NURS 6225 Advanced Health
Assessment Exam 2 (2022)
When examining a patient for the apical impulse (PMI), which of the following is
LEAST important
... [Show More] to assess?
A. Location
B. Amplitude
C. Rhythm
D. Diameter - Answer- C. Rhythm
Assess location, amplitude, duration, and diameter
5 A's of tobacco cessation - AnswerWhat is tactile fremitus? - Answer- palpable vibrations transmitted through the
bronchopulmonary tree to the chest wall as the patient is speaking "99"
NORMAL= buzzing on hands when patient say "99"
SOLIDS CONDUCT SOUND/VIBRATIONS BETTER THAN AIR
Conditions where tactile fremitus is absent or decreased - Answer- Fremitus is
decreased or absent when the transmission of vibrations is impeded.
Feeling little or no buzzing at all compared to similar lung areas; LARGE POCKETS
OF AIR IN THE LUNGS
thick chest wall
obstructed bronchus
COPD
pleural effusion
fibrosis
pneumo (Air)
infiltrating tumor
fibrosis
emphysema
consolidation
Asthma
Causes of asymmetrical fremitus - Answer- Decreased fremitus
Unilateral pleural effusion
Pneumo
neoplasm
Increased fremitus
Unilateral pneumonia
Causes of increased fremitus - Answer- feeling of a strong vibration compared to
similar lung areas
Consolidation of lung tissue
pneumonia
atelectasis
bronchitis
Apical Impulse (PMI) - Answer- Point of Maximal Impulse (Apex of the heart):
between 4th to 5th intercostal space, midclavicular
Apex beat is palpable in only 25-40% of healthy adults in supine position and 50% in
left lateral decubitus position—>especially those who are thin
Some hide behind rib cage, despite positioning
diaphragmatic excursion - Answer- *assesses degree and symmetry of diaphragm
movement; percuss from areas of resonance to dullness
* not percussing the diaphragm itself you are identifying the resonant lung tissue and
the duller structures below.
* you can infer the probable location of the diaphragm from the level of dullness
during diaphragmatic excursion an "absent decent" means what? - Answer- An
abnormally high level suggests a pleural effusion or an elevated hemidiaphragm
from atelectasis or phrenic nerve paralysis
fine crackles/rales - Answer- occurrence- on end inspiration; dont clear with cough.
Quality- High pitched short crackling
Causes- collapses or fluid-filled alveoli open
Course crackles/rales - Answer- Occurrence- End inspiration, doesn't clear with
cough
Quality- Loud, moist, low-pitched, bubbling
Causes- Collapsed or fluid-filled alveoli open
Wheezes - Answer- Occurrence- Expiration and inspiration when severe
Quality- High-pitched, continuous
Causes- blocked airflow as in asthma, infection, foreign body obstruction
Ronchi - Answer- Occurrence- Expiration/inspiration; change/disappeat with cough
Quality- Low-pitched, continuous, snoring, rattling
Cause- Fluid blocked airways
Stridor - Answer- Occurrence- Inspiration
Quality- loud, hi-pitched crowing heard without stethoscope
Cause- obstructed upper airway
pleural friction rub - Answer- Occurrence- Inhalation/expiration
Quality- low-pitched grating, rubbing
Cause- pleural inflammation
Percussion technique - AnswerNormal percussion findings in Adult by location - AnswerTracheal deviation with atelectasis - Answer- When a plug obstructs bronchial air
flow, affected alveoli collapse and become airless
*Trachea may shift to involved side
Tracheal deviation with Pleural effusion - Answer- fluid accumulates in the pleural
space and separates air-filled lungs from the chest wall, blocking the transmission of
breath sounds
* Trachea may shift towards the unaffected side in a large effusion
Tracheal deviation in a pneumothorax - Answer- Air leaks into the pleural space,
usually unilaterally, the lung recoils away from the chest wall. Pleural air blocks
transmission of sound
*Trachea shifts toward unaffected side if tension pneumo
Which conditions lead to absent breath sounds? - Answer- *Fluid or exudate has
accumulated in pleural space (think emphysema)
*When lungs are hyperinflated
*Breathing shallow from splinting for pain
When palpating the posterior chest, the clinician notes increased tactile fremitus over
the left
lower lobe. This can be indicative of:
A. Pneumonia
B. Emphysema
C. Pneumothorax
D. Asthma - Answer- Ans: A
Areas of increased fremitus should raise the suspicion of conditions resulting in
increased
solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor,
or
pulmonary fibrosis. Conversely, areas of decreased fremitus raise the suspicion of
abnormal
fluid- or air-filled spaces, such as occurs with pleural effusion, pneumothorax, or
emphysema. In the instance of an extensive bronchial obstruction, no palpable
vibration is
felt in the related field.
