Pediatric CCRN Exam Pediatric CCRN Cardiovascular 1 — Questions and Answers
Question 1: A 6-month-old with Tetralogy of Fallot develops a sudden hypercyanotic (tet) spell. What is the FIRST intervention?
- Place the infant in the knee-chest position (Correct answer)
- Administer 100% oxygen via face mask
- Give IV morphine sulfate
- Initiate IV fluid bolus
Correct answer: Place the infant in the knee-chest position
The knee-chest position increases systemic vascular resistance and decreases right-to-left shunting, immediately improving oxygenation during a tet spell.
Question 2: Which congenital heart defect produces a continuous 'machinery' murmur best heard at the left upper sternal border?
- Ventricular septal defect
- Patent ductus arteriosus (Correct answer)
- Atrial septal defect
- Pulmonary stenosis
Correct answer: Patent ductus arteriosus
A patent ductus arteriosus produces a continuous machinery-type murmur because blood flows through it in both systole and diastole.
Question 3: A neonate post-cardiac surgery has a central venous pressure of 18 mmHg, decreased urine output, and hepatomegaly. These findings are MOST consistent with:
- Left ventricular failure
- Right ventricular failure (Correct answer)
- Cardiac tamponade
- Hypovolemic shock
Correct answer: Right ventricular failure
Elevated CVP, hepatomegaly, and oliguria indicate right-sided heart failure with systemic venous congestion following cardiac surgery.
Question 4: Which medication is the drug of choice to close a hemodynamically significant patent ductus arteriosus in a premature neonate?
- Prostaglandin E1
- Indomethacin (Correct answer)
- Digoxin
- Furosemide
Correct answer: Indomethacin
Indomethacin, a prostaglandin synthesis inhibitor (NSAID), promotes ductal closure by reducing prostaglandin E2, which normally keeps the ductus open.
Question 5: A child with a large ventricular septal defect is at greatest risk for developing which complication over time if left unrepaired?
- Eisenmenger syndrome (Correct answer)
- Complete heart block
- Coarctation of the aorta
- Tricuspid atresia
Correct answer: Eisenmenger syndrome
Chronic left-to-right shunting from a large VSD causes pulmonary hypertension; when pulmonary pressure exceeds systemic, Eisenmenger syndrome (reversal of shunt) develops.
Question 6: What does a Qp:Qs ratio greater than 2:1 indicate in a child with a cardiac shunt?
- Significant right-to-left shunting with cyanosis
- Significant left-to-right shunting requiring intervention (Correct answer)
- Balanced pulmonary and systemic blood flow
- Pulmonary vascular obstructive disease
Correct answer: Significant left-to-right shunting requiring intervention
A Qp:Qs >2:1 means pulmonary flow is more than twice systemic flow, indicating significant left-to-right shunting that typically warrants surgical or catheter-based correction.
Pediatric CCRN Exam Pediatric CCRN Cardiovascular 1
A 6-month-old with Tetralogy of Fallot develops a sudden hypercyanotic (tet) spell.
What is the FIRST intervention?