Truncus Arteriosus NCLEX Questions

Truncus arteriosus NCLEX questions for nursing students. Truncus arteriosus is a congenital heart defect disorder.

Don’t forget to watch the lecture on truncus arteriosus before taking the quiz.

This quiz is part of a pediatric NCLEX review series.

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Truncus Arteriosus NCLEX Questions

1. A newborn is diagnosed with truncus arteriosus. You’re educating the parents about this heart defect. Which statement by the mother demonstrates she understood the education provided about this condition?

A. “My baby has narrowing in the pulmonary artery, and the aorta is arising out of the right ventricle rather than the left ventricle.”

B. “My baby’s heart shares one artery that connects the right and left ventricles.”

C. “The left side of my baby’s heart is not fully developed.”

D. “The natural structure in my baby’s heart, the ductus arteriosus, has failed to close after birth leading to more blood flow to the lungs.”

The answer is B. Truncus arteriosus is a congenital heart defect where there is ONE artery along with one truncal valve that connects the right and left ventricles. This structure will function to carry blood to both the lungs and body.  In a normal heart, there should be TWO separate arteries (pulmonary artery and aorta) with their own valves (instead of one truncal valve). The pulmonary artery will carry blood from the right side of the heart to the lungs, and the aorta will carry blood from the left side of the heart to the body.

2. What other congenital heart defect is most commonly present in truncus arteriosus?

A. Atrial septal defect

B. Pulmonary stenosis

C. Tetralogy of Fallot

D. Ventricular septal defect

The answer is D. A ventricular septal defect (VSD) is commonly present in this CHD. The VSD will be near the truncus arteriosus and it will allow blood to mix in the right and left ventricles and enter the truncus artery. It is very uncommon for one not to be present.

3. Which of the following genetic disorders increases a patient risk of developing truncus arteriosus?

A. Edward’s syndrome (trisomy 18)

B. Down syndrome

C. DiGeorge syndrome

D. Patau syndrome

The answer is C. About 33% of babies with truncus arteriosus have a genetic problem called DiGeorge syndrome (C.S. Mott Children’s Hospital).

4. A 3-day-old infant is diagnosed with truncus arteriosus. As the nurse, you know to monitor the infant for what complications? Select all that apply:

A. Tet spells

B. Heart failure

C. Pulmonary hypertension

D. Increased cardiac output

The answers are B and C. This infant has only one artery that is arising out of the right and left ventricle. Deoxygenated and oxygenated blood is mixing in the ventricles, entering the truncus arteriosus, and going to both the lungs and systemic circulation. Consequently, more blood is flowing to the lungs than the systemic circulation (the body) because resistance in lower to the lungs than the body. Hence, it is easier to pump blood to the lungs than to body (blood flow to the body requires a lot of pressure when compared to the lungs). It’s important to note that the blood that is entering the body is a mixture of deoxygenated and oxygenated blood (leading to cyanosis).  Now because there is more blood flow going to the lungs, this leads to damage to the arteries that feed the lungs, and this leads to pulmonary hypertension. The pulmonary hypertension increases the resistance the heart must pump against to get the blood to the lungs. Therefore, the heart becomes very weak from having to pump so hard against the resistance to the lungs, and this leads to heart failure. Many infants with a severe case of truncus arteriosus will develop heart failure within the first 7 days of life. Tet spells are found in the congenital heart defect tetralogy of fallot, and there is DECREASED cardiac output with this condition (not increased).

