NUR 4132 Pediatric Nursing Exam 2026 | Questions with Answers &
Rationales | Complete Success
1. A child diagnosed with Tetralogy of Fallot experiences a Tet spell. What is the priority
nursing intervention?
A. Place the child in the knee-to-chest position
B. Encourage the child to walk to improve circulation
C. Place the child flat on the back
D. Restrict oxygen administration
Answer: A
Rationale: The knee-to-chest position increases systemic vascular resistance, decreases right-to-
left shunting, and improves pulmonary blood flow during a Tet spell.
2. Which congenital heart defect is associated with decreased pulmonary blood flow?
A. Atrial septal defect (ASD)
B. Tetralogy of Fallot (TOF)
C. Ventricular septal defect (VSD)
D. Patent ductus arteriosus (PDA)
Answer: B
Rationale: Tetralogy of Fallot is a cyanotic congenital heart defect caused by reduced pulmonary
blood flow.
3. Which finding is expected in a child with Tetralogy of Fallot?
A. Cyanosis, clubbing, and risk for polycythemia
B. Severe hypertension in all extremities
C. Increased oxygen saturation above 98%
D. Absence of heart murmurs
Answer: A
Rationale: Chronic hypoxemia in Tetralogy of Fallot causes cyanosis, clubbing, and increased red
blood cell production.
4. Which assessment finding is commonly associated with an atrial septal defect (ASD)?
A. Fixed split S2 with a systolic murmur
B. Severe cyanosis at birth
C. Absent peripheral pulses
D. Continuous machinery murmur
Answer: A
,Rationale: ASD commonly produces a systolic murmur and split S2 due to abnormal blood flow
between the atria.
5. Which congenital heart defect is known for producing a loud, harsh murmur?
A. Atrial septal defect
B. Ventricular septal defect
C. Coarctation of the aorta
D. Tetralogy of Fallot
Answer: B
Rationale: A VSD creates turbulent blood flow between ventricles, producing a loud harsh
murmur.
6. A child with coarctation of the aorta is assessed by the nurse. Which finding is expected?
A. Higher blood pressure in the arms with weak lower extremity pulses
B. Equal blood pressure in all extremities
C. Higher blood pressure in the legs than arms
D. Only respiratory symptoms without circulation changes
Answer: A
Rationale: Coarctation causes obstruction of blood flow to the lower body, resulting in elevated
arm pressures and decreased leg pulses.
7. Which finding is characteristic of patent ductus arteriosus (PDA)?
A. A loud machinery-like murmur with bounding pulses
B. A silent heart with normal pulses
C. Severe cyanosis with no murmur
D. Absent respiratory symptoms
Answer: A
Rationale: PDA produces a continuous machinery-like murmur and increased pulmonary blood
flow.
8. Which medication is used in Kawasaki disease to decrease the risk of coronary artery
complications?
A. Aspirin and immune globulin
B. Insulin and glucagon
C. Digoxin and furosemide only
D. Anticoagulants only
Answer: A
, Rationale: Aspirin reduces inflammation and immune globulin lowers the risk of coronary artery
complications.
9. Acute rheumatic fever develops after infection with which organism?
A. Group A beta-hemolytic streptococcus
B. Staphylococcus aureus
C. Escherichia coli
D. Influenza virus
Answer: A
Rationale: Acute rheumatic fever occurs after a group A streptococcal infection.
10. Which finding is associated with Sydenham chorea in acute rheumatic fever?
A. Aimless involuntary movements of the extremities
B. Persistent productive cough
C. Severe hyperglycemia
D. Loss of hearing
Answer: A
Rationale: Sydenham chorea causes involuntary, purposeless movements due to neurologic
involvement.
11. A child diagnosed with Tetralogy of Fallot experiences a Tet spell. What is the priority
nursing intervention?
A. Place the child in the knee-to-chest position
B. Encourage the child to walk to improve circulation
C. Place the child flat on the back
D. Restrict oxygen administration
Answer: A
Rationale: The knee-to-chest position increases systemic vascular resistance, decreases right-to-
left shunting, and improves pulmonary blood flow during a Tet spell.
12. Which congenital heart defect is associated with decreased pulmonary blood flow?
A. Atrial septal defect (ASD)
B. Tetralogy of Fallot (TOF)
C. Ventricular septal defect (VSD)
D. Patent ductus arteriosus (PDA)
Answer: B
Rationale: Tetralogy of Fallot is a cyanotic congenital heart defect caused by reduced pulmonary
blood flow.
