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NUR524 Exam 2 Questions And 100% Correct Answers
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NUR524 Exam 2 Questions And 100%Correct Answers
Normal PMI? In cardiomegaly? - Answer Midclavicular 5th intercostal space
In Cardiomegaly displaced to the left
What should you tell your patient to do when assessing for carotid bruits? - Answer Hold
breath
S1 - Answer Closure of AV valves when ventricular pressure exceeds atrial pressures at
beginning of systole
Corresponds with pulse
Best heard at apex
S2 - Answer 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 - Answer 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-Answer 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-Answer 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 - Answer Pulmonary HTN as valve closes earlier d/t high
pulmonary resistance
Mild-moderate aortic stenosis as closure of valve is delayed
Pathologic Single S2 - Answer 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 - Answer 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 - Answer Aortic
stenosis and mitral regurgitation
Grades of Intensity of murmurs - Answer Grade 1: Faintly audible with stethoscope,
special attention to hear
grade 2: Soft but easily detectable
Grade 3: Easily detected, but not loud
,Grade 4: Loud with associated thrill palpable
Grade 5: Very loud
Grade 6: Without use of stethoscope
What determines the Frequency of a murmur - Answer Rates of blood flow
Lower and slower flow -> Lower frequency
Higher and faster flow -> Higher frequency
Contour of murmur - Answer Configuration of murmur concerning its audibility
Crescendo, decrescendo, flat, or crescendo-decrescendo
Duration of murmurs - Answer Duration of systole or diastole
Mid-systolic, holo-diastolic, pan-systolic
Timing of murmurs - Answer Systolic murmurs start with or shortly after S1 and
terminate before or at S2
The diastolic murmurs start with or shortly after S2 and terminate before or at S1
What do murmurs in the aortic auscultation area indicate - Answer Pathology of the atria
ventricular or left ventricular outflow tracts
Aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
What do murmurs in the pulmonic area indicate - Answer Tend to be quiet
Pathology of the pulmonic valve such as a PDA.
Further supported if intensity varies with respiration
What does murmurs in Erb's point indicate
, Answer Murmurs in this location are sometimes louder if the patient leans forward
Diastolic murmurs of R atrium and many pulmonic and aortic murmurs
What does murmurs in the tricuspid area indicate
Answer 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 - Answer 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 - Answer 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 - Answer 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 - Answer Pansystolic blowing
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