Neonatal Nurse Practitioner Practice Exam

In a neonate with suspected transposition of the great arteries, when should a ventricular septal defect be suspected?

1. A pronounced murmur is heard

2. Cyanosis is present

3. The heart is boot-shaped

4. There is altered heart rhythm

The correct answer is: A pronounced murmur is heard

In the context of transposition of the great arteries (TGA), the presence of a pronounced murmur often indicates the potential coexistence of a ventricular septal defect (VSD). In cases of TGA, the blood flow typically bypasses the lungs due to the aorta and pulmonary artery being switched, leading to significant hypoxemia and cyanosis. While the presence of a VSD may not be directly related to cyanosis, the hemodynamic changes introduced by a VSD can alter blood flow patterns, potentially allowing for some oxygenated blood to mix with deoxygenated blood, which can manifest as an audible murmur. A pronounced murmur suggests turbulence that arises when blood flows from one chamber of the heart to another through a defect like a VSD, which would not be present without such a defect. Thus, in a neonate showing signs of TGA, the detection of a pronounced murmur can signal the presence of a VSD, highlighting the importance of thorough cardiac evaluation during examination. The other options, while they may be observed in a patient with TGA, do not specifically indicate the presence of a ventricular septal defect. Cyanosis, a boot-shaped heart on imaging, and altered heart rhythm can occur in various