Congenital Heart Defects in Children Practice Questions
14 free Congenital Heart Defects in Children practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which defect is characterised by left-to-right shunting and increased pulmonary blood flow without early cyanosis?
- A Tetralogy of Fallot (TOF)
- B Atrial septal defect (ASD)
- C Tricuspid atresia
- D Transposition of the great arteries
Correct answer: Atrial septal defect (ASD)
ASD causes acyanotic left-to-right shunt, increased pulmonary flow, and generally no early cyanosis, consistent with many acyanotic CHDs.
A child with a PDA (patent ductus arteriosus) would most likely present with which finding?
- A Bounding pulses and a “machinery” murmur
- B Single S2 and cyanosis at birth
- C Clubbing and polycythaemia in infancy
- D Murmur disappearing by one month of age
Correct answer: Bounding pulses and a “machinery” murmur
A PDA causes continuous machinery-type murmur and bounding peripheral pulses because of left-to-right shunt and increased systemic flow returning to lungs/left heart.
In the nursing care of a child with CHD, a priority assessment is:
- A Maternal rubella infection in early pregnancy
- B Maternal influenza vaccination during pregnancy
- C Drinking adequate water during pregnancy
- D A routine second-trimester ultrasound
Correct answer: Maternal rubella infection in early pregnancy
Nursing priorities include monitoring oxygenation, perfusion status, growth & development, and feeding tolerance because CHDs impair cardiac output and tissue perfusion.
Which prenatal maternal risk factor is linked to a higher incidence of congenital heart defects?
- A Oxygen saturation, perfusion, growth, and feeding tolerance
- B Growth chart reviewed only at the annual visit
- C Auscultation of heart sounds every six months only
- D Activity tolerance during exercise alone
Correct answer: Oxygen saturation, perfusion, growth, and feeding tolerance
Maternal infections such as rubella during early pregnancy are known risk factors for CHDs, as structural development of the fetal heart is disrupted.
A child with hypoplastic left heart syndrome (HLHS) would have which hemodynamic problem?
- A Placing the child supine with the legs extended flat
- B Placing the child in a knee-chest position, giving oxygen and calming them
- C Giving a large volume of hypotonic IV fluid only
- D Doing nothing because the spell resolves on its own
Correct answer: Placing the child in a knee-chest position, giving oxygen and calming them
HLHS is a cyanotic defect in which the left ventricle, mitral valve, aortic valve or ascending aorta are underdeveloped so systemic circulation is compromised.
Which defect typically causes early signs of heart failure in infancy (tachypnoea, poor feeding, hepatomegaly) due to volume overload?
- A Coarctation of the aorta
- B A large ventricular septal defect (VSD)
- C Tetralogy of Fallot (TOF)
- D Truncus arteriosus
Correct answer: A large ventricular septal defect (VSD)
A large VSD causes left-to-right shunt and increased pulmonary circulation and workload on left heart, resulting in signs of heart failure early in infancy.
A child after surgery for a congenital heart defect develops edema, ascites and weight gain over two days. The nurse recognises these signs as consistent with:
- A Decreased cardiac output and heart failure
- B Improved cardiac output and recovery
- C Expected, normal postoperative findings
- D Dehydration with fluid volume deficit
Correct answer: Decreased cardiac output and heart failure
Post-operative CHD patients are at risk of heart failure due to residual defects or surgical stress; fluid retention and weight gain indicate decreased cardiac output and fluid overload.
A cyanotic spell (“Tet” spell) in a toddler with TOF is best managed by:
- A Placing the child in supine position with legs extended
- B Placing child in knee-chest (squatting) position, administering oxygen and calming the child
- C Giving large volume hypotonic fluids only
- D Ignoring it because it resolves spontaneously
Correct answer: Placing child in knee-chest (squatting) position, administering oxygen and calming the child
In a Tet spell, squatting (or knee-chest) increases systemic vascular resistance, reducing right-to-left shunt, while oxygen and calming reduce the hypoxic episode.
Which congenital heart defect often allows blood to flow from the right side of the heart to the left (right-to-left shunt) and causes clubbing of fingers in older children?
- A Large VSD without obstruction
- B Unrepaired TOF or other cyanotic lesions
- C Small ASD that closes spontaneously
- D Mild coarctation of aorta
Correct answer: Unrepaired TOF or other cyanotic lesions
Cyanotic lesions with right-to-left shunt allow deoxygenated blood into systemic circulation; chronic hypoxia causes clubbing and polycythaemia in older children.
When teaching parents about the nutrition of an infant with CHD who tires easily during feeding, the nurse should advise:
- A Spontaneous closure of the fenestration without consequence
- B Liver congestion or fibrosis, arrhythmias, and thromboembolism
- C Complete resolution of all symptoms after the procedure
- D Progressively increased pulmonary blood flow over time
Correct answer: Liver congestion or fibrosis, arrhythmias, and thromboembolism
Infants with CHD often have increased metabolic demands and fatigue during feeds, so high-calorie formulas and frequent small feeds help meet needs while reducing exertion.
A child with a fenestrated Fontan procedure for single-ventricle physiology is most at risk for which long-term complication?
- A Spontaneous closure of the fenestration without consequence
- B Liver congestion/ fibrosis, arrhythmias, thromboembolism
- C No complications once procedure is done
- D Increased systemic blood flow to lungs only
Correct answer: Liver congestion/ fibrosis, arrhythmias, thromboembolism
Fontan circulation places systemic venous return directly into pulmonary arteries; over time this may cause liver fibrosis, arrhythmias and thromboembolic events.
Which statement best describes the prevalence of congenital heart defects?
- A Deficient fluid volume
- B Impaired gas exchange
- C Imbalanced nutrition: less than body requirements
- D Risk for self-care deficit
Correct answer: Imbalanced nutrition: less than body requirements
CHDs affect approximately 1 % of live births (~1 in 100) and are the most common congenital anomalies.
A 3-year-old child is postoperative for CHD repair. The nurse notes persistent periorbital edema, hepatomegaly and poor weight gain. Which nursing diagnosis is most appropriate?
- A Deficient fluid volume related to losses
- B Impaired gas exchange related to congestion
- C Imbalanced nutrition: less than body requirements
- D Risk for impaired skin integrity from edema
Correct answer: Imbalanced nutrition: less than body requirements
The child shows signs of poor growth and nutrition (weight gain poor) likely due to increased metabolic need and cardiac inefficiency; thus imbalanced nutrition is appropriate.
Which of the following defects is most likely to require prostaglandin E₁ infusion in the newborn period to maintain ductal patency?
- A A small, asymptomatic atrial septal defect
- B Transposition of the great arteries or hypoplastic left heart syndrome
- C Mild coarctation of the aorta in a 5-year-old child
- D A simple ventricular septal defect in a toddler
Correct answer: Transposition of the great arteries or hypoplastic left heart syndrome
In critical congenital heart defects such as TGA or HLHS, maintaining the ductus arteriosus via prostaglandin E₁ is required early to allow systemic or pulmonary circulation until intervention.