NUR 524 EXAM 2 | ALL QUESTIONS AND CORRECT
ANSWERS | ALREADY GRADED A+ | PROFESSOR
VERIFIED|| NEWEST VERSION 2025/26
Normal PMI? In cardiomegaly? -CORRECTANSWER Midclavicular 5th intercostal
space
In Cardiomegaly displaced to the left
What should you tell your patient to do when assessing for carotid bruits? -
CORRECTANSWER Hold breath
S1 -CORRECTANSWER Closure of AV valves when ventricular pressure exceeds atrial
pressures at beginning of systole
Corresponds with pulse
Best heard at apex
S2 -CORRECTANSWER 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 -CORRECTANSWER 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 -CORRECTANSWER 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 -CORRECTANSWER 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 -CORRECTANSWER Pulmonary HTN as valve closes
earlier d/t high pulmonary resistance
Mild-moderate aortic stenosis as closure of valve is delayed
Pathologic Single S2 -CORRECTANSWER 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 -CORRECTANSWER 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 -
CORRECTANSWER Aortic stenosis and mitral regurgitation
Intensity Grades of murmurs -CORRECTANSWER 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 -CORRECTANSWER Blood flow rates
Lower and slower flow -> Lower pitch
Higher and faster flow -> Higher pitch
, Murmur configuration -CORRECTANSWER Shape of murmur with respect to its
audibility
Crescendo, decrescendo, flat, or crescendo-decrescendo
Duration of murmurs -CORRECTANSWER Length of systole or diastole
Mid-systolic, holo-diastolic, pan-systolic
Timing of murmurs -CORRECTANSWER 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 -CORRECTANSWER
Pathology of the atria ventricular or left ventricular outflow tracts
Aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
What do murmurs in the pulmonic area indicate -CORRECTANSWER 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 -CORRECTANSWER Murmurs in this area are
sometimes more audible if the patient leans forward
Diastolic murmurs of R atrium and many pulmonic and aortic murmurs
ANSWERS | ALREADY GRADED A+ | PROFESSOR
VERIFIED|| NEWEST VERSION 2025/26
Normal PMI? In cardiomegaly? -CORRECTANSWER Midclavicular 5th intercostal
space
In Cardiomegaly displaced to the left
What should you tell your patient to do when assessing for carotid bruits? -
CORRECTANSWER Hold breath
S1 -CORRECTANSWER Closure of AV valves when ventricular pressure exceeds atrial
pressures at beginning of systole
Corresponds with pulse
Best heard at apex
S2 -CORRECTANSWER 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 -CORRECTANSWER 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 -CORRECTANSWER 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 -CORRECTANSWER 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 -CORRECTANSWER Pulmonary HTN as valve closes
earlier d/t high pulmonary resistance
Mild-moderate aortic stenosis as closure of valve is delayed
Pathologic Single S2 -CORRECTANSWER 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 -CORRECTANSWER 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 -
CORRECTANSWER Aortic stenosis and mitral regurgitation
Intensity Grades of murmurs -CORRECTANSWER 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 -CORRECTANSWER Blood flow rates
Lower and slower flow -> Lower pitch
Higher and faster flow -> Higher pitch
, Murmur configuration -CORRECTANSWER Shape of murmur with respect to its
audibility
Crescendo, decrescendo, flat, or crescendo-decrescendo
Duration of murmurs -CORRECTANSWER Length of systole or diastole
Mid-systolic, holo-diastolic, pan-systolic
Timing of murmurs -CORRECTANSWER 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 -CORRECTANSWER
Pathology of the atria ventricular or left ventricular outflow tracts
Aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
What do murmurs in the pulmonic area indicate -CORRECTANSWER 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 -CORRECTANSWER Murmurs in this area are
sometimes more audible if the patient leans forward
Diastolic murmurs of R atrium and many pulmonic and aortic murmurs
