NCLEX Practice Exam for Pediatric Nursing: Cardiovascular Disorders

Practice Mode – Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam.

Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.

Text Mode – Text version of the exam

1. A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart from the identified symptoms of the disease, she may also likely develop which of the following?

1. Sepsis
2. Meningitis
3. Mitral valve disease
4. Aneurysm formation

2. Clay is an 8-year-old boy diagnosed with heart failure. Which of the following shows that he is strictly following the directed therapeutic regimen?

1. Daily use of an antibiotic
2. Pulse rate less than 50 beats/minute
3. Normal weight for age
4. Elevation in red blood cell (RBC) count

3. The Foley Family is caring for their youngest child, Justin, who is suffering from tetralogy of Fallot. Which of the following are defects associated with this congenital heart condition?

1. Aorta exits from the right ventricle, pulmonary artery exits from the left ventricle, and two noncommunicating circulations
2. Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy
3. Coarctation of aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus
4. Tricuspid valve atresia, atrial septal defect, ventricular septal defect, and hypoplastic right ventricle

4. When creating a teaching program for the parents of Jessica who is diagnosed with pulmonic stenosis (PS), Nurse Alex would keep in mind that this disorder involves which of the following?

1. A single vessel arising from both ventricles
2. Obstruction of blood flow from the left ventricle
3. Obstruction of blood flow from the right ventricle
4. Return of blood to the heart without entry to the left atrium

5. Bryce is a child diagnosed with coarctation of aorta. While assessing him, Nurse Zach would expect to find which of the following?

1. Squatting posture
2. Absent or diminished femoral pulses
3. Severe cyanosis at birth
4. Cyanotic (“tet”) episodes

6. Which of the following instructions would Nurse Courtney include in a teaching plan that focuses on initial prevention for Sheri who is diagnosed with rheumatic fever?

1. Treating streptococcal throat infections with an antibiotic
2. Giving penicillin to patients with rheumatic fever
3. Using corticosteroid to reduce inflammation
4. Providing an antibiotic before dental work

7. Which of the following would Nurse Tony suppose to regard as a cardinal manifestation or symptom of digoxin toxicity to his patient Clay diagnosed with heart failure?

1. Headache
2. Respiratory distress
3. Extreme bradycardia
4. Constipation

8. Appropriate intervention is vital for many children with heart disease in order to go on to live active, full lives. Which of the following outlines an effective nursing intervention to decrease cardiac demands and minimize cardiac workload?

1. Feeding the infant over long periods
2. Allowing the infant to have her way to avoid conflict
3. Scheduling care to provide for uninterrupted rest periods
4. Developing and implementing a consistent care plan

9. Mr. and Mrs. Baker’s only daughter is diagnosed with heart failure. Which of the following interventions would be appropriate to promote optimal nutrition for the infant?

1. Replacing regular nipples with easy-to-suck ones
2. Allowing the infant to feed for at least 1 hour
3. Providing large feedings evenly spaced every 4 hours
4. Offering formula that is high in sodium and calories

10. It is considered as the bluntly rounded portion of the heart

1. Base
2. Pericardium
3. Aorta
4. Apex

11. Arrange these parts of the conduction system of the heart in the correct order as an action potential would pass through them.

1. AV node
   
2. Purkinje fibers
   
3. Atrioventricular bundle
   
4. R and L bundle of His
   
5. SA node

1. 2—4—3—5—1
2. 2—5—4—3—1
3. 3—5—2—4—1
4. 2—5—3—4—1

12. Which of these statements regarding the conduction system of the heart is NOT correct? Select all that apply.

1. The sinoatrial (SA) node of the heart acts as the pacemaker.
2. The SA node is located on the upper wall of the left atrium.
3. The AV node conducts action potentials rapidly through it.
4. Action potentials are carried slowly through the atrioventricular bundle.

13. Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation?

