NUR 524 Exam 2 Questions and Answers| New Update with 100% Correct Answers
Normal PMI? In cardiomegaly? Midclavicular 5th intercostal space
In Cardiomegaly displaced to the left
What should you tell your patient to do when assessing for carotid bruits? Hold breath
S1 Closure of AV valves when ventricular pressure exceeds atrial pressures at beginning of
systole
Corresponds with pulse
Best heard at apex
S2 Closure of semilunar valves
Normally split because Aortic valve closes before Pulmonic valve
Closure pressure on left is 80mmHg compared to 10 on right
Normal for split to widen during inspiration d/t increased RV filling from negative intrathoracic
pressure
S3 Transition from rapid to slow ventricular filling in early diastole. May be normal in
children
Best heard with bell
Can be caused by poor systolic dysfunction or poor myocardial contracility such as CHF
S4 Abnormal late diastolic sound caused by forcible atrial contraction in the presence of
decreased ventricular compliance
Best heard with bell (Higher pitch than S3)
Caused by diastolic dysfunction or poor myocardial relaxation (Compliance) such as in recurrent
MI, uncontrolled HTN
,Pathologic Wide Split S2 Best heard in pulmonic region
RV volume overload such as ASD, and is usually fixed with no difference in inspiration or
expiration
RV outflow obstruction such as pulmonary stenosis
Delayed RV depolarization such as complete RBBB
Pathologic Narrow Split S2 Pulmonary HTN as valve closes earlier d/t high pulmonary
resistance
Mild-moderate aortic stenosis as closure of valve is delayed
Pathologic Single S2 May occur if one SL valve is missing (Pulmonary/Aortic atresia or
truncus arteriosus)
If both valves close simulatenously as in Pulmonary HTN with equal pulmonary and aortic
pressures OR in double outlet single ventricle OR in large VSD with equal ventricular pressures
Paradoxical split S2 Caused by pulmonary valve closure before aortic valve closure; Greater
with expiration
Occurs in severe aortic stenosis
What are the most common types of degenerative valvular heart disease Aortic stenosis and
mitral regurgitation
Intensity Grades of murmurs Grade 1: Faintly heard with stethoscope, requires special
attention to hear
grade 2: Soft but readily detectable
Grade 3: Prominent but not loud
Grade 4: Loud with palpable thrill
Grade 5: Very loud
Grade 6: Audible without use of stethoscope
,What determines the frequency of a murmur Blood flow rates
Lower and slower flow -> Lower pitch
Higher and faster flow -> Higher pitch
Murmur configuration Shape of murmur with respect to its audibility
Crescendo, decrescendo, flat, or crescendo-decrescendo
Duration of murmurs Length of systole or diastole
Mid-systolic, holo-diastolic, pan-systolic
Timing of murmurs Systolic murmurs begin with or just after S1 and end before or at S2
Diastolic murmurs begin with or just after S2 and end before or at S1
What do murmurs in the aortic auscultation area indicate Pathology of the atria ventricular
or left ventricular outflow tracts
Aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
What do murmurs in the pulmonic area indicate Tend to be quiet
Pathology of the pulmonic valve such as a PDA.
Further supported if intensity varies with respiration
What do murmurs in Erb's point indicate Murmurs in this area are sometimes more audible
if the patient leans forward
Diastolic murmurs of R atrium and many pulmonic and aortic murmurs
What do murmurs in the tricuspid area indicate Systolic murmurs indicate pulmonic stenosis
or tricuspid regurgitation
, Diastolic murmurs indicate tricuspid stenosis or pulmonic regurgitation
What do murmurs in the mitral/apex area indicate Systolic murmurs indicate mitral regurg,
aortic outflow obstruction, or VSD.
