The College of Maasin

“Nisi Dominus Frustra”

College of Nursing and Allied Health Sciences
Competency Appraisal 1
Quiz 2

1. A baby, exhibiting no obvious signs of congestive heart failure, has been diagnosed with a small ventricular septal
defect. Which of the following information should the nurse explain to the baby’s parents?
1. Th e baby will likely need open-heart surgery within a week.
2. Th e defect will likely close without therapy.
3. Th e defect likely developed early in the second trimester.
4. Th e baby will likely be placed on high-calorie formula.

2. A nurse is educating the parents of a child with an atrial septal defect regarding the child’s condition. Which of the
following information would be appropriate for the nurse to provide?
1. The baby becomes cyanotic because the blood is fl owing through a hole from the right side of the heart to the left
side of the heart.
2. The baby has a murmur because there is a hole between the aorta and the pulmonary artery.
3. The baby’s heart is working harder than a normal heart because some of its blood is reentering the pulmonary
system.
4. The baby’s heart rate is slowed because of the high number of red blood cells in the blood.

3. A newborn baby is receiving digoxin (Lanoxin) and furosemide (Lasix) for congestive heart failure. Which of the
following actions would be appropriate for the nurse to perform?
1. Hold digoxin if the apical heart rate is 170 bpm.
2. Hold digoxin for a digoxin level of 1 ng/mL.
3. Hold both the digoxin and furosemide for a weight increase of 5% in one day.
4. Hold both the digoxin and the furosemide for a potassium 3.2 mEq/L.

4. A baby that was born 5 minutes earlier is tachypneic, tachycardic, and markedly cyanotic. A STAT echocardiogram
confi rms the presence of a cyanotic congenital cardiac defect. Which of the following defects would be consistent
with the assessment fi ndings?
1. Patent ductus arteriosus
2. Transposition of the great vessels
3. Atrial septal defect
4. Ventricular septal defect

5. The neonatal cardiologist orders digoxin (Lanoxin)for a newborn in congestive heart failure. Th e baby weighs 7 lb 8
oz and is 21 inches long. Th e drug reference states: for full-term newborns, 8 to 10 mcg/kg/day in divided doses every
12 hr. Which of the following orders would be safe for the nurse to administer?
1. 10 mcg PO every 12 hr
2. 15 mcg PO every 12 hr
3. 20 mcg PO every 12 hr
4. 25 mcg PO every 12 hr

6. A 7-year-old child has been diagnosed with rheumatic fever. Which of the following physical fi ndings would the
nurse expect to assess?
1. Vesicular rash over the face and chest
2. Warm and swollen knees and elbows
3. Palpable mass in the upper right quadrant of the abdomen
4. Yellow pigmentation of the sclerae of the eyes
7. A 12-year-old child has been diagnosed with group A strep pharyngitis. Th e primary health-care provider has
ordered penicillin V 500 mg PO tid for 10 days. Which of the following questions is important for the nurse to ask the
parents and the child before giving them the prescription?
1. “Is there any reason why you will not be able to take medicine 3 times a day for 10 days?”
2. “Would you rather get 1 shot or take 40 pills?”
3. “Have you ever had strep throat before?”
4. “Do you know of any other children in your school who have recently had sore throats?”

8. A child who has been diagnosed with chorea has been admitted to the pediatric unit with a diagnosis of rheumatic
fever. Immediately prior to admission, the child’s throat culture was positive for group A strep. Which of the following
actions should the nurse perform when admitting the child? Select all that apply.
1. Cover the headboard with a soft material.
2. Put the child on droplet precautions.
3. Place a tracheostomy tray in the child’s room.
4. Have the child perform active range of motion exercises.
5. Assess the child’s apical heart rate for one full minute.

9. A 10-year-old child is in the hospital on bedrest with a diagnosis of rheumatic fever complicated by carditis. When
the nurse responds to the child’s call bell, the child states, “I hate this! I want to get up and play!” Which of the
following responses is appropriate for the nurse to make at this time?
1. “I know that you are unhappy, but you must stay in bed so that you can get better and go home.”
2. “What if we make a deal and I promise to let you get up for 10 minutes every 2 hours if you are very good the rest of
the day?”
3. “I am sure that I can get the doctor to let you go to the playroom for 1 to 2 hours this aft ernoon.”
4. “I am so sorry that you are unhappy, but what if I contact the play lady and have her bring you a selection of video
games to play with?”

