During an assessment, where would the nurse best auscultate for a tricuspid valve murmur?

A. Bronchophony: Bronchophony is an increase in clarity of spoken sounds when auscultating the lungs, typically indicating lung consolidation or pathology. It is not an adventitious sound associated with airflow through narrowed bronchioles.

B. Wheezes: Wheezes are high-pitched, musical sounds that occur when air passes through narrowed or obstructed airways, such as in cases of severe asthma. They are often heard during expiration and indicate bronchoconstriction or inflammation in the airways. This is the correct answer for the scenario presented.

C. Bronchial sounds: Bronchial sounds are normal breath sounds typically heard over the trachea and major bronchi. They are characterized by a higher pitch and a hollow quality. They are not classified as adventitious sounds and are not indicative of asthma.

D. Whispered pectoriloquy: Whispered pectoriloquy is a clinical finding where whispered sounds are heard more clearly over areas of lung consolidation. Like bronchophony, it does not represent an adventitious sound caused by airflow through narrowed bronchioles and is more indicative of lung pathology.

A. Assess child's ability to read: A 2-year-old is too young for a standard reading assessment, as they may not yet recognize letters. Visual acuity tests for this age group typically use pictures or symbols rather than reading letters. Assessing reading ability would not be appropriate or useful in diagnosing strabismus, as the condition affects eye alignment rather than literacy skills.

B. Consider this a normal finding: Strabismus, or "lazy eye," is not a normal finding beyond infancy. If left untreated, it can lead to amblyopia (permanent vision loss in the weaker eye). Early detection and intervention are crucial for proper visual development, and dismissing the finding as normal could result in a missed opportunity for corrective treatment, such as patching or corrective lenses.

C. Assess the child's visual fields with the confrontation test: The confrontation test assesses peripheral vision, not strabismus. It is more appropriate for older children and adults, as it requires the child to understand and follow instructions. While it can identify visual field deficits, it does not evaluate binocular vision or eye misalignment, which are essential in diagnosing strabismus.

D. Test for strabismus by performing the corneal light reflex test (Sparkle Test): The corneal light reflex test evaluates eye alignment by shining a light at the child's eyes and observing the reflection on the corneas. If the light reflex is asymmetrical, it suggests strabismus, which requires further evaluation and possible treatment. Early detection is critical to prevent amblyopia, and this simple test is a quick and effective method to screen for misalignment in young children.