NUR 6001 Advanced Health Assessment Exam 2 Review
Guide | Latest actual study with Complete Solutions | 2026
Updates | 100% Pass Guarantee
Exam 2 GUIDE
Please study ALL materials in Modules 3 and 4.
Cardiovascular: Heart sounds – (both normal and abnormal ie S1, S2, S3, S4 murmurs) –
location of valve sounds, pathophysiology
· S1 signifies the beginning of systole
It’s the sound made by the atrioventricular valves closure.
Once the ventricles are filled, the valves close. It snaps shut like a door and that’s the S1
sound you hear. The S1 is heard loudest on the apex of the heart (mitral area)
· Ventricle contracts/empties
· Atria relaxes/fills
· S2 signifies the end of systole = Diastole Is
the closure of your pulmonic & aortic valve.
The ventricles have contracted.
It pushes all the blood on the right side to the lungs on the left side and to the aorta.
The pulmonic & aortic valve closing is the S2 sound, loudest at the base of the heart.
It's heard at the end of S1, it’s the beginning S2 and its loudest at the base of the heart.
· Ventricle relaxes/fills
· Atria contracts/empties
· Split S2
Sometimes you hear a split S2 with a difference.
It's millisecond difference between the closure of a pulmonic and aortic valve.
So, there's some disease condition if the patient has like pulmonary issues, particularly,
you might hear split S2.
· S3 aka ventricular gallop/ Extra heart sounds
Due to the blood going into the Atria and there's a lot of volume makes a sound.
It occurs after S2, right before the opening of the atrioventricular valves.
There's a lot of fluid/blood in the atrium it slushes and makes that extra heart sound.
Benign
o Children
o Pregnant women increased volume
Pathologic
o Adults signifies Heart Failure
The ‘SLASHING’ is kind of a mnemonic for you to remember what the cause of S3 is,
it's slashing because there's a lot of volume.
· S4 aka atrial gallop
It occurs after the atrial contraction, so at the end of diastole and immediately before
S1.
The atrioventricular valves are open, just before it closes, the atrial kick occurs.
,This occurs because the ventricles are stiff, the blood coming in makes a sound = S4
Hypertrophy, particularly with hypertension, makes an S4 sound. ’tenessee’
Summation gallop is a patient who actually has S1, S2, S3, S4.
, So, it's like a galloping of horses. When you listen to there.
Important Not heard in atrial fibrillation
because there is no organized atrial contraction (“atrial kick”)
MURMUR
Murmur decreases in upright position
· increased blood flow exercise or thyrotoxicosis
· decreased viscosity
· structural defects
o narrowing or stenosis
o incompetence
Remember: the valve closest shut & should not allow blood to go through when its closed. When
valves are incompetent, it allows regurgitation or leaking when the valve is closed.
It’s similar to closing a door but it jams or doesn’t fit in the frame well, you feel the draft.
the door jams and kind of jammed or it's not, it doesn't fit in a frame too well then you'll feel like
a draft.
Systolic murmurs
In systole the heart is pumping or contracting more common because more issues can occur
during
atrioventricular valves are closed
aortic & pulmonic valves are open 2
most common systolic murmurs:
· 🔑AS Aortic stenosis heard on 2nd intercostal space, right upper sternal boarder
Narrowing of your aorta during systole, the blood is trying to go through it, causing
turbulence, which is a murmur.
Syncope, angina, and dyspnea (remembered with the acronym SAD) on exertion are the
classic symptoms of aortic stenosis. If syncope occurs with exertion, the aortic stenosis is
typically severe. Angina may be present because of decreased perfusion of the left ventricle due
to left ventricular hypertrophy (LVH) rather than CAD, but both exist in many cases.
Associated physical findings include the following: an early ejection click, a diminished S2, a
heave or sustained apical impulse with LVH, crackles at the lung bases with left ventricular
failure, jugular venous distension, hepatomegaly, and peripheral edema that may be
associated with right ventricular failure.
· 🔑MR Mitral Regurgitation heard on 2nd intercostal space, left upper sternal
boarder
What is your mitral valve doing on systole? The heart is contracting & aortic valve is
open. What is your mitral valve doing at this point? It should be closed.
But what did we say happens if there is incompetence in that valve = it’s not closing
properly. When the ventricle squeeze or contracts, the blood goes into the aorta but
because the mitral valve is not closing well, there will be backflow aka mitral
regurgitation.
