NUR 524 Exam 2 Questions and Answers Already Passed Latest Update 2025-2026
Normal PMI? In cardiomegaly? - Answers Midclavicular 5th intercostal space
In Cardiomegaly displaced to the left
What should you tell your patient to do when assessing for carotid bruits? - Answers Hold
breath
S1 - Answers Closure of AV valves when ventricular pressure exceeds atrial pressures at
beginning of systole
Corresponds with pulse
Best heard at apex
S2 - Answers 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 - Answers 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 - Answers 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 - Answers 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 - Answers Pulmonary HTN as valve closes earlier d/t high pulmonary
resistance
Mild-moderate aortic stenosis as closure of valve is delayed
Pathologic Single S2 - Answers 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 - Answers 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 - Answers Aortic
stenosis and mitral regurgitation
Intensity Grades of murmurs - Answers 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 - Answers Blood flow rates
Lower and slower flow -> Lower pitch
Higher and faster flow -> Higher pitch
Murmur configuration - Answers Shape of murmur with respect to its audibility
Crescendo, decrescendo, flat, or crescendo-decrescendo
Duration of murmurs - Answers Length of systole or diastole
Mid-systolic, holo-diastolic, pan-systolic
Timing of murmurs - Answers 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 - Answers Pathology of the atria
ventricular or left ventricular outflow tracts
Aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
What do murmurs in the pulmonic area indicate - Answers 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 - Answers 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 - Answers 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 - Answers 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 - Answers 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 - Answers 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 - Answers Pansystolic blowing
Laterally displaced, hyper dynamic apical impulse, brisk carotid upstroke
LVH on ECG and XR
Unchanged with valsalva
Mitral valve prolapse murmur - Answers Midsystolic to late systolic; Occasionally honking; may
have click and murmur that are intermittent
Lower L sternal border
Common finding with precuts excavated or scoliosis
Valsalva causes click/murmur to move
Min. ECG changes, inverted T waves II, III, aVF
Triuspid regurgitation murmur - Answers Early systolic, midsystolic, late systolic or pansystolic
Lower left sternal border with radiation to RSB
Sustained precordial lift
Decrease in murmur with valsalva
ECG: RAE, RADe
Hypertrophic cardiomyopathy murmur - Answers Peaks midsystole
LSB
Murmur decreases with change from standing to squatting and may develop S4 going from
standing to squatting
Murmur increases with valsalva
ECG: LAE, may have LVH
Benign murmurs - Answers Early systolic crescendo-decrescendo that changes intensity with
rate
Location will vary
Murmur disappears with holding breath and valsalva
Aortic regurgitation murmur - Answers Loud, blowing high-pitched
Normal PMI? In cardiomegaly? - Answers Midclavicular 5th intercostal space
In Cardiomegaly displaced to the left
What should you tell your patient to do when assessing for carotid bruits? - Answers Hold
breath
S1 - Answers Closure of AV valves when ventricular pressure exceeds atrial pressures at
beginning of systole
Corresponds with pulse
Best heard at apex
S2 - Answers 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 - Answers 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 - Answers 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 - Answers 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 - Answers Pulmonary HTN as valve closes earlier d/t high pulmonary
resistance
Mild-moderate aortic stenosis as closure of valve is delayed
Pathologic Single S2 - Answers 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 - Answers 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 - Answers Aortic
stenosis and mitral regurgitation
Intensity Grades of murmurs - Answers 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 - Answers Blood flow rates
Lower and slower flow -> Lower pitch
Higher and faster flow -> Higher pitch
Murmur configuration - Answers Shape of murmur with respect to its audibility
Crescendo, decrescendo, flat, or crescendo-decrescendo
Duration of murmurs - Answers Length of systole or diastole
Mid-systolic, holo-diastolic, pan-systolic
Timing of murmurs - Answers 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 - Answers Pathology of the atria
ventricular or left ventricular outflow tracts
Aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
What do murmurs in the pulmonic area indicate - Answers 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 - Answers 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 - Answers 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 - Answers 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 - Answers 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 - Answers 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 - Answers Pansystolic blowing
Laterally displaced, hyper dynamic apical impulse, brisk carotid upstroke
LVH on ECG and XR
Unchanged with valsalva
Mitral valve prolapse murmur - Answers Midsystolic to late systolic; Occasionally honking; may
have click and murmur that are intermittent
Lower L sternal border
Common finding with precuts excavated or scoliosis
Valsalva causes click/murmur to move
Min. ECG changes, inverted T waves II, III, aVF
Triuspid regurgitation murmur - Answers Early systolic, midsystolic, late systolic or pansystolic
Lower left sternal border with radiation to RSB
Sustained precordial lift
Decrease in murmur with valsalva
ECG: RAE, RADe
Hypertrophic cardiomyopathy murmur - Answers Peaks midsystole
LSB
Murmur decreases with change from standing to squatting and may develop S4 going from
standing to squatting
Murmur increases with valsalva
ECG: LAE, may have LVH
Benign murmurs - Answers Early systolic crescendo-decrescendo that changes intensity with
rate
Location will vary
Murmur disappears with holding breath and valsalva
Aortic regurgitation murmur - Answers Loud, blowing high-pitched