5. A 1-day-old infant is ordered an echocardiogram due to abnormal signs and symptoms related to a congenital heart defect. The echo confirms that truncus arteriosus is present. What signs and symptoms may present in this congenital heart defect? Select all that apply:

A. Cyanosis

B. Machinery-like murmur

C. Poor feeding

D. Inability to gain weight

E. Hypercyanotic spells

F. Clubbing of fingers

The answers are A, C, and D. Deoxygenated blood is going to the body, while more blood is shifting to pulmonary circulation via a shared artery. This leads to cyanosis (bluish body at birth) and dyspnea. Heart failure and pulmonary hypertension occur within the first weeks of life. The baby can experience poor feeding and poor weight gain, low cardiac output, activity intolerance, sweating that is cold and calmly, nutrition issues, crackles in lungs etc. A heart murmur from the blood flowing through the truncus arteriosus can create a turbulence leading to an ejection systolic murmur heard at the left sternal border. A machinery-like murmur is present in patent ductus arteriosus, and hypercyanotic spells are present in tetralogy of fallot (also called tet spells).

6. You’re teaching a class to a group of parents about congenital heart defects. During the class discussion, you ask the group to describe the surgical repair for truncus arteriosus. Select all the TRUE statements by the group members about this surgical repair:

A. “During the surgery the pulmonary arteries are separated from the truncus arteriosus and connected to the right ventricle using a valved conduit.”

B. “This surgery is done within the first 2-3 months of life.”

C. “Some patients may need another surgical repair later on because of narrowing of the conduit that may occur or they may outgrow it.”

D. “During the surgery the aorta is separated from the truncus arteriosus and connected to the left ventricle using a valved conduit.”

The answers are A and C. These are the only correct statements. Option B is WRONG because this surgery is performed with the first 2 weeks of life. Option D is wrong because during the surgery the pulmonary arteries are separated from the truncus arteriosus and connected to the right ventricle using a valved conduit.

7. A newborn is taking Digoxin prior to surgical repair of a truncus arteriosus. You’re assessing morning labs and the patient’s Digoxin level is 1.8 ng/mL. The next dose of Digoxin is due at 1000. As the nurse you will? Select all that apply:

A. Redraw a Digoxin level to confirm the morning lab level

B. Hold the 1000 dose and notify the physician

C. Administer the dose as ordered

D. Administer the dose as ordered, but notify the physician about the abnormal level

E. Check apical pulse prior to administration of the scheduled dose at 1000

F. Hold scheduled dose if apical pulse less than 60

The answers are: C and E. A normal digoxin level is 0.5-2 ng/mL (the patient’s digoxin level is normal in this scenario). Therefore, the nurse should ADMINISTER the dose as ordered…..AFTER checking the apical pulse. The nurse would hold the dose if the apical pulse was less than 90-110 beats per minute in an INFANT. It is less than 60 bpm for adults (that is why option F is wrong).

8. An ACE inhibitor is ordered by the physician for an infant with truncus arteriosus. This medication will decrease afterload and help with the management of heart failure. Which medication below is an ACE inhibitor?

A. Losartan

B. Celiprolol

C. Furosemide

D. Catopril

The answer is D. This is an ACE inhibitor.

9. You’re developing a care plan for an infant with truncus arteriosus. When analyzing the pathophysiology for this condition, what nursing diagnosis can be included in this patient’s plan of care? Select all that apply:

A. Risk for increase cardiac output

B. Imbalance Nutrition

C. Activity intolerance

D. Ineffective breathing pattern

The answers are B, C, and D. This patient with truncus arteriosus may experience heart failure and pulmonary hypertension along with cyanosis. Heart failure will lead to fatigue, which leads to an inability to tolerant activity (this includes feeding). The infant is at risk for poor feeding and may not be able to gain weight. In addition, breathing will be affected because a dyspnea experienced due to heart failure and cyanosis (patient is unable to get oxygenated blood to the body) leading to an ineffective breathing pattern.

10. Prior to surgery for truncus arteriosus, what medications may be ordered to help with heart function and complications related to heart failure? Select all that apply:

A. Angiotensin II receptor blockers (ARBs)

B. Digoxin

C. ACE Inhibitors

D. Diuretics

The answers are B, C, and D. Digoxin, ACE inhibitors, and Diuretics may be ordered to help with heart function and prevent complications associated with heart failure in an infant prior to surgery.

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