A client is admitted to the hospital with a systolic ejection murmur that is best heard at the left upper sternal border.
The client has no other symptoms and is otherwise healthy.
The client asks the nurse, "What does this murmur mean?".
The nurse's best response is:.

"This murmur is a sign of a heart defect called coarctation of the aorta (COA).”.

Choice A rationale:

"This murmur is a sign of a heart defect called coarctation of the aorta (COA).”.

A systolic ejection murmur heard at the left upper sternal border can be indicative of coarctation of the aorta (COA).

Coarctation of the aorta is a congenital heart defect characterized by a narrowing or constriction of the aorta, typically near the site of the ductus arteriosus.

This narrowing leads to increased pressure and turbulence in the left ventricle and aorta, resulting in the systolic ejection murmur.

Informing the client about the likely diagnosis is a good approach as it helps provide them with essential information about their condition.

Choice B rationale:

"This murmur is a sign of a heart defect called atrial septal defect (ASD).”.

An atrial septal defect (ASD) typically presents with a different type of murmur, not a systolic ejection murmur heard at the left upper sternal border.

ASD is characterized by a fixed, split second heart sound (S2) and a mid-systolic murmur at the upper left sternal border.

The description in the question does not align with the typical findings of an ASD.

Choice C rationale:

"This murmur is a sign of a heart defect called ventricular septal defect (VSD).”.

A ventricular septal defect (VSD) also presents with a different type of murmur, typically a harsh holosystolic murmur heard at the lower left sternal border.

The description of the murmur in the question, a systolic ejection murmur at the left upper sternal border, is not characteristic of a VSD.

Choice D rationale:

"This murmur is a sign of a heart defect called tetralogy of Fallot (TOF).”.

Tetralogy of Fallot (TOF) is characterized by a different set of heart defects, including a ventricular septal defect (VSD), overriding aorta, right ventricular outflow tract obstruction, and right ventricular hypertrophy.

The murmur described in the question is not specific to TOF and is more indicative of coarctation of the aorta (COA) due to its location and characteristics.

Choice A rationale:

Cyanosis that worsens with crying or feeding is characteristic of Tetralogy of Fallot (TOF).

TOF is a congenital heart defect characterized by four specific cardiac abnormalities, one of which is a ventricular septal defect (VSD).

The VSD allows deoxygenated blood to flow from the right ventricle into the left ventricle and then into the aorta, leading to systemic cyanosis, which is exacerbated by crying or feeding due to increased right-to-left shunting.

Choice B rationale:

Severe chest pain is not a characteristic symptom of Tetralogy of Fallot (TOF).

TOF primarily presents with cyanosis and other associated symptoms related to the heart defect.

Choice C rationale:

Palpitations are not a characteristic symptom of TOF.

While some children with congenital heart defects may experience palpitations, this is not a specific hallmark of TOF.

Choice D rationale:

Frequent respiratory infections are not a characteristic symptom of TOF.

The symptoms associated with TOF are primarily related to cardiac function, such as cyanosis, and do not directly cause respiratory infections.