Download Heart Activities

Heart Activities to Accompany Delmar’s Heart & Lung Sounds for Nurses CD-ROM
Directions:
 Read the section on the Cardiac Cycle on pages 487-488 in Health Assessment & Physical
Examination, third edition.
 Listen to Heart Sounds, Cardiac cycle on Delmar’s Heart & Lung Sounds CD-ROM.
1.
In the normal cardiac cycle:
(a) systole is when the ventricles are contracting and diastole is when the ventricles are relaxing.
(b) systole is when the ventricles are relaxing and diastole is when the ventricles are contracting.
(c) systole is when the right ventricle is contracting and the left ventricle is relaxing.
(d) systole is when the right ventricle is relaxing and the left ventricle is contracting.
Answer: a
Rationale: The ventricles work together, and systole is when they are contracting and producing the
greatest force.
2.
Cardiac muscle must recover from each contraction. This means that:
(a) systole is generally half as long as diastole.
(b) systole takes the same amount of time as diastole.
(c) systole takes twice as long as diastole.
(d) systole takes three times as long as diastole.
Answer: a
Rationale: The recovery takes about twice as long as the contraction.
3.
During systole in the normal cardiac cycle, the S1 sound is produced by closure of which valves?
(a) pulmonic and aortic
(b) pulmonic and tricuspid
(c) mitral and aortic
(d) mitral and tricuspid
Answer: d
Rationale: The mitral and tricuspid valves are pushed closed with increasing pressure in the ventricles.
4.
All of the following are stages or phases of systole except:
(a) the isovolumic or isometric stage.
(b) early systole.
(c) mid systole.
(d) late systole.
Answer: c
Rationale: Systole is divided into three stages or phases, in the order (a), (b), and (d) above.
5.
During diastole in the normal cardiac cycle, the S2 sound is produced by closure of which valves?
(a) pulmonic and tricuspid
(b) pulmonic and aortic
(c) mitral and aortic
(d) mitral and tricuspid
Answer: b
Rationale: Pressures in the aortic and pulmonic valves are higher than in the ventricles, closing the
pulmonic and aortic valves.
Heart Activities, page 1 of 20
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6.
The stages or phases of diastole in the normal cardiac cycle are called:
(a) isovolumic or isometric phase.
(b) early, mid, and late diastole.
(c) late diastole.
(d) all of the above
Answer: d
Rationale: Diastole is divided into four phases or stages in this order: isovolumic or isometric phase, early
diastole, mid diastole, late diastole.
7.
Ventricles begin filling with blood during which stage of diastole?
(a) isovolumic or isometric stage
(b) early diastole
(c) mid diastole
(d) late diastole
Answer: b
Rationale: During early diastole, atrial pressures exceed ventricular pressures, pushing the mitral and
tricuspid valves open, and blood begins to flow into the ventricles.
Directions:
 Read Assessment of the Precordium, pages 507-508, and Auscultation, pages 513 and 817-818 in
Health Assessment & Physical Examination, third edition.
 Listen to Heart Sounds, Auscultation on Delmar’s Heart & Lung Sounds CD-ROM.
8.
When auscultating heart sounds (choose two):
(a) use the diaphragm to listen to high-pitched sounds, like S1 or S2.
(b) use the diaphragm to listen to low-pitched sounds, like S3 or S4.
(c) use the bell to listen to high-pitched sounds, like S1 or S2.
(d) use the bell to listen to low-pitched sounds, like S3 or S4.
Answer: a, d
Rationale: The diaphragm is used for high-pitched sounds and the bell is used for low-pitched sounds.
9.
When auscultating heart sounds:
(a) it is acceptable to listen through clothing.
(b) the patient should be supine or sitting.
(c) the aortic and pulmonary areas may be heard better if the patient is in the left lateral decubitus
position.
(d) when using the bell, press it tightly on the skin.
Answer: b
Rationale: Never auscultate through clothing. The left lateral decubitus position may be better for hearing
the mitral and tricuspid areas.
