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HESI Congenital Heart Defect Exam
Bank: Neonatal Care, Surgery &
Emergency Q&A
Table of Contents
Subtopic 1: Initial Assessment and Recognition of Congenital Heart Defects in
Neonates..........................................................................................................2
Subtopic 2: Preoperative Nursing Management of Infants with Congenital
Heart Defects.................................................................................................10
Subtopic 3: Postoperative Nursing Care and Complications in Congenital
Heart Surgery................................................................................................18
Subtopic 4: Long-Term Management, Discharge Education, and Family
Support in CHD..............................................................................................25
Subtopic 5: Emergency Interventions and Complications of Congenital Heart
Defects...........................................................................................................33
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Subtopic 1: Initial Assessment and
Recognition of Congenital Heart Defects in
Neonates
(Questions 1–20)
1. A newborn exhibits cyanosis that does not improve with oxygen therapy.
Which congenital heart defect is most likely responsible?
A. Atrial Septal Defect (ASD)
B. Transposition of the Great Arteries (TGA)
C. Patent Ductus Arteriosus (PDA)
D. Coarctation of the Aorta
Correct Answer: B. Transposition of the Great Arteries (TGA)
Rationale: TGA causes cyanosis that is unresponsive to oxygen because the
systemic and pulmonary circulations are parallel rather than connected in
series, preventing adequate oxygenation of blood.
2. Which physical assessment finding is most concerning in a newborn
suspected of having a congenital heart defect?
A. Heart rate of 130 bpm
B. Occasional regurgitation after feeding
C. Poor feeding with diaphoresis
D. Weight loss of 5% in the first 48 hours
Correct Answer: C. Poor feeding with diaphoresis
Rationale: Poor feeding with sweating indicates increased metabolic demand
and poor cardiac output, which are signs of possible heart failure related to
congenital heart disease.
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3. A nurse notes bounding pulses and a widened pulse pressure in a neonate.
Which heart defect is suspected?
A. Tetralogy of Fallot
B. Coarctation of the Aorta
C. Patent Ductus Arteriosus (PDA)
D. Pulmonary Atresia
Correct Answer: C. Patent Ductus Arteriosus (PDA)
Rationale: PDA results in increased blood flow from the aorta to the
pulmonary artery, leading to bounding pulses and widened pulse pressure
due to volume overload.
4. Which diagnostic tool is the most definitive for identifying congenital heart
defects in neonates?
A. Chest X-ray
B. ECG
C. Echocardiogram
D. Pulse oximetry
Correct Answer: C. Echocardiogram
Rationale: Echocardiography allows visualization of cardiac structures and
blood flow, providing a definitive diagnosis of structural heart defects.
5. A newborn is suspected of having Tetralogy of Fallot. What initial sign
might a nurse observe?
A. Hypotension
B. Bradycardia
C. Central cyanosis
, 4
D. Excessive crying
Correct Answer: C. Central cyanosis
Rationale: Central cyanosis due to decreased pulmonary blood flow is a
hallmark of Tetralogy of Fallot and may be seen shortly after birth.
6. What condition may present with a systolic murmur and a split second
heart sound in a neonate?
A. Ventricular Septal Defect (VSD)
B. Atrial Septal Defect (ASD)
C. Tricuspid Atresia
D. Hypoplastic Left Heart Syndrome
Correct Answer: B. Atrial Septal Defect (ASD)
Rationale: ASD often causes a systolic murmur from increased pulmonary
flow and a fixed, split S2 due to prolonged right ventricular systole.
7. Which congenital defect is characterized by a machine-like murmur?
A. Patent Ductus Arteriosus (PDA)
B. Truncus Arteriosus
C. Pulmonary Valve Stenosis
D. Aortic Stenosis
Correct Answer: A. Patent Ductus Arteriosus (PDA)
Rationale: PDA has a continuous, machinery-like murmur heard best at the
left upper sternal border.
