1.

You're providing an in-service to a group of new nurses who will be

caring for patients who have Tetralogy of Fallot. Which statement below is
INCORRECT concerning how the blood normally flows through the heart?
*
A. Unoxygenated blood enters through the superior and inferior vena
cava and travels to the left atrium.
B. The pulmonic valve receives blood from the right ventricle and allows
blood to flow to the lungs via the pulmonary artery.
C. The left atrium allows blood to flow down through the bicuspid valve
(mitral) into the left ventricle.
D. Oxygenated blood leaves the left ventricle and flows up through the aortic
valve and aorta to be pumped to the rest of the body.

2. A 4-month-old is diagnosed with Tetralogy of Fallot. You're providing an

illustration to the parent to help him understand the pathophysiology of this
condition. What defects must be present in the illustration to help the parent
understand their child's condition? Select all that apply:*
A. Aortic stenosis
B. Ventricular septal defect
C. Coarctation of aorta
D. Right ventricular hypertrophy
E. Displacement of the aorta
F. Pulmonic stenosis
G. Patent ductus arteriosus

3. As the nurse you know which statements are TRUE about Tetralogy of
Fallot? Select all that apply:*
A. "Tetralogy of Fallot is a cyanotic heart defect."
B. "In this condition the heart has to work harder to pump blood to the
lungs, which cause the right ventricle to work harder and enlarge."
C. "Tetralogy of Fallot is treated with only palliative surgery."
D. "Many patients with this condition will experience clubbing of the
nails."

4. While feeding a 3-month-old infant, who has Tetralogy of Fallot, you

notice the infant's skin begins to have a bluish tint and the breathing rate has
increased. Your immediate nursing action is to?*
A. Continue feeding the infant and place the infant on oxygen.
B. Stop feeding the infant and provide suction.
C. Stop feeding the infant and place the infant in the knee-to-chest
position and administer oxygen.
D. Assess the infant’s heart rate and rhythm.
 5. You are assessing the heart sounds of a patient with a severe case of
Tetralogy of Fallot. You would expect to hear a __________ murmur at the
_______ of the sternal border?*
A. diastolic; right
B. systolic; left
C. diastolic; left
D. systolic; right

6. As the registered nurse you are developing a plan of care for a patient
with Tetralogy of Fallot. Select all the appropriate nursing diagnoses below
that would be specific to this patient:*
A. Risk for deficient fluid volume
B. Ineffective airway clearance
C. Activity Intolerance
D. Failure to thrive
E. Risk for impaired liver function

7. A family member, who is caring for a 2-year-old with Tetralogy of

Fallot, asks you why the child will periodically squat when playing with
other children. Your response is:*
A. “Squatting helps to increase systemic vascular resistance, which will
decrease the right to left shunt that is occurring in the ventricles and this helps
increase oxygen levels.”
B. “Squatting helps to decrease systemic vascular resistance, which will
decrease the left to right shunt that is occurring in the ventricles and this helps
increase oxygen levels.”
C. “Squatting helps to decrease systemic vascular resistance, which will
increase the right to left shunt that is occurring in the ventricles and this helps
increase oxygen levels.”
D. “Squatting helps to normalize systemic vascular resistance, which will
increase the left to right shunt that is occurring in the ventricles and this helps
increase oxygen levels.”

8. You're caring for a newborn who has Tetralogy of Fallot with severe
cyanosis. You anticipate the newborn will be started on ___________?*
A: Indomethacin
B. Diclofenac
C. Celecoxib
D. Alprostadil
 9. True or False: Atrial septal defects are characterized by a hole in the
interatrial septum that allows blood to mix in the right and left atria, which
are the lower chambers of the heart.
True
False

10. A patient is diagnosed with a large atrial septal defect. You’re providing
information for the patient on the complications related to this condition.
What topics will you include in the patient's education? Select all that
apply:
A. Tet spells
B. Heart failure
C. Stroke
D. Pulmonary Hypertension
E. Rheumatic Fever

11. An echocardiogram shows that your patient has an atrial septal defect
located at the bottom of the septum near the tricuspid and mitral valves. As
the nurse you know this is what type of atrial septal defect (ASD)?
A. Ostium Primum
B. Ostium Secundum
C. Sinus Venosus
D. Coronary Sinus