Diastolic murmurs indicate mitral stenosis or aortic regurgitation; Mitral stenosis is ONLY heard
at apex and is accompanied by opening snap sound
Aortic Stenosis murmur a systolic ejection-type, harsh crescendo-decrescendo murmur
Heard best RSB 2nd intercostal space
Delayed carotid upstroke, narrowed pulse pressure, systolic thrill
ECG findings: LAE, Left axis deviation, LVH
Pulmonary stenosis murmur Ejection systolic murmur with variable intensity; Harsh
crescendo-decrescendo
3rd and 4th LIS down left sternal border
Heard best at 2nd ICS LSB; S1 and split S2
Increased with valsalva
ECG: Right axis deviation, increased P-wave amplitude
XR: Dilated pulmonary trunk or a main pulmonary artery (Congenital)
Mitral Valve Regurgitation murmur Pansystolic blowing
Laterally displaced, hyper dynamic apical impulse, brisk carotid upstroke
LVH on ECG and XR
Unchanged with valsalva
Mitral valve prolapse murmur Midsystolic to late systolic; Occasionally honking; may have
click and murmur that are intermittent
Lower L sternal border
Normal PMI? In cardiomegaly? Midclavicular 5th intercostal space
In Cardiomegaly displaced to the left
What should you tell your patient to do when assessing for carotid bruits? Hold breath
S1 Closure of AV valves when ventricular pressure exceeds atrial pressures at beginning of
systole
Corresponds with pulse
Best heard at apex
S2 Closure of semilunar valves
Normally split because Aortic valve closes before Pulmonic valve
Closure pressure on left is 80mmHg compared to 10 on right
Normal for split to widen during inspiration d/t increased RV filling from negative intrathoracic
pressure
S3 Transition from rapid to slow ventricular filling in early diastole. May be normal in
children
Best heard with bell
Can be caused by poor systolic dysfunction or poor myocardial contracility such as CHF
S4 Abnormal late diastolic sound caused by forcible atrial contraction in the presence of
decreased ventricular compliance
Best heard with bell (Higher pitch than S3)
Caused by diastolic dysfunction or poor myocardial relaxation (Compliance) such as in recurrent
MI, uncontrolled HTN
,Pathologic Wide Split S2 Best heard in pulmonic region
RV volume overload such as ASD, and is usually fixed with no difference in inspiration or
expiration
RV outflow obstruction such as pulmonary stenosis
Delayed RV depolarization such as complete RBBB
Pathologic Narrow Split S2 Pulmonary HTN as valve closes earlier d/t high pulmonary
resistance
Mild-moderate aortic stenosis as closure of valve is delayed
Pathologic Single S2 May occur if one SL valve is missing (Pulmonary/Aortic atresia or
truncus arteriosus)
If both valves close simulatenously as in Pulmonary HTN with equal pulmonary and aortic
pressures OR in double outlet single ventricle OR in large VSD with equal ventricular pressures
Paradoxical split S2 Caused by pulmonary valve closure before aortic valve closure; Greater
with expiration
Occurs in severe aortic stenosis
What are the most common types of degenerative valvular heart disease Aortic stenosis and
mitral regurgitation
Intensity Grades of murmurs Grade 1: Faintly heard with stethoscope, requires special
attention to hear
grade 2: Soft but readily detectable
Grade 3: Prominent but not loud
Grade 4: Loud with palpable thrill
Grade 5: Very loud
Grade 6: Audible without use of stethoscope
,What determines the frequency of a murmur Blood flow rates
Lower and slower flow -> Lower pitch
Higher and faster flow -> Higher pitch
Murmur configuration Shape of murmur with respect to its audibility
Crescendo, decrescendo, flat, or crescendo-decrescendo
Duration of murmurs Length of systole or diastole
Mid-systolic, holo-diastolic, pan-systolic
Timing of murmurs Systolic murmurs begin with or just after S1 and end before or at S2
Diastolic murmurs begin with or just after S2 and end before or at S1
What do murmurs in the aortic auscultation area indicate Pathology of the atria ventricular
or left ventricular outflow tracts
Aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
What do murmurs in the pulmonic area indicate Tend to be quiet
Pathology of the pulmonic valve such as a PDA.
Further supported if intensity varies with respiration
What do murmurs in Erb's point indicate Murmurs in this area are sometimes more audible
if the patient leans forward
Diastolic murmurs of R atrium and many pulmonic and aortic murmurs
What do murmurs in the tricuspid area indicate Systolic murmurs indicate pulmonic stenosis
or tricuspid regurgitation
, Diastolic murmurs indicate tricuspid stenosis or pulmonic regurgitation
What do murmurs in the mitral/apex area indicate Systolic murmurs indicate mitral regurg,
aortic outflow obstruction, or VSD.
Diastolic murmurs indicate mitral stenosis or aortic regurgitation; Mitral stenosis is ONLY heard
at apex and is accompanied by opening snap sound
Aortic Stenosis murmur a systolic ejection-type, harsh crescendo-decrescendo murmur
Heard best RSB 2nd intercostal space
Delayed carotid upstroke, narrowed pulse pressure, systolic thrill
ECG findings: LAE, Left axis deviation, LVH
Pulmonary stenosis murmur Ejection systolic murmur with variable intensity; Harsh
crescendo-decrescendo
3rd and 4th LIS down left sternal border
Heard best at 2nd ICS LSB; S1 and split S2
Increased with valsalva
ECG: Right axis deviation, increased P-wave amplitude
XR: Dilated pulmonary trunk or a main pulmonary artery (Congenital)
Mitral Valve Regurgitation murmur Pansystolic blowing
Laterally displaced, hyper dynamic apical impulse, brisk carotid upstroke
LVH on ECG and XR
Unchanged with valsalva
Mitral valve prolapse murmur Midsystolic to late systolic; Occasionally honking; may have
click and murmur that are intermittent
Lower L sternal border
