COMPREHENSIVE PEDIATRIC CARDIAC NURSING
CERTIFICATION & LICENSURE EXAMINATION
Focus: Infant Heart Failure, Digoxin Therapy, Toxicity Recognition,
Congenital Heart Defects & Pharmacologic Management
Total: 200 Clinical Examination Questions with Complete Rationales
MODULE 1: Digoxin Pharmacology, Administration, & Toxicity
Management (Questions 1 - 40)
Q1. A nurse is caring for an infant who has heart failure and is
receiving digoxin. Which of the following findings indicates digoxin
toxicity and should be reported immediately?
A) Heart rate of 110 beats/min
B) Vomiting and refusal to nurse
C) Mild diaphoresis during feeding
D) Respiratory rate of 38 breaths/min
Correct Answer: B) Vomiting and refusal to nurse
Rationale: Gastrointestinal symptoms (vomiting, anorexia, poor
feeding) are cardinal early signs of digoxin toxicity in infants. A heart
rate of 110 bpm is within the normal resting range for an infant (100-160
bpm); toxicity typically presents with bradycardia (<90-100 bpm).
Q2. An infant is prescribed digoxin elixir. Which nursing action is
essential prior to administering each dose?
A) Obtain the infant's blood pressure
B) Auscultate the apical pulse for 1 full minute
C) Check peripheral capillary refill time
D) Assess anterior fontanel tension
Correct Answer: B) Auscultate the apical pulse for 1 full minute
,Rationale: The nurse must auscultate the apical pulse for 60 seconds to
accurately evaluate heart rate and detect bradycardia or arrhythmias
before administering digoxin.
Q3. What is the primary mechanism of action of digoxin in an infant
with congestive heart failure?
A) Direct systemic vasodilation
B) Positive inotropic and negative chronotropic effect
C) Stimulation of beta-2 adrenergic receptors
D) Potassium-sparing diuresis
Correct Answer: B) Positive inotropic and negative chronotropic
effect
Rationale: Digoxin increases myocardial contractility (positive
inotrope) while slowing AV node conduction and heart rate (negative
chronotrope), improving overall cardiac output.
Q4. A laboratory report for an infant receiving digoxin and
furosemide reveals a serum potassium level of 3.0 mEq/L. What is
the nurse's priority action?
A) Administer the scheduled digoxin dose immediately
B) Withhold digoxin and notify the provider regarding hypokalemia
C) Document the finding as a normal expected variant
D) Administer a rapid intravenous bolus of sterile water
Correct Answer: B) Withhold digoxin and notify the provider
regarding hypokalemia
Rationale: Hypokalemia enhances digoxin binding to myocardial
Na+/K+-ATPase pumps, significantly increasing the risk of fatal cardiac
arrhythmias. Digoxin must be withheld until potassium is corrected.
Q5. When teaching parents about administering digoxin elixir at
home, which instruction should the nurse emphasize?
, A) Mix the medication in a full 8 oz bottle of formula to ensure it is
taken
B) Use the calibrated oral syringe provided with the medication
C) Double the next dose if the infant vomits the previous dose
D) Store the medication bottle in the home refrigerator
Correct Answer: B) Use the calibrated oral syringe provided with
the medication
Rationale: Precise dosing is critical for digoxin. A calibrated oral
dispensing syringe (never household spoons) must be used. Never mix in
a full bottle (if the infant doesn't finish, dose is lost). Never double
doses.
Q6. Clinical Scenario 6: A 6-month-old infant with ventricular
septal defect and heart failure is receiving maintenance digoxin
therapy. Which clinical assessment finding requires immediate
nursing intervention?
A) Giving the dose if the infant vomits
B) Administering a double dose after a missed dose
C) Checking the apical pulse for one full minute before every dose
D) Administering the medication via household teaspoon
Correct Answer: C) Checking the apical pulse for one full minute
before every dose
Rationale: Checking the apical pulse for a full minute is a mandatory
safety check prior to each administration to detect bradycardia.
Q7. Clinical Scenario 7: A 6-month-old infant with ventricular
septal defect and heart failure is receiving maintenance digoxin
therapy. Which clinical assessment finding requires immediate
nursing intervention?
A) Greenish-yellow visual halos
, B) Sudden refusal to feed and repeated vomiting
C) Hyperactivity and excessive crying
D) Jaundice of the sclera
Correct Answer: B) Sudden refusal to feed and repeated vomiting
Rationale: Gastrointestinal upset, anorexia, and vomiting are classic
early manifestations of digoxin toxicity in infants.
Q8. Clinical Scenario 8: A 6-month-old infant with ventricular
septal defect and heart failure is receiving maintenance digoxin
therapy. Which clinical assessment finding requires immediate
nursing intervention?
A) Apical heart rate of 82 beats/min
B) Respiratory rate of 40 breaths/min
C) Mild weight gain of 30g over 24 hours
D) Cool extremities with brisk cap refill
Correct Answer: A) Apical heart rate of 82 beats/min
Rationale: An apical heart rate below 90-100 bpm in an infant indicates
severe bradycardia and potential digoxin toxicity, requiring immediate
withholding of the drug and provider notification.
Q9. Clinical Scenario 9: A 6-month-old infant with ventricular
septal defect and heart failure is receiving maintenance digoxin
therapy. Which clinical assessment finding requires immediate
nursing intervention?
