CCRN (Highlights) Exam Questions &
Answers
S1 Heart sound - ANSWERS"Lub"
-Caused by closure of the AV (mitral, tricuspid) valves
-Loudest at APEX of the heart (midclavicular, 5th intercostal space)
-Marks end of diastole, beginning of systole
S2 Heart sound - ANSWERS"Dub"
-Caused by closure of semilunar (aortic, pulmonic) valves
-Loudest at the base (right sternal border 2nd intercostal space)
-Marks end of systole, beginning of diastole
-S2 splits on inspiration; wide, fixed splitting of s2 caused by RBBB
-S2 LOUDER with PULMONARY EMBOLISM
Abnormal Heart Sounds in Adults: - ANSWERSS3 and S4
,S3 - ANSWERS-Caused by rapid rush of blood into a dilated ventricle
-Heard best at the apex with the bell of the stethoscope
*Associated with heart failure, may occur before crackles
S3 can be caused by: - ANSWERS*S3 is also caused by PULMONARY HTN and COR PULMONALE
*Mitrale, aortic, or tricuspid insufficiency(regurgitation)
S4 - ANSWERS-Caused by atrial contraction of blood into a noncompliant ventricle
-Best heard at apex with bell of stethoscope
-Associated with myocardial ischemia, infarction, HTN, ventricular hypertrophy, and AORTIC
STENOSIS
S4 is associated with: - ANSWERSAssociated with myocardial ischemia, infarction, HTN,
ventricular hypertrophy, and AORTIC STENOSIS
Pericardial Friction Rub: - ANSWERS-Due to pericarditis associated with pain on deep inspiration
-May be positional
Pulse pressure: - ANSWERSSystolic - Diastolic = Pulse Pressure
Systolic Blood Pressure: - ANSWERSis an indirect measurement of the cardiac output and stroke
volume.
,-a decrease in systolic blood pressure with little change or increase in diastolic pressure is
narrowing of pulse pressure, seen most often with severe hypovolemia or severe drop in CO
Diastolic Blood Pressure: - ANSWERSis an indirect measurement of SVR (after load)
-a decrease in diastolic pressure WIDENS pulse pressure may indicate vasodilation, drop in SVR,
often in seen in severe sepsis, septic shock, i.e., 100/38
Coronary arteries are perfused during? - ANSWERSdiastole
Normal heart sounds, S1 and S2 in are due to? - ANSWERSValve closure
Valves open and close based on the pressure changes in the chamber above the valve and
below the valve. When the pressure in the chamber above a valve is higher than that below the
valve, the value opens. When the pressure drops in the chamber above the valve and the
pressure is greater below the cave, the valve closes.
Causes of Valvular Heart Dz: - ANSWERSCoronary Artery Dz, Ischemia, and Acute MI
Dilated Cardiomyopathy
Rheumatic Fever
Infection
Murmurs: Insufficiency and Stenosis - ANSWERSMurmurs of insufficiency (regurgitation) occur
when the valve is closed: Acute or chronic
, Murmurs of STENOSIS occur when the valve is open: Chronic problem, develops over time, NOT
acute
Mitral Insufficiency will cause? - ANSWERSLarge giant V waves on the PAOP if the patient has a
pulmonary artery catheter
Tricuspid Insufficiency will cause? - ANSWERSVSD - which is the most common with acute MI,
may result in systolic murmur. It is heard at the left sternal border, 5th intercostal space (ICS).