10.
The area in the second intercostal space to the right of the sternum is the:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
(d) mitral area.
Answer: a
Rationale: This is where the aortic valve is best heard.
Heart Activities, page 2 of 20
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11.
The area in the second intercostal space to the left of the sternum is the:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
(d) mitral area.
Answer: b
Rationale: This is where the pulmonic valve is best heard.
12.
The area over the fifth intercostal space to the left of the sternum is the:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
(d) mitral area.
Answer: c
Rationale: This is where the tricuspid valve is best heard.
13.
The area over the fifth intercostal space at the left midclavicular line is the:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
(d) mitral area.
Answer: d
Rationale: This is where the mitral valve is best heard.
Directions:
 Read the sections on Auscultation, pages 513-515 and 817-818 in Health Assessment & Physical
Examination, third edition.
 Listen to Heart Sounds, S1 S2 on Delmar’s Heart & Lung Sounds CD-ROM.
14.
An abnormally loud aortic portion of the S2, called intensified A2, could indicate:
(a) aortic stenosis.
(b) a thickened or calcified aortic valve.
(c) arterial hypertension.
(d) pulmonary hypertension.
Answer: c
Rationale: Intense A2 is caused by increased pressure in the aorta.
15.
Intense A2 is best heard:
(a) over the aortic auscultation site using the bell of the stethoscope.
(b) over the tricuspid auscultation site using the diaphragm of the stethoscope.
(c) over the mitral auscultation site using the bell of the stethoscope.
(d) over the aortic auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched
sounds better.
Heart Activities, page 3 of 20
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16.
An abnormally soft portion of S2, called diminished A2, could indicate (choose two):
(a) aortic stenosis.
(b) a thickened or calcified aortic valve.
(c) arterial hypertension.
(d) pulmonary hypertension.
Answer: a, b
Rationale: When the aortic valve is less pliable, as with stenosis, calcification, or thickening, it could
produce a diminished sound.
17.
Diminished A2 is best heard:
(a) over the aortic auscultation site using the bell of the stethoscope.
(b) over the tricuspid auscultation site using the diaphragm of the stethoscope.
(c) over the mitral auscultation site using the bell of the stethoscope.
(d) over the aortic auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched
sounds better.
18.
An abnormally loud pulmonic portion of the S2, called intensified P2, could indicate:
(a) aortic stenosis.
(b) a thickened or calcified aortic valve.
(c) arterial hypertension.
(d) pulmonary hypertension.
Answer: d
Rationale: Intensified P2 is caused by increased pressure in the pulmonary artery.
19.
Intense P2 is best heard:
(a) over the aortic auscultation site using the bell of the stethoscope.
(b) over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c) over the mitral auscultation site using the bell of the stethoscope.
(d) over the aortic auscultation site using the diaphragm of the stethoscope.
Answer: b
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched
sounds better.
20.
An abnormally soft portion of S2, called diminished P2, could indicate:
(a) stenosis of the pulmonic valve.
(b) a thickened or calcified aortic valve.
(c) arterial hypertension.
(d) pulmonary hypertension.
Answer: a
Rationale: When the pulmonic valve is less pliable, as with stenosis, calcification, or thickening, it could
produce a diminished sound.
21.
Diminished P2 is best heard:
(a) over the aortic auscultation site using the bell of the stethoscope.
(b) over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c) over the mitral auscultation site using the bell of the stethoscope.
(d) over the aortic auscultation site using the diaphragm of the stethoscope.
Answer: b
Heart Activities, page 4 of 20
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Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched
sounds better.
22.
An abnormally loud S1 can be caused by (choose two):
(a) mitral stenosis.
(b) short PR interval syndrome.
(c) rheumatic fever.
(d) atrial fibrillation.
Answer: a, b
Rationale: A loud S1 occurs when the mitral valve is wide open when systolic contraction begins, and
then slams shut.
23.