Guide | Latest actual study with Complete Solutions | 2026
Updates | 100% Pass Guarantee
Exam 2 GUIDE
Please study ALL materials in Modules 3 and 4.
Cardiovascular: Heart sounds – (both normal and abnormal ie S1, S2, S3, S4 murmurs) –
location of valve sounds, pathophysiology
· S1 signifies the beginning of systole
It’s the sound made by the atrioventricular valves closure.
Once the ventricles are filled, the valves close. It snaps shut like a door and that’s the S1
sound you hear. The S1 is heard loudest on the apex of the heart (mitral area)
· Ventricle contracts/empties
· Atria relaxes/fills
· S2 signifies the end of systole = Diastole Is
the closure of your pulmonic & aortic valve.
The ventricles have contracted.
It pushes all the blood on the right side to the lungs on the left side and to the aorta.
The pulmonic & aortic valve closing is the S2 sound, loudest at the base of the heart.
It's heard at the end of S1, it’s the beginning S2 and its loudest at the base of the heart.
· Ventricle relaxes/fills
· Atria contracts/empties
· Split S2
Sometimes you hear a split S2 with a difference.
It's millisecond difference between the closure of a pulmonic and aortic valve.
So, there's some disease condition if the patient has like pulmonary issues, particularly,
you might hear split S2.
· S3 aka ventricular gallop/ Extra heart sounds
Due to the blood going into the Atria and there's a lot of volume makes a sound.
It occurs after S2, right before the opening of the atrioventricular valves.
There's a lot of fluid/blood in the atrium it slushes and makes that extra heart sound.
Benign
o Children
o Pregnant women increased volume
Pathologic
o Adults signifies Heart Failure
The ‘SLASHING’ is kind of a mnemonic for you to remember what the cause of S3 is,
it's slashing because there's a lot of volume.
· S4 aka atrial gallop
It occurs after the atrial contraction, so at the end of diastole and immediately before
S1.
The atrioventricular valves are open, just before it closes, the atrial kick occurs.
,This occurs because the ventricles are stiff, the blood coming in makes a sound = S4
Hypertrophy, particularly with hypertension, makes an S4 sound. ’tenessee’
Summation gallop is a patient who actually has S1, S2, S3, S4.
, So, it's like a galloping of horses. When you listen to there.
Important Not heard in atrial fibrillation
because there is no organized atrial contraction (“atrial kick”)
MURMUR
Murmur decreases in upright position
· increased blood flow exercise or thyrotoxicosis
· decreased viscosity
· structural defects
o narrowing or stenosis
o incompetence
Remember: the valve closest shut & should not allow blood to go through when its closed. When
valves are incompetent, it allows regurgitation or leaking when the valve is closed.
It’s similar to closing a door but it jams or doesn’t fit in the frame well, you feel the draft.
the door jams and kind of jammed or it's not, it doesn't fit in a frame too well then you'll feel like
a draft.
Systolic murmurs
In systole the heart is pumping or contracting more common because more issues can occur
during
atrioventricular valves are closed
aortic & pulmonic valves are open 2
most common systolic murmurs:
· 🔑AS Aortic stenosis heard on 2nd intercostal space, right upper sternal boarder
Narrowing of your aorta during systole, the blood is trying to go through it, causing
turbulence, which is a murmur.
Syncope, angina, and dyspnea (remembered with the acronym SAD) on exertion are the
classic symptoms of aortic stenosis. If syncope occurs with exertion, the aortic stenosis is
typically severe. Angina may be present because of decreased perfusion of the left ventricle due
to left ventricular hypertrophy (LVH) rather than CAD, but both exist in many cases.
Associated physical findings include the following: an early ejection click, a diminished S2, a
heave or sustained apical impulse with LVH, crackles at the lung bases with left ventricular
failure, jugular venous distension, hepatomegaly, and peripheral edema that may be
associated with right ventricular failure.
· 🔑MR Mitral Regurgitation heard on 2nd intercostal space, left upper sternal
boarder
What is your mitral valve doing on systole? The heart is contracting & aortic valve is
open. What is your mitral valve doing at this point? It should be closed.
But what did we say happens if there is incompetence in that valve = it’s not closing
properly. When the ventricle squeeze or contracts, the blood goes into the aorta but
because the mitral valve is not closing well, there will be backflow aka mitral
regurgitation.
