3160 Exam 3 Review Part 1

When auscultating an apical pulse, you suspect that there is an abnormal heart sound. You then:

• compare the apical pulse to the carotid pulse simultaneously

• notify the provider that the patient has a dangerous murmur

• determine when the sound occurs in the respiratory cycle

• Educate the patient that all murmurs are innocent

You are auscultating a patient's carotid artery and hear a "whooshing" sound. This could indicate:

• That the patient has cardiovascular disease

• that the patient has adequate blood flow to the brain

• that the patient has a pansystolic murmur

• that the patient has an active clot in the carotid artery

A murmur that is very loud and can be heard with one corner of the stethoscope lifted off the chest is:

• grade 6

• grade 4

• grade 5

• grade 3

Where do you auscultate the apical pulse?

• the pulmonic valve, located at the 2nd intercostal space, left of sternum

• the mitral valve, located at 5th intercostal space, left midclavicular line

• the aortic valve, located at the 2nd intercostal space, right of sternum

• the mitral valve, located at the 3rd intercostal space, left sternal border

What questions should you prioritize asking to differentiate cardiac and non-cardiac chest pain? (SATA)

• Is the pain recreated when palpating the chest?

• Does the pain worsen when you change position?

• does the chest pain get worse when you breathe in?

• do you have a family history of GERD?

When S3 and S4 are "smooshed" together, also known as a quadruplet sound. It is a really loud, long sound heard after S2

• Mitral prosthetic sound

• S4

• Summation

• pericardial friction rub

Which of the following can be caused by thrusting inside of the ventricles, such as in ventricular hypertrophy?

• thrill

• murmur

• bruit

• a lift/heave

In order to avoid causing bradycardia, the nurse should

• tell the patient to "bear down" when palpating for a thrill

• ask the patient to hold their breath while auscultating for heart murmurs

• only use light pressure when palpating the carotid pulse

• avoid palpating when assessing for jugular vein distention

This is the sound heard when the tricuspid and mitral valves (the AV valves) are closing:

• S3

• S1

• S4

• S2

In what ways can the nurse assess jugular vein distention? (SATA)

• elevated the HOB to 30 degrees and look for distention in the neck

• palpate the carotid pulse in the neck unilaterally

• place the patient in Trendelenburg and assess for distention in the neck

• hold a ruler parallel with the angle of louis while looking for distention