NURS 612 ADVANCED HEALTH ASSESSMENT EXAM 2 STUDY GUIDE LATEST 2026
UPDATED QUESTIONS AND VERIFIED 100% SOLUTIONS (2026/2027) GRADE:
A+|STATUS: GUARANTEED PASS
Chest pain subjective data - Answers -*substernal pain or intense pressure radiating to the neck,
jaw, and arms (particularly the left)
*often accompanied by SOB, fatigue, diaphoresis, faintness, and syncope
Objective questions about chest pain to ask patients - Answers -1. are you currently having
chest pain?
2. what medicines are you currently taking?
3. do you have any comorbidities?
4. is this your 1st time having CP or is it recurrent?
5. how long has the chest pain been occuring?
6. is it constant or intermittent?
7. does the pain radiate anywhere?
8. how long does the CP last?
9. what does the pain feel like?
10. what would you rate the pain?
11. do you have any other symptoms?
12. what makes the CP worse?
13. what makes the CP better?
14. have you had an injury to your chest recently?
What is a split S1 and possible causes? - Answers -*S1 is usually heard as 1 sound even though
there is asynchrony between the closure of the mitral and tricuspid valve. Split S1 is when you
can hear the asynchrony & is best heard in the tricuspid area
*may occur in RBBB and with PVCs
1|Page
,What conditions cause an increase of the intensity of S2? - Answers -*systemic hypertension,
syphilis of the aortic valve, exercise, or excitement
*pulmonary hypertension, mitral stenosis, CHF
*diseased valves but still mobile
What conditions cause a decrease in the intensity of S2? - Answers -*shock-like state with
arterial hypotension
*valves are immobile, thickened, or calcified
*aortic stenosis, pulmonic stenosis
*overlying tissue, fat, or fluid
What conditions cause an increase in the intensity of S1? - Answers -*complete heart block
*rhythm disruption (fibrillation)
What conditions cause a decrease in the intensity of S1? - Answers -*systemic or pulmonary
hypertension
*fibrosis and calcification of a diseased mitral valve (rheumatic heart disease)
Wide Splitting: S1 and S2 - Answers -*split becomes wider when delayed activation of
contraction or right ventricle emptying slows pulmonic closure
*S1 - caused by RBBB
*S2 - caused by RBBB, pulmonic stenosis, pulmonary hypertension, or mitral regurgitation
2|Page
,Fixed splitting of S2 - Answers -*unaffected by respiration
*Occurs with large atrial septal defects, ventricular septal defects with L to R shunting, or right
ventricular failure
Paradoxical (Reversed) Splitting of S2 - Answers -*only heard during expiration
*associated with delayed closure of aortic valve (LBBB)
Ventricular Gallop (S3) - Answers -*Ken-TUCK-y; best heart in left lateral recumbent
*low pitch; best heard in apex with bell during inspiration
*Physiological - children, young adults, pregnancy = rapid early ventricular filling
*Pathological - adults with decreased myocardial contractility, HF, volume overload
Atrial Gallop (S4) - Answers -*TEN-nes-see; supine or left semi-lateral
*Loud S4 always suggests pathology!
*low pitch; best heard in apex with bell on inspiration - just before S1
*most commonly heard in elderly; may be heard at any age when there is increased resistance
to filling because the ventricular walls have lost compliance (HTN/CAD) or with increased stroke
volume of high-output states (profound anemia, pregnancy, thyrotoxicosis)
Opening snap heart sound - Answers -*abrupt recoil of stenotic mitral or tricuspid valve
*high pitch; heard in any position in apex with diaphragm
*may be confused with S3
3|Page
, Ejection sounds - Answers -*best heard sitting or supine in 2nd RICS or 2nd LICS or apex
*high pitch; use diaphragm
*sounds are increased on expiration with pulmonary stenosis
*due to opening of deformed semi-lunar valves
*Aortic ejection sound same as S1 & S2; pulmonary ejection sound increased on expiration
Systolic Click - Answers -*best heard in sitting or supine in apex with diaphragm
*high pitch; increased on inspiration
*due to prolapse of mitral valve leaflet
*occurs later in systole with increased venous return
Pericardial friction rub - Answers -*easily mistaken for cardiac-generated sounds
*rubbing machine-like sound due to inflammation of the pericardial sac
*usually heard widely, but more distinct toward apex
*may have 3 components
*if only 1 or 2 components, it will be less intense and may sound like a murmur
Heart Murmurs - Answers -*prolonged extra sounds heard during systole or diastole; some a
benign and some are pathologic
*caused by disruption of blood flow
4|Page
UPDATED QUESTIONS AND VERIFIED 100% SOLUTIONS (2026/2027) GRADE:
A+|STATUS: GUARANTEED PASS
Chest pain subjective data - Answers -*substernal pain or intense pressure radiating to the neck,
jaw, and arms (particularly the left)
*often accompanied by SOB, fatigue, diaphoresis, faintness, and syncope
Objective questions about chest pain to ask patients - Answers -1. are you currently having
chest pain?
