Neonatal Nurse Practitioner Exam Cardiovascular Assessment and Management 1 — Questions and Answers
Question 1: Which congenital heart defect presents with a 'boot-shaped' heart on chest X-ray and cyanosis?
- Transposition of the great arteries
- Tetralogy of Fallot (Correct answer)
- Ventricular septal defect
- Patent ductus arteriosus
Correct answer: Tetralogy of Fallot
Tetralogy of Fallot causes right ventricular hypertrophy and decreased pulmonary flow, producing a classic boot-shaped heart on CXR and cyanosis.
Question 2: A term neonate has differential cyanosis (pink upper body, blue lower body). Which defect is most likely?
- Coarctation of the aorta
- Transposition of the great arteries with PDA (Correct answer)
- Total anomalous pulmonary venous return
- Hypoplastic left heart syndrome
Correct answer: Transposition of the great arteries with PDA
TGA with a right-to-left ductal shunt causes unoxygenated blood to flow to the lower body while oxygenated blood perfuses the upper body.
Question 3: What is the primary mechanism by which prostaglandin E1 (PGE1) helps a ductal-dependent lesion?
- Closes the ductus arteriosus
- Maintains or reopens the ductus arteriosus (Correct answer)
- Increases systemic vascular resistance
- Reduces pulmonary blood flow
Correct answer: Maintains or reopens the ductus arteriosus
PGE1 prevents closure of the ductus arteriosus, maintaining pulmonary or systemic blood flow in ductal-dependent congenital heart defects.
Question 4: A murmur heard at the left upper sternal border in a premature infant, with a bounding pulse and widened pulse pressure, most likely represents:
- Ventricular septal defect
- Patent ductus arteriosus (PDA) (Correct answer)
- Atrial septal defect
- Pulmonary stenosis
Correct answer: Patent ductus arteriosus (PDA)
A PDA produces a continuous machinery murmur at the left upper sternal border with bounding pulses and wide pulse pressure due to left-to-right shunting.
Question 5: Indomethacin is used to close a hemodynamically significant PDA. What is an important contraindication to its use?
- Mild thrombocytopenia (platelets 120,000)
- Necrotizing enterocolitis or compromised renal function (Correct answer)
- Hyperbilirubinemia
- Mild anemia
Correct answer: Necrotizing enterocolitis or compromised renal function
Indomethacin reduces renal and mesenteric blood flow via prostaglandin inhibition, making NEC and renal impairment contraindications to its use.
Question 6: Which four-extremity blood pressure finding is most consistent with coarctation of the aorta?
- Equal pressures in all four limbs
- Higher blood pressure in lower extremities than upper extremities
- Higher blood pressure in upper extremities than lower extremities by >10 mmHg (Correct answer)
- Low blood pressure in all extremities
Correct answer: Higher blood pressure in upper extremities than lower extremities by >10 mmHg
Coarctation of the aorta causes upper extremity hypertension and reduced perfusion pressure in the lower extremities, creating a measurable gradient.
Neonatal Nurse Practitioner Exam Cardiovascular Assessment and Management 1
Which congenital heart defect presents with a 'boot-shaped' heart on chest X-ray and cyanosis?