Practice Question
The nurse is observing a student nurse caring for an infant with Tetralogy of Fallot. The student asks, “Why does the baby sometimes turn blue and cry inconsolably?" What is the best response by the nurse?
Answer Choices:
Correct Answer:
"This is called a tet spell, which happens when oxygen levels drop suddenly due to increased right-to-left shunting.”
Rationale:
💙 Tetralogy of Fallot is a cyanotic congenital heart defect characterized by VSD, pulmonic stenosis, overriding aorta, and right ventricular hypertrophy.
💙 A “tet spell” occurs when there is a sudden increase in right-to-left shunting through the VSD, often triggered by crying, feeding, or agitation, leading to a sharp drop in oxygen levels.
💙 During a tet spell, the infant may become acutely cyanotic, irritable, and inconsolable, with increased respiratory effort.
💙 Explaining that this is due to decreased pulmonary blood flow and more deoxygenated blood entering systemic circulation helps the student connect behavior with underlying physiology.
💙 This response correctly names the phenomenon (tet spell) and accurately links it to sudden desaturation from increased right-to-left shunt.
"It means the left side of the heart is failing to pump blood effectively, which we refer to as a tet spell.”
💙 Tet spells are not due to isolated left-sided heart failure; rather, they are related to right ventricular outflow obstruction and altered shunting.
💙 In Tetralogy of Fallot, the primary problem is obstruction of blood flow to the lungs and subsequent right-to-left shunting across the VSD.
💙 Left-sided failure would more typically cause pulmonary congestion, tachypnea, and crackles, not classic sudden cyanotic spells.
💙 Calling tet spells a sign of “left-sided heart failure” misrepresents the true pathophysiology and may confuse the learner.
💙 Therefore, this explanation is inaccurate and not the best teaching response.
"This is due to fluid overload in the lungs, causing pulmonary edema."
💙 Pulmonary edema is characterized by fluid accumulation in the alveoli, often resulting from left-sided heart failure or volume overload, not from Tetralogy’s typical mechanism.
💙 In Tetralogy of Fallot, the problem is actually reduced pulmonary blood flow, not excessive fluid in the lungs.
💙 During a tet spell, cyanosis worsens because less blood reaches the lungs for oxygenation, not because fluid is flooding the alveoli.
💙 Describing this as pulmonary edema implies a different pathologic process and does not match the infant’s cyanotic episodes.
💙 Thus, this statement is incorrect and misleads the student regarding the nature of tet spells.
"It is a normal response in infants with congenital heart defects and will resolve on its own."
💙 While tet spells are common in Tetralogy of Fallot, they are not “normal” in the sense of being harmless or ignorable.
💙 These episodes can lead to severe hypoxia, acidosis, and even loss of consciousness if not managed promptly.
💙 They require interventions such as placing the infant in a knee-chest position, administering oxygen, and sometimes morphine or beta-blockers, depending on protocol.
💙 Reassuring the student that this will simply “resolve on its own” ignores the potential life-threatening nature of these spells.
💙 Therefore, this answer is unsafe and inaccurate as education.
Want to practice more questions like this?
This question is from Exam 4 - Modules 8, 9, and 10 which contains 74 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: General Exams
- Domain: 👶🏼Pediatrics
- Answer Choices: 4