1. Aortic stenosis (AS)
2. Coarctation of aorta
3. Patent ductus arteriosus (PDA)
4. Tetralogy of Fallot

14. The procedure that has to be performed in order to shift the high pressure from the right ventricle to the left ventricle in Transposition of the Great Arteries (TGA) is:

1. Rashkind Procedure
2. Rastelli Procedure
3. Pulmonary Artery Banding
4. Jatene Procedure

15. The ductus arteriosus is another fetal structure that is important in the intrauterine life. It functions to:

1. Shunts the combined cardiac output from the pulmonary artery to the aorta going to the lungs
2. Shunts the combined cardiac output from the pulmonary artery to the systemic circulation
3. Shunts the combined cardiac output from the aorta to the pulmonary artery and later to the pulmonary veins
4. Shunts the combined cardiac output from the aorta to the pulmonary artery to the right ventricle

Answers and Rationale

1. Answer: D. Aneurysm formation. Kawasaki disease is a rare childhood illness that affects the blood vessels. 20% to 25% of children can develop aneurysm formation if not intervened. Treatment depends on the degree of the disease, but is often immediate treatment with IV gamma globulin or aspirin. Corticosteroids can sometimes lessen impending complications. Children who experience the disease usually need lifelong follow-up appointments to keep an eye on heart health.

2. Answer: C. Normal weight for age

• C: Adequate weight for height demonstrates adequate nutritional intake and lack of edema.
• A: Daily use of antibiotic is not indicated in heart failure.
• B. A pulse rate less than 50 beats/minute, bradycardia, probably indicates digoxin toxicity.
• D: An elevated RBC count demonstrates polycythemia.

3. Answer: B. Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy

• B: The defects associated with tetralogy of Fallot include ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy.
• A: The aorta exiting from the right ventricle with no communication between the systemic and pulmonic circulation describes the defects associated with transposition of the great vessels.
• C: Coarctation of aorta and aortic and mitral valve stenosis are defects associated with tricuspid atresia. Severe coarctation of aorta, severe aortic valvular stenosis or atresia, and severe mitral valve stenosis or atresia are defects associated with hypoplastic left heart syndrome.
• D: Also, the left ventricle, aortic valve, mitral valve, and ascending aorta usually are small or hypoplastic.

4. Answer: C. Obstruction of blood flow from the right ventricle

• C: PS refers to an obstruction of blood flow from the right ventricle.
• A: Truncus arteriosus involves a single vessel arising from both ventricles.
• D: Total anomalous pulmonary venous communications involve the return of blood to the heart without entry into the left atrium and obstruction of blood flow from the left ventricle.

5.  Answer: B. Absent or diminished femoral pulses

• B: Absent or diminished femoral pulse is a classic characteristic of coarctation of aorta.
• C: Severe cyanosis at birth is seen in such defects as transposition of the great vessels.
• A, D: Tet episodes and squatting are characteristic of tetralogy of Fallot.

6. Answer: A. Treating streptococcal throat infections with an antibiotic

• A: Rheumatoid fever results from improperly treated group beta-hemolytic streptococcal infections, usually pharyngitis. Therefore, prompt treatment of streptococcal throat infections with an antibiotic is a key preventive measure.
• B: Initial prevention is not possible once the child has rheumatic fever. However, the child will be treated with penicillin to prevent a recurrence of streptococcal infections.
• C: A corticosteroid may be used to reduce inflammation during treatment of rheumatic fever, not as a preventive measure.
• D: An antibiotic is given to children with cardiac disease to prevent carditis, not rheumatic fever.

7. Answer: C. Extreme bradycardia

• C: Extreme bradycardia is a cardinal sign of digoxin toxicity
• A, B, D: Headache, respiratory distress, and constipation are not related to digoxin toxicity.

8. Answer: C. Scheduling care to provide for uninterrupted rest periods

• C: Organizing nursing care to provide for uninterrupted periods of sleep reduces cardiac demand.
• A: Feeding time should be restricted to a maximum of 45 minutes or discontinued sooner if the infant tires.
• B: In an attempt to get her own way, the child may cry. Excessive crying should be limited; however, appropriate limit setting should still be observed.
• D: Developing and implementing a consistent care plan can be important, but it is not related to decreasing cardiac demands or workload.

