NURS 535 EVALUATION EXAM UPDATED QUESTIONS
AND SOLUTIONS RATED A+
✔✔What is the expected outcome for small VSDs? - ✔✔Many close spontaneously by
age 4, with monitoring recommended.
✔✔What is the role of the foramen ovale in fetal circulation? - ✔✔It allows blood to
bypass the lungs by connecting the right and left atria.
✔✔What are the signs of exercise intolerance in older children with CHF? -
✔✔Increased fatigue and difficulty during physical activity.
✔✔What is the significance of Prostaglandin E₁ (PGE₁) in cyanotic congenital heart
defects? - ✔✔PGE₁ is needed to keep the ductus arteriosus open to sustain life until
surgical repair.
✔✔What are the five common cyanotic lesions known as the 5 T's? - ✔✔Tetralogy of
Fallot (TOF)
Transposition of the Great Arteries (TGA) Tricuspid Atresia
Total Anomalous Pulmonary Venous Return (TAPVR)
Truncus Arteriosus
✔✔What are the four structural defects in Tetralogy of Fallot (TOF)? - ✔✔Pulmonary
stenosis
right ventricular hypertrophy
ventricular septal defect (VSD)
overriding aorta
✔✔How does blood shunting occur in Tetralogy of Fallot? - ✔✔Blood is shunted right-
to-left across the VSD due to pulmonary obstruction, leading to cyanosis.
✔✔What are 'Tet spells' in the context of Tetralogy of Fallot? - ✔✔Sudden onset of
deep cyanosis, tachypnea, and irritability, often during crying or feeding, caused by
spasm and increasing right-to-left shunting.
✔✔What diagnostic findings are associated with Tetralogy of Fallot? - ✔✔CXR shows a
'boot-shaped heart'; EKG shows right axis deviation and RV hypertrophy;
echocardiogram defines anatomy and defect severity.
✔✔What is the immediate management for Tetralogy of Fallot during a Tet spell? -
✔✔Knee-chest position
oxygen
morphine
PGE₁ infusion.
,✔✔What is Transposition of the Great Arteries (TGA)? - ✔✔A condition where the aorta
arises from the right ventricle and the pulmonary artery arises from the left ventricle,
causing two separate circulations.
✔✔What are the clinical features of Transposition of the Great Arteries? - ✔✔Cyanosis
within minutes to hours after birth, tachypnea without distress, and a single loud S2
heart sound.
✔✔What is the emergency management for Transposition of the Great Arteries? -
✔✔Prostaglandin E₁ to keep the ductus arteriosus open and balloon atrial septostomy
to create an ASD for mixing.
✔✔What is Tricuspid Atresia? - ✔✔A condition characterized by the absence of the
tricuspid valve, requiring an ASD + VSD or PDA for survival.
✔✔What are the clinical features of Tricuspid Atresia? - ✔✔Severe cyanosis at or soon
after birth, poor feeding, tachypnea, and failure to thrive.
✔✔What is Total Anomalous Pulmonary Venous Return (TAPVR)? - ✔✔A condition
where pulmonary veins drain into the right atrium or systemic venous system instead of
the left atrium.
✔✔What are the clinical features of TAPVR? - ✔✔Cyanosis and respiratory distress in a
neonate, signs of right-sided heart failure, and a soft systolic murmur.
✔✔What is Truncus Arteriosus? - ✔✔A condition where a single arterial trunk arises
from both ventricles, supplying systemic, pulmonary, and coronary circulations.
✔✔What are the clinical features of Truncus Arteriosus? - ✔✔Cyanosis
tachypnea
bounding pulses
signs of heart failure within weeks of birth
✔✔What is the management for Coarctation of the Aorta? - ✔✔PGE₁ infusion to
maintain ductal patency, especially in infants, and surgical repair if necessary.
✔✔What are the clinical features of Coarctation of the Aorta in infants? - ✔✔Shock,
poor feeding
lethargy
weak lower extremity pulses
differential cyanosis
, ✔✔What is the hallmark finding in the chest X-ray for Tetralogy of Fallot? - ✔✔A boot-
shaped heart due to right ventricular hypertrophy.
