NUR 550 EXAM TEST PAPER QUESTIONS AND
ANSWERS SET A+
✔✔Which family history is especially important during cardiac assessment? -
✔✔Premature coronary artery disease or sudden cardiac death.
✔✔Premature CAD is defined as occurring before what age? - ✔✔Men <55 years;
women <65 years.
✔✔Major modifiable cardiovascular risk factors? - ✔✔Hypertension, diabetes, smoking,
hyperlipidemia, obesity, sedentary lifestyle.
✔✔Major nonmodifiable cardiovascular risk factors? - ✔✔Age, male sex, family history.
✔✔Normal blood pressure? - ✔✔<120/<80 mmHg.
✔✔Elevated blood pressure? - ✔✔120-129 systolic and <80 diastolic.
✔✔Stage 1 hypertension? - ✔✔130-139 systolic OR 80-89 diastolic.
✔✔Stage 2 hypertension? - ✔✔≥140 systolic OR ≥90 diastolic.
✔✔Hypertensive crisis? - ✔✔≥180 systolic and/or ≥120 diastolic requiring urgent
evaluation.
✔✔What causes S1? - ✔✔Closure of the mitral and tricuspid (AV) valves.
✔✔When does S1 occur? - ✔✔Beginning of ventricular systole.
✔✔Mnemonic for S1? - ✔✔S1 = Start of Systole = Shut AV valves.
,✔✔Where is S1 heard best? - ✔✔Cardiac apex (mitral area).
✔✔What causes S2? - ✔✔Closure of the aortic and pulmonic (semilunar) valves.
✔✔When does S2 occur? - ✔✔Beginning of diastole.
✔✔Mnemonic for S2? - ✔✔S2 = Start of Diastole = Shut semilunar valves.
✔✔Where is S2 heard best? - ✔✔Base of the heart (aortic and pulmonic areas).
✔✔What causes a physiologic split S2? - ✔✔Inspiration delays pulmonic valve closure.
✔✔When is a physiologic split S2 considered normal? - ✔✔Young healthy individuals
during inspiration.
✔✔Persistent fixed split S2 suggests what congenital lesion? - ✔✔Atrial septal defect.
✔✔What is an S3 heart sound? - ✔✔Early diastolic ventricular filling into a volume-
overloaded ventricle.
✔✔Who may normally have an S3? - ✔✔Children, young adults, and pregnant patients.
✔✔An S3 in an older adult usually indicates what? - ✔✔Systolic heart failure or volume
overload.
✔✔What is another name for an S3? - ✔✔Ventricular gallop.
✔✔What is an S4 heart sound? - ✔✔Atrial contraction into a stiff, noncompliant
ventricle.
✔✔What conditions commonly cause S4? - ✔✔Hypertension, left ventricular
hypertrophy, aortic stenosis, hypertrophic cardiomyopathy.
✔✔Why is S4 absent in atrial fibrillation? - ✔✔Because atrial contraction is absent.
✔✔When is S4 heard? - ✔✔Late diastole immediately before S1.
✔✔What is a pericardial friction rub? - ✔✔A scratchy, high-pitched sound caused by
inflamed pericardial layers rubbing together.
✔✔Pericardial friction rub is classically associated with what? - ✔✔Acute pericarditis
and recent myocardial infarction.
, ✔✔What is an opening snap? - ✔✔A high-pitched early diastolic sound caused by
opening of a stenotic mitral valve.
✔✔Opening snap is classically associated with what disease? - ✔✔Mitral stenosis.
✔✔What imaging study is first-line for evaluation of a murmur? - ✔✔Echocardiography.
✔✔How should a murmur be described? - ✔✔Timing, location, radiation, pitch, intensity,
patient position, and associated findings.
✔✔What does murmur timing refer to? - ✔✔Whether the murmur occurs during systole,
diastole, or continuously.
✔✔What does murmur radiation describe? - ✔✔Where the murmur sound travels, such
as to the carotids or axilla.
✔✔What murmur finding suggests aortic stenosis? - ✔✔Harsh crescendo-decrescendo
systolic murmur radiating to the carotids.
✔✔Where is aortic stenosis best heard? - ✔✔Right 2nd intercostal space at the sternal
border.
✔✔Classic symptom triad of severe aortic stenosis? - ✔✔SAD: syncope, angina,
dyspnea.
✔✔What causes aortic stenosis? - ✔✔Narrowing/calcification of the aortic valve causing
left ventricular outflow obstruction.
✔✔Aortic stenosis can eventually lead to what type of heart failure? - ✔✔Left-sided
heart failure.
✔✔What position helps assess aortic stenosis? - ✔✔Sitting upright and leaning forward;
also listen at the right upper sternal border.
✔✔What murmur radiates to the carotids? - ✔✔Aortic stenosis.
✔✔What heart sound may be present with aortic stenosis? - ✔✔S4 from a stiff
hypertrophied left ventricle.
✔✔What murmur is associated with aortic regurgitation? - ✔✔High-pitched blowing
early diastolic decrescendo murmur.
✔✔Where is aortic regurgitation best heard? - ✔✔Left sternal border with patient
leaning forward at end-expiration.