10. An 8-year-old girl, who is complaining of a “really bad” sore throat and whose temperature is 102.2°F, is seen in
the school nurse’s offi ce. Th e nurse has the child lie down in a room away from other children. Which of the
following statements is most important for the nurse to convey when calling the child’s parents?
1. “Your child should be seen by her primary care provider.”
2. “Your child is very uncomfortable with a sore throat.”
3. “Your child is crying and asking for mommy and daddy.”
4. “Your child may be contagious to the other children.”

11. A child has been diagnosed with Kawasaki disease. Which of the following signs and symptoms would the nurse
expect to see? Select all that apply.
1. Diarrhea
2. Vertigo
3. Purpural rash over torso
4. Reddened and crusty eyes
5. Skin peeling from hands and feet

12. A 2½-year-old child is in the hospital with Kawasaki disease. Which of the following actions by the nurse is
important for the child’s psychosocial care?
1. Place the child in a single-bedded room.
2. Make sure the child always has his transitional object with him.
3. Supply the child with board games for play.
4. Let the child see what he looks like in a surgical mask and cap.

13. A toddler with Kawasaki disease is to receive IV immune globulin. Which of the following actions must the nurse
perform? Select all that apply.
1. Discard the immune globulin if it appears cloudy.
2. Check the expiration date of the immune globulin.
3. Secure the arm to the arm board with a clear shield.
4. Document the lot number of the infusion in the child’s medical record.
5. Allow the refrigerated immune globulin to warm in the microwave for 1 full minute.

14. A child with Kawasaki disease is to receive IV immune globulin on day 7 of the illness. A parent asks the nurse, “I
am so scared. Will my child be cured aft er getting the medicine?” Which of the following responses by the nurse is
appropriate?
1. “I cannot promise, but children have been shown to have the best results from the medicine when it is given before
the 10th day of the illness.”
2. “I am sure that your child will be fi ne. This medicine has been shown to work well for children with Kawasaki
disease.”
3. “I really do not know. We will fi nd out more when your child has follow up testing in 1 or 2 days.”
4. “I know that you are scared, but it is important for you to have faith in your doctors because they are doing all that
they can do.”

15. The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse
should assess the infant for which early sign of HF?
1. Pallor
2. Cough
3. Tachycardia
4. Slow and shallow breathing

16. The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that
which laboratory study would assist in confirming the diagnosis?
1. Immunoglobulin
2. Red blood cell count
3. White blood cell count
4. Anti–streptolysin O titery

17. On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note
which clinical manifestation of the acute stage of the disease?
1. Cracked lips
2. Normal appearance
3. Conjunctival hyperemia
4. Desquamation of the skin

18. The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for
administration of digoxin (Lanoxin). Which statement made by the parent indicates the need for further instruction?
1. “I will not mix the medication with food.”
2. “I will take my child’s pulse before administering the medication.”
3. “If more than one dose is missed, I will call the health care provider.”
4. “If my child vomits after medication administration, I will repeat the dose.”

19. The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic
therapy. The nurse should use which most appropriate method to assess the urine output?
1. Weighing the diapers
2. Inserting a Foley catheter
3. Comparing intake with output
4. Measuring the amount of water added to formula
20. The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected
aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this
disorder?
1. Pallor
2. Hyperactivity
3. Exercise intolerance
4. Gastrointestinal disturbances

21. The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac
surgery. Which statement made by the parents indicates a need for further instructions?
1. “A balance of rest and exercise is important.”
2. “I can apply lotion or powder to the incision if it is itchy.”
3. “Activities in which my child could fall need to be avoided for 2 to 4 weeks.”
4. “Large crowds of people need to be avoided for at least 2 weeks after surgery.”

