NSG 3160 EXAM 3 QUESTIONS WITH VERIFIED
ANSWERS
The nurse is assessing heart sounds and hears a murmur at the second intercostal space,
right sternal border during systole. Which heart valve is most likely affected?
A. Mitral valve
B. Tricuspid valve
C. Aortic valve
D. Pulmonic valve
C. Aortic valve
Rationale: The aortic valve is best auscultated at the second intercostal space, right sternal
border. A murmur heard in this area during systole suggests aortic stenosis, a condition where
the aortic valve does not fully open, restricting blood flow from the left ventricle to the aorta.
A patient with mitral valve stenosis is most likely to develop which complication?
A. Right ventricular hypertrophy
B. Left ventricular hypertrophy
C. Pulmonary congestion
D. Decreased right atrial pressure
C. Pulmonary congestion
Rationale: Mitral stenosis causes increased pressure in the left atrium, leading to pulmonary
hypertension and congestion as blood backs up into the lungs. This can result in symptoms such
as dyspnea and orthopnea.
A patient is diagnosed with tricuspid regurgitation. Which of the following symptoms
would the nurse expect to find?
A. Pulmonary edema
B. Peripheral edema
C. Decreased jugular venous pressure
D. Bounding carotid pulse
B. Peripheral edema
Rationale: Tricuspid regurgitation causes blood to back up into the right atrium and venous
system, leading to peripheral edema, ascites, and jugular vein distension. It does not cause
pulmonary edema because it affects the right heart, not the left.
During cardiac auscultation, the nurse hears a diastolic murmur at the second intercostal
space, left sternal border. Which valve disorder is most likely?
A. Aortic regurgitation
B. Pulmonic stenosis
C. Mitral stenosis
D. Tricuspid stenosis
,A. Aortic regurgitation
Rationale: Aortic regurgitation causes a diastolic murmur heard best at the second intercostal
space, left sternal border due to backflow of blood from the aorta into the left ventricle during
diastole.
Which valve disorder is most commonly associated with rheumatic heart disease?
A. Aortic stenosis
B. Mitral stenosis
C. Pulmonic regurgitation
D. Tricuspid regurgitation
B. Mitral stenosis
Rationale: Mitral stenosis is the most common valvular complication of rheumatic heart disease,
leading to thickening and narrowing of the mitral valve, impeding blood flow from the left
atrium to the left ventricle.
The nurse is assessing a patient with pulmonary valve stenosis. Which finding would be
expected?
A. Increased right atrial pressure
B. Bounding pulses
C. Hypertension
D. Widened pulse pressure
A. Increased right atrial pressure
Rationale: Pulmonic stenosis causes right ventricular hypertrophy and increased right atrial
pressure, leading to jugular vein distension (JVD), hepatomegaly, and peripheral
A patient with aortic stenosis is at risk for which complication?
A. Left ventricular hypertrophy
B. Right ventricular hypertrophy
C. Increased cardiac output
D. Bradycardia
A. Left ventricular hypertrophy
Rationale: Aortic stenosis causes increased resistance to left ventricular outflow, resulting in left
ventricular hypertrophy as the heart works harder to pump blood through the stenotic valve.
A nurse is educating a patient with mitral valve prolapse. Which statement by the patient
indicates a need for further teaching?
A. "I should avoid caffeine and alcohol."
B. "I need antibiotics before every dental procedure."
C. "I might experience palpitations and dizziness."
D. "My condition may be associated with a mid-systolic click."
B. "I need antibiotics before every dental procedure."
Rationale: Routine antibiotic prophylaxis for mitral valve prolapse is not recommended unless
,the patient has a history of infective endocarditis or a prosthetic valve. The other statements are
correct.
The nurse is monitoring a patient post-valve replacement surgery. Which finding requires
immediate intervention?
A. Bruising at the incision site
B. INR of 1.8 in a patient with a mechanical valve
C. Heart rate of 88 beats per minute
D. Mild shortness of breath when walking
B. INR of 1.8 in a patient with a mechanical valve
Rationale: Patients with mechanical heart valves require anticoagulation with warfarin to prevent
clot formation. The target INR is typically 2.5-3.5. An INR of 1.8 is too low, increasing the risk
of thrombus formation.
Which of the following findings is most concerning in a patient with aortic regurgitation?
A. Widened pulse pressure
B. Water hammer pulse
C. Decreasing systolic blood pressure
D. Diastolic murmur
C. Decreasing systolic blood pressure
Rationale: A decreasing systolic blood pressure may indicate acute aortic regurgitation leading to
cardiogenic shock. While widened pulse pressure and water hammer pulse are classic findings,
they are not immediately life-threatening.
The nurse is auscultating heart sounds and notes that S1 is loudest at which location?