Rationales | Complete Success
1. A child diagnosed with Tetralogy of Fallot experiences a Tet spell. What is the priority
nursing intervention?
A. Place the child in the knee-to-chest position
B. Encourage the child to walk to improve circulation
C. Place the child flat on the back
D. Restrict oxygen administration
Answer: A
Rationale: The knee-to-chest position increases systemic vascular resistance, decreases right-to-
left shunting, and improves pulmonary blood flow during a Tet spell.
2. Which congenital heart defect is associated with decreased pulmonary blood flow?
A. Atrial septal defect (ASD)
B. Tetralogy of Fallot (TOF)
C. Ventricular septal defect (VSD)
D. Patent ductus arteriosus (PDA)
Answer: B
Rationale: Tetralogy of Fallot is a cyanotic congenital heart defect caused by reduced pulmonary
blood flow.
3. Which finding is expected in a child with Tetralogy of Fallot?
A. Cyanosis, clubbing, and risk for polycythemia
B. Severe hypertension in all extremities
C. Increased oxygen saturation above 98%
D. Absence of heart murmurs
Answer: A
Rationale: Chronic hypoxemia in Tetralogy of Fallot causes cyanosis, clubbing, and increased red
blood cell production.
4. Which assessment finding is commonly associated with an atrial septal defect (ASD)?
A. Fixed split S2 with a systolic murmur
B. Severe cyanosis at birth
C. Absent peripheral pulses
D. Continuous machinery murmur
Answer: A
,Rationale: ASD commonly produces a systolic murmur and split S2 due to abnormal blood flow
between the atria.
5. Which congenital heart defect is known for producing a loud, harsh murmur?
A. Atrial septal defect
B. Ventricular septal defect
C. Coarctation of the aorta
D. Tetralogy of Fallot
Answer: B
Rationale: A VSD creates turbulent blood flow between ventricles, producing a loud harsh
murmur.
6. A child with coarctation of the aorta is assessed by the nurse. Which finding is expected?
A. Higher blood pressure in the arms with weak lower extremity pulses
B. Equal blood pressure in all extremities
C. Higher blood pressure in the legs than arms
D. Only respiratory symptoms without circulation changes
Answer: A
Rationale: Coarctation causes obstruction of blood flow to the lower body, resulting in elevated
arm pressures and decreased leg pulses.
7. Which finding is characteristic of patent ductus arteriosus (PDA)?
A. A loud machinery-like murmur with bounding pulses
B. A silent heart with normal pulses
C. Severe cyanosis with no murmur
D. Absent respiratory symptoms
Answer: A
Rationale: PDA produces a continuous machinery-like murmur and increased pulmonary blood
flow.
8. Which medication is used in Kawasaki disease to decrease the risk of coronary artery
complications?
A. Aspirin and immune globulin
B. Insulin and glucagon
C. Digoxin and furosemide only
D. Anticoagulants only
Answer: A
, Rationale: Aspirin reduces inflammation and immune globulin lowers the risk of coronary artery
complications.
9. Acute rheumatic fever develops after infection with which organism?
A. Group A beta-hemolytic streptococcus
B. Staphylococcus aureus
C. Escherichia coli
D. Influenza virus
Answer: A
Rationale: Acute rheumatic fever occurs after a group A streptococcal infection.
10. Which finding is associated with Sydenham chorea in acute rheumatic fever?
A. Aimless involuntary movements of the extremities
B. Persistent productive cough
C. Severe hyperglycemia
D. Loss of hearing
Answer: A
Rationale: Sydenham chorea causes involuntary, purposeless movements due to neurologic
involvement.
11. A child diagnosed with Tetralogy of Fallot experiences a Tet spell. What is the priority
nursing intervention?
A. Place the child in the knee-to-chest position
B. Encourage the child to walk to improve circulation
C. Place the child flat on the back
D. Restrict oxygen administration
Answer: A
Rationale: The knee-to-chest position increases systemic vascular resistance, decreases right-to-
left shunting, and improves pulmonary blood flow during a Tet spell.
12. Which congenital heart defect is associated with decreased pulmonary blood flow?
A. Atrial septal defect (ASD)
B. Tetralogy of Fallot (TOF)
C. Ventricular septal defect (VSD)
D. Patent ductus arteriosus (PDA)
Answer: B
Rationale: Tetralogy of Fallot is a cyanotic congenital heart defect caused by reduced pulmonary
blood flow.
