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Web N205/206 Exam 4

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1 :
The nurse is conducting a physical examination of a child with a ventricular septal defect. Which of the following assessment findings is expected with this disorder?

Right ventricular heave - [ 🖤 A right ventricular heave indicates increased right ventricular workload or hypertrophy and is not the classic defining assessment finding of an uncomplicated VSD. 🖤 It may develop when significant pulmonary hypertension causes increased pressure on the right side of the heart. 🖤 The characteristic finding that most directly identifies a VSD is the harsh holosystolic murmur. ]

Holosystolic harsh murmur along left sternal border

Fixed split-second heat sound - [ 🖤 A fixed split S2 is classically associated with an atrial septal defect because of persistently increased right-sided blood flow. 🖤 The splitting remains relatively unchanged with respiration, making it an important auscultatory feature of ASD. 🖤 This finding is not the characteristic heart sound associated with VSD. ]

Systolic ejection murmur - [ 🖤 A systolic ejection murmur is associated with turbulent flow through certain semilunar valves or increased flow across an outflow tract. 🖤 Conditions such as pulmonary stenosis or aortic stenosis can produce characteristic systolic ejection murmurs. 🖤 VSD instead classically produces a harsh holosystolic murmur along the left sternal border. ]

Hint : ❤️ VSD creates turbulent ventricular flow.

Correct Answers:

Holosystolic harsh murmur along left sternal border

Rationale :

🖤 A ventricular septal defect (VSD) is an abnormal opening between the right and left ventricles that permits blood to flow between the ventricular chambers.

🖤 Because left ventricular pressure is normally higher than right ventricular pressure, blood generally moves through the defect from the left ventricle to the right ventricle during systole.

🖤 This left-to-right shunting creates significant turbulent blood flow across the ventricular septal opening.

🖤 The characteristic auscultatory finding is a harsh holosystolic murmur, typically heard best along the lower left sternal border.

🖤 The murmur extends throughout systole because the pressure gradient between the ventricles persists during ventricular contraction.

🖤 Smaller restrictive VSDs can actually produce particularly loud, harsh murmurs because blood passes rapidly through the small opening.

🖤 Large VSDs can produce increased pulmonary blood flow and manifestations of heart failure, including tachypnea, poor feeding, diaphoresis, and inadequate weight gain in infants.

🖤 A harsh holosystolic murmur along the left sternal border is therefore the most characteristic assessment finding among these choices.

Distractor Analysis :

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QLexNursing

1 : The nurse is conducting a physical examination of a child with a ventricular septal defect. Which of the following assessment findings is expected with this disorder?

1 :
The nurse is conducting a physical examination of a child with a ventricular septal defect. Which of the following assessment findings is expected with this disorder?