriding aorta, and right ventricular hypertrophy.
✔✔The parents of a 3-year-old child with congenital heart disease are afraid to let their
child play with other children because of possible overexertion. The nurse's reply should
include which of the following?
a. Parents can meet all the child's needs.
b. Child needs opportunities to play with peers.
c. Constant parental supervision is needed to avoid overexertion.
d. Child needs to understand that peers' activities are too strenuous. - ✔✔ANS: B
The child needs opportunities for social development. Children are able to regulate and
limit their activities based on their energy level. Parents must be encouraged to seek
appropriate social activities for the child, especially before kindergarten. The child needs
to have activities that foster independence.
, ✔✔Which of the following should the nurse consider when preparing a school-age child
and the family for heart surgery?
a. Unfamiliar equipment should not be shown.
b. Let child hear the sounds of a cardiac monitor, including alarms.
c. Explain that an endotracheal tube will not be needed if the surgery goes well.
d. Discussion of postoperative discomfort and interventions is not necessary before the
procedure. - ✔✔ANS: B
The child and family should be exposed to the sights and sounds of the intensive care
unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The
family and child should make the decision about a tour of the unit if it is an option. The
child should be shown unfamiliar equipment and its use demonstrated on a doll.
Carefully prepare the child for the postoperative experience, including intravenous lines,
incision, endotracheal tube, expected discomfort, and management strategies.
✔✔Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4o
C (101.1° F). The nurse should do which of the following?
a. Report findings to practitioner.
b. Apply a hypothermia blanket.
c. Keep child warm with blankets.
d. Record temperature on assessment flow sheet. - ✔✔ANS: A
In the first 24 to 48 hours after surgery, the body temperature may increase to 37.8° C
(100° F) as part of the inflammatory response to tissue trauma. If the temperature is
higher or fever continues after this period, it is most likely a sign of an infection, and
immediate investigation is indicated. Hypothermia blanket is not indicated for this level
of temperature. Blankets should be removed from the child to keep the temperature
from increasing. The temperature should be recorded, but the practitioner must be
notified for evaluation.
✔✔The nurse notices that a child is increasingly apprehensive and has tachycardia
after heart surgery. The chest tube drainage is now 8 ml/kg/hr. Which of the following
should be the nurse's initial intervention?
a. Apply warming blankets.
b. Notify the practitioner of these findings.
c. Give additional pain medication per protocol.
d. Encourage child to cough, turn, and deep breathe. - ✔✔ANS: B
The practitioner is notified immediately. Increases of chest tube drainage to more than 3
ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate
postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and
tachycardia may indicate cardiac tamponade—blood or fluid in the pericardial space
constricting the heart—which is a life-threatening complication. Warming blankets are
not indicated at this time. Additional pain medication can be given before the practitioner
drains the fluid, but the notification is the first action. Encouraging the child to cough,
turn, and deep breathe should be deferred until after evaluation by the practitioner.
