NUFT 204 ACTUAL 2026 STUDY GUIDE QUESTIONS AND
SOLUTIONS RATED A+
✔✔"Lub" sound is the systole and it correlates with - ✔✔The carotid pulse
✔✔How to identify the S1 sound - ✔✔Heard loudest at the apex (when listening for
mitral/apical heart rate)
✔✔What produces the systole sound? - ✔✔A wave of blood
✔✔What is the second heart sound? - ✔✔"Dub"
✔✔The second heart sound is produced by - ✔✔The closure of the aortic and
pulmonary valves
✔✔When does the S2 sound occur? - ✔✔Occurs with diastole - the filling phase,
relaxation of ventricles
✔✔Explain S2: - ✔✔Closure of Semilunar valves (aortic & pulmonic)
✔✔Does the s2 correspond to a wave in pulse? - ✔✔No
✔✔What are the extra heart sounds? - ✔✔S3 and S4
✔✔What is the S3 sound? - ✔✔A ventricular gallop
✔✔What causes the S3 sounds? Caused by premature rush of blood into ventricle that
is stiff or dilated from heart failure and HTN (hypertension) - ✔✔
✔✔What do you hear when you hear S3? - ✔✔Blood rushing into the ventricle and
banging around in the ventricle
✔✔What is the S4 sound? - ✔✔atrial gallop
✔✔What causes the S4 sound? - ✔✔Caused by an atrial contraction pushing blood
against a ventricle not accepting blood because of heart failure or other alterations.
✔✔When does the S4 noise occur? - ✔✔Noise occurs when the atria beats and the
ventricle did not know it was going to be accepting blood
✔✔Where are extra heart sounds heard best? - ✔✔Extra heard sounds are best heard
at the apex of the heart with the patient lying on the left side/left lateral position.
✔✔S3 and s4 are best heard - ✔✔at apex when using the bell
,✔✔Is S4 a normal physiological sound? - ✔✔Never
✔✔Can s3 ever be a physiological/normal? - ✔✔Yes in children and fit individuals under
30
✔✔When is S3 a normal sound? - ✔✔In children and fit individuals under 30
✔✔Example of when the S3 sound is not idea - ✔✔In a 65yr old in heart failure, then
the sound is pathological
✔✔Where is the S2 sound heard best? - ✔✔Over the aortic and pulmonic areas
✔✔Where do you listen to the Aortic valve? - ✔✔At the 2nd intercostal space on the
sternal border (R) ®
✔✔Where do you listen to the Pulmonic valve? - ✔✔At the 2nd intercostal space on the
sternal border (L)
✔✔Where do you listen to Erbs point? - ✔✔At the 3rd intercostal space on the sternal
border (L)
✔✔What are you listening for at Erb's point? - ✔✔Listening for 'whooshing' sounds /
heart murmurs from all valves
✔✔Where do you listen to the Tricuspid valve? - ✔✔At the 4 intercostal space on
sternal border (L)
✔✔Where do you listen to the Mitral valve? - ✔✔At the 5th intercostal space at the mid
clavicular line (apex of the heart) (L)
✔✔Where do you take the apical pulse? - ✔✔Apical pulse is taken at the apex of the
heart over the mitral valve on the 5th intercostal space on the left sternal border for 1
minute with the diaphragm
✔✔Where are you more likely going to hear more than one murmur and why? - ✔✔Erbs
point. Murmurs can overlap here due to the proximity of the valves
✔✔Murmurs: - ✔✔gentle, blowing, swooshing sound
✔✔Where do you listen for murmurs? - ✔✔Listen for murmurs in the auscultatory sites
(APETM)
, ✔✔Why and where may you hear murmurs during a cardiac assessment? - ✔✔Heard
on chest wall due to turbulence
✔✔Reasons for a heart murmur to occur - ✔✔The blood velocity increases or
decreases, there are structural deficits in valves or chambers
✔✔Reasons for the velocity of blood to increase - ✔✔Exercise, thyrotoxicosis (too much
thyroid hormone in the body), pregnancy
✔✔Reasons for the velocity of blood to increase - ✔✔Anemia
✔✔Examples of structural defects in valves or chambers - ✔✔Narrow valves,
incompetent valves, wall defects, dilated chambers
✔✔A valve that does not close efficiently results in - ✔✔backflow of blood (i.e.,
insufficiency or regurgitation)
✔✔A valve that does not open wide enough may cause - ✔✔turbulent backflow
secondary to obstruction or narrowing (i.e., stenosis).
✔✔Stenosis: - ✔✔narrowing that results in turbulent flow
✔✔Things to assess during a physical assessment - ✔✔General appearance, mental
status, vital signs, pulses, heart rate and rhythm, perfusion, edema, lung sounds
✔✔Lift or heaves - ✔✔Forceful cardiac contractions that cause a slight to vigorous
movement of sternum and ribs.
✔✔What to look for when inspecting the patient during a cardiac assessment -
✔✔visible pulsations, lifts/heaves, PMI location
✔✔How should the patient be positioned for a cardiac assessment? - ✔✔The patient
should be in the supine position
✔✔What two systems go hand in hand? - ✔✔Cardiovascular and respiratory
✔✔When listening for murmurs, you're listening for a change in? - ✔✔Grade, pitch and
quality
✔✔Auscultation techniques for a cardiac assessment - ✔✔Begin with the diaphragm
and listen for rate, rhythm, identify S1 and S2 separately. Some sounds may flow
together. Then try to identify any extra heart sounds or murmurs.