2. what medicines are you currently taking?
3. do you have any comorbidities?
4. is this your 1st time having CP or is it recurrent?
5. how long has the chest pain been occuring?
6. is it constant or intermittent?
7. does the pain radiate anywhere?
8. how long does the CP last?
9. what does the pain feel like?
10. what would you rate the pain?
11. do you have any other symptoms?
12. what makes the CP worse?
13. what makes the CP better?
14. have you had an injury to your chest recently?
What is a split S1 and possible causes? - Answers -*S1 is usually heard as 1 sound even though
there is asynchrony between the closure of the mitral and tricuspid valve. Split S1 is when you
can hear the asynchrony & is best heard in the tricuspid area
*may occur in RBBB and with PVCs
1|Page
,What conditions cause an increase of the intensity of S2? - Answers -*systemic hypertension,
syphilis of the aortic valve, exercise, or excitement
*pulmonary hypertension, mitral stenosis, CHF
*diseased valves but still mobile
What conditions cause a decrease in the intensity of S2? - Answers -*shock-like state with
arterial hypotension
*valves are immobile, thickened, or calcified
*aortic stenosis, pulmonic stenosis
*overlying tissue, fat, or fluid
What conditions cause an increase in the intensity of S1? - Answers -*complete heart block
*rhythm disruption (fibrillation)
What conditions cause a decrease in the intensity of S1? - Answers -*systemic or pulmonary
hypertension
*fibrosis and calcification of a diseased mitral valve (rheumatic heart disease)
Wide Splitting: S1 and S2 - Answers -*split becomes wider when delayed activation of
contraction or right ventricle emptying slows pulmonic closure
*S1 - caused by RBBB
*S2 - caused by RBBB, pulmonic stenosis, pulmonary hypertension, or mitral regurgitation
2|Page
,Fixed splitting of S2 - Answers -*unaffected by respiration
*Occurs with large atrial septal defects, ventricular septal defects with L to R shunting, or right
ventricular failure
Paradoxical (Reversed) Splitting of S2 - Answers -*only heard during expiration
*associated with delayed closure of aortic valve (LBBB)
Ventricular Gallop (S3) - Answers -*Ken-TUCK-y; best heart in left lateral recumbent
*low pitch; best heard in apex with bell during inspiration
*Physiological - children, young adults, pregnancy = rapid early ventricular filling
*Pathological - adults with decreased myocardial contractility, HF, volume overload
Atrial Gallop (S4) - Answers -*TEN-nes-see; supine or left semi-lateral
*Loud S4 always suggests pathology!
*low pitch; best heard in apex with bell on inspiration - just before S1
*most commonly heard in elderly; may be heard at any age when there is increased resistance
to filling because the ventricular walls have lost compliance (HTN/CAD) or with increased stroke
volume of high-output states (profound anemia, pregnancy, thyrotoxicosis)
Opening snap heart sound - Answers -*abrupt recoil of stenotic mitral or tricuspid valve
*high pitch; heard in any position in apex with diaphragm
*may be confused with S3
3|Page
, Ejection sounds - Answers -*best heard sitting or supine in 2nd RICS or 2nd LICS or apex
*high pitch; use diaphragm
*sounds are increased on expiration with pulmonary stenosis
*due to opening of deformed semi-lunar valves
*Aortic ejection sound same as S1 & S2; pulmonary ejection sound increased on expiration
Systolic Click - Answers -*best heard in sitting or supine in apex with diaphragm
*high pitch; increased on inspiration
*due to prolapse of mitral valve leaflet
*occurs later in systole with increased venous return
Pericardial friction rub - Answers -*easily mistaken for cardiac-generated sounds
*rubbing machine-like sound due to inflammation of the pericardial sac
*usually heard widely, but more distinct toward apex
*may have 3 components
*if only 1 or 2 components, it will be less intense and may sound like a murmur
Heart Murmurs - Answers -*prolonged extra sounds heard during systole or diastole; some a
benign and some are pathologic
*caused by disruption of blood flow
4|Page