12. You’re caring for a 2-year-old patient who has a large atrial septal
defect that needs repair. This defect is causing complications. These
complications are arising from an abnormal shunting of blood throughout
the heart. As the nurse, you know that a __________________ shunt is
occurring in the heart due to the defect.
A. Right-to-left
B. Right
C. Left
D. Left-to-right

13. You’re assessing the heart sounds of a child with an atrial septal defect.
You note a heart murmur at the 2nd intercostal space at the left upper
sternal border. Heart murmurs noted in patients with an atrial septal defect
are called?
A. Holosystolic murmurs
B. Diastolic murmurs
C. Early systolic murmurs
D. Midsystolic murmurs
 14. Select the structure below that allows blood to flow from the right to left
atrium in utero and that should close after birth:
A. Ductus Arteriosus
B. Formen Ovale
C. Ductus Venosus
D. Ligamentum teres

15. After admitting a child with an atrial septal defect, you start developing
a nursing care plan. What nursing diagnoses can you include in the patient's
plan of care based on the complications that arise from this condition?
Select all that apply:
A. Activity Intolerance
B. Risk for Infection
C. Decrease Cardiac Output
D. Excess Fluid Volume
E. Risk for Aspiration

16. True or False: Atrial septal defects can lead to a decrease in lung blood
flow.
True
False

17. A two-month-old is showing signs and symptoms of heart failure. An

echocardiogram is ordered. The test shows the infant has a ventricular
septal defect (VSD). Which statement below best describes the blood flow
in the heart due to this congenital heart defect?*
A. “The blood in the heart is shunting from the right ventricle to the left
ventricle, which is increasing pulmonary blood flow.”
B. “The blood in the heart is shunting from the left ventricle to the right
ventricle, which is decreasing pulmonary blood flow.”
C. “The blood in the heart is shunting from the left ventricle to the right
ventricle, which is increasing pulmonary blood flow.”
D. “The blood in the heart is bypassing the left ventricle and is being shunted to
the right ventricle, which is decreasing lung blood flow.”

18. An infant has a large ventricular septal defect (VSD). The defect is
located in the upper section of the ventricular septum and is near the
tricuspid and aortic valve. Based on this description, what type of
ventricular septal defect is this?*
A. Outlet (conal or subarterial)
B. Muscular
C. Inlet (atrioventricular)
D. Membranous

19. TRUE or FALSE: A small muscular ventricular septal defect has a high
probability of self-closure, and these types of VSDs are found in the lower
portion of the ventricular septum.*
True
False

20. TRUE or FALSE: The signs and symptoms of a ventricular septal

defect are most commonly detected in a baby following birth.*
True
False

21. A concerned mother brings her 3-month-old to the clinic. The mother
states the infant seems to be small for its age. In addition, she states the
infant fatigues very easily while feeding and rarely finishes a feeding.
While collecting a thorough health history, what other signs and symptoms
described by the mother may indicate the child has a congenital heart
defect, such as a ventricular septal defect? Select all that apply:*
A. Diarrhea
B. Frequent treatment for lung infectio
C. Excessive wet diapers
D. Diaphoresis when nursing
E. Swelling in the hands and feet

22. After speaking with the mother of the infant in the previous question,
who may have a ventricular septal defect, you auscultate heart sounds. If a
ventricular septal defect was present, you may hear a harsh murmur that is
_______________________.*
A. Located at the lower left sternal border and starts at S1 and extends into S2.
B. Located at the upper left sternal border and is continuous during systole.
C. Located at the lower left sternal border and is continuous machine-like.
D. Located at the upper left sternal border and is only heard during diastole.

23. A 4-month-old is scheduled to take Digoxin for treatment of a

ventricular septal defect. The patient’s apical pulse is 89 beats per minute.
As the nurse you will? Select all that apply:*
A. Hold the dose
B. Recheck the pulse via the brachial artery
C. Administer the dose as scheduled
D. Notify the physician
 24. As the nurse you know that if a patient has a large ventricular septal
defect and does not receive treatment, the patient may develop Eisenmenger
Syndrome. This syndrome causes?
A. A reversal of blood shunting in the heart from right to left and will cause
pulmonary hypertension.
B. A reversal of blood shunting in the heart from left to right and will cause
cyanosis.
C. A reversal of blood shunting in the heart from left to right and will cause
pulmonary hypertension.
D. A reversal of blood shunting in the heart from right to left and will cause
cyanosis.