9. Answer: A. Replacing regular nipples with easy-to-suck ones

• A: The nurse should replace regular nipples with easy-to-suck-ones because the infant may tire instantly with regular nipples and thus would not be able to suck sufficiently.
• B, C: Also to prevent tiring, small frequent feedings lasting no more than 45 minutes, rather than large evenly spaced feedings or ones lasting longer than 1 hour, should be given.
• D: Typically, the infant receives a low-sodium, high-calorie diet.

10. Answer: D. Apex

• D: The blunt, rounded point of the heart is the apex.
• A: The larger, flat portion at the opposite is the base.
• B: The pericardium is also called the pericardial sac. It has a fibrous outer layer and a thin inner layer that surrounds the heart.
• C: The aorta is the largest artery that carries blood from the left ventricle to the body.

11. Answer: D. 2—5—3—4—1. The SA node is the natural pacemaker of the heart. The electrical stimulus from the SA node eventually reaches the AV node and is delayed briefly so that the contracting atria have enough time to pump all the blood into the ventricles. Once the atria are empty of blood the valves between the atria and ventricles close. At this point, the atria begin to refill and the electrical stimulus passes through the AV node and Bundle of His into the Bundle branches and Purkinje fibers.

12. Answer: B, C, and D

• B: The SA node consists of a cluster of cells that are situated in the upper part of the wall of the right atrium (the right upper chamber of the heart).
• C: When action potentials reach the AV node, they spread slowly through it.
• D: Action potentials pass slowly through the atrioventricular node.
• A: The SA node is the heart’s natural pacemaker.

13. Answer: D. Tetralogy of Fallot

• D: Tetralogy of Fallot consists of four major anomalies: ventricular septal defect, right ventricular hypertrophy, pulmonic stenosis (PS), aorta overriding the ventricular septal defect. PS impedes the flow of blood to the lungs, causing increased pressure in the right ventricle, forcing deoxygenated blood through the septal defect the left ventricle. As a result of this decreased pulmonary flow, deoxygenated blood is shunted into the systemic circulation. The increased workload on the right ventricle causes hypertrophy. The overriding aorta receives blood from both the right and left ventricles. This is the definition of defect with decreased pulmonary blood flow where unoxygenated blood is shunted into the systemic circulation.
• A,B: Coarctation of aorta and AS are obstructive defects where obstruction, not shunting, is the problem.
• C: With PDA, blood flows from the aorta through the PDA and back to the pulmonary artery and lungs (shunting of oxygenated blood to the pulmonic system), causing increased pulmonary vascular congestion.

14. Answer: D. Jatene Procedure

• D: The Jatene procedure, arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextro-transposition of the great arteries (d-TGA).
  
• B: The Rastelli operation was originally used for the repair of d-transposition of the great vessels with ventricular septal defect and pulmonary stenosis. It has subsequently been utilized for a variety of congenital heart defects characterized by two ventricles and overriding of the aorta with severe pulmonary stenosis or pulmonary atresia. Pulmonary atresia with ventricular septal defect and double outlet right ventricle with pulmonary stenosis or atresia are anatomic subtypes also frequently submitted for the Rastelli procedure. Cyanosis is the prevailing preoperative pathophysiology.
• A: A Balloon Atrial Septostomy (Rashkind procedure) is a procedure that is used to create an opening in the wall between the upper chambers of the heart (atria). This is performed in certain cases to improve blood oxygenation, particularly for congenital heart defects. A deflated balloon catheter is guided into the heart and into a small hole in the atrial septum. The balloon is then inflated, created a larger hole in the atrial septum.
• C: The purpose of PAB is to lessen pulmonary artery pressure and excess pulmonary blood flow. PAB requires the insertion of a band around the pulmonary artery to reduce blood flow into the lungs. A variety of banding materials are used; one commonly used material is polytetrafluoroethylene.

15.  Answer: B. Shunts the combined cardiac output from the pulmonary artery to the systemic circulation. In the developing fetus, the ductus arteriosus, also called the ductus Botalli, is a blood vessel connecting the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus’s fluid-filled non-functioning lungs.