1
HESI Exit Exam CHD Review Bank:
Congenital Heart Defects,
Interventions & Pharmacologic
Care
Table of Contents
Subtopic 1: Overview of Congenital Heart Defects (CHDs)..............................2
Subtopic 2: Diagnostic Tools and Imaging in Congenital Heart Defects (CHDs)
.......................................................................................................................11
Subtopic 3: Pathophysiology and Hemodynamics of Congenital Heart Defects
(CHDs)............................................................................................................21
Subtopic 4: Surgical and Interventional Treatments in Congenital Heart
Defects (CHDs)..............................................................................................30
Subtopic 5: Pharmacologic Management in CHD and Postoperative Care.....39
Subtopic 6: Genetic, Prenatal, and Environmental Risk Factors in CHDs.......49
Subtopic 7: Diagnostic Evaluation and Imaging in CHDs...............................58
Subtopic 8: Postoperative Care and Long-Term Management in CHD Patients
.......................................................................................................................67
Subtopic 9: Genetic, Environmental, and Prenatal Risk Factors in Congenital
Heart Defects (CHDs).....................................................................................77
Subtopic 10: Ethical Considerations and Family-Centered Care in CHD
Management..................................................................................................86
, 2
Subtopic 1: Overview of Congenital Heart
Defects (CHDs)
Focus: Basic concepts, types of CHDs, diagnostic cues, and clinical
recognition in pediatrics.
Question 1
A newborn is diagnosed with a ventricular septal defect (VSD). Which clinical
finding should the nurse expect during assessment?
A. Cyanosis at rest
B. Bounding peripheral pulses
C. Loud systolic murmur at the left sternal border
D. Weak femoral pulses
Correct Answer: C. Loud systolic murmur at the left sternal border
Rationale: A VSD typically presents with a loud, harsh systolic murmur best
heard at the left lower sternal border. Cyanosis is more common in cyanotic
heart defects, not isolated VSDs.
Question 2
Which congenital heart defect is most commonly associated with a “boot-
shaped” heart on chest X-ray?
A. Coarctation of the aorta
B. Tetralogy of Fallot
C. Patent ductus arteriosus
D. Atrial septal defect
, 3
Correct Answer: B. Tetralogy of Fallot
Rationale: Tetralogy of Fallot is characterized by right ventricular
hypertrophy, which causes the classic “boot-shaped” heart on imaging.
Question 3
Which congenital heart defect results in increased pulmonary blood flow?
A. Tetralogy of Fallot
B. Pulmonary stenosis
C. Atrial septal defect
D. Tricuspid atresia
Correct Answer: C. Atrial septal defect
Rationale: An ASD allows oxygenated blood to flow from the left atrium to the
right atrium, increasing pulmonary circulation.
Question 4
Which of the following conditions is classified as a cyanotic congenital heart
defect?
A. Ventricular septal defect
B. Atrial septal defect
C. Transposition of the great arteries
D. Patent ductus arteriosus
Correct Answer: C. Transposition of the great arteries
, 4
Rationale: This defect involves reversed placement of the pulmonary artery
and aorta, leading to severe cyanosis due to poorly oxygenated systemic
circulation.
Question 5
A newborn presents with a continuous "machinery-like" murmur. Which
condition should the nurse suspect?
A. Pulmonary atresia
B. Patent ductus arteriosus
C. Aortic stenosis
D. Truncus arteriosus
Correct Answer: B. Patent ductus arteriosus
Rationale: PDA is characterized by a continuous murmur due to persistent
shunting of blood from the aorta to the pulmonary artery.
Question 6
What is the primary concern in an infant with truncus arteriosus?
A. Hypertension
B. Mixing of oxygenated and deoxygenated blood
C. Increased systemic vascular resistance
D. Hypovolemia
Correct Answer: B. Mixing of oxygenated and deoxygenated blood
Rationale: In truncus arteriosus, a single arterial trunk arises from the heart,
leading to mixing of blood and systemic hypoxemia.