25. You're caring for a 2-day-old infant with a large patent ductus
arteriosus. The mother of the infant is anxious and asks you to explain her
child's condition to her again. Which statement below BEST describes this
condition?*
A. "The vessel connecting the aorta and pulmonary vein has closed
prematurely, which is leading to increased blood flow to the lungs."
B. "The vessel connecting the aorta and pulmonary artery has failed to close at
birth, which is leading to a left-to-right shunt of blood."
C. The vessel connecting the aorta and pulmonary vein has failed to close at
birth, which is leading to a right-to-left shunt of blood."
D. "The vessel connecting the aorta and pulmonary artery has closed
prematurely, which is leading to a left-to-right shunt of blood."

26. As the nurse you know which statements below are correct about the
ductus arteriosus? Select all that apply:*
A. "The ductus arteriosus is a structure that should be present in all babies in
utero.
B. "The ductus arteriosus normally closes about 3 days after birth or sooner."
C. "The purpose of the ductus arteriosus is to help carry blood that is entering
the left side of the heart to the rest of the body, hence bypassing the lungs."
D. "The ductus arteriosus connects the aorta to the pulmonary vein."

27. While assessing a newborn’s heart sounds you note a loud murmur at
the left upper sternal border. You report this to the physician who suspects
the infant may have patent ductus arteriosus. The physician asks you to
obtain a pulse pressure. If patent ductus arteriosus is present, the pulse
pressure would be ___________.*
A. Narrow
B. Fluctuating
C. Wide
D. Normal
 28. As noted in the previous question, a loud murmur was noted during
assessment of a newborn with patent ductus arteriosus. As the nurse you
know that what type of murmur is a hallmark sign of this condition?*
A. harsh, loud systolic murmur
B. soft, blowing diastolic murmur
C. systolic and diastolic machinery-like murmur
D. machinery-like murmur present on only diastole

29. You’re working on a unit that provides specialized cardiac care to the
pediatric population. Which patient below would be the best candidate for
Indomethacin from the treatment of patent ductus arteriosus?*
A. A 25-year-old adult
B. A premature infant
C. An 8 month old child
D. A 12 year old child

30. You’re working in the NICU providing care to a neonate who has a
large patent ductus arteriosus. Which finding during your head-to-toe
assessment would require you to immediately notify the physician?*
A. Loud, harsh continuous murmur
B. Abnormal pulse pressure
C. Crackles
D. Diaphoresis when feeding

31. You’re providing education to the parents of a child who has a patent
ductus arteriosus. The parents want to know the complications of this
condition. In your education, you will include which of the following
complications of PDA? Select all that apply:*
A. Heart failure
B. Pulmonary hypertension
C. Recurrent lung infections
D. Clubbing of the fingernails
E. Endocarditis
F. Pulmonary stenosis

32. A newborn baby is born with transposition of the great arteries (TGA).
You're explaining the condition to the parents. Which statement by the
father demonstrates he understood the education provided about this
condition?*
A. "The pulmonary vein and artery are switched, which causes the pulmonary
vein to deliver unoxygenated blood to the systemic circulation while the
pulmonary artery delivers oxygenated blood back to the lungs."
B. "The aorta and pulmonary vein are switched, which causes the aorta to arise
from the right ventricle and the pulmonary vein to arise from the left ventricle."
C. "The aorta and pulmonary artery are switched, which causes the aorta to
arise from the left ventricle and the pulmonary artery to arise from the right
ventricle."
D. "The aorta and pulmonary artery are switched, which causes the aorta to
arise from the right ventricle and the pulmonary artery to arise from the left
ventricle."