During physical examination of a patient, you note resonance on percussion in the
upper
lung fields. This is consistent with:
A. Chronic obstructive pulmonary disease
B. Pneumothorax
C. A normal finding
D. Pleural effusion - Answer- ANS: C The lung fields should be percussed
posteriorly, starting from the superior-most areas and then proceeding inferiorly to
the level of the diaphragm. Resonance is the normal sound on percussion.
Hyperresonance suggests air trapping, which occurs with chronic obstructive
pulmonary disease or tension pneumothorax. Dullness to percussion is detected
over the actual site of consolidated lung or pleural fluid. Dullness is also found with
pneumonia, severe atelectasis, or pleural effusion.
On assessment of respiratory excursion, the clinician notes asymmetric expansion of
the
chest. One side expands greater than the other. This could be due to:
A. Pneumothorax
B. Pleural effusion
C. Pneumonia
D. Pulmonary embolism - Answer- ANS: A The respiratory excursion, or expansion,
is determined by placing hands around the patient's posterior rib cage with the
thumbs approximately at the level of the 10th rib between the thumbs, and then
asking the patient to take a deep breath and observing the movement of the hands.
The motion should be symmetrical. Less than anticipated movement occurs with
advanced chronic obstructive pulmonary disease and many restrictive processes,
such as interstitial lung disease. Asymmetry of movement occurs with atelectasis,
lobar collapse, pneumothorax, and several other conditions
During auscultation of the chest, your examination reveals a loud grating sound at
the lower
anterolateral lung fields, at full inspiration and early expiration. This finding is
consistent
with:
A. Pneumonia
B. Pleuritis
C. Pneumothorax
D. A and B - Answer- ANS: A&B
An adventitious sound, called a pleural friction rub, is a typically loud, grating sound
produced when the two inflamed and roughened surfaces of the visceral and parietal
pleurae
rub together. A friction rub is usually noted in the late inspiratory and early expiratory
phases, and in the lower anterolateral lung fields. Examples of conditions that result
in a
pleural rub include pneumonia, pleuritis, and malignancy.
A cough is described as chronic if it has been present for:
A. 2 weeks or more
B. 8 weeks or more
C. 3 months or more
D. 6 months or more - Answer- ANS: B
Cough is classified as acute (less than 3 weeks in duration), subacute (lasting 3 to 8
weeks), and chronic (8 or more weeks in duration), and these distinctions help to
narrow the potential differential diagnoses.
The following criterion is considered a positive finding when determining whether a
patient
with pneumonia can be safely monitored and treated at home:
A. Age over 40
B. Fever greater than 101°F
C. Tachypnea greater than 30 breaths per minute
D. Productive cough - Answer- ANS: C
Decision Rule: CURB-65 provides framework for determining whether the patient
diagnosed with community-acquired pneumonia can be safely monitored and treated
at
home. One point is awarded for each of the following factors present:
• Confusion of new onset
• Blood urea nitrogen greater than 20 mg/dL
• Respiratory rate of 30 breaths per minute or more
• Blood pressure less than 90 mm Hg systolic or diastolic 60 mm Hg or less
• Age 65 or older
Patients scoring 3 to 5 typically require hospitalization for observation and therapy.
Scores
of 0 to 1 indicate likelihood that outpatient management is appropriate. A score of 2
is
inconclusive.
The most common etiological organism for community-acquired pneumonia is:
A. Streptococcus pneumoniae
B. Beta hemolytic streptococcus
C. Mycoplasma
D. Methicillin resistant staphylococcus - Answer- ANS: A Pneumonia involves
inflammation and consolidation of lung tissue. Pneumonia is broadly categorized by
whether it occurs outside of the hospital (community-acquired pneumonia) or within
the hospital (nosocomial, or hospital-acquired, pneumonia). The cause is most often
Streptococcus pneumoniae, Haemophilus influenzae, or Staphylococcus aureus.
Atypical pneumonia involves infection of mycoplasma, legionella, or chlamydia.
