Chapter 29 Osborn, Medical-Surgical Nursing, 2e

Question 1 Type: MCSA A patient has a split S2 heart sound. Where would the nurse auscultate to best hear this sound? 1. 2nd intercostal space left of the sternum 2. 5th intercostal space midclavicular line 3. 3rd intercostal space right of the sternum 4. 4th intercostal space left midaxillary line Correct Answer: 1 Rationale 1: A split S2 heart sound is heard best in the pulmonic area, which is the 2nd intercostal space left of the sternum. Rationale 2: The 5th intercostal space midclavicular line is the mitral area. S1 is heard best at the mitral area. Rationale 3: It would be more difficult to hear an S2 split to the right of the sternum. Rationale 4: It would be difficult to hear an S2 split at the midaxillary line in the 4th intercostal space. Global Rationale:Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 29-4 Question 2 Type: MCSA A patient has a split S1 heart sound. How should the nurse explain this finding to the patient? 1. “Your mitral and tricuspid valves are not closing at exactly the same time.” 2. “You probably have some calcification in the pulmonary valve that slows its closure.” 3. “Your aortic valve is closing more slowly than it should.” 4. “Your atrioventricular valves are not closing at exactly the same time.” Correct Answer: 1 Rationale 1: The S1 heart sound is caused by closure of the mitral and tricuspid valves. If they do not close at exactly the same time a “splitting” of the sound occurs. Rationale 2: The pulmonary valve is not associated with the S1 heart sound. Rationale 3: The aortic valve is not associated with the S1 heart sound