SOLUTIONS RATED A+
✔✔"Lub" sound is the systole and it correlates with - ✔✔The carotid pulse
✔✔How to identify the S1 sound - ✔✔Heard loudest at the apex (when listening for
mitral/apical heart rate)
✔✔What produces the systole sound? - ✔✔A wave of blood
✔✔What is the second heart sound? - ✔✔"Dub"
✔✔The second heart sound is produced by - ✔✔The closure of the aortic and
pulmonary valves
✔✔When does the S2 sound occur? - ✔✔Occurs with diastole - the filling phase,
relaxation of ventricles
✔✔Explain S2: - ✔✔Closure of Semilunar valves (aortic & pulmonic)
✔✔Does the s2 correspond to a wave in pulse? - ✔✔No
✔✔What are the extra heart sounds? - ✔✔S3 and S4
✔✔What is the S3 sound? - ✔✔A ventricular gallop
✔✔What causes the S3 sounds? Caused by premature rush of blood into ventricle that
is stiff or dilated from heart failure and HTN (hypertension) - ✔✔
✔✔What do you hear when you hear S3? - ✔✔Blood rushing into the ventricle and
banging around in the ventricle
✔✔What is the S4 sound? - ✔✔atrial gallop
✔✔What causes the S4 sound? - ✔✔Caused by an atrial contraction pushing blood
against a ventricle not accepting blood because of heart failure or other alterations.
✔✔When does the S4 noise occur? - ✔✔Noise occurs when the atria beats and the
ventricle did not know it was going to be accepting blood
✔✔Where are extra heart sounds heard best? - ✔✔Extra heard sounds are best heard
at the apex of the heart with the patient lying on the left side/left lateral position.
✔✔S3 and s4 are best heard - ✔✔at apex when using the bell
,✔✔Is S4 a normal physiological sound? - ✔✔Never
✔✔Can s3 ever be a physiological/normal? - ✔✔Yes in children and fit individuals under
30
✔✔When is S3 a normal sound? - ✔✔In children and fit individuals under 30
✔✔Example of when the S3 sound is not idea - ✔✔In a 65yr old in heart failure, then
the sound is pathological
✔✔Where is the S2 sound heard best? - ✔✔Over the aortic and pulmonic areas
✔✔Where do you listen to the Aortic valve? - ✔✔At the 2nd intercostal space on the
sternal border (R) ®
✔✔Where do you listen to the Pulmonic valve? - ✔✔At the 2nd intercostal space on the
sternal border (L)
✔✔Where do you listen to Erbs point? - ✔✔At the 3rd intercostal space on the sternal
border (L)
✔✔What are you listening for at Erb's point? - ✔✔Listening for 'whooshing' sounds /
heart murmurs from all valves
✔✔Where do you listen to the Tricuspid valve? - ✔✔At the 4 intercostal space on
sternal border (L)
✔✔Where do you listen to the Mitral valve? - ✔✔At the 5th intercostal space at the mid
clavicular line (apex of the heart) (L)
✔✔Where do you take the apical pulse? - ✔✔Apical pulse is taken at the apex of the
heart over the mitral valve on the 5th intercostal space on the left sternal border for 1
minute with the diaphragm
✔✔Where are you more likely going to hear more than one murmur and why? - ✔✔Erbs
point. Murmurs can overlap here due to the proximity of the valves
✔✔Murmurs: - ✔✔gentle, blowing, swooshing sound
✔✔Where do you listen for murmurs? - ✔✔Listen for murmurs in the auscultatory sites
(APETM)
, ✔✔Why and where may you hear murmurs during a cardiac assessment? - ✔✔Heard
on chest wall due to turbulence
✔✔Reasons for a heart murmur to occur - ✔✔The blood velocity increases or
decreases, there are structural deficits in valves or chambers
✔✔Reasons for the velocity of blood to increase - ✔✔Exercise, thyrotoxicosis (too much
thyroid hormone in the body), pregnancy
✔✔Reasons for the velocity of blood to increase - ✔✔Anemia
✔✔Examples of structural defects in valves or chambers - ✔✔Narrow valves,
incompetent valves, wall defects, dilated chambers
✔✔A valve that does not close efficiently results in - ✔✔backflow of blood (i.e.,
insufficiency or regurgitation)
✔✔A valve that does not open wide enough may cause - ✔✔turbulent backflow
secondary to obstruction or narrowing (i.e., stenosis).
✔✔Stenosis: - ✔✔narrowing that results in turbulent flow
✔✔Things to assess during a physical assessment - ✔✔General appearance, mental
status, vital signs, pulses, heart rate and rhythm, perfusion, edema, lung sounds
✔✔Lift or heaves - ✔✔Forceful cardiac contractions that cause a slight to vigorous
movement of sternum and ribs.
✔✔What to look for when inspecting the patient during a cardiac assessment -
✔✔visible pulsations, lifts/heaves, PMI location
✔✔How should the patient be positioned for a cardiac assessment? - ✔✔The patient
should be in the supine position
✔✔What two systems go hand in hand? - ✔✔Cardiovascular and respiratory
✔✔When listening for murmurs, you're listening for a change in? - ✔✔Grade, pitch and
quality
✔✔Auscultation techniques for a cardiac assessment - ✔✔Begin with the diaphragm
and listen for rate, rhythm, identify S1 and S2 separately. Some sounds may flow
together. Then try to identify any extra heart sounds or murmurs.
