NCLEX RN Paediatric Cardiac Disorders
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A nurse assesses an infant with a ventricular septal defect (VSD). Which
finding is most characteristic of a significant VSD?
A. Continuous machinery-like murmur
B. Harsh holosystolic murmur
C. Fixed split S2
D. Bounding peripheral pulses
Answer: B. Harsh holosystolic murmur
Rationale: A VSD typically produces a harsh holosystolic murmur because
blood flows from the higher-pressure left ventricle to the right ventricle
throughout systole.
2. Which congenital cardiac defect is characterized by a continuous
"machinery" murmur?
A. Atrial septal defect
B. Ventricular septal defect
C. Patent ductus arteriosus
D. Tetralogy of Fallot
Answer: C. Patent ductus arteriosus
Rationale: Patent ductus arteriosus causes continuous blood flow between
the aorta and pulmonary artery, producing a characteristic machinery-like
murmur.
,3. A child with tetralogy of Fallot suddenly becomes severely cyanotic and
dyspneic while crying. What should the nurse do first?
A. Place the child supine
B. Administer oral fluids
C. Place the child in the knee-chest position
D. Begin chest compressions
Answer: C. Place the child in the knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting and improving pulmonary blood flow during a
hypercyanotic spell.
4. Which finding is expected in a child with coarctation of the aorta?
A. Weak upper-extremity pulses
B. Higher blood pressure in the arms than in the legs
C. Equal blood pressure in all extremities
D. Bounding femoral pulses
Answer: B. Higher blood pressure in the arms than in the legs
Rationale: Coarctation causes obstruction of aortic blood flow to the lower
body, resulting in hypertension in the upper extremities and diminished
lower-extremity pulses.
5. A child with Kawasaki disease is at greatest risk for which complication?
A. Pulmonary fibrosis
B. Renal failure
C. Coronary artery aneurysm
D. Liver cirrhosis
Answer: C. Coronary artery aneurysm
,Rationale: Kawasaki disease causes systemic vasculitis and can damage the
coronary arteries, leading to aneurysms, thrombosis, and myocardial
ischemia.
6. Which medication is commonly administered during the acute phase of
Kawasaki disease?
A. Digoxin alone
B. Intravenous immunoglobulin and aspirin
C. Warfarin and furosemide
D. Epinephrine and atropine
Answer: B. Intravenous immunoglobulin and aspirin
Rationale: IV immunoglobulin reduces the risk of coronary artery
complications, while aspirin helps reduce inflammation and platelet
aggregation.
7. Which congenital cardiac defect is associated with a fixed, widely split S2?
A. VSD
B. PDA
C. Atrial septal defect
D. Coarctation of the aorta
Answer: C. Atrial septal defect
Rationale: An ASD causes increased right-sided volume and delayed closure
of the pulmonic valve, producing a fixed, widely split S2.
8. Which congenital heart defect is classified as a cyanotic heart defect?
A. ASD
B. VSD
C. PDA
D. Tetralogy of Fallot
, Answer: D. Tetralogy of Fallot
Rationale: Tetralogy of Fallot is a cyanotic congenital heart defect caused by
reduced pulmonary blood flow and right-to-left shunting.
9. Which four abnormalities are components of tetralogy of Fallot?
A. ASD, PDA, coarctation, and pulmonary stenosis
B. VSD, pulmonary stenosis, overriding aorta, and right ventricular
hypertrophy
C. VSD, mitral stenosis, ASD, and PDA
D. Aortic stenosis, ASD, VSD, and PDA
Answer: B. VSD, pulmonary stenosis, overriding aorta, and right ventricular
hypertrophy
Rationale: Tetralogy of Fallot consists of a VSD, pulmonary outflow
obstruction, overriding aorta, and right ventricular hypertrophy.
10. A nurse is teaching parents about digoxin administration for their child.
Which instruction is most important?
A. Give an extra dose if the child vomits
B. Mix the medication with a large bottle of formula
C. Check the child's apical pulse before administering the medication
D. Give the medication only when the child has symptoms
Answer: C. Check the child's apical pulse before administering the medication
Rationale: Digoxin can cause bradycardia and toxicity. The nurse should
assess the apical pulse before administration and follow prescribed hold
parameters.
