Level 1
A newborn takes the first breath after delivery. Which structure normally closes because left atrial pressure becomes greater than right atrial pressure?
A. Ductus venosus
B. Foramen ovale
C. Pulmonary valve
D. Tricuspid valve
Correct answer: B
Rationale:With the first breaths, the lungs inflate, pulmonary vascular resistance drops, blood flow to the left side of the heart increases, and this pressure change leads to closure of the foramen ovale.
Which statement about CCHD screening is correct?
A. The pulse ox is placed on both feet
B. The pulse ox is placed on the right hand and left foot
C. It is done only if a murmur is present
D. It is done after 1 month of age
Correct answer: B
Rationale:CCHD screening is done within the first 24 hours using pulse oximetry on the right hand and left foot.
A child is scheduled for an ECG. Which teaching is correct?
A. “This test is painful.”
B. “You will need to stay still for about 5 minutes.”
C. “You must be NPO after midnight.”
D. “You will need to lie flat for 24 hours after.”
Correct answer: B
Rationale:The ECG is painless, and the child should lie still for about 5 minutes.
A newborn in the nursery has oxygen saturation of 82%, cyanosis, and no improvement after oxygen is applied. The nurse notifies the provider and suspects a congenital heart defect. Which nursing reasoning is best?
A. Cyanosis that does not improve with oxygen suggests cardiac mixing of blood
B. Oxygen always fully corrects cyanotic heart disease
C. This finding is normal in all newborns
D. This most likely means pneumonia only
Correct answer: A
Rationale:The notes emphasize that newborn cyanosis that does not improve with oxygen suggests CHD, often because oxygenated and deoxygenated blood are mixing.
A 4-month-old infant has poor growth, easy fatigability, and shortness of breath. The provider suspects a very large atrial septal defect. Which explanation best matches this defect?
A. Oxygen-poor blood moves from right to left atrium only
B. Oxygenated blood moves from the left atrium to the right atrium
C. The pulmonary artery and aorta are switched
D. The tricuspid valve is absent
Correct answer: B
Rationale:An ASD allows oxygenated blood to move from the left atrium to the right atrium. Large defects can lead to heart failure symptoms.
Which heart defect is caused by failure of the ductus arteriosus to close after birth?
A. ASD
B. VSD
C. PDA
D. PFO
Correct answer: C
Rationale:Patent ductus arteriosus is the failure of the ductus arteriosus to close, causing too much blood to flow to the lungs.
Which screening result means a newborn passes CCHD screening?
A. Right hand 94%, left foot 96%
B. Right hand 96%, left foot 94%
C. Right hand 97%, left foot 96%
D. Right hand 92%, left foot 92%
Correct answer: C
Rationale:To pass, the reading must be greater than 95% in the hand or foot with less than 3% difference between the two sites.
Which test is used to monitor the child’s heart rhythm during normal activity for 24 hours?
A. Echocardiogram
B. Holter monitor
C. Cardiac catheterization
D. Stress test
Correct answer: B
Rationale:A Holter monitor is an ambulatory ECG used over 24 hours during normal activity.
A newborn has a right hand oxygen saturation of 96% and a left foot saturation of 91% during CCHD screening. What should the nurse conclude?
A. The newborn passes because one value is above 95%
B. The newborn passes because both sites were checked
C. The result is abnormal because the difference is greater than 3%
D. The test should only be done on the feet
Correct answer: C
Rationale:A difference greater than 3% between the hand and foot is abnormal, even if one value is normal.
A child with coarctation of the aorta is being assessed. Which additional finding should the nurse expect?
A. High blood pressure in the legs
B. High blood pressure in the arms with pale skin
C. Severe diarrhea and petechiae
D. Clubbing with salty skin
Correct answer: B
Rationale:Coarctation commonly presents with high blood pressure in the arms, lower pressure in the legs, and pale skin.
Which finding in a newborn is most concerning for congenital heart disease?
A. Cyanosis that improves with oxygen
B. Cyanosis that does not improve with oxygen
C. Acrocyanosis in the first few days
D. Soft innocent murmur
Correct answer: B
Rationale:The notes specifically state that cyanosis in a newborn that does not improve with oxygen should make the nurse suspect CHD.
Which diagnostic test is the most comprehensive noninvasive test for cardiac anatomy and function?
A. ECG
B. Holter monitor
C. Echocardiogram
D. Chest x-ray
Correct answer: C
Rationale:The echocardiogram is described as the most comprehensive noninvasive ultrasound for visualizing cardiac anatomy and function.
Which nursing action is most important before cardiac catheterization?
