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Nurse Practitioner:
doi: 10.1097/01.NPR.0000395036.55411.5d
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Pediatric Heart Murmurs: Evaluation and management in primary care

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INSTRUCTIONS Pediatric heart murmurs: Evaluation and management in primary care

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Pediatric heart murmurs: Evaluation and management in primary care

General Purpose: To provide the NP with an overview of the evaluation and management of pediatric heart murmurs in primary care. Learning Objectives: After reading the preceding article and taking the following test, you should be able to: 1. Describe the types of pediatric innocent and pathologic heart murmurs. 2. Demonstrate how to assess and manage pediatric heart murmurs.

1. The National Heart Lung and Blood Institute defines a heart murmur as an

a. abnormal rhythm of the heart causing an extra audible sound.

b. extra or unusual sound heard during a heartbeat.

c. extra or unusual sound heard during diastole.

d. unusual sound caused by a pathologic condition of the heart or vessels.

2. The majority of heart murmurs in the pediatric population are

a. innocent heart murmurs.

b. attributable to a problematic health condition.

c. symptomatic.

d. serious and caused by congenital heart disease.

3. The S2 sound represents

a. an atypical heart sound following S1.

b. the atrioventricular valves closing and ventricular systole beginning.

c. the semilunar valves closing and ventricular diastole beginning.

d. turbulent blood flow through vasculature.

4. All of the following factors can be responsible for a heart murmur except

a. blood flow ejected through a competent mitral valve into the left ventricle.

b. turbulent blood flow through a normal opening in the heart.

c. blood flow traveling forward through a narrowed valve into a dilated heart chamber.

d. blood flow traveling backward into a previous heart chamber via an incompetent valve.

5. A holosystolic or pansystolic murmur

a. begins after S1.

b. is heard throughout the duration of systole.

c. begins immediately after S1 and ends midway through systole.

d. is heard shortly after S2.

6. During a pediatric cardiac exam, you should

a. use the stethoscope bell to detect higher pitch sounds.

b. first try to detect a murmur then listen for normal heart sounds.

c. use the stethoscope diaphragm to detect lower pitch sounds.

d. auscultate the heart before palpating the precordium.

7. Using the Levine Scale, an easily audible, moderate-volume murmur with a palpable thrill is a

a. Grade 2.

b. Grade 3.

c. Grade 4.

d. Grade 5.

8. Which peripheral pulse is best to use when assessing a neonate?

a. radial

b. brachial

c. popliteal

d. dorsalis pedis

9. Which systolic murmur has a vibrating musical quality and can be accentuated by exercise?

a. venous hum

b. systolic flow murmur

c. pulmonary flow murmur

d. Still murmur

10. A murmur with a discrete blowing sound and harsh quality and associated with a palpable thrill is characteristic of

a. a ventricular septal defect.

b. pulmonary flow.

c. an atrial septal defect.

d. pulmonary stenosis.

11. The murmur of mitral valve prolapse can be intensified by

a. inspiration.

b. the standing position.

c. compression of the jugular vein.

d. the supine position.

12. A pulmonary flow murmur

a. is heard during diastole.

b. has a low pitch.

c. is most easily audible at the left lower sternal border.

d. is more common in children and adolescents than in neonates and infants.

13. A systolic flow murmur

a. is a low-pitched, soft murmur.

b. originates from a physiologic increase in blood flow.

c. is best heard in the left upper sternal border.

d. is caused by abnormal aortic outflow.

14. Which characteristic is likely in a pathologic systolic murmur?

a. shorter in duration than an innocent murmur

b. less intense than an innocent murmur

c. heard as a venous hum

d. holosystolic

15. The patent ductus arteriosus

a. produces a continuous, holosystolic murmur.

b. is best heard at the lower right sternal border.

c. is characterized by a wide splitting of S2.

d. is associated with weaker-than-normal pulses in children.

16. Ejection clicks are heard with murmurs in association with

a. mitral stenosis.

b. aortic and pulmonary stenosis.

c. aortic regurgitation.

d. mitral regurgitation.

17. The gold standard test for diagnosing congenital cardiac malformations is a/an

a. echocardiogram.

b. ECG.

c. computed tomography scan.

d. magnetic resonance imaging.

18. The family of a pediatric patient with a murmur should be counseled that

a. most murmurs must be referred to a cardiologist for surgical correction.

b. their infant's innocent murmur is pathologic and will only worsen over the years.

c. innocent murmurs are harmless and simply due to normal blood flow patterns.

d. all but 1% of pediatric murmurs are pathologic.

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