NUR 265 Exam 2: (Latest 2026/2027 Update) Cardiac Assessment,
Heart Sounds, Peripheral Vascular Disease & Respiratory
Examination | Q&A | Grade A | 100% Correct (Verified Answers)
Complete Review: S1‑S4, Murmurs, JVD, Pitting Edema, Arterial vs Venous Insufficiency, Adventitious Lung Sounds &
Developmental Changes
SUBJECT SOURCE FORMAT
Medical-Surgical Nursing / NUR 265 Galen Exam 2 Study Guide 2026/2027 Q&A Guide with Rationale
Q1
During systole, what event produces the S1 heart sound ("Lub")?
CORRECT ANSWER
Closure of the mitral and tricuspid (AV) valves
RATIONALE
• S1 marks the beginning of ventricular systole.
• S1 is loudest at the apex (mitral area, 5th ICS midclavicular).
• S2 (diastole) is loudest at the base (aortic/pulmonic areas).
Q2
An S3 heart sound is often associated with which condition in an adult?
CORRECT ANSWER
Volume overload (heart failure, hypervolemia) – ventricular gallop
RATIONALE
• S3 occurs in early diastole (rapid filling phase).
• Normal in children/young adults up to age 30, but pathologic in older adults.
• S4 indicates stiff ventricle (hypertrophy, hypertension).
, Q3
A nurse auscultates a murmur. Which factors should be described?
CORRECT ANSWER
Timing, loudness, pitch, pattern, quality, location, radiation
RATIONALE
• Timing: systolic vs diastolic.
• Grade I‑VI for loudness.
• Thrill = palpable vibration (grade IV or higher).
Q4
Place the five cardiac auscultation areas in order from right sternal border to midclavicular.
CORRECT ANSWER
Aortic (2nd ICS RSB) → Pulmonic (2nd ICS LSB) → Erb's point (3rd ICS LSB) → Tricuspid (4th ICS
LSB) → Mitral (5th ICS MCL)
RATIONALE
• Aortic and pulmonic = base; best for S2.
• Mitral = apex; best for S1 and murmurs.
• Use diaphragm then bell.
Q5
Jugular venous distention (JVD) is most indicative of:
CORRECT ANSWER
Right‑sided heart failure (increased central venous pressure)
RATIONALE
• Assess with HOB at 45°, patient supine.
• JVD >4 cm above sternal angle is abnormal.
• Also seen in pericardial tamponade, fluid overload, pulmonary HTN.
Heart Sounds, Peripheral Vascular Disease & Respiratory
Examination | Q&A | Grade A | 100% Correct (Verified Answers)
Complete Review: S1‑S4, Murmurs, JVD, Pitting Edema, Arterial vs Venous Insufficiency, Adventitious Lung Sounds &
Developmental Changes
SUBJECT SOURCE FORMAT
Medical-Surgical Nursing / NUR 265 Galen Exam 2 Study Guide 2026/2027 Q&A Guide with Rationale
Q1
During systole, what event produces the S1 heart sound ("Lub")?
CORRECT ANSWER
Closure of the mitral and tricuspid (AV) valves
RATIONALE
• S1 marks the beginning of ventricular systole.
• S1 is loudest at the apex (mitral area, 5th ICS midclavicular).
• S2 (diastole) is loudest at the base (aortic/pulmonic areas).
Q2
An S3 heart sound is often associated with which condition in an adult?
CORRECT ANSWER
Volume overload (heart failure, hypervolemia) – ventricular gallop
RATIONALE
• S3 occurs in early diastole (rapid filling phase).
• Normal in children/young adults up to age 30, but pathologic in older adults.
• S4 indicates stiff ventricle (hypertrophy, hypertension).
, Q3
A nurse auscultates a murmur. Which factors should be described?
CORRECT ANSWER
Timing, loudness, pitch, pattern, quality, location, radiation
RATIONALE
• Timing: systolic vs diastolic.
• Grade I‑VI for loudness.
• Thrill = palpable vibration (grade IV or higher).
Q4
Place the five cardiac auscultation areas in order from right sternal border to midclavicular.
CORRECT ANSWER
Aortic (2nd ICS RSB) → Pulmonic (2nd ICS LSB) → Erb's point (3rd ICS LSB) → Tricuspid (4th ICS
LSB) → Mitral (5th ICS MCL)
RATIONALE
• Aortic and pulmonic = base; best for S2.
• Mitral = apex; best for S1 and murmurs.
• Use diaphragm then bell.
Q5
Jugular venous distention (JVD) is most indicative of:
CORRECT ANSWER
Right‑sided heart failure (increased central venous pressure)
RATIONALE
• Assess with HOB at 45°, patient supine.
• JVD >4 cm above sternal angle is abnormal.
• Also seen in pericardial tamponade, fluid overload, pulmonary HTN.
