Tetralogy of Fallot NCLEX questions for nursing students. Tetralogy of Fallot (TOF) is a congenital heart defect disorder that will affect four specific structures in the heart.
This quiz is part of a pediatric NCLEX review series.
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Tetralogy of Fallot NCLEX Questions
1. You’re providing an in-service to a group of new nurses who will be caring for patients who have Tetralogy of Fallot. Which statement below is INCORRECT concerning how the blood normally flows through the heart?
A. Unoxygenated blood enters through the superior and inferior vena cava and travels to the left atrium.
B. The pulmonic valve receives blood from the right ventricle and allows blood to flow to the lungs via the pulmonary artery.
C. The left atrium allows blood to flow down through the bicuspid valve (mitral) into the left ventricle.
D. Oxygenated blood leaves the left ventricle and flows up through the aortic valve and aorta to be pumped to the rest of the body.
The answer is A. This statement is INCORRECT. It should say: “Unoxygenated blood enters through the superior and inferior vena cava to the RIGHT (not left) atrium.
2. A 4-month-old is diagnosed with Tetralogy of Fallot. You’re providing an illustration to the parent to help him understand the pathophysiology of this condition. What defects must be present in the illustration to help the parent understand their child’s condition? Select all that apply:
A. Aortic stenosis
B. Ventricular septal defect
C. Coarctation of aorta
D. Right ventricular hypertrophy
E. Displacement of the aorta
F. Pulmonic stenosis
G. Patent ductus arteriosus
The answers are: B, D, E, and F. Let the condition’s name help you: “TETRAOLOGY”…this means there will be FOUR problems with this heart defect. Remember from the lecture the mnemonic RAPS: Right ventricular hypertrophy, Aorta displacement, Pulmonary stenosis, Septal defect (ventricular)
3. As the nurse you know which statements are TRUE about Tetralogy of Fallot? Select all that apply:
A. “Tetralogy of Fallot is a cyanotic heart defect.”
B. “In this condition the heart has to work harder to pump blood to the lungs, which cause the right ventricle to work harder and enlarge.”
C. “Tetralogy of Fallot is treated with only palliative surgery.”
D. “Many patients with this condition will experience clubbing of the nails.”
The answers are A, B, and D. Option C is wrong because this condition can be treated with both palliative surgery (used to help alleviate symptoms until the child is old enough for complete repair) and complete repair. All the other options are correct.
4. While feeding a 3-month-old infant, who has Tetralogy of Fallot, you notice the infant’s skin begins to have a bluish tint and the breathing rate has increased. Your immediate nursing action is to?
A. Continue feeding the infant and place the infant on oxygen.
B. Stop feeding the infant and provide suction.
C. Stop feeding the infant and place the infant in the knee-to-chest position and administer oxygen.
D. Assess the infant’s heart rate and rhythm.
The answer is C. The patient is experiencing a “tet spell”. This is where during any type of activity like feeding, crying, playing etc. the child’s heart (due to Tetralogy of Fallot) is unable to maintain proper oxygen levels in the blood (these activities place extra work on the heart and it can’t keep up). Therefore, there are low amounts of oxygen in the blood, and the skin will become cyanotic (bluish tint) and the respiratory rate will increase (this is the body’s way of trying to increase the oxygen levels in the body but it doesn’t work because it’s not a gas exchange problem in the lungs but a heart problem). The nurse would want to place the infant in the knee-to-chest position. WHY? This increases systemic vascular resistance (which will help decrease the right to left shunt that is occurring in the heart…hence helps replenish the body with oxygenated blood). In addition, the nurse would want to place the patient on oxygen.
5. You are assessing the heart sounds of a patient with a severe case of Tetralogy of Fallot. You would expect to hear a __________ murmur at the _______ of the sternal border?
A. diastolic; right
B. systolic; left
C. diastolic; left
D. systolic; right
The answer is B. The patient will have a harsh systolic murmur due to pulmonary stenosis, which would lead you to find the murmur at the LEFT of the sternal border (the sound location of the pulmonary valve).
6. As the registered nurse you are developing a plan of care for a patient with Tetralogy of Fallot. Select all the appropriate nursing diagnoses below that would be specific to this patient:
A. Risk for deficient fluid volume
B. Ineffective airway clearance
C. Activity Intolerance
D. Failure to thrive
E. Risk for impaired liver function
The answers are C and D. A patient with TOF will have activity intolerance because remember this is a cyanotic heart defect where there is not enough oxygen in the blood (due to the structural defect of the heart) and any activity (feeding, crying, play etc.) can increase the demands for oxygen. Therefore, the patient will experience activity intolerance. In addition, the patient can experience failure to thrive because the constant hypoxemia (low oxygen in the blood) experienced can lead the child to have poor growth, weight loss, clubbing of the nails etc. Remember organs need plenty of oxygen to work and grow but in TOF this isn’t happening very well. Options A, B, and E are not appropriate nursing diagnoses.
7. A family member, who is caring for a 2-year-old with Tetralogy of Fallot, asks you why the child will periodically squat when playing with other children. Your response is:
A. “Squatting helps to increase systemic vascular resistance, which will decrease the right to left shunt that is occurring in the ventricles and this helps increase oxygen levels.”
B. “Squatting helps to decrease systemic vascular resistance, which will decrease the left to right shunt that is occurring in the ventricles and this helps increase oxygen levels.”
C. “Squatting helps to decrease systemic vascular resistance, which will increase the right to left shunt that is occurring in the ventricles and this helps increase oxygen levels.”
D. “Squatting helps to normalize systemic vascular resistance, which will increase the left to right shunt that is occurring in the ventricles and this helps increase oxygen levels.”
The answer is A. Squatting is common in patient with TOF. Why? Squatting helps to increase systemic vascular resistance, which will decrease the right to left shunt that is occurring in the ventricles and this helps increase oxygen levels.
8. You’re caring for a newborn who has Tetralogy of Fallot with severe cyanosis. You anticipate the newborn will be started on ___________?
The answer is D. Alprostadil, prostaglandin E, will keep the ductus arteriosus open after birth. This will help with keeping the oxygen levels up because it allows more blood to flow to the lungs that is oxygenated via the ductus arteriosus. Remember this usually closes shortly after birth, but in a patient with severe Tetralogy of Fallot this opening needs to stay opened until surgery can be performed.
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