HESI Congenital Heart Defect Exam
Bank: Neonatal Care, Surgery &
Emergency Q&A
Table of Contents
Subtopic 1: Initial Assessment and Recognition of Congenital Heart Defects in
Neonates..........................................................................................................2
Subtopic 2: Preoperative Nursing Management of Infants with Congenital
Heart Defects.................................................................................................10
Subtopic 3: Postoperative Nursing Care and Complications in Congenital
Heart Surgery................................................................................................18
Subtopic 4: Long-Term Management, Discharge Education, and Family
Support in CHD..............................................................................................25
Subtopic 5: Emergency Interventions and Complications of Congenital Heart
Defects...........................................................................................................33
, 2
Subtopic 1: Initial Assessment and
Recognition of Congenital Heart Defects in
Neonates
(Questions 1–20)
1. A newborn exhibits cyanosis that does not improve with oxygen therapy.
Which congenital heart defect is most likely responsible?
A. Atrial Septal Defect (ASD)
B. Transposition of the Great Arteries (TGA)
C. Patent Ductus Arteriosus (PDA)
D. Coarctation of the Aorta
Correct Answer: B. Transposition of the Great Arteries (TGA)
Rationale: TGA causes cyanosis that is unresponsive to oxygen because the
systemic and pulmonary circulations are parallel rather than connected in
series, preventing adequate oxygenation of blood.
2. Which physical assessment finding is most concerning in a newborn
suspected of having a congenital heart defect?
A. Heart rate of 130 bpm
B. Occasional regurgitation after feeding
C. Poor feeding with diaphoresis
D. Weight loss of 5% in the first 48 hours
Correct Answer: C. Poor feeding with diaphoresis
Rationale: Poor feeding with sweating indicates increased metabolic demand
and poor cardiac output, which are signs of possible heart failure related to
congenital heart disease.
, 3
3. A nurse notes bounding pulses and a widened pulse pressure in a neonate.
Which heart defect is suspected?
A. Tetralogy of Fallot
B. Coarctation of the Aorta
C. Patent Ductus Arteriosus (PDA)
D. Pulmonary Atresia
Correct Answer: C. Patent Ductus Arteriosus (PDA)
Rationale: PDA results in increased blood flow from the aorta to the
pulmonary artery, leading to bounding pulses and widened pulse pressure
due to volume overload.
4. Which diagnostic tool is the most definitive for identifying congenital heart
defects in neonates?
A. Chest X-ray
B. ECG
C. Echocardiogram
D. Pulse oximetry
Correct Answer: C. Echocardiogram
Rationale: Echocardiography allows visualization of cardiac structures and
blood flow, providing a definitive diagnosis of structural heart defects.
5. A newborn is suspected of having Tetralogy of Fallot. What initial sign
might a nurse observe?
A. Hypotension
B. Bradycardia
C. Central cyanosis
, 4
D. Excessive crying
Correct Answer: C. Central cyanosis
Rationale: Central cyanosis due to decreased pulmonary blood flow is a
hallmark of Tetralogy of Fallot and may be seen shortly after birth.
6. What condition may present with a systolic murmur and a split second
heart sound in a neonate?
A. Ventricular Septal Defect (VSD)
B. Atrial Septal Defect (ASD)
C. Tricuspid Atresia
D. Hypoplastic Left Heart Syndrome
Correct Answer: B. Atrial Septal Defect (ASD)
Rationale: ASD often causes a systolic murmur from increased pulmonary
flow and a fixed, split S2 due to prolonged right ventricular systole.
7. Which congenital defect is characterized by a machine-like murmur?
A. Patent Ductus Arteriosus (PDA)
B. Truncus Arteriosus
C. Pulmonary Valve Stenosis
D. Aortic Stenosis
Correct Answer: A. Patent Ductus Arteriosus (PDA)
Rationale: PDA has a continuous, machinery-like murmur heard best at the
left upper sternal border.