A. Aortic area
B. Pulmonic area
C. Erb's point
D. Mitral area
D. Mitral area
Rationale: S1 (first heart sound) is loudest at the mitral area (apex of the heart, fifth intercostal
space, midclavicular line) because it represents closure of the mitral and tricuspid valves at the
beginning of systole.
A nurse is auscultating a patient's heart sounds and notes a physiologic split of S2. When is
this sound best heard?
A. During expiration at the apex
B. During inspiration at the pulmonic area
C. During systole at the aortic area
D. During diastole at the mitral area
B. During inspiration at the pulmonic area
Rationale: A physiologic split of S2 occurs when the aortic valve (A2) closes before the
, pulmonic valve (P2) during inspiration, and it is best heard at the pulmonic area (second
intercostal space, left sternal border).
A third heart sound (S3) is best heard in which situation?
A. A 22-year-old athlete
B. A 65-year-old patient with heart failure
C. A patient with aortic stenosis
D. A patient with pericarditis
B. A 65-year-old patient with heart failure
Rationale: S3 (ventricular gallop) occurs due to rapid ventricular filling and is often a sign of
heart failure (HF) or volume overload in older adults. However, in young athletes and pregnant
women, S3 may be normal.
A nurse auscultates an S4 heart sound. Which condition is most likely associated with this
finding?
A. Atrial fibrillation
B. Hypertension
C. Mitral stenosis
D. Pulmonary embolism
B. Hypertension
Rationale: S4 (atrial gallop) occurs due to stiff ventricular walls caused by conditions such as
hypertension, aortic stenosis, or left ventricular hypertrophy. It occurs just before S1 due to atrial
contraction forcing blood into a noncompliant ventricle.
A murmur heard during systole that is described as a crescendo-decrescendo pattern at the
second right intercostal space is most likely caused by which condition?
A. Aortic stenosis
B. Mitral stenosis
C. Aortic regurgitation
D. Tricuspid regurgitation
A. Aortic stenosis
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic murmur best heard at the
second right intercostal space (aortic area) and may radiate to the carotids.
The nurse auscultates a holosystolic murmur at the apex of the heart that radiates to the
axilla. Which valve disorder is most likely?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Tricuspid stenosis
B. Mitral regurgitation
Rationale: Mitral regurgitation causes a holosystolic (pansystolic) murmur heard best at the apex
(fifth intercostal space, midclavicular line) and radiates to the axilla.
ANSWERS
The nurse is assessing heart sounds and hears a murmur at the second intercostal space,
right sternal border during systole. Which heart valve is most likely affected?
A. Mitral valve
B. Tricuspid valve
C. Aortic valve
D. Pulmonic valve
C. Aortic valve
Rationale: The aortic valve is best auscultated at the second intercostal space, right sternal
border. A murmur heard in this area during systole suggests aortic stenosis, a condition where
the aortic valve does not fully open, restricting blood flow from the left ventricle to the aorta.
A patient with mitral valve stenosis is most likely to develop which complication?
A. Right ventricular hypertrophy
B. Left ventricular hypertrophy
C. Pulmonary congestion
D. Decreased right atrial pressure
C. Pulmonary congestion
Rationale: Mitral stenosis causes increased pressure in the left atrium, leading to pulmonary
hypertension and congestion as blood backs up into the lungs. This can result in symptoms such
as dyspnea and orthopnea.
A patient is diagnosed with tricuspid regurgitation. Which of the following symptoms
would the nurse expect to find?
A. Pulmonary edema
B. Peripheral edema
C. Decreased jugular venous pressure
D. Bounding carotid pulse
B. Peripheral edema
Rationale: Tricuspid regurgitation causes blood to back up into the right atrium and venous
system, leading to peripheral edema, ascites, and jugular vein distension. It does not cause
pulmonary edema because it affects the right heart, not the left.
During cardiac auscultation, the nurse hears a diastolic murmur at the second intercostal
space, left sternal border. Which valve disorder is most likely?
A. Aortic regurgitation
B. Pulmonic stenosis
C. Mitral stenosis
D. Tricuspid stenosis
,A. Aortic regurgitation
Rationale: Aortic regurgitation causes a diastolic murmur heard best at the second intercostal
space, left sternal border due to backflow of blood from the aorta into the left ventricle during
diastole.
Which valve disorder is most commonly associated with rheumatic heart disease?
A. Aortic stenosis
B. Mitral stenosis
C. Pulmonic regurgitation
D. Tricuspid regurgitation
B. Mitral stenosis
Rationale: Mitral stenosis is the most common valvular complication of rheumatic heart disease,
leading to thickening and narrowing of the mitral valve, impeding blood flow from the left
atrium to the left ventricle.