✔✔What does the 'egg on a string' appearance indicate in a chest X-ray? - ✔✔It is
associated with Transposition of the Great Arteries.
✔✔What is the significance of a hyperoxia test in cyanotic infants? - ✔✔Minimal
increase in PaO₂ after 100% oxygen suggests a cardiac cause of cyanosis.
✔✔What is the long-term management requirement for patients with congenital heart
defects? - ✔✔Lifelong follow-up with cardiology is typically required for monitoring and
management of potential complications.
✔✔What is pulse discrepancy in the context of congenital heart defects? - ✔✔Strong
brachial/radial pulses with weak or delayed femoral pulses.
✔✔What is a characteristic murmur associated with aortic stenosis? - ✔✔A systolic
murmur loudest at the right upper sternal border radiating to the neck.
✔✔What diagnostic finding indicates a significant blood pressure differential? - ✔✔A
systolic difference of greater than 20 mmHg between arms and legs.
✔✔What does the '3 sign' on a chest X-ray indicate? - ✔✔Indentation of the aorta
associated with coarctation of the aorta.
✔✔What is the initial management for critical newborns with ductal-dependent systemic
flow? - ✔✔Start Prostaglandin E₁ (PGE₁) to maintain ductal flow.
✔✔What is the most common form of aortic stenosis? - ✔✔Bicuspid aortic valve.
✔✔What are the clinical features of severe aortic stenosis in neonates? - ✔✔Shock,
poor feeding, weak pulses, pallor, and tachypnea after ductal closure.
✔✔What is the treatment of choice for moderate-to-severe pulmonary stenosis? -
✔✔Balloon valvuloplasty.
✔✔What is hypoplastic left heart syndrome (HLHS)? - ✔✔Underdevelopment of left-
sided cardiac structures including hypoplastic left ventricle and aortic atresia.
✔✔What is the primary pathophysiological concern in HLHS? - ✔✔The left heart cannot
support systemic circulation, relying on the patent ductus arteriosus (PDA).
✔✔What are the immediate management steps for HLHS? - ✔✔Administer PGE₁ to
maintain the ductus arteriosus and support perfusion.
AND SOLUTIONS RATED A+
✔✔What is the expected outcome for small VSDs? - ✔✔Many close spontaneously by
age 4, with monitoring recommended.
✔✔What is the role of the foramen ovale in fetal circulation? - ✔✔It allows blood to
bypass the lungs by connecting the right and left atria.
✔✔What are the signs of exercise intolerance in older children with CHF? -
✔✔Increased fatigue and difficulty during physical activity.
✔✔What is the significance of Prostaglandin E₁ (PGE₁) in cyanotic congenital heart
defects? - ✔✔PGE₁ is needed to keep the ductus arteriosus open to sustain life until
surgical repair.
✔✔What are the five common cyanotic lesions known as the 5 T's? - ✔✔Tetralogy of
Fallot (TOF)
Transposition of the Great Arteries (TGA) Tricuspid Atresia
Total Anomalous Pulmonary Venous Return (TAPVR)
Truncus Arteriosus
✔✔What are the four structural defects in Tetralogy of Fallot (TOF)? - ✔✔Pulmonary
stenosis
right ventricular hypertrophy
ventricular septal defect (VSD)
overriding aorta
✔✔How does blood shunting occur in Tetralogy of Fallot? - ✔✔Blood is shunted right-
to-left across the VSD due to pulmonary obstruction, leading to cyanosis.
✔✔What are 'Tet spells' in the context of Tetralogy of Fallot? - ✔✔Sudden onset of
deep cyanosis, tachypnea, and irritability, often during crying or feeding, caused by
spasm and increasing right-to-left shunting.
✔✔What diagnostic findings are associated with Tetralogy of Fallot? - ✔✔CXR shows a
'boot-shaped heart'; EKG shows right axis deviation and RV hypertrophy;
echocardiogram defines anatomy and defect severity.
✔✔What is the immediate management for Tetralogy of Fallot during a Tet spell? -
✔✔Knee-chest position
oxygen
morphine
PGE₁ infusion.