A 75-year-old patient with community-acquired pneumonia presents with a
temperature of
102.1°F, chills, productive cough, blood pressure 90/62, respiratory rate 28, white
blood
count 12,000, and blood urea nitrogen 20 mg/dl. He has a history of mild dementia
and his
mental status is unchanged from his last visit. These findings indicate that the
patient:
A. Can be treated as an outpatient
B. Requires hospitalization for treatment
C. Requires a high dose of parenteral antibiotic
D. Can be treated with oral antibiotics - Answer- ANS: A
Decision Rule: CURB-65 provides framework for determining whether the patient
diagnosed with community-acquired pneumonia can be safely monitored and treated
at
home. One point is awarded for each of the following factors present:
• Confusion of new onset
• Blood urea nitrogen greater than 20 mg/dl
• Respiratory rate 30 breaths or more per minute
• Blood pressure less than 90 mm Hg systolic or diastolic 60 mm Hg or less
• Age 65 or older
Patients scoring 3 to 5 typically require hospitalization for observation and therapy.
Scores
of 0 to 1 indicate likelihood that outpatient management is appropriate. A score of 2
is
inconclusive.
If on physical examination the clinician auscultates rhonchi, the clinician should ask
the
patient to take a deep breath and cough in order to:
A. Mobilize secretions
B. Diagnose pleural effusion
C. Accurately distinguish lung sounds
D. A and C - Answer- ANS: D
Cough is the most common symptom of bronchitis and may persist for several weeks
after
the initial infection is resolved. During the acute phase, the cough may be productive.
There
may be associated symptoms, including fever, malaise, chest discomfort, chills, and
headache. The chills and chest discomfort are mild in comparison to the symptoms
of
pneumonia. There may be wheezes and/or rhonchi on auscultation, which disappear
or alter
with cough effort.
Which of the following is considered a red flag when diagnosing a patient with
pneumonia?
A. Fever of 102°F
B. Infiltrates on chest x-ray
C. Pleural effusion on chest x-ray
D. Elevated white blood cell count - Answer- ANS: C
With pneumonia, the chest film typically reveals an area of infiltrate. It is a red flag if
a
pleural effusion is also visualized, in which case adequate follow-up to exclude
development of an empyema is mandatory. This often involves prompt referral to a
pulmonologist for possible thoracentesis. Cultures and Gram stains of sputum are
usually
not ordered for outpatients. The white blood cell count is often elevated.
A 76-year-old patient with a 200-pack year smoking history presents with complaints
of
chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2
months. The
physical examination reveals decreased breath sounds and dullness to percussion
over the
left lower lung field. The chest x-ray demonstrates shift of the mediastinum and
trachea to
the left. These are classic signs of:
A. Lung cancer
B. Tuberculosis
C. Pneumonia
D. Chronic obstructive pulmonary disease - Answer- ANS: A
Dyspnea is the most common symptom associated with pleural effusion, but effusion
may
be accompanied by cough, pain, and systemic symptoms, such as malaise and
fever.
Abnormal physical findings become evident as the effusion increases in volume.
These
include decreased lung sounds, dullness over the effusion, decreased fremitus,
egophony,
and whispered pectoriloquy. With extremely large effusions, the mediastinum and
trachea
may shift to the opposite side. The exception involves effusion related to malignancy,
in
which case the mediastinum and trachea may be pulled toward the malignancy.
A 24-year-old patient presents to the emergency department after sustaining multiple
traumatic injuries after a motorcycle accident. On examination you note tachypnea,
use of
intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds
over the
left lower lobe. It is most important to suspect:
A. Pulmonary embolism
B. Pleural effusion
C. Pneumothorax
D. Fracture of ribs - Answer- ANS: C
Pneumothorax involves air in the pleural cavity. A pneumothorax can occur
spontaneously
in otherwise healthy individuals or be secondary to trauma or intrinsic lung disease.
There is
history of sudden onset of shortness of breath associated with chest pain. The
patient usually
presents in great distress, with tachycardia and tachypnea, and is often splinting the
chest.
There is decreased fremitus and increased hyperresonance on the affected side.
Lung sounds
are diminished or absent. The trachea may shift away from the affected side if a
large
pneumothorax is present
The first heart sound (S1) occurs because of the closure of the:
A. Aortic and mitral valves
B. Mitral and tricuspid valves
C. Pulmonic valve
D. Aortic valve - Answer- ANS: B
S1 is the closing of the mitral and tricuspid (T1) valves; together they are known as
the atrioventricular (AV) valves. S2 is the closing of the aortic (A2) and pulmonic (P2)
valves; together they
are known as the semilunar valves.