The nurse is assessing a patient with pulmonary valve stenosis. Which finding would be
expected?
A. Increased right atrial pressure
B. Bounding pulses
C. Hypertension
D. Widened pulse pressure
A. Increased right atrial pressure
Rationale: Pulmonic stenosis causes right ventricular hypertrophy and increased right atrial
pressure, leading to jugular vein distension (JVD), hepatomegaly, and peripheral
A patient with aortic stenosis is at risk for which complication?
A. Left ventricular hypertrophy
B. Right ventricular hypertrophy
C. Increased cardiac output
D. Bradycardia
A. Left ventricular hypertrophy
Rationale: Aortic stenosis causes increased resistance to left ventricular outflow, resulting in left
ventricular hypertrophy as the heart works harder to pump blood through the stenotic valve.
A nurse is educating a patient with mitral valve prolapse. Which statement by the patient
indicates a need for further teaching?
A. "I should avoid caffeine and alcohol."
B. "I need antibiotics before every dental procedure."
C. "I might experience palpitations and dizziness."
D. "My condition may be associated with a mid-systolic click."
B. "I need antibiotics before every dental procedure."
Rationale: Routine antibiotic prophylaxis for mitral valve prolapse is not recommended unless
,the patient has a history of infective endocarditis or a prosthetic valve. The other statements are
correct.
The nurse is monitoring a patient post-valve replacement surgery. Which finding requires
immediate intervention?
A. Bruising at the incision site
B. INR of 1.8 in a patient with a mechanical valve
C. Heart rate of 88 beats per minute
D. Mild shortness of breath when walking
B. INR of 1.8 in a patient with a mechanical valve
Rationale: Patients with mechanical heart valves require anticoagulation with warfarin to prevent
clot formation. The target INR is typically 2.5-3.5. An INR of 1.8 is too low, increasing the risk
of thrombus formation.
Which of the following findings is most concerning in a patient with aortic regurgitation?
A. Widened pulse pressure
B. Water hammer pulse
C. Decreasing systolic blood pressure
D. Diastolic murmur
C. Decreasing systolic blood pressure
Rationale: A decreasing systolic blood pressure may indicate acute aortic regurgitation leading to
cardiogenic shock. While widened pulse pressure and water hammer pulse are classic findings,
they are not immediately life-threatening.
The nurse is auscultating heart sounds and notes that S1 is loudest at which location?
A. Aortic area
B. Pulmonic area
C. Erb's point
D. Mitral area
D. Mitral area
Rationale: S1 (first heart sound) is loudest at the mitral area (apex of the heart, fifth intercostal
space, midclavicular line) because it represents closure of the mitral and tricuspid valves at the
beginning of systole.
A nurse is auscultating a patient's heart sounds and notes a physiologic split of S2. When is
this sound best heard?
A. During expiration at the apex
B. During inspiration at the pulmonic area
C. During systole at the aortic area
D. During diastole at the mitral area
B. During inspiration at the pulmonic area
Rationale: A physiologic split of S2 occurs when the aortic valve (A2) closes before the
, pulmonic valve (P2) during inspiration, and it is best heard at the pulmonic area (second
intercostal space, left sternal border).
A third heart sound (S3) is best heard in which situation?
A. A 22-year-old athlete
B. A 65-year-old patient with heart failure
C. A patient with aortic stenosis
D. A patient with pericarditis
B. A 65-year-old patient with heart failure
Rationale: S3 (ventricular gallop) occurs due to rapid ventricular filling and is often a sign of
heart failure (HF) or volume overload in older adults. However, in young athletes and pregnant
women, S3 may be normal.
A nurse auscultates an S4 heart sound. Which condition is most likely associated with this
finding?
A. Atrial fibrillation
B. Hypertension
C. Mitral stenosis
D. Pulmonary embolism
B. Hypertension
Rationale: S4 (atrial gallop) occurs due to stiff ventricular walls caused by conditions such as
hypertension, aortic stenosis, or left ventricular hypertrophy. It occurs just before S1 due to atrial
contraction forcing blood into a noncompliant ventricle.
A murmur heard during systole that is described as a crescendo-decrescendo pattern at the
second right intercostal space is most likely caused by which condition?
A. Aortic stenosis
B. Mitral stenosis
C. Aortic regurgitation
D. Tricuspid regurgitation
A. Aortic stenosis
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic murmur best heard at the
second right intercostal space (aortic area) and may radiate to the carotids.
The nurse auscultates a holosystolic murmur at the apex of the heart that radiates to the
axilla. Which valve disorder is most likely?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Tricuspid stenosis
B. Mitral regurgitation
Rationale: Mitral regurgitation causes a holosystolic (pansystolic) murmur heard best at the apex
(fifth intercostal space, midclavicular line) and radiates to the axilla.
