NURS 612 Exam 2 Advanced Health Assessment (Maryville
University) Questions and Answers| Updated| Pass
Guaranteed
1. What causes the first heart sound (S1)?
A. Closure of the aortic and pulmonic valves
B. Rapid ventricular filling
C. Closure of the mitral and tricuspid valves at the beginning of systole
D. Atrial contraction against a stiff ventricle
Answer: C. Closure of the mitral and tricuspid valves at the beginning of
systole
Rationale: S1 ("lub") marks the start of ventricular systole and is heard best at
the apex. S2 results from closure of the semilunar valves.
2. What causes the second heart sound (S2), and where is it best heard?
A. Closure of the mitral and tricuspid valves; best heard at the apex
B. Ventricular filling; best heard at the apex
C. Closure of the aortic and pulmonic valves; best heard at the base
D. Atrial contraction; best heard at the left sternal border
Answer: C. Closure of the aortic and pulmonic valves; best heard at the base
Rationale: S2 ("dub") marks the end of systole and is loudest at the base of the
heart.
NURS 612 Exam 2 | Page 1
,3. Physiologic splitting of S2 is normally heard:
A. During inspiration and disappears or narrows with expiration
B. During expiration only
C. As a fixed split throughout the respiratory cycle
D. Only in patients with heart failure
Answer: A. During inspiration and disappears or narrows with expiration
Rationale: Inspiration increases venous return to the right heart and delays
pulmonic closure, causing a normal split. A fixed split suggests an atrial septal
defect.
4. A low-pitched extra heart sound heard early in diastole after S2
(ventricular gallop) is:
A. S4, which suggests ventricular hypertrophy
B. S3, which suggests volume overload or heart failure in an adult
C. A normal finding in all adults
D. A pericardial friction rub
Answer: B. S3, which suggests volume overload or heart failure in an adult
Rationale: S3 occurs with rapid ventricular filling into a dilated ventricle. It can
be normal in children, young adults, and pregnancy.
NURS 612 Exam 2 | Page 2
,5. An S4 heart sound, heard just before S1, is associated with:
A. A stiff, noncompliant ventricle, such as in hypertension or left ventricular
hypertrophy
B. Volume overload in heart failure
C. Mitral stenosis
D. Normal aging in all patients
Answer: A. A stiff, noncompliant ventricle, such as in hypertension or left
ventricular hypertrophy
Rationale: S4 (atrial gallop) results from atrial contraction into a stiff ventricle,
giving the "Ten-nes-see" rhythm. S3 gives "Ken-tuc-ky." Both are best heard
with the bell.
6. Where is the aortic auscultatory area located?
A. Second intercostal space, left sternal border
B. Second intercostal space, right sternal border
C. Fifth intercostal space, midclavicular line
D. Fourth intercostal space, left sternal border
Answer: B. Second intercostal space, right sternal border
Rationale: Aortic: right 2nd ICS. Pulmonic: left 2nd ICS. Erb's point: left 3rd
ICS. Tricuspid: left lower sternal border, 4th-5th ICS. Mitral: apex, left 5th ICS
at the midclavicular line.
NURS 612 Exam 2 | Page 3
, 7. Where is the point of maximal impulse (PMI) normally found in an adult?
A. Second intercostal space, right sternal border
B. Seventh intercostal space, anterior axillary line
C. Third intercostal space, left sternal border
D. Fifth intercostal space at or medial to the left midclavicular line
Answer: D. Fifth intercostal space at or medial to the left midclavicular line
Rationale: The PMI reflects the apex of the left ventricle. Lateral displacement
suggests cardiomegaly or ventricular hypertrophy.
8. A PMI displaced laterally and downward to the sixth intercostal space,
anterior axillary line suggests:
A. Left ventricular enlargement
B. Normal finding
C. Mitral stenosis alone
D. Dextrocardia in all cases
Answer: A. Left ventricular enlargement
Rationale: A displaced and diffuse PMI is a sign of cardiomegaly from
conditions such as heart failure or cardiomyopathy.