22. A child with rheumatic fever will be arriving in the nursing unit for admission. On admission assessment, the nurse
should ask the parents which question to elicit assessment information specific to the development of rheumatic
fever?
1. “Has the child complained of back pain?”
2. “Has the child complained of headaches?”
3. “Has the child had any nausea or vomiting?”
4. “Did the child have a sore throat or fever within the last 2 months?”

23. A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should
the nurse administer the oxygen to the infant?
1. During sleep
2. When changing the infant’s diapers
3. When the mother is holding the infant
4. When drawing blood for electrolyte level testing

24. Assessment findings of an infant admitted to the hospital reveal a machinery-like murmur on auscultation of the
heart and signs of heart failure. The nurse reviews congenital cardiac anomalies and identifies the infant’s condition
as which disorder? Refer to figure (the circled area) to determine the condition.
1. Aortic stenosis
2. Atrial septal defect
3. Patent ductus arteriosus
4. Ventricular septal defect

25. When caring for a child with a ventricular septal defect (VSD), the nurse should monitor for which clinical
manifestations of hemodynamic alterations?
S elect all that apply:
[ ] 1. P ulmonic murmur
[ ] 2. Bradycardia
[ ] 3. T achypnea
[ ] 4. F atigue
[ ] 5. Dyspnea
[ ] 6. A nxiety

26. The nurse is reviewing the chart of a child with coarctation of the aorta. Which of the following findings would the
nurse anticipate?
1. Congestive heart failure
2. Cerebral hypertension
3. Hypoxemia
4. F emoral artery hypertension

27. T he nurse is planning care for a 2-year-old child immediately following cardiac catheterization.
Which of these activities should have the highest priority?
1. Change the dressing at the puncture site
2. A pply direct pressure to the catheterization site for at least 15 minutes
3. M onitor the heart rate for at least 1 minute during vital signs
4. S tart oral fluids
28. The nurse includes which of the following in a discharge teaching plan for parents of a child who has just
undergone a cardiac catheterization for a cardiac defect?
1. M onitor the dressing and stitches until the return appointment
2. M aintain the postsurgical clear liquid diet for 48 hours
3. U se a home cardiac monitoring system
4. A dminister antibiotics for two weeks

29. T he nurse asks the mother of a child suspected of having a congenital heart defect about eating patterns and
activities. Based on an understanding of this child’s condition, which of the following should the nurse consider before
recommending a plan of care?
1. P oor feeding and activity intolerance are common in children with congenital heart
disease
2. T he child’s favorite foods and playtime activities are essential to compliance with therapy
3. T he parenting techniques should be assessed
4. M ealtimes should be coordinated to the child’s activity schedule

30. T he nurse is evaluating heart sounds in four children. Which of the following heart sounds found in a 4-year-old
child does the nurse report as pathologic?
1. S1
2. S2
3. S3
4. S4

31. A 5-year-old child is scheduled for an echocardiogram. She asks the nurse if the test will hurt. Which of the
following is the nurse’s best response?
1. “It is different for everyone.”
2. “I’m not sure. You should ask your physician.”
3. “There will be a jelly that will feel cool, but it won’t hurt.”
4. “The various positions you will have to assume may cause a little discomfort.”

32. The nurse is caring for a child with tetralogy of Fallot who experiences an episode of acute cyanosis. Which of the
following is the primary clinical manifestation the nurse will assess?
1. Decreased respiratory rate
2. Decreased pulse rate and blood pressure
3. L oss of consciousness
4. A nxiousness and irritability

33. Which of the following should be included in the discharge teaching the nurse is preparing for the parents of a
child with tetralogy of Fallot?
1. A demonstration of suctioning procedures
2. T he signs of infection
3. U se of the knee-chest position for cyanotic spells
4. Complete bed rest
34. T he nurse is caring for a child with Kawasaki disease. Which of the following would indicate to the nurse that the
client’s condition is deteriorating?
1. Bradycardia
2. S trep throat
3. Arrhythmias
4. Hypotension

35. T he nurse would expect which of the following clinical manifestations to be present in a 9-month-old infant with
hypoplastic left heart? S elect all that apply:
[ ] 1. H eart murmur
[ ] 2. Cyanosis
[ ] 3. H ypertension
[ ] 4. H eart rate of 130 beats per minute
[ ] 5. T achypnea
[ ] 6. S yncope

