A nurse is assessing an infant in the cardiology clinic. Which of the following sets of clinical manifestations is consistent with a ventricular septal defect?

Rationale: A. Cyanosis, fatigue with feeds, and diminished breath sounds is incorrect because ventricular septal defect (VSD) typically causes a left-to-right shunt, which does not initially produce cyanosis. Cyanosis is more characteristic of cyanotic congenital heart defects, such as Tetralogy of Fallot. Diminished breath sounds are not a hallmark of VSD. B. Cyanosis, murmur, and weight loss is incorrect for the same reason: infants with a VSD are usually acyanotic at rest. Weight loss may occur if heart failure develops, but cyanosis is not typical for isolated VSD. C. Murmur, tachypnea, and wheezing is incorrect because wheezing is more indicative of respiratory conditions such as bronchiolitis or asthma. While tachypnea and murmur can occur with VSD, wheezing is not a consistent clinical manifestation. D. Murmur, tachycardia, and fatigue with feeds is correct because these are classic manifestations of VSD. A holosystolic murmur is usually audible along the left lower sternal border due to turbulent blood flow across the defect. Tachycardia and fatigue with feeding occur because the heart works harder to pump blood, leading to increased pulmonary blood flow and decreased systemic perfusion during exertion. Infants may also experience poor weight gain and signs of congestive heart failure if the defect is significant.