,✔✔What is Transposition of the Great Arteries (TGA)? - ✔✔A condition where the aorta
arises from the right ventricle and the pulmonary artery arises from the left ventricle,
causing two separate circulations.
✔✔What are the clinical features of Transposition of the Great Arteries? - ✔✔Cyanosis
within minutes to hours after birth, tachypnea without distress, and a single loud S2
heart sound.
✔✔What is the emergency management for Transposition of the Great Arteries? -
✔✔Prostaglandin E₁ to keep the ductus arteriosus open and balloon atrial septostomy
to create an ASD for mixing.
✔✔What is Tricuspid Atresia? - ✔✔A condition characterized by the absence of the
tricuspid valve, requiring an ASD + VSD or PDA for survival.
✔✔What are the clinical features of Tricuspid Atresia? - ✔✔Severe cyanosis at or soon
after birth, poor feeding, tachypnea, and failure to thrive.
✔✔What is Total Anomalous Pulmonary Venous Return (TAPVR)? - ✔✔A condition
where pulmonary veins drain into the right atrium or systemic venous system instead of
the left atrium.
✔✔What are the clinical features of TAPVR? - ✔✔Cyanosis and respiratory distress in a
neonate, signs of right-sided heart failure, and a soft systolic murmur.
✔✔What is Truncus Arteriosus? - ✔✔A condition where a single arterial trunk arises
from both ventricles, supplying systemic, pulmonary, and coronary circulations.
✔✔What are the clinical features of Truncus Arteriosus? - ✔✔Cyanosis
tachypnea
bounding pulses
signs of heart failure within weeks of birth
✔✔What is the management for Coarctation of the Aorta? - ✔✔PGE₁ infusion to
maintain ductal patency, especially in infants, and surgical repair if necessary.
✔✔What are the clinical features of Coarctation of the Aorta in infants? - ✔✔Shock,
poor feeding
lethargy
weak lower extremity pulses
differential cyanosis
, ✔✔What is the hallmark finding in the chest X-ray for Tetralogy of Fallot? - ✔✔A boot-
shaped heart due to right ventricular hypertrophy.
✔✔What does the 'egg on a string' appearance indicate in a chest X-ray? - ✔✔It is
associated with Transposition of the Great Arteries.
✔✔What is the significance of a hyperoxia test in cyanotic infants? - ✔✔Minimal
increase in PaO₂ after 100% oxygen suggests a cardiac cause of cyanosis.
✔✔What is the long-term management requirement for patients with congenital heart
defects? - ✔✔Lifelong follow-up with cardiology is typically required for monitoring and
management of potential complications.
✔✔What is pulse discrepancy in the context of congenital heart defects? - ✔✔Strong
brachial/radial pulses with weak or delayed femoral pulses.
✔✔What is a characteristic murmur associated with aortic stenosis? - ✔✔A systolic
murmur loudest at the right upper sternal border radiating to the neck.
✔✔What diagnostic finding indicates a significant blood pressure differential? - ✔✔A
systolic difference of greater than 20 mmHg between arms and legs.
✔✔What does the '3 sign' on a chest X-ray indicate? - ✔✔Indentation of the aorta
associated with coarctation of the aorta.
✔✔What is the initial management for critical newborns with ductal-dependent systemic
flow? - ✔✔Start Prostaglandin E₁ (PGE₁) to maintain ductal flow.
✔✔What is the most common form of aortic stenosis? - ✔✔Bicuspid aortic valve.
✔✔What are the clinical features of severe aortic stenosis in neonates? - ✔✔Shock,
poor feeding, weak pulses, pallor, and tachypnea after ductal closure.
✔✔What is the treatment of choice for moderate-to-severe pulmonary stenosis? -
✔✔Balloon valvuloplasty.
✔✔What is hypoplastic left heart syndrome (HLHS)? - ✔✔Underdevelopment of left-
sided cardiac structures including hypoplastic left ventricle and aortic atresia.
✔✔What is the primary pathophysiological concern in HLHS? - ✔✔The left heart cannot
support systemic circulation, relying on the patent ductus arteriosus (PDA).
✔✔What are the immediate management steps for HLHS? - ✔✔Administer PGE₁ to
maintain the ductus arteriosus and support perfusion.
