Peds Cardiac

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Sample questions from Peds Cardiac

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 4-month-old infant with Tetralogy of Fallot (TOF) begins to cry during a diaper change, becoming deeply cyanotic with rapid, labored respirations. Which action should the nurse take first?

   • A.Administer 100% oxygen via face mask.
   • B.Place the infant in a knee-chest position.
   • C.Prepare for an immediate dose of morphine sulfate.
   • D.Assess the infant's apical pulse and blood pressure.

   Rationale: The knee-chest position is the priority intervention for a hypercyanotic ('Tet') spell because it increases systemic vascular resistance, reducing the right-to-left shunt and improving pulmonary blood flow. Oxygen and morphine are appropriate secondary interventions, but physical positioning provides the most immediate hemodynamic benefit. Assessment is important, but the nurse must first intervene to stabilize the infant's oxygenation during an acute spell.

2. 2.The nurse is caring for a 6-year-old child 4 hours after a cardiac catheterization via the right femoral artery. The nurse notes the pedal pulse in the right foot is weaker than the left. Which action is the priority?

   • A.Elevate the right leg on two pillows.
   • B.Notify the healthcare provider immediately.
   • C.Document the finding as expected post-procedure.
   • D.Re-evaluate the pulse in 1 hour.

   Rationale: A weakened or absent pulse distal to a catheterization site may indicate arterial obstruction or thrombus formation and requires immediate notification of the provider. While some coolness or diminished pulse can occur initially, persistent or worsening findings are critical. Documentation is necessary, but only after escalating the concern for potential limb ischemia.

3. 3.An infant with a large ventricular septal defect (VSD) is receiving digoxin 20 mcg orally twice daily. The nurse notes the infant has vomited two consecutive feeds and the heart rate is 84 beats/min. Which action should the nurse take?

   • A.Administer the medication and notify the provider.
   • B.Hold the medication and notify the provider.
   • C.Wait one hour and attempt to re-feed the infant.
   • D.Give the medication mixed with an ounce of formula.

   Rationale: Vomiting and bradycardia (heart rate < 90-110 in an infant) are classic signs of digoxin toxicity. The nurse must hold the dose and contact the healthcare provider to check serum digoxin levels and electrolytes. Re-feeding or mixing the medication with food does not address the underlying toxicity risk and may further delay necessary intervention.

4. 4.A nurse is teaching the parents of a child with Kawasaki disease about discharge care. The child received intravenous immunoglobulin (IVIG) therapy. Which instruction is most important to include?

   • A.Avoid live virus vaccinations for at least 11 months.
   • B.Perform daily range-of-motion exercises for joints.
   • C.Apply cooling blankets if a high fever returns.
   • D.Check the child's blood glucose levels daily.

   Answer and rationale are in the full material.

5. 5.A 2-week-old newborn is diagnosed with Coarctation of the Aorta. Which clinical finding should the nurse expect during the physical assessment?

   • A.Bounding pulses in the feet and weak radial pulses.
   • B.Cyanosis of the upper extremities with pink lower extremities.
   • C.Blood pressure in the arms significantly higher than in the legs.
   • D.A continuous machinery-like murmur at the left clavicle.

   Answer and rationale are in the full material.