11. Which finding suggests digoxin toxicity in a child?
A. Increased appetite
B. Tachypnea only
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A nurse assesses an infant with a ventricular septal defect (VSD). Which
finding is most characteristic of a significant VSD?
A. Continuous machinery-like murmur
B. Harsh holosystolic murmur
C. Fixed split S2
D. Bounding peripheral pulses
Answer: B. Harsh holosystolic murmur
Rationale: A VSD typically produces a harsh holosystolic murmur because
blood flows from the higher-pressure left ventricle to the right ventricle
throughout systole.
2. Which congenital cardiac defect is characterized by a continuous
"machinery" murmur?
A. Atrial septal defect
B. Ventricular septal defect
C. Patent ductus arteriosus
D. Tetralogy of Fallot
Answer: C. Patent ductus arteriosus
Rationale: Patent ductus arteriosus causes continuous blood flow between
the aorta and pulmonary artery, producing a characteristic machinery-like
murmur.
,3. A child with tetralogy of Fallot suddenly becomes severely cyanotic and
dyspneic while crying. What should the nurse do first?
A. Place the child supine
B. Administer oral fluids
C. Place the child in the knee-chest position
D. Begin chest compressions
Answer: C. Place the child in the knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting and improving pulmonary blood flow during a
hypercyanotic spell.
4. Which finding is expected in a child with coarctation of the aorta?
A. Weak upper-extremity pulses
B. Higher blood pressure in the arms than in the legs
C. Equal blood pressure in all extremities
D. Bounding femoral pulses
Answer: B. Higher blood pressure in the arms than in the legs
Rationale: Coarctation causes obstruction of aortic blood flow to the lower
body, resulting in hypertension in the upper extremities and diminished
lower-extremity pulses.
5. A child with Kawasaki disease is at greatest risk for which complication?
A. Pulmonary fibrosis
B. Renal failure
C. Coronary artery aneurysm
D. Liver cirrhosis
Answer: C. Coronary artery aneurysm
,Rationale: Kawasaki disease causes systemic vasculitis and can damage the
coronary arteries, leading to aneurysms, thrombosis, and myocardial
ischemia.
6. Which medication is commonly administered during the acute phase of
Kawasaki disease?
A. Digoxin alone
B. Intravenous immunoglobulin and aspirin
C. Warfarin and furosemide
D. Epinephrine and atropine
Answer: B. Intravenous immunoglobulin and aspirin
Rationale: IV immunoglobulin reduces the risk of coronary artery
complications, while aspirin helps reduce inflammation and platelet
aggregation.
7. Which congenital cardiac defect is associated with a fixed, widely split S2?
A. VSD
B. PDA
C. Atrial septal defect
D. Coarctation of the aorta
Answer: C. Atrial septal defect
Rationale: An ASD causes increased right-sided volume and delayed closure
of the pulmonic valve, producing a fixed, widely split S2.
8. Which congenital heart defect is classified as a cyanotic heart defect?
A. ASD
B. VSD
C. PDA
D. Tetralogy of Fallot
, Answer: D. Tetralogy of Fallot
Rationale: Tetralogy of Fallot is a cyanotic congenital heart defect caused by
reduced pulmonary blood flow and right-to-left shunting.
9. Which four abnormalities are components of tetralogy of Fallot?
A. ASD, PDA, coarctation, and pulmonary stenosis
B. VSD, pulmonary stenosis, overriding aorta, and right ventricular
hypertrophy
C. VSD, mitral stenosis, ASD, and PDA
D. Aortic stenosis, ASD, VSD, and PDA
Answer: B. VSD, pulmonary stenosis, overriding aorta, and right ventricular
hypertrophy
Rationale: Tetralogy of Fallot consists of a VSD, pulmonary outflow
obstruction, overriding aorta, and right ventricular hypertrophy.
10. A nurse is teaching parents about digoxin administration for their child.
Which instruction is most important?
A. Give an extra dose if the child vomits
B. Mix the medication with a large bottle of formula
C. Check the child's apical pulse before administering the medication
D. Give the medication only when the child has symptoms
Answer: C. Check the child's apical pulse before administering the medication
Rationale: Digoxin can cause bradycardia and toxicity. The nurse should
assess the apical pulse before administration and follow prescribed hold
parameters.
11. Which finding suggests digoxin toxicity in a child?
A. Increased appetite
B. Tachypnea only