The second heart sound (S2) occurs because of the closure of the:
A. Aortic valve
B. Tricuspid valve
C. Aortic and pulmonic valves
D. A and B - Answer- ANS: C
S1 is the closing of the mitral and tricuspid (T1) valves; together they are known as
the atrioventricular (AV) valves. S2 is the closing of the aortic (A2) and pulmonic (P2)
valves; together they
are known as the semilunar valves.
An S3 gallop is commonly heard in:
A. Children with fever
B. Adults with heart failure
C. Children with aortic stenosis
D. Adults with hypertension - Answer- ANS: B
Pathological S3, also called a ventricular gallop, is heard in adults and is associated
with decreased myocardial contractility, heart failure, and volume overload
conditions, as can occur
with mitral or tricuspid regurgitation. The sound is the same as a physiological S3
and is heard
just after S2 with the patient supine or in the left lateral recumbent position. The
sound is very
soft and can be difficult to hear.
An S4 sound is commonly heard in:
A. Children with fever
B. Adults with atrial fibrillation
C. Adults with hypertension
D. Children with pulmonic stenosis - Answer- ANS: C
S4, also called an atrial gallop, occasionally occurs in a normal adult or well-trained
athlete, but
is usually due to increased resistance to filling of the ventricle. Possible causes of a
left-sided S4
include hypertension, cardiovascular disease, cardiomyopathy, and aortic stenosis.
Possible
causes of a right-sided S4 include pulmonic stenosis and pulmonary hypertension.
S4 is heard just
before S1 with the patient supine or in the left lateral recumbent position. The sound
can be as
loud as S1 and S2. S4 is not heard in patients with chronic atrial fibrillation due to no
distinct atrial kic
Which of the following heart sounds is commonly heard after myocardial infarction?
A. Friction rub
B. S4
C. S3
D. Opening snap - Answer- ANS:A
Friction rubs occur frequently after a myocardial infarction or with pericarditis. The
sound is a high-pitched grating, scratching sound—resulting from inflammation of the
pericardial sac—that issues from the parietal and visceral surfaces of the inflamed
pericardium as
they rub together.
When is an opening snap heard on auscultation? - Answer- Opening snap is caused
by the opening of a stenotic mitral or tricuspid valve and is heard early in
diastole along the lower left sternal border. It is high pitched and heard best with the
diaphragm
of the stethoscope
When palpating the chest, you find the point of maximal impulse (PMI) in the left
midaxillary
region. This can be indicative of:
A. Normal PMI
B. Congenital heart disease
C. Ventricular hypertrophy
D. Hypertension - Answer- ANS: C
The examiner should palpate the PMI and the precordium for heaves or lifts, seen in
ventricular
hypertrophy. The apical impulse is easily observed in the pediatric client but not
always visible
in the adult. An accentuated or displaced apical impulse may indicate ventricular
hypertrophy
On inspecting the patient, you find jugular venous distension. This is a sign of:
A. Left ventricular hypertrophy
B. Right ventricular failure
C. Hypertension
D. Valve disease - Answer- ANS: B
In right ventricular failure, hydrostatic pressure builds up back into the right atrium
and superior
as well as inferior vena cava. Venous congestion occurs throughout the body. A sign
of venous
congestion of the superior vena cava is jugular vein distension. Signs of right
ventricular failure
include jugular venous distension, ascites, hepatomegaly, splenomegaly, and ankle
edema
The pain of ___________________ can frequently be mistaken for cardiac chest
pain.
A. Gastroesophageal reflux disease
B. Peptic ulcer disease
C. Cholecystitis
D. All of the above - Answer- ANS: D
It is often difficult to differentiate the symptoms of gastroesophageal reflux disease
(GERD) or
peptic ulcer disease (PUD) from cardiac symptoms. A thorough history and
diagnostic tests are
necessary. Patients with a history of GERD or PUD should still be worked up for a
cardiac etiology, particularly if the characteristics of the symptoms or the history have
changed to raise the
index of suspicion for cardiac disease. The pain of cholecystitis, also sometimes
mistaken for
cardiac pain, typically presents with right upper quadrant pain with radiation to the
thoracic region of the b
The pain of pancreatitis is described as:
A. Abdominal sharp and piercing pain in the left upper quadrant
B. Dull and cramping pain in the right upper quadrant
C. Severe, epigastric pain radiating straight into the back
D. Sharp pain radiating to the shoulder - Answer- ANS: C
The pain of pancreatitis is severe, steady, and "boring"—radiating from the epigastric
region
through to the back. It is often accompanied by nausea and vomiting, tachycardia,
hypotension,
and diaphoresis. These symptoms are also seen in myocardial infarction; however,
the exquisite
abdominal tenderness present in pancreatitis assists in differentiating it from cardiac
pain
The pain of costochondritis typically:
A. Mimics cardiac crushing and squeezing pain
B. Worsens with movement and full inspiration
C. Radiates from the epigastrium into the back
D. Is a tearing and ripping pain - Answer- ANS: B
Costochondritis, which is inflammatory pain of the chest wall, can often be
differentiated from
cardiac pain through history. A history of injury, heavy lifting, contact sports,
excessive coughing, or late-stage pregnancy (which stretches the intercostal
muscles) leads the examiner to consider chest wall pain. This often occurs in a
younger population with no cardiac risk factors. One
of the most helpful differentiating symptoms is that the pain increases with
movement, cough, or,
in some cases, respiration.
