A nurse is caring for a child diagnosed with Ventricular septal defect (VSD).
The child presents with poor feeding, fast breathing, and sweating with exertion.
Which of the following is the characteristic heart murmur associated with VSD?

Choice A rationale:

A continuous "machinery" murmur that is loudest below the left clavicle is typically associated with a patent ductus arteriosus (PDA), not VSD.

PDA is a different congenital heart defect.

Choice B rationale:

A harsh holosystolic murmur that is best heard at the left lower sternal border is the characteristic murmur associated with Ventricular Septal Defect (VSD).

This murmur is caused by the blood flowing from the high-pressure left ventricle to the low-pressure right ventricle through the VSD hole throughout the cardiac cycle.

Choice C rationale:

A systolic ejection murmur that is best heard at the left upper sternal border is often associated with aortic stenosis, not VSD.

Choice D rationale:

A systolic ejection murmur that radiates to the back is characteristic of aortic regurgitation, which is a different cardiac condition.

The characteristic heart murmur in VSD is the result of blood flowing from the left ventricle to the right ventricle through the VSD hole during systole.

This causes a harsh holosystolic murmur, which is loudest at the left lower sternal border due to the location of the defect in the ventricular septum.

Therefore, choice B is The correct answer.

Choice A rationale:

Checking the child's oxygen saturation using a pulse oximeter is an appropriate action during the assessment of a child with a congenital heart defect.

Oxygen saturation monitoring helps assess the child's oxygen levels, which is crucial in determining the adequacy of oxygen supply to the body.

Children with congenital heart defects are at risk of reduced oxygen levels, and monitoring oxygen saturation is a vital part of their care.

Choice B rationale:

Ensuring the child receives all their vaccinations is important for the child's overall health but is not directly related to the assessment of a congenital heart defect.

Vaccinations are typically administered as part of routine healthcare, but they do not address the specific concerns related to a congenital heart defect assessment.

Choice C rationale:

Assessing the child's neurological development is important but is not the primary focus of the assessment for a congenital heart defect.

While neurological assessment is important for overall child development, it does not directly relate to the cardiac assessment.

Choice D rationale:

Monitoring the child's growth based on height alone is not a comprehensive assessment for a child with a congenital heart defect.

Monitoring growth should include various parameters, such as weight, head circumference, and developmental milestones.

Relying solely on height may not provide a complete picture of the child's overall development.