Galen College of Nursing – NSG 3600 Nursing Practice –
Children’s Health Exam 2 – Questions and Answers |
2026/2027 Latest Update
SECTION 1: CARDIAC — CONGENITAL HEART DEFECTS AND FETAL CIRCULATION
Questions 1–25
1. Which fetal structure allows blood to move from the right atrium toward the left atrium,
bypassing most of the fetal pulmonary circulation?
A) Foramen ovale
B) Ductus arteriosus
C) Ductus venosus
D) Umbilical vein
Correct Answer: Foramen ovale
Rationale: The foramen ovale is an opening between the fetal right and left atria that allows blood to
bypass the nonfunctioning fetal lungs. The ductus arteriosus connects the pulmonary artery with the
aorta. The ductus venosus helps bypass the fetal liver, while the umbilical vein carries oxygenated
blood from the placenta.
2. During assessment of a newborn, which finding is most consistent with coarctation of the
aorta?
A) Equal blood pressure in all extremities
B) Higher blood pressure in the upper extremities than the legs
C) Bounding pulses in both legs
D) Continuous machinery-like murmur
Correct Answer: Higher blood pressure in the upper extremities than the legs
Rationale: Coarctation narrows the aorta and obstructs blood flow to the lower body. Consequently,
blood pressure is typically higher proximal to the narrowing and lower in the lower extremities. The
defect can increase left ventricular workload and produce diminished lower-extremity pulses. A
continuous machinery murmur is more characteristic of patent ductus arteriosus.
3. Which combination correctly identifies the four defects associated with tetralogy of Fallot?
A) ASD, PDA, pulmonary edema, and LV hypertrophy
B) VSD, aortic stenosis, ASD, and LV hypertrophy
C) VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy
D) PDA, mitral stenosis, VSD, and left ventricular hypertrophy
Correct Answer: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy
Rationale: Tetralogy of Fallot consists of four structural abnormalities: ventricular septal defect,
pulmonary outflow obstruction, overriding aorta, and right ventricular hypertrophy. These
,abnormalities can reduce pulmonary blood flow and cause cyanosis. The American Heart Association
identifies these four findings as the defining components of the condition.
4. What is the primary hemodynamic consequence of a significant ventricular septal defect in a
child?
A) Increased blood flow from the right atrium into the left atrium
B) Complete obstruction of pulmonary blood flow
C) Immediate closure of the ductus arteriosus
D) Increased pulmonary blood flow from left-to-right shunting
Correct Answer: Increased pulmonary blood flow from left-to-right shunting
Rationale: A significant VSD usually permits oxygenated blood from the higher-pressure left ventricle
to move into the right ventricle. This creates a left-to-right shunt and increases pulmonary blood flow.
Large defects can eventually contribute to pulmonary hypertension, heart failure, poor feeding, and
poor growth.
5. Which assessment finding would most strongly suggest heart failure in an infant with
congenital heart disease?
A) Increased appetite and rapid weight gain
B) Tachypnea with feeding and poor weight gain
C) Bradycardia during sleep
D) Increased tolerance for activity
Correct Answer: Tachypnea with feeding and poor weight gain
Rationale: Infants with heart failure often have increased respiratory effort and fatigue during
feeding because feeding requires substantial energy. Tachypnea, diaphoresis, poor feeding, and
failure to thrive are important warning signs. Weight gain may be inadequate because the infant
cannot consume enough calories to meet increased metabolic demands.
6. Which congenital cardiac defect involves an abnormal opening between the atria?
A) Atrial septal defect
B) Ventricular septal defect
C) Coarctation of the aorta
D) Pulmonary stenosis
Correct Answer: Atrial septal defect
Rationale: An atrial septal defect is an opening between the right and left atria. Blood generally
moves from the higher-pressure left atrium toward the right atrium, increasing blood flow through
the pulmonary circulation. VSD involves the ventricles, while coarctation and pulmonary stenosis are
obstructive defects rather than septal openings.