The medical record of your patient lists a grade III systolic murmur. This indicates the
patient
has a heart murmur that is:
A. Soft and after S2
B. Loud and crescendo in quality
C. Moderately loud and after S1
D. Loud and after S2 - Answer- ANS: C
A grade III murmur is moderately loud and a systolic murmur immediately follows S1.
the radiation of a mitral valve murmur is commonly heard in the:
A. Carotid arteries
B. Left midaxillary line
C. Base of the heart
D. Left midclavicular line - Answer- ANS: B
A through cardiac examination is performed with the patient sitting, leaning forward,
lying, and in the left lateral recumbent position. Some murmurs are heard better in
different positions. Listen over the carotids for radiation of an aortic or pulmonic
murmur, in the left midaxillary line for radiation on a mitral murmur, and in the
epigastric area for a bruit, indicating an aneurysm
The murmur of aortic stenosis is best heard in the:
A. Left second intercostal space left sternal border
B. Left fifth intercostal space midclavicular line
C. Right fourth intercostal space right sternal border
D. Right second intercostal space right sternal border - Answer- ANS: D
Aortic stenosis is heard best in the second right intercostal space with the client
leaning forward.
The murmur is harsh, loud, and often associated with a thrill. It may radiate to the
neck, left
sternal border, and, in some cases, to the apex
The pulmonary valve is best heard over the:
A. Left second intercostal space left sternal border
B. Left fifth intercostal space midclavicular line
C. Right fourth intercostal space right sternal border
D. Right second intercostal space right sternal border - Answer- ANS: A
The valves are best heard over the chest at specific areas. The aortic valve is best
heard over the
second intercostal space right sternal border and the pulmonic valve is best heard
over the second
intercostal space left sternal border. The mitral valve is best heard over the fifth
intercostal space
midclavicular line.
Classically in mitral valve prolapse, the clinician can hear a(n):
A. Midsystolic click followed by a grade I murmur that crescendos up to S2
B. Opening snap followed by a grade III holosystolic murmur
C. Crescendo-decrescendo grade I diastolic murmur after S2
D. Rough grade III holosystolic murmur that obscures S1 and S2 - Answer- ANS: A
In mitral valve prolapse, a portion of the mitral valve flops open up into the left
atrium, giving rise to a classic midsystolic click followed by a soft grade I murmur that
crescendos up to S2. It is high pitched and is heard best at the apex or left sternal
border.
The tricuspid valve is best heard over the:
A. Third intercostal space left sternal border
B. Fifth intercostal space right sternal border
C. Fourth intercostal space left sternal border
D. Third intercostal space right sternal border - Answer- ANS: C
The tricuspid valve is best heard over the fourth intercostal space left sternal border.
Erb's point
is located over the third intercostal space left sternal border. The mitral valve is best
heard over
the fifth intercostal space in the midclavicular line. The aortic valve is best heard over
the second
intercostal space right sternal border. The pulmonic valve is best heard over the
second intercostal space left sternal borde
From Erb's point, all the heart valves can be heard equally. Erb's point is located
over the:
A. Third intercostal space left sternal border
B. Fifth intercostal space right sternal border
C. Fourth intercostal space left sternal border
D. Third intercostal space right sternal border - Answer- ANS: A
The tricuspid valve is best heard over the fourth intercostal space left sternal border.
Erb's point
is where all valves can be heard equally well. Erb's point is located over the third
intercostal
space left sternal border. The mitral valve is best heard over the fifth intercostal
space in the
midclavicular line. The aortic valve is best heard over the second intercostal space
right sternal
border. The pulmonic valve is best heard over the second intercostal space left
sternal border.
