NR643 Final Study Guide: 100 Essential Exam
Questions with Answers & Clinical Rationales (2026-
2028 Updated)
**1. All the following are correct statements regarding the S3
component of the heart sound EXCEPT:**
- **A)** It occurs early in diastole and is sometimes called an opening
snap
- **B)** It is a normal finding in some children, healthy young adults,
and athletes
- **C)** It can be a normal variant if heard in a person age 40 or older
- **D)** It signifies CHF (congestive heart failure)
**Answer: C) It can be a normal variant if heard in a person age 40 or
older**
*Rationale:* An S3 heart sound heard in a patient over 40 is considered
pathological and warrants further evaluation for heart failure or volume
overload. S3 is normal in children, young adults, and athletes, but in
older adults it suggests decreased ventricular compliance .
---
,**2. You notice a medium-pitched harsh systolic murmur during an
episodic exam. It is best heard at the right upper border of the sternum.
What is most likely?**
- **A)** Aortic regurgitation
- **B)** Aortic stenosis
- **C)** Pulmonic stenosis
- **D)** Tricuspid regurgitation
**Answer: B) Aortic stenosis**
*Rationale:* Aortic stenosis produces a harsh, medium-pitched systolic
ejection murmur best heard at the right upper sternal border (aortic
area). It radiates to the carotids and is associated with a crescendo-
decrescendo pattern .
---
**3. Potential complications of mitral valve prolapse include all the
following EXCEPT:**
- **A)** Severe mitral regurgitation
- **B)** Endocarditis
- **C)** Increased risk of stroke and TIA
- **D)** Mitral Stenosis
,**Answer: D) Mitral Stenosis**
*Rationale:* MVP does not lead to mitral stenosis. Complications
include mitral regurgitation, infective endocarditis, and embolic events
(stroke/TIA). Mitral stenosis is a separate valvular pathology, most
commonly rheumatic in origin .
---
**4. A 21-year-old female complaining of random palpitations is
diagnosed with mitral valve prolapse. Echocardiogram reveals
redundant and thickened leaflets. You note a Grade III/VI systolic
murmur with an ejection click. What would you recommend?**
- **A)** Endocarditis prophylaxis for most dental and urologic
procedures
- **B)** Endocarditis prophylaxis is not necessary
- **C)** Lifetime anticoagulation therapy with warfarin sodium
- **D)** Endocarditis prophylaxis for dental procedures only
**Answer: B) Endocarditis prophylaxis is not necessary**
*Rationale:* According to current AHA guidelines, antibiotic
prophylaxis for infective endocarditis is no longer recommended for
mitral valve prolapse unless the patient has a prior history of
endocarditis or a prosthetic valve .
, ---
**5. Heberden's nodes are commonly found in which of the following
diseases?**
- **A)** Rheumatoid arthritis
- **B)** Degenerative joint disease (Osteoarthritis)
- **C)** Psoriatic arthritis
- **D)** Septic arthritis
**Answer: B) Degenerative joint disease (Osteoarthritis)**
*Rationale:* Heberden's nodes are bony enlargements of the distal
interphalangeal (DIP) joints, classically associated with osteoarthritis.
Bouchard's nodes involve the proximal interphalangeal (PIP) joints .
---
**6. When confirming a case of temporal arteritis, the erythrocyte
sedimentation rate (ESR) is expected to be:**
- **A)** Normal
- **B)** Lower than normal
- **C)** Elevated
Questions with Answers & Clinical Rationales (2026-
2028 Updated)
**1. All the following are correct statements regarding the S3
component of the heart sound EXCEPT:**
- **A)** It occurs early in diastole and is sometimes called an opening
snap
- **B)** It is a normal finding in some children, healthy young adults,
and athletes
- **C)** It can be a normal variant if heard in a person age 40 or older
- **D)** It signifies CHF (congestive heart failure)
**Answer: C) It can be a normal variant if heard in a person age 40 or
older**
*Rationale:* An S3 heart sound heard in a patient over 40 is considered
pathological and warrants further evaluation for heart failure or volume
overload. S3 is normal in children, young adults, and athletes, but in
older adults it suggests decreased ventricular compliance .
---
,**2. You notice a medium-pitched harsh systolic murmur during an
episodic exam. It is best heard at the right upper border of the sternum.
What is most likely?**
- **A)** Aortic regurgitation
- **B)** Aortic stenosis
- **C)** Pulmonic stenosis
- **D)** Tricuspid regurgitation
**Answer: B) Aortic stenosis**
*Rationale:* Aortic stenosis produces a harsh, medium-pitched systolic
ejection murmur best heard at the right upper sternal border (aortic
area). It radiates to the carotids and is associated with a crescendo-
decrescendo pattern .
---
**3. Potential complications of mitral valve prolapse include all the
following EXCEPT:**
- **A)** Severe mitral regurgitation
- **B)** Endocarditis
- **C)** Increased risk of stroke and TIA
- **D)** Mitral Stenosis
,**Answer: D) Mitral Stenosis**
*Rationale:* MVP does not lead to mitral stenosis. Complications
include mitral regurgitation, infective endocarditis, and embolic events
(stroke/TIA). Mitral stenosis is a separate valvular pathology, most
commonly rheumatic in origin .
---
**4. A 21-year-old female complaining of random palpitations is
diagnosed with mitral valve prolapse. Echocardiogram reveals
redundant and thickened leaflets. You note a Grade III/VI systolic
murmur with an ejection click. What would you recommend?**
- **A)** Endocarditis prophylaxis for most dental and urologic
procedures
- **B)** Endocarditis prophylaxis is not necessary
- **C)** Lifetime anticoagulation therapy with warfarin sodium
- **D)** Endocarditis prophylaxis for dental procedures only
**Answer: B) Endocarditis prophylaxis is not necessary**
*Rationale:* According to current AHA guidelines, antibiotic
prophylaxis for infective endocarditis is no longer recommended for
mitral valve prolapse unless the patient has a prior history of
endocarditis or a prosthetic valve .
, ---
**5. Heberden's nodes are commonly found in which of the following
diseases?**
- **A)** Rheumatoid arthritis
- **B)** Degenerative joint disease (Osteoarthritis)
- **C)** Psoriatic arthritis
- **D)** Septic arthritis
**Answer: B) Degenerative joint disease (Osteoarthritis)**
*Rationale:* Heberden's nodes are bony enlargements of the distal
interphalangeal (DIP) joints, classically associated with osteoarthritis.
Bouchard's nodes involve the proximal interphalangeal (PIP) joints .
---
**6. When confirming a case of temporal arteritis, the erythrocyte
sedimentation rate (ESR) is expected to be:**
- **A)** Normal
- **B)** Lower than normal
- **C)** Elevated