7. A child with tetralogy of Fallot suddenly becomes markedly cyanotic and distressed after
vigorous activity. Which position is commonly used to help improve oxygenation?
A) Supine with legs elevated
, B) Trendelenburg position
C) Knee-chest position
D) Prone with the head turned sideways
Correct Answer: Knee-chest position
Rationale: During a hypercyanotic spell, the knee-chest position increases systemic vascular
resistance and can reduce right-to-left shunting. This helps direct more blood toward the pulmonary
circulation. The child should also be kept calm because crying and agitation can worsen oxygen
demand and cyanosis.
8. Which finding is most characteristic of a clinically significant patent ductus arteriosus?
A) Narrow pulse pressure
B) Weak peripheral pulses
C) Fixed split S2 without other findings
D) Bounding pulses and a wide pulse pressure
Correct Answer: Bounding pulses and a wide pulse pressure
Rationale: A significant PDA allows blood to flow from the aorta into the pulmonary artery after birth.
This produces increased pulmonary blood flow and characteristic bounding pulses with a widened
pulse pressure. A continuous murmur may also be present. These findings are consistent with
recognized PDA physiology.
9. Which medication may be used in selected premature infants to encourage closure of a
patent ductus arteriosus?
A) Ibuprofen
B) Digoxin
C) Furosemide
D) Propranolol
Correct Answer: Ibuprofen
Rationale: Prostaglandins help maintain ductal patency before birth, so medications that inhibit
prostaglandin synthesis can promote ductal closure in selected premature infants. Ibuprofen is one
such medication. Digoxin and furosemide may be used for certain heart-failure management
situations but do not directly close the PDA.
10. Why may a child with a large left-to-right cardiac shunt develop signs of respiratory distress?
A) The lungs receive too little blood
B) Pulmonary blood flow becomes excessive
C) The airway becomes mechanically obstructed
D) Hemoglobin production immediately stops
Correct Answer: Pulmonary blood flow becomes excessive
Children’s Health Exam 2 – Questions and Answers |
2026/2027 Latest Update
SECTION 1: CARDIAC — CONGENITAL HEART DEFECTS AND FETAL CIRCULATION
Questions 1–25
1. Which fetal structure allows blood to move from the right atrium toward the left atrium,
bypassing most of the fetal pulmonary circulation?
A) Foramen ovale
B) Ductus arteriosus
C) Ductus venosus
D) Umbilical vein
Correct Answer: Foramen ovale
Rationale: The foramen ovale is an opening between the fetal right and left atria that allows blood to
bypass the nonfunctioning fetal lungs. The ductus arteriosus connects the pulmonary artery with the
aorta. The ductus venosus helps bypass the fetal liver, while the umbilical vein carries oxygenated
blood from the placenta.
2. During assessment of a newborn, which finding is most consistent with coarctation of the
aorta?
A) Equal blood pressure in all extremities
B) Higher blood pressure in the upper extremities than the legs
C) Bounding pulses in both legs
D) Continuous machinery-like murmur
Correct Answer: Higher blood pressure in the upper extremities than the legs
Rationale: Coarctation narrows the aorta and obstructs blood flow to the lower body. Consequently,
blood pressure is typically higher proximal to the narrowing and lower in the lower extremities. The
defect can increase left ventricular workload and produce diminished lower-extremity pulses. A
continuous machinery murmur is more characteristic of patent ductus arteriosus.
3. Which combination correctly identifies the four defects associated with tetralogy of Fallot?
A) ASD, PDA, pulmonary edema, and LV hypertrophy
B) VSD, aortic stenosis, ASD, and LV hypertrophy
C) VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy
D) PDA, mitral stenosis, VSD, and left ventricular hypertrophy
Correct Answer: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy
Rationale: Tetralogy of Fallot consists of four structural abnormalities: ventricular septal defect,
pulmonary outflow obstruction, overriding aorta, and right ventricular hypertrophy. These
,abnormalities can reduce pulmonary blood flow and cause cyanosis. The American Heart Association
identifies these four findings as the defining components of the condition.