36. T he nurse is administering digoxin (Lanoxin) to a child with cardiac disease. The nurse should report which of the
following manifestations indicative of digoxin toxicity? S elect all that apply:
[ ] 1. H ypertension
[ ] 2. Cyanosis
[ ] 3. V isual disturbances
[ ] 4. I nconsolability
[ ] 5. Weakness
[ ] 6. H eadache

37. T he nurse is caring for a child with a possible diagnosis of rheumatic fever. Which of the following assessment
findings does the nurse evaluate as a diagnostic criterion?
1. Decreased erythrocyte sedimentation rate
2. Bradycardia
3. E levation of antistreptolysin (ASO) levels
4. Desquamation of the fingertips

38. When preparing discharge teaching for a family of a child recovering from rheumatic fever, the nurse’s priority
instruction is
1. the child needs to take prophylactic antibiotics to prevent endocarditis.
2. the child should resume school activities as soon as tolerated.
3. parents should inform the school nurse of the child’s illness.
4. parents should monitor the child for poor appetite and growth.

39. Which of the following should the nurse include in the discharge instructions for an infant with an atrial septal
defect?
1. A discussion of speech development
2. Cardiopulmonary resuscitation
3. T he necessity of monitoring for obesity
4. H ome oxygen saturation monitoring

40. A child’s mother asks the nurse how her child got hypertension and what it means. In explaining hypertension in
children, the nurse would most appropriately respond that in children, hypertension “is
1. generally related to another disease process.”
2. generally not treated.”
3. usually nothing to worry about.”
4. related to cholesterol levels.”
41. Which of the following should the nurse include in the preoperative teaching for the parents of a child scheduled
for cardiac surgery?
1. A warning to avoid bringing toys from home to the hospital
2. A warning that siblings should not visit
3. Concepts of pain management
4. A tour of the general pediatric care unit

42. A nurse caring for a young child with a newly diagnosed atrial septal defect would
1. prepare the child for echocardiogram.
2. discuss life expectancy with the parents.
3. assess for signs of liver damage.
4. monitor the child for cyanotic spells.

43. T o reduce cardiac workload, the nurse should implement which of the following nursing interventions for a child
in heart failure?
1. P lace the child in Trendelenburg position
2. E ncourage fluids
3. S chedule regular meals three times a day
4. P rovide a quiet environment

44. The parents of a 3-year-old child with tetralogy of Fallot tell the nurse that their child frequently squats during
play. Based on an understanding of tetralogy of Fallot, the nurse recognizes that this is
1. normal for the child’s developmental age.
2. a sign of constipation.
3. a compensatory mechanism.
4. a disinterest in engaging in play.

45. Which of the following should the nurse include in the plan of care for a child diagnosed with secondary
hypertension?
1. Weight control
2. M anaging cholesterol levels
3. U se of diuretics
4. T reatment of the underlying condition

46. T he nurse caring for an infant with patent ductus arteriosus informs the parents that corrective surgery will
prevent
1. pulmonary vascular congestion.
2. increased systemic venous pressure.
3. cerebral vascular hemorrhage.
4. hepatomegaly.

47. Which of the following is the nurse’s priority intervention in a child with pulmonary stenosis?
1. M onitor for indications of congestive heart failure
2. E ducate the parents regarding home medications
3. P rovide sensory preparation for a chest x-ray
4. Discuss the child’s nutritional and developmental needs

48. A child with an atrioventricular canal has been experiencing difficulty breathing and productive cough for 3 days.
On admission, the nurse notes nasal flaring and retractions. At this point the nurse’s priority action is to
1. inform the physician of the client’s worsening condition.
2. administer oxygen via mask.
3. reassure the parents.
4. obtain the child’s weight.
49. T he nurse is assessing an infant who has been transferred from another facility for examination of possible
cardiac anomalies.The child has congestive heart failure, is severely cyanotic, and is on mechanical ventilation. The
chest x-ray shows an abnormally large right ventricle and a very small left ventricle. The nurse recognizes that this is
most likely
1. coarctation of the aorta.
2. an atrioventricular canal defect.
3. truncus arteriosus.
4. hypoplastic left heart syndrome.

