Advanced Health Assessment NSG 625 Quiz 3
Updated Solution
Areas of cardiac auscultation - ✔✔✔ - Aortic
Pulmonic
Erb's point
Tricuspid
Mitral/bicuspid
"At Pub Erb Tries Beer"
Where is the aortic valve heard? - ✔✔✔ - 2nd ICS RSB
Where is the Pulmonic valve heard - ✔✔✔ - 2nd ICS LSB
Where is Erb's point heard? - ✔✔✔ - 3rd ICS LSB
Where is the tricuspid valve heard? - ✔✔✔ - 4th ICS LSB
where is the Mitral/bicuspid valve heard? - ✔✔✔ - 5th ICS Midclavicular line
what are the positionings of a patient for listening to cardiac sounds? - ✔✔✔ - supine --> LLD
--> Sitting --> Sitting leaning forward
In what position is the mitral valve heard best? - ✔✔✔ - LLD
In what position are the aortic and pulmonic valve heard best? - ✔✔✔ - Sitting leaning
forward
,What is a carotid bruit - ✔✔✔ - vascular sound or murmur heard on auscultation d/t
increased turbulence through narrowed artery d/t increased plaque build-up
indication of potential occlusive area that could potentially lead to stroke and should be
evaluated in patients w/ various CV and hyperlipidemia conditions
creates blowing/swishing sound
How to evaluate for carotid bruit - ✔✔✔ - Have the patient lay supine with their head turned
to the side and slightly elevated.
have the head turned to the opposite side of the carotid being assessed
have the patient hold their breath during auscultation for better findihngs
Using a stethoscope, auscultate the right and left carotid artery making note of any sound or
murmur.
A normal exam would yield no or transmitted heart sounds
an abnormal exam would yield a murmur like rushing sound on auscultation
How to examine for a renal bruit - ✔✔✔ - Have the patient lay supine while auscultating the
abdomen 2 inches above the navel and 1-2 inches to the right and left of the mid-position
The presence of a renal bruit can indicate narrowing of the renal arteries and is commonly
seen in hypertension
How to examine for abdominal bruits - ✔✔✔ - rushing sounds heard on auscultation of the
abdominal cavity. The provider should have the patient lay supine while placing the
diaphragm of the stethoscope 2 inches above the navel
What does a carotid bruit indicate - ✔✔✔ - Atherosclerotic disease
the carotid arteries are the main arteries that supply the brain with oxygen rich blood
What does an abdominal bruit indicate - ✔✔✔ - involves the aorta
bruit is heard when there is an abdominal aortic aneurysm (AAA)
, rare finding
can't r/o AAA if not found d/t only 10% of patients presenting with it
If accompanied by extreme pain in the abdomen or lower back and loss of pulses in the lower
extremities - medical emergency where the AAA ruptured and the pt. is actively bleeding into
the abdominal space
What does a renal bruit indicate - ✔✔✔ - renal artery stenosis
important to distinguish if bruit occurs on systole or diastole
if coincides with diastole and systole this has correlation with renovascular HTN
Just systole classic HTN
How do you identify systole and diastole on auscultation - ✔✔✔ - S1 marks the beginning of
systole and end of diastole
S2 marks the end of systole and beginning of diastole
How to use carotid pulse to identify S1 and S2 - ✔✔✔ - palpate the carotid artery with L hand,
auscultate with right hand
the sound that precedes the carotid pulse is the S1 and the S2 follows the pulse
How to distinguish between systolic and diastolic murmur - ✔✔✔ - A diastolic murmur
occurs after S2 and before S1 - it is associated with ventricular relaxation and filling. Sound
is more intense in the beginning of diastole and decreases in intensity
A systolic murmur occurs between S1 and S2
when the heart muscle contracts
divided into ejection and regurgitant murmurs
What is a murmur - ✔✔✔ - Hearing blood move past a valve in a way it's not supposed to
due to increased blood flow, stenosis, or regurgitation.