A) Serum digoxin level of 0.8 ng/mL
B) Serum digoxin level of 2.4 ng/mL
C) Serum potassium level of 4.5 mEq/L
D) Serum sodium level of 138 mEq/L
Correct Answer: B) Serum digoxin level of 2.4 ng/mL
CERTIFICATION & LICENSURE EXAMINATION
Focus: Infant Heart Failure, Digoxin Therapy, Toxicity Recognition,
Congenital Heart Defects & Pharmacologic Management
Total: 200 Clinical Examination Questions with Complete Rationales
MODULE 1: Digoxin Pharmacology, Administration, & Toxicity
Management (Questions 1 - 40)
Q1. A nurse is caring for an infant who has heart failure and is
receiving digoxin. Which of the following findings indicates digoxin
toxicity and should be reported immediately?
A) Heart rate of 110 beats/min
B) Vomiting and refusal to nurse
C) Mild diaphoresis during feeding
D) Respiratory rate of 38 breaths/min
Correct Answer: B) Vomiting and refusal to nurse
Rationale: Gastrointestinal symptoms (vomiting, anorexia, poor
feeding) are cardinal early signs of digoxin toxicity in infants. A heart
rate of 110 bpm is within the normal resting range for an infant (100-160
bpm); toxicity typically presents with bradycardia (<90-100 bpm).
Q2. An infant is prescribed digoxin elixir. Which nursing action is
essential prior to administering each dose?
A) Obtain the infant's blood pressure
B) Auscultate the apical pulse for 1 full minute
C) Check peripheral capillary refill time
D) Assess anterior fontanel tension
Correct Answer: B) Auscultate the apical pulse for 1 full minute
,Rationale: The nurse must auscultate the apical pulse for 60 seconds to
accurately evaluate heart rate and detect bradycardia or arrhythmias
before administering digoxin.
Q3. What is the primary mechanism of action of digoxin in an infant
with congestive heart failure?
A) Direct systemic vasodilation
B) Positive inotropic and negative chronotropic effect
C) Stimulation of beta-2 adrenergic receptors
D) Potassium-sparing diuresis
Correct Answer: B) Positive inotropic and negative chronotropic
effect
Rationale: Digoxin increases myocardial contractility (positive
inotrope) while slowing AV node conduction and heart rate (negative
chronotrope), improving overall cardiac output.
Q4. A laboratory report for an infant receiving digoxin and
furosemide reveals a serum potassium level of 3.0 mEq/L. What is
the nurse's priority action?
A) Administer the scheduled digoxin dose immediately
B) Withhold digoxin and notify the provider regarding hypokalemia
C) Document the finding as a normal expected variant
D) Administer a rapid intravenous bolus of sterile water
Correct Answer: B) Withhold digoxin and notify the provider
regarding hypokalemia
Rationale: Hypokalemia enhances digoxin binding to myocardial
Na+/K+-ATPase pumps, significantly increasing the risk of fatal cardiac
arrhythmias. Digoxin must be withheld until potassium is corrected.
Q5. When teaching parents about administering digoxin elixir at
home, which instruction should the nurse emphasize?
, A) Mix the medication in a full 8 oz bottle of formula to ensure it is
taken
B) Use the calibrated oral syringe provided with the medication
C) Double the next dose if the infant vomits the previous dose
D) Store the medication bottle in the home refrigerator
Correct Answer: B) Use the calibrated oral syringe provided with
the medication
Rationale: Precise dosing is critical for digoxin. A calibrated oral
dispensing syringe (never household spoons) must be used. Never mix in
a full bottle (if the infant doesn't finish, dose is lost). Never double
doses.
Q6. Clinical Scenario 6: A 6-month-old infant with ventricular
septal defect and heart failure is receiving maintenance digoxin
therapy. Which clinical assessment finding requires immediate
nursing intervention?
A) Giving the dose if the infant vomits
B) Administering a double dose after a missed dose
C) Checking the apical pulse for one full minute before every dose
D) Administering the medication via household teaspoon
Correct Answer: C) Checking the apical pulse for one full minute
before every dose
Rationale: Checking the apical pulse for a full minute is a mandatory
safety check prior to each administration to detect bradycardia.
Q7. Clinical Scenario 7: A 6-month-old infant with ventricular
septal defect and heart failure is receiving maintenance digoxin
therapy. Which clinical assessment finding requires immediate
nursing intervention?
A) Greenish-yellow visual halos
, B) Sudden refusal to feed and repeated vomiting
C) Hyperactivity and excessive crying
D) Jaundice of the sclera
Correct Answer: B) Sudden refusal to feed and repeated vomiting
Rationale: Gastrointestinal upset, anorexia, and vomiting are classic
early manifestations of digoxin toxicity in infants.
Q8. Clinical Scenario 8: A 6-month-old infant with ventricular
septal defect and heart failure is receiving maintenance digoxin
therapy. Which clinical assessment finding requires immediate
nursing intervention?
A) Apical heart rate of 82 beats/min
B) Respiratory rate of 40 breaths/min
C) Mild weight gain of 30g over 24 hours
D) Cool extremities with brisk cap refill
Correct Answer: A) Apical heart rate of 82 beats/min
Rationale: An apical heart rate below 90-100 bpm in an infant indicates
severe bradycardia and potential digoxin toxicity, requiring immediate
withholding of the drug and provider notification.
Q9. Clinical Scenario 9: A 6-month-old infant with ventricular
septal defect and heart failure is receiving maintenance digoxin
therapy. Which clinical assessment finding requires immediate
nursing intervention?
A) Serum digoxin level of 0.8 ng/mL
B) Serum digoxin level of 2.4 ng/mL
C) Serum potassium level of 4.5 mEq/L
D) Serum sodium level of 138 mEq/L
Correct Answer: B) Serum digoxin level of 2.4 ng/mL