A 75-year-old patient complains of pain and paresthesias in the right foot that
worsens with
exercise and is relieved by rest. On physical examination, you note pallor of the right
foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right
foot, and +2 pulse in
left foot. Which of the following is a likely cause of the signs and symptoms?
A. Arterial insufficiency
B. Femoral vein thrombus
C. Venous insufficiency
D. Peripheral neuropathy - Answer- ANS: A
Intermittent claudication is pain in the leg or foot that becomes worse with exercise
and is relieved by rest. The classic signs of peripheral arterial disease include pain,
pallor, weak pulse,
paresthesias, and palpable coolness. The signs of venous thrombosis are erythema
and ropiness,
as well as warmth and tenderness along the course of the vein. Edema of the leg
and Homan's
sign of the foot are also common.
Your patient complains of a feeling of heaviness in the lower legs daily. You note
varicosities,
edema, and dusky color of both ankles and feet. Which of the following is the most
likely cause
for these symptoms?
A. Femoral vein thrombosis
B. Femoral artery thrombus
C. Venous insufficiency
D. Musculoskeletal injury - Answer- ANS: C
Chronic venous insufficiency can be a long-term complication of venous thrombosis,
owing to
the destruction of valves in the deep veins. The calf muscle pump that returns blood
from the
lower legs is damaged, increasing ambulatory pressure in the calf veins. A
constellation of
symptoms is set up: aching or pain in the lower legs, edema, thinning and
hyperpigmentation of
the skin, superficial varicosities, venous stasis, and ulceration. Ankle edema is often
the earliest
sign.
Clinical presentation of pneumonia - Answer- Presentation: Cough associated with
malaise, fever, chills, rigors, and/or chest discomfort. often appears ill
VS: tachycardia, tachypnea, fever
*uneven fremitus and the area over the consolidation percusses dull
* On auscultation there are bronchial breath sounds often with crackles.
*Bronchophony, egophony, and whispered pectoriloquy are often present
Clinical presentation of Mitral valve prolapse (MVP)
(Click Murmur syndrome) - Answer- *variant of mitral regurgitation. 10% of young
women
*heart size and hemodynamics usually normal; can progress
*S/S: usually asymptomatic or complain of palpitations.
* characteristically, a portion of the mitral valve balloons into the left atrium giving
rise to a midsystolic click followed by a soft grade I murmur that crescendos up to S2
*The sound is high-pitched and best heard at the apex or left sternal border.
Placement/auscultation of S3. Reason/clinical presentation for sound - AnswerHeard in early diastole right after S2.
*PHYSIOLOGICAL S3: Usually confined to children, young adults, and pregnant
women as a result of rapid early ventricular filling
- Low pitched and heard best at the apex or left sternal border
*PATHOLOGICAL S3: aka ventricular gallop; heard in adults and associated with
decreased myocardial contractility, HF, and volume overload as can occur with mitral
or tricuspid regurg.
-sound is same
Placement/auscultation of S4. Reason/clinical presentation for sound - AnswerHeard in late diastole just before S1.
*aka Atrial gallop; occasionally occurs in a normal adult or well trained athlete but is
usually due to increased resistance to filling of the ventricle
LEFT SIDED- caused by HTN, CVD, cardiomyopathy, and aortic stenosis
RIGHT SIDED- pulmonic stenosis and pulmonary HTN.
** NOT heard in a-fib due to no distinct atrial kick.
In which case is S3 a normal heart sound? - Answer- During pregnancy and in well
trained athletes.
* the ventricles are holding extra blood due to increased volume
Explain S4 heart sounds - Answer- due to stiff or hypertrophied ventricles that have
increased in size to pump against high blood pressure
*due to pressure overload or severe hypertension
physical finding for an adult with MVP may also include? - Answer- A minor thoracic
deformity such as pectus excavatum which is characterized by a deformity of the
anterior thoracic wall which the sternum and ribcage are shaped abnormally
producing a concave or sunken chest appearance
When preforming a cardiac exam for MVP you would expect to hear which kind of
murmur? - Answer- A mid-to late systolic murmur
* MVP is best described as a grade 1 to 3/6 late systolic crescendo murmur with a
honking quality that is best heard at the apex
Aside from heart murmur, additional findings in MVP include? - Answer- The murmur
typically follows a mid-systolic- click. The click with move forward into earlier systole
upon standing from the sitting or supine position
When a heart valve fails to open to its normal orifice size, it is said to be? - AnswerStenotic
When a heat valve fails to close properly it is said to be? - Answer- incompetent
which will lead to regurg [Show Less]