The nurse is assessing the heart sounds of a child and decides that the child needs further evaluation. Which could be the reason for seeking further evaluation?

A. Presence of S1 and S2 heart sounds: S1 and S2 are the normal “lub-dub” heart sounds representing closure of the atrioventricular and semilunar valves, respectively. Their presence alone indicates normal basic cardiac function. B. Presence of S3 and S4 heart sounds: S3 and S4 are extra heart sounds that may indicate abnormal ventricular filling or decreased compliance. While an S3 can be normal in some children, the presence of both S3 and S4 in a child warrants further evaluation for potential structural or functional cardiac abnormalities. C. Auscultation of an S1 heart sound: S1 is a normal heart sound corresponding to closure of the mitral and tricuspid valves at the start of systole. Hearing S1 alone does not suggest cardiac pathology. D. Auscultation of an S3 heart sound: S3, also known as a ventricular gallop, can be normal in children and adolescents due to compliant ventricles. While it may warrant monitoring, it does not always require immediate further evaluation unless accompanied by symptoms or other abnormal findings.