50. T he registered nurse is preparing clinical assignments for a pediatric unit. Which of the following nursing
assignments may be delegated to a licensed practical nurse?
1. I nstruct the parents of a child with septal defect in cardiopulmonary resuscitation
2. I nform the parents of a child with an atrioventricular canal of the clinical manifestations of congestive heart failure
3. A ssist a child with tetralogy of Fallot to a knee-chest position during an acute hypoxic spell
4. A ssess a child with tricuspid atresia for growth retardation and failure to thrive

51. 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?
A. Sepsis
B. Meningitis
C. Mitral valve disease
D. Aneurysm formation

52. 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?
A. Daily use of an antibiotic
B. Pulse rate less than 50 beats/minute
C. Normal weight for age
D. Elevation in red blood cell (RBC) count

53. 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?
A. Aorta exits from the right ventricle, pulmonary artery exits from the left ventricle, and two noncommunicating
circulations
B. Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right ventricular hypertrophy
C. Coarctation of aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus
D. Tricuspid valve atresia, atrial septal defect, ventricular septal defect, and hypoplastic right ventricle

54. 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?
A. A single vessel arising from both ventricles
B. Obstruction of blood flow from the left ventricle
C. Obstruction of blood flow from the right ventricle
D. Return of blood to the heart without entry to the left atrium

55. Bryce is a child diagnosed with coarctation of aorta. While assessing him, Nurse Zach would expect to find which
of the following?
A. Squatting posture
B. Absent or diminished femoral pulses
C. Severe cyanosis at birth
D. Cyanotic (“tet”) episodes
56. 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?
A. Treating streptococcal throat infections with an antibiotic
B. Giving penicillin to patients with rheumatic fever
C. Using corticosteroid to reduce inflammation
D. Providing an antibiotic before dental work

57. 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?
A. Headache
B. Respiratory distress
C. Extreme bradycardia
D. Constipation

58. 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?
A. Feeding the infant over long periods
B. Allowing the infant to have her way to avoid conflict
C. Scheduling care to provide for uninterrupted rest periods
D. Developing and implementing a consistent care plan

59. 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?
A. Replacing regular nipples with easy-to-suck ones
B. Allowing the infant to feed for at least 1 hour
C. Providing large feedings evenly spaced every 4 hours
D. Offering formula that is high in sodium and calories

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

A. Base
B. Pericardium
C. Aorta
D. Apex

61. Arrange these parts of the conduction system of the heart in the correct order as an action potential would pass
through them.
AV node
Purkinje fibers
Atrioventricular bundle
R and L bundle of His
SA node
A. SA Node – Purkinje Fibers – R and L bundle of His – Atrioventricular bundle – AV Node
B. SA Node – AV Node – Purkinje fibers – R and L bundle of His – Atrioventricular bundle
C. SA Node – Purkinje Fibers – Atrioventricular Bundle – R and L bundle of His – AV Node
D. SA Node – AV Node – Atrioventricular bundle – R and L bundle of His – Purkinje Fibers

62. Which of these statements regarding the conduction system of the heart is NOT correct? Select all that apply.
A. The sinoatrial (SA) node of the heart acts as the pacemaker.
B. The SA node is located on the upper wall of the left atrium.
C. The AV node conducts action potentials rapidly through it.
D. Action potentials are carried slowly through the atrioventricular bundle.
63. Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial
circulation?
A. Aortic stenosis (AS)
B. Coarctation of aorta
C. Patent ductus arteriosus (PDA)
D. Tetralogy of Fallot

64. 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:
A. Rashkind Procedure
B. Rastelli Procedure
C. Pulmonary Artery Banding
D. Jatene Procedure

65. The ductus arteriosus is another fetal structure that is important in the intrauterine life. It functions to:
A. Shunts the combined cardiac output from the pulmonary artery to the aorta going to the lungs
B. Shunts the combined cardiac output from the pulmonary artery to the systemic circulation
C. Shunts the combined cardiac output from the aorta to the pulmonary artery and later to the pulmonary veins
D. Shunts the combined cardiac output from the aorta to the pulmonary artery to the right ventricle