33. A newborn baby with transposition of the great arteries has an

echocardiogram performed to detect if any other defects are present in the
heart. As the nurse, you know that what other defects can most commonly
occur with TGA? Select all that apply:*
A. Complete atrioventricular canal defect
B. Ventricular septal defect
C. Patent ductus arteriosus
D. Tricuspid atresia
E. Tetralogy of fallot
F. Atrial septal defect

34. A newborn baby, who is diagnosed with transposition of the great

arteries, is ordered by the physician to be started on an infusion of
prostaglandin E (alprostadil). The purpose of this medication is to:*
A. Prevent the closure of the foramen ovale.
B. Allow a continued connection between the aorta and pulmonary artery via
the ductus arteriosus.
C. Prevent the closure of the ductus venosus.
D. Increase the blood flow to the pulmonary vein, which will increase oxygen
levels.

35. You're educating the parents of a patient with transposition of the great
arteries about the treatment options. Which treatment option below provides
a permanent solution and is performed within the first few weeks of life?*
A. Prostaglandin E infusion
B. Balloon atrial septostomy
C. Arterial switch procedure
D. Complete repair with a patch

36. True or False: In a normal heart without any type of congenital heart
defect, the pulmonary vein carries oxygenated blood away from the lungs to
the left side of the heart.*
True
False
 37. Your newborn patient has a severe case of transposition of the great
arteries. The baby does not have any other defects and is therefore
experiencing severe cyanosis and needs medical intervention immediately.
The newborn is started on prostaglandin E and is scheduled for a balloon
atrial septostomy. Select the statement below that best describes this
procedure:*
A. During this procedure the pulmonary artery and aorta are switched along
with their coronary arteries.
B. This procedure will enlarge a hole in the ventricular septum and provide
permanent treatment for this condition.
C. During this procedure a hole in the atrial septum is enlarged, which will be
temporary.
D. The procedure will switch the pulmonary vein and aorta long with their
coronary arteries, which will be permanent.

38. Select all the signs and symptoms of how a newborn with transposition
of the great arteries may present after birth:*
A. Machinery-like heart murmur
B. Cyanosis
C. Low oxygen levels
D. Bounding pulses in the upper extremities
E. Increased respiratory rate
F. Increased heart rate
G. Knee-to-chest position

39. A newborn is diagnosed with truncus arteriosus. You're educating the

parents about this heart defect. Which statement by the mother
demonstrates she understood the education provided about this condition?*
A. "My baby has narrowing in the pulmonary artery, and the aorta is arising out
of the right ventricle rather than the left ventricle."
B. "My baby's heart shares one artery that connects the right and left
ventricles."
C. "The left side of my baby's heart is not fully developed."
D. "The natural structure in my baby's heart, the ductus arteriosus, has failed to
close after birth leading to more blood flow to the lungs."

40. What other congenital heart defect is most commonly present in truncus
arteriosus?*
A. Atrial septal defect
B. Pulmonary stenosis
C. Tetralogy of Fallot
D. Ventricular septal defect
 41. Which of the following genetic disorders increases a patient risk of
developing truncus arteriosus?*
A. Edward's syndrome (trisomy 18)
B. Down syndrome
C. DiGeorge syndrome
D. Patau syndrome

42. A 3-day-old infant is diagnosed with truncus arteriosus. As the nurse,

you know to monitor the infant for what complications? Select all that
apply:*
A. Tet spells
B. Heart failure
C. Pulmonary hypertension
D. Increased cardiac output

43. A 1-day-old infant is ordered an echocardiogram due to abnormal signs

and symptoms related to a congenital heart defect. The echo confirms that
truncus arteriosus is present. What signs and symptoms may present in this
congenital heart defect? Select all that apply:*
A. Cyanosis
B. Machinery-like murmur
C. Poor feeding
D. Inability to gain weight
E. Hypercyanotic spells
F. Clubbing of fingers

44. You're teaching a class to a group of parents about congenital heart

defects. During the class discussion, you ask the group to describe the
surgical repair for truncus arteriosus. Select all the TRUE statements by the
group members about this surgical repair:*
A. "During the surgery the pulmonary arteries are separated from the truncus
arteriosus and connected to the right ventricle using a valved conduit."
B. "This surgery is done within the first 2-3 months of life."
C. "Some patients may need another surgical repair later on because of
narrowing of the conduit that may occur or they may outgrow it."
D. "During the surgery the aorta is separated from the truncus arteriosus and
connected to the left ventricle using a valved conduit."

