Auscultation of a 3 year-old child's heart reveals a pansystolic, harsh murmur. It is heard loudest over the lower left sternal border. This finding is consistent with a:
pericardial friction rub.
venous hum.
patent ductus arteriosus.
ventricular septal defect.
The Correct Answer is D
Rationale:
A. A pericardial friction rub is a scratching or grating sound caused by inflammation of the pericardium and is not typically described as a pansystolic murmur.
B. A venous hum is a continuous, low-pitched sound heard over the neck and upper chest, not a harsh pansystolic murmur at the lower left sternal border.
C. A patent ductus arteriosus usually produces a continuous “machinery-like” murmur rather than a pansystolic murmur.
D. A ventricular septal defect (VSD) often presents as a pansystolic, harsh murmur best heard at the lower left sternal border. The intensity of the murmur may vary with the size of the defect, but this location and quality are classic for VSD in a young child.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. By 3 months, the plantar grasp reflex may still be present; disappearance occurs later.
B. At 4 months, the reflex is gradually fading but not fully absent in all infants.
C. The plantar grasp reflex, in which the infant curls the toes when the sole of the foot is stroked, typically disappears by around 8 months of age as voluntary control over the toes develops.
D. By 12 months, the reflex is expected to be fully absent, and persistence beyond this age may indicate neurologic abnormalities.
Correct Answer is C
Explanation
Rationale:
A. Bowel cleansing may be considered if constipation is contributing, but it is not the standard next step when behavioral strategies alone fail.
B. Urinalysis is useful for ruling out underlying urinary tract infections or diabetes but is typically performed earlier in the evaluation process.
C. A bedwetting alarm is a first-line second-step intervention after behavioral modifications have not produced improvement. It conditions the child to wake in response to bladder fullness and has demonstrated efficacy in reducing nocturnal enuresis.
D. Referral to a pediatric urologist is generally reserved for refractory cases, underlying anatomic abnormalities, or complicated presentations, not as the immediate next step after failed behavioral therapy.
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