produced when there is turbulent energy in the walls of the heart and blood vessels
Updated Solution
Areas of cardiac auscultation - ✔✔✔ - Aortic
Pulmonic
Erb's point
Tricuspid
Mitral/bicuspid
"At Pub Erb Tries Beer"
Where is the aortic valve heard? - ✔✔✔ - 2nd ICS RSB
Where is the Pulmonic valve heard - ✔✔✔ - 2nd ICS LSB
Where is Erb's point heard? - ✔✔✔ - 3rd ICS LSB
Where is the tricuspid valve heard? - ✔✔✔ - 4th ICS LSB
where is the Mitral/bicuspid valve heard? - ✔✔✔ - 5th ICS Midclavicular line
what are the positionings of a patient for listening to cardiac sounds? - ✔✔✔ - supine --> LLD
--> Sitting --> Sitting leaning forward
In what position is the mitral valve heard best? - ✔✔✔ - LLD
In what position are the aortic and pulmonic valve heard best? - ✔✔✔ - Sitting leaning
forward
,What is a carotid bruit - ✔✔✔ - vascular sound or murmur heard on auscultation d/t
increased turbulence through narrowed artery d/t increased plaque build-up
indication of potential occlusive area that could potentially lead to stroke and should be
evaluated in patients w/ various CV and hyperlipidemia conditions
creates blowing/swishing sound
How to evaluate for carotid bruit - ✔✔✔ - Have the patient lay supine with their head turned
to the side and slightly elevated.
have the head turned to the opposite side of the carotid being assessed
have the patient hold their breath during auscultation for better findihngs
Using a stethoscope, auscultate the right and left carotid artery making note of any sound or
murmur.
A normal exam would yield no or transmitted heart sounds
an abnormal exam would yield a murmur like rushing sound on auscultation
How to examine for a renal bruit - ✔✔✔ - Have the patient lay supine while auscultating the
abdomen 2 inches above the navel and 1-2 inches to the right and left of the mid-position
The presence of a renal bruit can indicate narrowing of the renal arteries and is commonly
seen in hypertension
How to examine for abdominal bruits - ✔✔✔ - rushing sounds heard on auscultation of the
abdominal cavity. The provider should have the patient lay supine while placing the
diaphragm of the stethoscope 2 inches above the navel
What does a carotid bruit indicate - ✔✔✔ - Atherosclerotic disease
the carotid arteries are the main arteries that supply the brain with oxygen rich blood
What does an abdominal bruit indicate - ✔✔✔ - involves the aorta
bruit is heard when there is an abdominal aortic aneurysm (AAA)
, rare finding
can't r/o AAA if not found d/t only 10% of patients presenting with it
If accompanied by extreme pain in the abdomen or lower back and loss of pulses in the lower
extremities - medical emergency where the AAA ruptured and the pt. is actively bleeding into
the abdominal space
What does a renal bruit indicate - ✔✔✔ - renal artery stenosis
important to distinguish if bruit occurs on systole or diastole
if coincides with diastole and systole this has correlation with renovascular HTN
Just systole classic HTN
How do you identify systole and diastole on auscultation - ✔✔✔ - S1 marks the beginning of
systole and end of diastole
S2 marks the end of systole and beginning of diastole
How to use carotid pulse to identify S1 and S2 - ✔✔✔ - palpate the carotid artery with L hand,
auscultate with right hand
the sound that precedes the carotid pulse is the S1 and the S2 follows the pulse
How to distinguish between systolic and diastolic murmur - ✔✔✔ - A diastolic murmur
occurs after S2 and before S1 - it is associated with ventricular relaxation and filling. Sound
is more intense in the beginning of diastole and decreases in intensity
A systolic murmur occurs between S1 and S2
when the heart muscle contracts
divided into ejection and regurgitant murmurs
What is a murmur - ✔✔✔ - Hearing blood move past a valve in a way it's not supposed to
due to increased blood flow, stenosis, or regurgitation.
produced when there is turbulent energy in the walls of the heart and blood vessels