HESI Exit Exam CHD Review Bank:
Congenital Heart Defects,
Interventions & Pharmacologic
Care
Table of Contents
Subtopic 1: Overview of Congenital Heart Defects (CHDs)..............................2
Subtopic 2: Diagnostic Tools and Imaging in Congenital Heart Defects (CHDs)
.......................................................................................................................11
Subtopic 3: Pathophysiology and Hemodynamics of Congenital Heart Defects
(CHDs)............................................................................................................21
Subtopic 4: Surgical and Interventional Treatments in Congenital Heart
Defects (CHDs)..............................................................................................30
Subtopic 5: Pharmacologic Management in CHD and Postoperative Care.....39
Subtopic 6: Genetic, Prenatal, and Environmental Risk Factors in CHDs.......49
Subtopic 7: Diagnostic Evaluation and Imaging in CHDs...............................58
Subtopic 8: Postoperative Care and Long-Term Management in CHD Patients
.......................................................................................................................67
Subtopic 9: Genetic, Environmental, and Prenatal Risk Factors in Congenital
Heart Defects (CHDs).....................................................................................77
Subtopic 10: Ethical Considerations and Family-Centered Care in CHD
Management..................................................................................................86
, 2
Subtopic 1: Overview of Congenital Heart
Defects (CHDs)
Focus: Basic concepts, types of CHDs, diagnostic cues, and clinical
recognition in pediatrics.
Question 1
A newborn is diagnosed with a ventricular septal defect (VSD). Which clinical
finding should the nurse expect during assessment?
A. Cyanosis at rest
B. Bounding peripheral pulses
C. Loud systolic murmur at the left sternal border
D. Weak femoral pulses
Correct Answer: C. Loud systolic murmur at the left sternal border
Rationale: A VSD typically presents with a loud, harsh systolic murmur best
heard at the left lower sternal border. Cyanosis is more common in cyanotic
heart defects, not isolated VSDs.
Question 2
Which congenital heart defect is most commonly associated with a “boot-
shaped” heart on chest X-ray?
A. Coarctation of the aorta
B. Tetralogy of Fallot
C. Patent ductus arteriosus
D. Atrial septal defect
, 3
Correct Answer: B. Tetralogy of Fallot
Rationale: Tetralogy of Fallot is characterized by right ventricular
hypertrophy, which causes the classic “boot-shaped” heart on imaging.
Question 3
Which congenital heart defect results in increased pulmonary blood flow?
A. Tetralogy of Fallot
B. Pulmonary stenosis
C. Atrial septal defect
D. Tricuspid atresia
Correct Answer: C. Atrial septal defect
Rationale: An ASD allows oxygenated blood to flow from the left atrium to the
right atrium, increasing pulmonary circulation.
Question 4
Which of the following conditions is classified as a cyanotic congenital heart
defect?
A. Ventricular septal defect
B. Atrial septal defect
C. Transposition of the great arteries
D. Patent ductus arteriosus
Correct Answer: C. Transposition of the great arteries
, 4
Rationale: This defect involves reversed placement of the pulmonary artery
and aorta, leading to severe cyanosis due to poorly oxygenated systemic
circulation.
Question 5
A newborn presents with a continuous "machinery-like" murmur. Which
condition should the nurse suspect?
A. Pulmonary atresia
B. Patent ductus arteriosus
C. Aortic stenosis
D. Truncus arteriosus
Correct Answer: B. Patent ductus arteriosus
Rationale: PDA is characterized by a continuous murmur due to persistent
shunting of blood from the aorta to the pulmonary artery.
Question 6
What is the primary concern in an infant with truncus arteriosus?
A. Hypertension
B. Mixing of oxygenated and deoxygenated blood
C. Increased systemic vascular resistance
D. Hypovolemia
Correct Answer: B. Mixing of oxygenated and deoxygenated blood
Rationale: In truncus arteriosus, a single arterial trunk arises from the heart,
leading to mixing of blood and systemic hypoxemia.