45. A newborn is taking Digoxin prior to surgical repair of a truncus

arteriosus. You’re assessing morning labs and the patient’s Digoxin level is
1.8 ng/mL. The next dose of Digoxin is due at 1000. As the nurse you will?
Select all that apply:*
A. Redraw a Digoxin level to confirm the morning lab level
B. Hold the 1000 dose and notify the physician
C. Administer the dose as ordered
D. Administer the dose as ordered, but notify the physician about the abnormal
level
E. Check apical pulse prior to administration of the scheduled dose at 1000
F. Hold scheduled dose if apical pulse less than 60

46. An ACE inhibitor is ordered by the physician for an infant with truncus
arteriosus. This medication will decrease afterload and help with the
management of heart failure. Which medication below is an ACE inhibitor?
*
A. Losartan
B. Celiprolol
C. Furosemide
D. Catopril

47. You’re developing a care plan for an infant with truncus arteriosus.
When analyzing the pathophysiology for this condition, what nursing
diagnosis can be included in this patient’s plan of care? Select all that
apply:*
A. Risk for increase cardiac output
B. Imbalance Nutrition
C. Activity intolerance
D. Ineffective breathing pattern

48. Prior to surgery for truncus arteriosus, what medications may be ordered
to help with heart function and complications related to heart failure? Select
all that apply:*
A. Angiotensin II receptor blockers (ARBs)
B. Digoxin
C. ACE Inhibitors
D. Diuretics

49. Select all the true statements about the aorta:*

A. “The ascending aorta branches off to supply the coronary arteries of the
heart.”
B. “It’s the third largest artery in the body.”
C. “The aorta comes off the right ventricle and supplies oxygenated blood to
the body.”
D. “The aortic arch branches off to supply the head, neck, and upper
extremities.”

50. You’re caring for a child with coarctation of the aorta and educating the
parents about the child’s condition. Which statement by the parents
demonstrates they understood the pathophysiology of this defect?*
A. “This condition can lead to right-sided heart failure.”
B. “The narrowing of the aorta leads to a high blood pressure in the arteries that
are found before the site of narrowing in the aorta.”
C. “The dilation of the aorta leads to a decrease blood pressure in the arteries
that are found after the site of dilation.”
D. “The upper and lower extremities will experience a decrease in blood flow
due to the defect in the aorta.”

51. A newborn has severe coarctation of the aorta. What signs and
symptoms would you expect to find in this patient? Select all that apply:*
A. Very strong bounding pulses in the upper extremities
B. Cool legs and feet
C. Machine-like murmur only on systole
D. Tet spells with activity
E. Severe cyanosis
F. Absent/diminished femoral pulses

52. You’re performing a head-to-toe- assessment on a newborn with severe

coarctation of the aorta. You note a systolic heart murmur. Where is this
heart murmur best auscultated in a patient with this condition?*
A. at the 4th intercostal space left to the sternal border
B. at the left interscapular area
C. at the 2nd intercostal space right to the sternal border
D. at the mid-subclavicular line right of the sternal border

53. You’re providing discharge education to the parents of a child who just
had surgery to repair coarctation of the aorta. What should the nurse include
in the teaching about issues that can arise after surgery that must be closely
monitored by a cardiologist? Select all that apply:*
A. Dilation of the aorta
B. Restenosis of the aorta
C. Hyperglycemia
D. Hypertension

54. As the nurse you know that some patients who have coarctation of the
aorta will develop collateral circulation of the arteries due to the
abnormality on the aorta. Which option below indicates a patient is
experiencing collateral circulation?*
A. Chest x-ray that demonstrates notching on the ribs
B. A harsh diastolic murmur on inspiration at the 2nd intercostal border
C. Ejection fraction of 12% on an echocardiogram
D. Chest x-ray that demonstrates cardiomegaly

55. After the birth of a newborn with severe coarctation of the aorta, the
physician orders a prostaglandin infusion. As the nurse you know that this
medication will have what type of therapeutic effects? Select all that
apply:*
A. Prevent the foramen ovale from closing
B. Allow a connection between the aorta and pulmonary artery
C. Decrease the workload on the left ventricle
D. Increase blood flow to the lower extremities