NURS 612 Exam 2 | Page 4
University) Questions and Answers| Updated| Pass
Guaranteed
1. What causes the first heart sound (S1)?
A. Closure of the aortic and pulmonic valves
B. Rapid ventricular filling
C. Closure of the mitral and tricuspid valves at the beginning of systole
D. Atrial contraction against a stiff ventricle
Answer: C. Closure of the mitral and tricuspid valves at the beginning of
systole
Rationale: S1 ("lub") marks the start of ventricular systole and is heard best at
the apex. S2 results from closure of the semilunar valves.
2. What causes the second heart sound (S2), and where is it best heard?
A. Closure of the mitral and tricuspid valves; best heard at the apex
B. Ventricular filling; best heard at the apex
C. Closure of the aortic and pulmonic valves; best heard at the base
D. Atrial contraction; best heard at the left sternal border
Answer: C. Closure of the aortic and pulmonic valves; best heard at the base
Rationale: S2 ("dub") marks the end of systole and is loudest at the base of the
heart.
NURS 612 Exam 2 | Page 1
,3. Physiologic splitting of S2 is normally heard:
A. During inspiration and disappears or narrows with expiration
B. During expiration only
C. As a fixed split throughout the respiratory cycle
D. Only in patients with heart failure
Answer: A. During inspiration and disappears or narrows with expiration
Rationale: Inspiration increases venous return to the right heart and delays
pulmonic closure, causing a normal split. A fixed split suggests an atrial septal
defect.
4. A low-pitched extra heart sound heard early in diastole after S2
(ventricular gallop) is:
A. S4, which suggests ventricular hypertrophy
B. S3, which suggests volume overload or heart failure in an adult
C. A normal finding in all adults
D. A pericardial friction rub
Answer: B. S3, which suggests volume overload or heart failure in an adult
Rationale: S3 occurs with rapid ventricular filling into a dilated ventricle. It can
be normal in children, young adults, and pregnancy.
NURS 612 Exam 2 | Page 2
,5. An S4 heart sound, heard just before S1, is associated with:
A. A stiff, noncompliant ventricle, such as in hypertension or left ventricular
hypertrophy
B. Volume overload in heart failure
C. Mitral stenosis
D. Normal aging in all patients
Answer: A. A stiff, noncompliant ventricle, such as in hypertension or left
ventricular hypertrophy
Rationale: S4 (atrial gallop) results from atrial contraction into a stiff ventricle,
giving the "Ten-nes-see" rhythm. S3 gives "Ken-tuc-ky." Both are best heard
with the bell.
6. Where is the aortic auscultatory area located?
A. Second intercostal space, left sternal border
B. Second intercostal space, right sternal border
C. Fifth intercostal space, midclavicular line
D. Fourth intercostal space, left sternal border
Answer: B. Second intercostal space, right sternal border
Rationale: Aortic: right 2nd ICS. Pulmonic: left 2nd ICS. Erb's point: left 3rd
ICS. Tricuspid: left lower sternal border, 4th-5th ICS. Mitral: apex, left 5th ICS
at the midclavicular line.
NURS 612 Exam 2 | Page 3
, 7. Where is the point of maximal impulse (PMI) normally found in an adult?
A. Second intercostal space, right sternal border
B. Seventh intercostal space, anterior axillary line
C. Third intercostal space, left sternal border
D. Fifth intercostal space at or medial to the left midclavicular line
Answer: D. Fifth intercostal space at or medial to the left midclavicular line
Rationale: The PMI reflects the apex of the left ventricle. Lateral displacement
suggests cardiomegaly or ventricular hypertrophy.
8. A PMI displaced laterally and downward to the sixth intercostal space,
anterior axillary line suggests:
A. Left ventricular enlargement
B. Normal finding
C. Mitral stenosis alone
D. Dextrocardia in all cases
Answer: A. Left ventricular enlargement
Rationale: A displaced and diffuse PMI is a sign of cardiomegaly from
conditions such as heart failure or cardiomyopathy.
NURS 612 Exam 2 | Page 4
