Tetralogy of Fallot — NCLEX Cheat Sheet
4 defects → TET spellsAlso known as: TOF · tet · blue baby · tet spells
Use this quick-reference guide to spot, treat, and prevent Tetralogy of Fallot on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
📌 Types
- PROVe: Pulm stenosis, RVH, Overriding aorta, VSD
- Right-to-left shunt = cyanotic
🩺 Signs
- TET spell: sudden cyanosis, crying
- Clubbing, ↓ O2 sat, murmur
✅ Do
- TET spell → KNEE-CHEST position
- Calm child, give O2, morphine
- Cluster care, prevent crying
🚩 Report
- Deepening cyanosis, ↓ LOC
- Surgical repair is definitive
📚 Tetralogy of Fallot — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Key points
Understand these first- Cyanosis appears because unoxygenated blood is shunted right-to-left across the VSD into systemic circulation.
- Tet spells (hypercyanotic episodes) cause acute deepening cyanosis, irritability, and dyspnea, often during crying, feeding, or stooling.
- Older infants and toddlers instinctively squat or are placed knee-to-chest to relieve a tet spell by increasing systemic vascular resistance.
- A loud systolic murmur is heard at the left sternal border from pulmonary stenosis.
- Chronic hypoxemia leads to clubbing of fingers and toes and polycythemia.
- Chest X-ray classically shows a boot-shaped heart.
Nursing priorities
What to do, in order- During a tet spell, immediately place the infant in a knee-to-chest position and remain calm.
- Administer oxygen and morphine as ordered during hypercyanotic spells to improve flow and reduce agitation.
- Cluster care and feed in small amounts to minimize crying and oxygen demand; allow frequent rest.
- Monitor oxygen saturation, color, respiratory effort, and for signs of dehydration that worsen polycythemia.
- Prepare the family and child for surgical repair and provide pre- and postoperative care.
Red flags — report now
Escalate immediately- A tet spell with rapidly deepening cyanosis, limpness, or loss of consciousness is an emergency.
- Worsening cyanosis, syncope, or seizures during a spell require immediate intervention.
- Polycythemia increases stroke risk; report signs of dehydration or neurologic changes promptly.
- Never leave a cyanotic infant in distress; position knee-to-chest and call for help at once.
Labs & values
Numbers to know- Oxygen saturation: normal 95-100%, often lower in TOF
- Hematocrit: normal 36-46% (children), elevated with chronic hypoxia/polycythemia
- Hemoglobin: normal 11-16 g/dL (children), elevated with polycythemia
Patient teaching
What patients must know- Learn to recognize tet spells and immediately place the child in a knee-to-chest position and call for help.
- Feed slowly in small amounts and allow rest to reduce crying and oxygen demand.
- Keep the child well hydrated to prevent blood from thickening.
- Keep all cardiology follow-up and surgical appointments and report increasing blue color or fainting.
❓ Tetralogy of Fallot: NCLEX FAQs
What are the priority nursing interventions for Tetralogy of Fallot?
During a tet spell, immediately place the infant in a knee-to-chest position and remain calm. Administer oxygen and morphine as ordered during hypercyanotic spells to improve flow and reduce agitation. Cluster care and feed in small amounts to minimize crying and oxygen demand; allow frequent rest. Monitor oxygen saturation, color, respiratory effort, and for signs of dehydration that worsen polycythemia.
What are the warning signs of Tetralogy of Fallot a nurse must report?
A tet spell with rapidly deepening cyanosis, limpness, or loss of consciousness is an emergency. Worsening cyanosis, syncope, or seizures during a spell require immediate intervention. Polycythemia increases stroke risk; report signs of dehydration or neurologic changes promptly. Never leave a cyanotic infant in distress; position knee-to-chest and call for help at once.
What do I need to know about Tetralogy of Fallot for the NCLEX?
Cyanosis appears because unoxygenated blood is shunted right-to-left across the VSD into systemic circulation. Tet spells (hypercyanotic episodes) cause acute deepening cyanosis, irritability, and dyspnea, often during crying, feeding, or stooling. Older infants and toddlers instinctively squat or are placed knee-to-chest to relieve a tet spell by increasing systemic vascular resistance. A loud systolic murmur is heard at the left sternal border from pulmonary stenosis.
What patient teaching is important for Tetralogy of Fallot?
Learn to recognize tet spells and immediately place the child in a knee-to-chest position and call for help. Feed slowly in small amounts and allow rest to reduce crying and oxygen demand. Keep the child well hydrated to prevent blood from thickening. Keep all cardiology follow-up and surgical appointments and report increasing blue color or fainting.
Quick Tip
Cyanosis appears because unoxygenated blood is shunted right-to-left across the VSD into systemic circulation.
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