A. Encourage a full breakfast
B. Confirm consent is signed and keep the child NPO
C. Encourage ambulation before sedation
D. Remove all IV access
Correct answer: B
Rationale:Cardiac catheterization is invasive and requires sedation, signed consent, and NPO status before the procedure.
A school-age child returns from cardiac catheterization via the femoral artery. Which finding requires the nurse’s immediate action?
A. Child is sleepy after sedation
B. Child asks when they can get up
C. Bleeding at the puncture site with diminished distal pulse
D. Child reports hunger
Correct answer: C
Rationale:After cardiac catheterization, the nurse must monitor for bleeding and check the distal pulse below the puncture site.
A child with pulmonary atresia is unstable and awaiting repair. Which provider order would the nurse expect?
A. Discontinue all circulation support
B. Prostaglandin E1 to maintain ductal patency
C. Encourage unrestricted activity
D. Start high-dose aspirin for scarlet fever
Correct answer: B
Rationale:For pulmonary atresia, the notes state treatment includes keeping the PDA open, typically with prostaglandin E1.
Which pulse pressure finding is associated with aortic stenosis?
A. Widened pulse pressure with bounding pulses
B. Narrow pulse pressure with weak thready pulses
C. Equal pulses with bradycardia
D. Bounding pulses in all extremities only
Correct answer: B
Rationale:A narrow pulse pressure with a weak thready pulse is associated with aortic stenosis
Which child is most likely to have coarctation of the aorta?
A. Child with high blood pressure in the arms and lower pressure in the legs
B. Child with a barking cough and stridor
C. Child with salty skin and thick mucus
D. Child with a petechial rash after a virus
Correct answer: A
Rationale:Coarctation causes narrowing of the aorta and is associated with higher blood pressure in the upper extremities than the lower extremities.
A child is taking digoxin. Which laboratory value is especially important to monitor?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium only
Correct answer: B
Rationale:The PDF notes highlight monitoring digoxin level and potassium because abnormal potassium increases toxicity risk.
A child with Tetralogy of Fallot is admitted for worsening symptoms. Which assessment finding is most expected?
A. Loud harsh murmur with signs of decreased pulmonary blood flow
B. Bradycardia with absent pulses
C. Productive cough with green sputum only
D. Fever with splinter hemorrhages
Correct answer: A
Rationale:Tetralogy of Fallot is a decreased pulmonary blood flow lesion and the notes describe a loud, harsh murmur as characteristic.
A teenager with congenital heart disease develops fever, fatigue, a new murmur, splinter hemorrhages, and painful red nodules on the fingers. Which nursing action is the priority?
A. Obtain blood cultures first
B. Start ambulation
C. Encourage a stress test
D. Schedule a lipid panel first
Correct answer: A
Rationale:These findings fit infective endocarditis, and the PDF notes say blood cultures first to identify the organism.
A nurse assessing a child for right-sided heart failure would expect which finding?
A. Dry cough and wheezing only
B. Abdominal distention and hepatomegaly
C. Hyperactive bowel sounds
D. Flushed skin and headache
Correct answer: B
Rationale:The PDF notes identify abdominal distention and hepatomegaly as signs of right-sided heart failure in children.
Which congenital heart defect is most associated with a loud harsh murmur and four structural abnormalities?
A. PDA
B. Tetralogy of Fallot
C. TAPVR
D. PFO
Correct answer: B
Rationale:Tetralogy of Fallot consists of four defects and is associated with a loud, harsh murmur.
Which medication is used to keep the ductus arteriosus open in certain critical heart defects?
A. Sildenafil
B. Furosemide
C. Prostaglandin E1
D. Digoxin
Correct answer: C
Rationale:Prostaglandin E1 is used to keep the PDA open, which can be lifesaving in some defects.
A newborn develops significant cyanosis without a murmur during the first days of life. The provider suspects transposition of the great vessels. Which statement best supports this suspicion?
A. TGV usually causes cyanosis only after age 2
B. Significant cyanosis without a murmur in the newborn period is highly indicative of TGV
C. TGV is usually mild and resolves on its own
D. TGV is treated with oral antibiotics first
Correct answer: B
Rationale:The PDF notes say significant cyanosis without a murmur in the newborn period is highly suggestive of TGV/TGA.
A 3-year-old child has fever for 6 days, bilateral nonpurulent conjunctivitis, red cracked lips, strawberry tongue, swollen peeling hands and feet, and unilateral cervical lymphadenopathy. Which complication is the nurse most concerned about?
A. Rheumatic fever
B. Coronary artery aneurysm
C. Glomerulonephritis
D. Endocarditis from IV drug use
Correct answer: B
Rationale:The comparison chart on the last page identifies these findings as Kawasaki disease, and the high-yield cardiac complication is coronary artery aneurysm.