Systolic Murmurs: Name 4 - ANSWERSAortic Stenosis/Pulmonic Stenosis/Mitral insufficiency
and Tricuspid insufficiency
Diastolic Murmurs: definition and name 4 - ANSWERSSemilunar valves are CLOSED during
diastole
Aortic insufficiency
Pulmonic insufficiency
Mitral stenosis
Tricuspid stenosis
Mitral stenosis is associated with? - ANSWERSAtrial fibrillation due to atrial enlargement that
occurs over time
Mitral insufficiency occurs when? - ANSWERSthe mitral valve is closed (murmur occurs). When
is the mitral valve closed? SYSTOLE
Mitral stenosis occurs when? - ANSWERSthe mitral valve is open (murmur occurs). When is the
mitral valve open? DIASTOLE
Answers
S1 Heart sound - ANSWERS"Lub"
-Caused by closure of the AV (mitral, tricuspid) valves
-Loudest at APEX of the heart (midclavicular, 5th intercostal space)
-Marks end of diastole, beginning of systole
S2 Heart sound - ANSWERS"Dub"
-Caused by closure of semilunar (aortic, pulmonic) valves
-Loudest at the base (right sternal border 2nd intercostal space)
-Marks end of systole, beginning of diastole
-S2 splits on inspiration; wide, fixed splitting of s2 caused by RBBB
-S2 LOUDER with PULMONARY EMBOLISM
Abnormal Heart Sounds in Adults: - ANSWERSS3 and S4
,S3 - ANSWERS-Caused by rapid rush of blood into a dilated ventricle
-Heard best at the apex with the bell of the stethoscope
*Associated with heart failure, may occur before crackles
S3 can be caused by: - ANSWERS*S3 is also caused by PULMONARY HTN and COR PULMONALE
*Mitrale, aortic, or tricuspid insufficiency(regurgitation)
S4 - ANSWERS-Caused by atrial contraction of blood into a noncompliant ventricle
-Best heard at apex with bell of stethoscope
-Associated with myocardial ischemia, infarction, HTN, ventricular hypertrophy, and AORTIC
STENOSIS
S4 is associated with: - ANSWERSAssociated with myocardial ischemia, infarction, HTN,
ventricular hypertrophy, and AORTIC STENOSIS
Pericardial Friction Rub: - ANSWERS-Due to pericarditis associated with pain on deep inspiration
-May be positional
Pulse pressure: - ANSWERSSystolic - Diastolic = Pulse Pressure
Systolic Blood Pressure: - ANSWERSis an indirect measurement of the cardiac output and stroke
volume.
,-a decrease in systolic blood pressure with little change or increase in diastolic pressure is
narrowing of pulse pressure, seen most often with severe hypovolemia or severe drop in CO
Diastolic Blood Pressure: - ANSWERSis an indirect measurement of SVR (after load)
-a decrease in diastolic pressure WIDENS pulse pressure may indicate vasodilation, drop in SVR,
often in seen in severe sepsis, septic shock, i.e., 100/38
Coronary arteries are perfused during? - ANSWERSdiastole
Normal heart sounds, S1 and S2 in are due to? - ANSWERSValve closure
Valves open and close based on the pressure changes in the chamber above the valve and
below the valve. When the pressure in the chamber above a valve is higher than that below the
valve, the value opens. When the pressure drops in the chamber above the valve and the
pressure is greater below the cave, the valve closes.
Causes of Valvular Heart Dz: - ANSWERSCoronary Artery Dz, Ischemia, and Acute MI
Dilated Cardiomyopathy
Rheumatic Fever
Infection
Murmurs: Insufficiency and Stenosis - ANSWERSMurmurs of insufficiency (regurgitation) occur
when the valve is closed: Acute or chronic
, Murmurs of STENOSIS occur when the valve is open: Chronic problem, develops over time, NOT
acute
Mitral Insufficiency will cause? - ANSWERSLarge giant V waves on the PAOP if the patient has a
pulmonary artery catheter
Tricuspid Insufficiency will cause? - ANSWERSVSD - which is the most common with acute MI,
may result in systolic murmur. It is heard at the left sternal border, 5th intercostal space (ICS).
Systolic Murmurs: Name 4 - ANSWERSAortic Stenosis/Pulmonic Stenosis/Mitral insufficiency
and Tricuspid insufficiency
Diastolic Murmurs: definition and name 4 - ANSWERSSemilunar valves are CLOSED during
diastole
Aortic insufficiency
Pulmonic insufficiency
Mitral stenosis
Tricuspid stenosis
Mitral stenosis is associated with? - ANSWERSAtrial fibrillation due to atrial enlargement that
occurs over time
Mitral insufficiency occurs when? - ANSWERSthe mitral valve is closed (murmur occurs). When
is the mitral valve closed? SYSTOLE
Mitral stenosis occurs when? - ANSWERSthe mitral valve is open (murmur occurs). When is the
mitral valve open? DIASTOLE
