N190 Midterm Review Spring 2026 West Coast University

N190 – Midterm Review



Cardiac Murmur Grades

Heart Murmurs: harsh, blowing sounds caused by disruption of blood flow
into the heart

Thrust: noticeable movement on chest wall

Thrills: soft vibratory sensations best assessed w/ either fingertips of
palm flattened on chest



Grade 1

 Barely audible (innocent murmur)
 Considered physiologic, not pathologic
 Requires concentration / quiet environment

Grade 2

 Very soft but distinctly audible

Grade 3

 Moderately loud
 No thrust or thrill

Grade 4

 Distinctly loud  assess for cardiac murmur
 Palpable thrill

Grade 5

 Very loud, can hear w/ diaphragm, thrill present
 Palpable thrust and thrill

Grade 6

 Loudest, can hear w/ diaphragm off chest
 Visible thrust and thrill

,How To Check for Pulse Deficit  to assess for decreased CO; Afib

Apical Pulse > Carotid Pulse

 Carotid used because closest to the heart and most accessible
 Auscultate apical pulse
 Simultaneously palpate a carotid pulse
 Compare the findings
o Should be synchronous

Carotid Pulse

 Always auscultate before you palpate
o Listen w/ bell & hold breath
o Check for bruits
 Bruit: blowing, or swishing sound caused by turbulent
blood flow
 Indicates a narrow vessel & arterial disease
 Palpated unilaterally
o Done to avoid potentially compressing the carotid sinus and
stimulate the vagus nerve
 Could lead to a drop in HR and syncope



ABCDE Tool (Cancerous Lesions)

A – Asymmetry

B – Border irregularity

C – Color variation

D – Diameter > 6mm

E – Evolving changes (itching, tenderness, bleeding)



What part of the stethoscope to use for bruits?

 Use the bell; hold breath




What does a “holistic health assessment” include?

,  Physical assessment
 Psychological assessment
 Sociological assessment
 Spiritual assessment
 Cultural assessment



Fremitus Assessment

Fremitus: vibrations felt through the chest wall when the client speaks or
coughs

 Test by having patient say “ninety-nine”
o Strong Fremitus: loud & clear (bronchophony  abnormal)
o Weak Fremitus: weak & inaudible (whispered pectoriloquy)



Resonance

 Normal finding

Hyperresonance

 Abnormally loud
 Air trapped in lungs

Flatness

 Over bone

Dullness

 Over organs including heart



How To Assess Nystagmus

Nystagmus: fluttering of the eyeball

 6 cardinal fields (H Method, Wagon Wheel)
 Penlight 12 in away



Romberg Test (CN VIII)

 Tests balance & equilibrium