4. What is the primary hemodynamic consequence of a significant ventricular septal defect in a
child?
A) Increased blood flow from the right atrium into the left atrium
B) Complete obstruction of pulmonary blood flow
C) Immediate closure of the ductus arteriosus
D) Increased pulmonary blood flow from left-to-right shunting
Correct Answer: Increased pulmonary blood flow from left-to-right shunting
Rationale: A significant VSD usually permits oxygenated blood from the higher-pressure left ventricle
to move into the right ventricle. This creates a left-to-right shunt and increases pulmonary blood flow.
Large defects can eventually contribute to pulmonary hypertension, heart failure, poor feeding, and
poor growth.
5. Which assessment finding would most strongly suggest heart failure in an infant with
congenital heart disease?
A) Increased appetite and rapid weight gain
B) Tachypnea with feeding and poor weight gain
C) Bradycardia during sleep
D) Increased tolerance for activity
Correct Answer: Tachypnea with feeding and poor weight gain
Rationale: Infants with heart failure often have increased respiratory effort and fatigue during
feeding because feeding requires substantial energy. Tachypnea, diaphoresis, poor feeding, and
failure to thrive are important warning signs. Weight gain may be inadequate because the infant
cannot consume enough calories to meet increased metabolic demands.
6. Which congenital cardiac defect involves an abnormal opening between the atria?
A) Atrial septal defect
B) Ventricular septal defect
C) Coarctation of the aorta
D) Pulmonary stenosis
Correct Answer: Atrial septal defect
Rationale: An atrial septal defect is an opening between the right and left atria. Blood generally
moves from the higher-pressure left atrium toward the right atrium, increasing blood flow through
the pulmonary circulation. VSD involves the ventricles, while coarctation and pulmonary stenosis are
obstructive defects rather than septal openings.
7. A child with tetralogy of Fallot suddenly becomes markedly cyanotic and distressed after
vigorous activity. Which position is commonly used to help improve oxygenation?
A) Supine with legs elevated
, B) Trendelenburg position
C) Knee-chest position
D) Prone with the head turned sideways
Correct Answer: Knee-chest position
Rationale: During a hypercyanotic spell, the knee-chest position increases systemic vascular
resistance and can reduce right-to-left shunting. This helps direct more blood toward the pulmonary
circulation. The child should also be kept calm because crying and agitation can worsen oxygen
demand and cyanosis.
8. Which finding is most characteristic of a clinically significant patent ductus arteriosus?
A) Narrow pulse pressure
B) Weak peripheral pulses
C) Fixed split S2 without other findings
D) Bounding pulses and a wide pulse pressure
Correct Answer: Bounding pulses and a wide pulse pressure
Rationale: A significant PDA allows blood to flow from the aorta into the pulmonary artery after birth.
This produces increased pulmonary blood flow and characteristic bounding pulses with a widened
pulse pressure. A continuous murmur may also be present. These findings are consistent with
recognized PDA physiology.
9. Which medication may be used in selected premature infants to encourage closure of a
patent ductus arteriosus?
A) Ibuprofen
B) Digoxin
C) Furosemide
D) Propranolol
Correct Answer: Ibuprofen
Rationale: Prostaglandins help maintain ductal patency before birth, so medications that inhibit
prostaglandin synthesis can promote ductal closure in selected premature infants. Ibuprofen is one
such medication. Digoxin and furosemide may be used for certain heart-failure management
situations but do not directly close the PDA.
10. Why may a child with a large left-to-right cardiac shunt develop signs of respiratory distress?
A) The lungs receive too little blood
B) Pulmonary blood flow becomes excessive
C) The airway becomes mechanically obstructed
D) Hemoglobin production immediately stops
Correct Answer: Pulmonary blood flow becomes excessive