ANSWERS SET A+
✔✔Which family history is especially important during cardiac assessment? -
✔✔Premature coronary artery disease or sudden cardiac death.
✔✔Premature CAD is defined as occurring before what age? - ✔✔Men <55 years;
women <65 years.
✔✔Major modifiable cardiovascular risk factors? - ✔✔Hypertension, diabetes, smoking,
hyperlipidemia, obesity, sedentary lifestyle.
✔✔Major nonmodifiable cardiovascular risk factors? - ✔✔Age, male sex, family history.
✔✔Normal blood pressure? - ✔✔<120/<80 mmHg.
✔✔Elevated blood pressure? - ✔✔120-129 systolic and <80 diastolic.
✔✔Stage 1 hypertension? - ✔✔130-139 systolic OR 80-89 diastolic.
✔✔Stage 2 hypertension? - ✔✔≥140 systolic OR ≥90 diastolic.
✔✔Hypertensive crisis? - ✔✔≥180 systolic and/or ≥120 diastolic requiring urgent
evaluation.
✔✔What causes S1? - ✔✔Closure of the mitral and tricuspid (AV) valves.
✔✔When does S1 occur? - ✔✔Beginning of ventricular systole.
✔✔Mnemonic for S1? - ✔✔S1 = Start of Systole = Shut AV valves.
,✔✔Where is S1 heard best? - ✔✔Cardiac apex (mitral area).
✔✔What causes S2? - ✔✔Closure of the aortic and pulmonic (semilunar) valves.
✔✔When does S2 occur? - ✔✔Beginning of diastole.
✔✔Mnemonic for S2? - ✔✔S2 = Start of Diastole = Shut semilunar valves.
✔✔Where is S2 heard best? - ✔✔Base of the heart (aortic and pulmonic areas).
✔✔What causes a physiologic split S2? - ✔✔Inspiration delays pulmonic valve closure.
✔✔When is a physiologic split S2 considered normal? - ✔✔Young healthy individuals
during inspiration.
✔✔Persistent fixed split S2 suggests what congenital lesion? - ✔✔Atrial septal defect.
✔✔What is an S3 heart sound? - ✔✔Early diastolic ventricular filling into a volume-
overloaded ventricle.
✔✔Who may normally have an S3? - ✔✔Children, young adults, and pregnant patients.
✔✔An S3 in an older adult usually indicates what? - ✔✔Systolic heart failure or volume
overload.
✔✔What is another name for an S3? - ✔✔Ventricular gallop.
✔✔What is an S4 heart sound? - ✔✔Atrial contraction into a stiff, noncompliant
ventricle.
✔✔What conditions commonly cause S4? - ✔✔Hypertension, left ventricular
hypertrophy, aortic stenosis, hypertrophic cardiomyopathy.
✔✔Why is S4 absent in atrial fibrillation? - ✔✔Because atrial contraction is absent.
✔✔When is S4 heard? - ✔✔Late diastole immediately before S1.
✔✔What is a pericardial friction rub? - ✔✔A scratchy, high-pitched sound caused by
inflamed pericardial layers rubbing together.
✔✔Pericardial friction rub is classically associated with what? - ✔✔Acute pericarditis
and recent myocardial infarction.
, ✔✔What is an opening snap? - ✔✔A high-pitched early diastolic sound caused by
opening of a stenotic mitral valve.
✔✔Opening snap is classically associated with what disease? - ✔✔Mitral stenosis.
✔✔What imaging study is first-line for evaluation of a murmur? - ✔✔Echocardiography.
✔✔How should a murmur be described? - ✔✔Timing, location, radiation, pitch, intensity,
patient position, and associated findings.
✔✔What does murmur timing refer to? - ✔✔Whether the murmur occurs during systole,
diastole, or continuously.
✔✔What does murmur radiation describe? - ✔✔Where the murmur sound travels, such
as to the carotids or axilla.
✔✔What murmur finding suggests aortic stenosis? - ✔✔Harsh crescendo-decrescendo
systolic murmur radiating to the carotids.
✔✔Where is aortic stenosis best heard? - ✔✔Right 2nd intercostal space at the sternal
border.
✔✔Classic symptom triad of severe aortic stenosis? - ✔✔SAD: syncope, angina,
dyspnea.
✔✔What causes aortic stenosis? - ✔✔Narrowing/calcification of the aortic valve causing
left ventricular outflow obstruction.
✔✔Aortic stenosis can eventually lead to what type of heart failure? - ✔✔Left-sided
heart failure.
✔✔What position helps assess aortic stenosis? - ✔✔Sitting upright and leaning forward;
also listen at the right upper sternal border.
✔✔What murmur radiates to the carotids? - ✔✔Aortic stenosis.
✔✔What heart sound may be present with aortic stenosis? - ✔✔S4 from a stiff
hypertrophied left ventricle.
✔✔What murmur is associated with aortic regurgitation? - ✔✔High-pitched blowing
early diastolic decrescendo murmur.
✔✔Where is aortic regurgitation best heard? - ✔✔Left sternal border with patient
leaning forward at end-expiration.
