NUR 102 Cardiac Assessment Exam
Questions & Answers (Grade A+)
A nurse is auscultating a client's heart sounds and hears an extra
heart sound before what should be considered the first heart
sounds S1. The nurse should document this as which of the
following heart sounds?
A. S4
B. Friction Rub
C. S3
D. Split S2 -
correct answer ✅A. S4
Rationale: S4 is an extra sound that is heard late in diastole just
before S1. It occurs due to resistance to blood flow in an enlarged
ventricle.
While auscultating a client's heart sounds, the nurse hears
turbulence between the S1 and S2 heart sounds. The nurse should
document this finding as which of the following?
A. Systolic Murmur
B. S3 sound
,NUR 102 Cardiac Assessment Exam
Questions & Answers (Grade A+)
C. unexpected heart sound
D. S4 sound -
correct answer ✅A. Systolic Murmur
Rationale - Cardiac murmurs are relatively loud, turbulent sounds
the nurse can hear between the usual, expected heart sounds. They
create a whooshing or a swishing sound. Those between S1 and S2
are systolic murmurs. Those between S2 and the next S1 are
diastolic murmurs.
A nurse is caring for a newborn and auscultates an apical heart rate
of 130/min. Which of the following actions should the nurse take?
A. Ask another nurse to verify the heart rate
B. Document this as an expected finding
C. Call the provider to further assess the newborn
D. Prepare the newborn for transport to the NICU -
correct answer ✅B. Document this as an expected finding.
Rationale: The expected reference range for an apical pulse in a
newborn who is awake is 120 to 160/min. The nurse should
document this as an expected finding.
, NUR 102 Cardiac Assessment Exam
Questions & Answers (Grade A+)
A client tells the nurse that he is concerned because his provider
told him he has a heart murmur. The nurse should explain to the
client that a murmur
A. Is a high-pitched sound due to a narrow valve
B. Extra sound due to blood entering an inflexible chamber
C. Means that there some inflammation around the heart
D. Indicates turbulent blood flow through the valve. -
correct answer ✅D. indicates turbulent blood flow through a
valve.
Rationale: Turbulent blood flow through a valve generates a
murmur, possibly due to a malfunctioning valve, increased blood
flow, or some type of defect in the structures of or around the
heart.
A nurse is assessing a client's radial pulse and determines that the
pulse is irregular. Which of the following actions should the nurse
take?
A. Assess the apical pulse for a full minute
Questions & Answers (Grade A+)
A nurse is auscultating a client's heart sounds and hears an extra
heart sound before what should be considered the first heart
sounds S1. The nurse should document this as which of the
following heart sounds?
A. S4
B. Friction Rub
C. S3
D. Split S2 -
correct answer ✅A. S4
Rationale: S4 is an extra sound that is heard late in diastole just
before S1. It occurs due to resistance to blood flow in an enlarged
ventricle.
While auscultating a client's heart sounds, the nurse hears
turbulence between the S1 and S2 heart sounds. The nurse should
document this finding as which of the following?
A. Systolic Murmur
B. S3 sound
,NUR 102 Cardiac Assessment Exam
Questions & Answers (Grade A+)
C. unexpected heart sound
D. S4 sound -
correct answer ✅A. Systolic Murmur
Rationale - Cardiac murmurs are relatively loud, turbulent sounds
the nurse can hear between the usual, expected heart sounds. They
create a whooshing or a swishing sound. Those between S1 and S2
are systolic murmurs. Those between S2 and the next S1 are
diastolic murmurs.
A nurse is caring for a newborn and auscultates an apical heart rate
of 130/min. Which of the following actions should the nurse take?
A. Ask another nurse to verify the heart rate
B. Document this as an expected finding
C. Call the provider to further assess the newborn
D. Prepare the newborn for transport to the NICU -
correct answer ✅B. Document this as an expected finding.
Rationale: The expected reference range for an apical pulse in a
newborn who is awake is 120 to 160/min. The nurse should
document this as an expected finding.
, NUR 102 Cardiac Assessment Exam
Questions & Answers (Grade A+)
A client tells the nurse that he is concerned because his provider
told him he has a heart murmur. The nurse should explain to the
client that a murmur
A. Is a high-pitched sound due to a narrow valve
B. Extra sound due to blood entering an inflexible chamber
C. Means that there some inflammation around the heart
D. Indicates turbulent blood flow through the valve. -
correct answer ✅D. indicates turbulent blood flow through a
valve.
Rationale: Turbulent blood flow through a valve generates a
murmur, possibly due to a malfunctioning valve, increased blood
flow, or some type of defect in the structures of or around the
heart.
A nurse is assessing a client's radial pulse and determines that the
pulse is irregular. Which of the following actions should the nurse
take?
A. Assess the apical pulse for a full minute