Loud S1 is best heard:
(a) over the aortic auscultation site using the bell of the stethoscope.
(b) over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c) over the mitral auscultation site using the bell of the stethoscope.
(d) over the mitral auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched
sounds better.
24.
An abnormally soft S1 can be caused by any of the following except:
(a) mitral stenosis.
(b) first degree heart block.
(c) rheumatic fever.
(d) atrial fibrillation.
Answer: d
Rationale: A soft S1 occurs when the mitral valve has only limited motion.
25.
Soft S1 is best heard:
(a) over the aortic auscultation site using the bell of the stethoscope.
(b) over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c) over the mitral auscultation site using the bell of the stethoscope.
(d) over the mitral auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched
sounds better.
26.
A variable S1 can be caused by (choose two):
(a) mitral stenosis.
(b) complete heart block.
(c) rheumatic fever.
(d) atrial fibrillation.
Answer: b, d
Rationale: A variable S1 occurs when the atria and ventricles are beating independently or when the
ventricles are beating irregularly.
Heart Activities, page 5 of 20
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27.
Variable S1 is best heard:
(a) over the aortic auscultation site using the bell of the stethoscope.
(b) over the pulmonic auscultation site using the diaphragm of the stethoscope.
(c) over the mitral auscultation site using the bell of the stethoscope.
(d) over the mitral auscultation site using the diaphragm of the stethoscope.
Answer: d
Rationale: It is best to listen at the closest site and to use the diaphragm, which picks up high-pitched
sounds better.
28.
Due to higher pressures on the left side of the heart, S2 is loudest over the:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
(d) mitral area.
Answer: a
Rationale: The pressures in the left side of the heart are higher than on the right side.
29.
The best site to auscultate the normal physiologic split S2 sound is the:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
(d) mitral area.
Answer: b
Rationale: During inspiration, venous return to the right side of the heart increases because of the more
negative intrathoracic pressure. Pulmonic closure is delayed because of the extra time needed for the
increased blood volume to pass through the valve. The split disappears if the patient holds his breath.
30.
The best site to auscultate the normal physiologic split S1 sound is the:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
Answer: c
Rationale: The mitral valve closes slightly before the tricuspid due to greater pressures in the left side of
the heart. The split disappears if the patient holds his breath.
31.
The S1 sound is loudest over the:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
(d) mitral area.
Answer: d
Rationale: The S1 sound is caused by the closure of the mitral and tricuspid valves.
Directions:
 Read the sections on Auscultation, pages 513-515, 746, and 818 in Health Assessment & Physical
Examination, third edition.
 Listen to Heart Sounds, Splits on Delmar’s Heart & Lung Sounds CD-ROM.
Heart Activities, page 6 of 20
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32.
An abnormal split S1 can be caused by (choose two):
(a) a diseased aortic valve.
(b) a diseased mitral valve.
(c) a diseased pulmonic valve.
(d) an electrical malfunction, such as a bundle branch block.
Answer: b, d
Rationale: The aortic and pulmonic valves are involved in the S2 sound.
33.
A wide split S2 (choose two):
(a) is heard only on inspiration.
(b) is heard throughout the respiratory cycle.
(c) is heard only with expiration.
(d) is wider with inspiration than with expiration.
Answer: b, d
Rationale: It is heard throughout the respiratory cycle but varies with inspiration and expiration.
34.
A wide split S2 may be caused by any of the following except:
(a) pulmonic stenosis.
(b) a right bundle branch block.
(c) mitral regurgitation.
(d) a left bundle branch block.
Answer: d
Rationale: The wide split is caused by the aortic valve closing early and the pulmonic valve closing late,
indicating delayed electrical stimulation or damage to a valve.
35.
A fixed split S2 may be caused by (choose two):
(a) left ventricular heart failure.
(b) right ventricular heart failure.
(c) an atrial septal defect.
(d) a ventral septal defect.
Answer: b, c
Rationale: Right ventricular failure can result in prolonged right ventricular systole.
36.
A fixed split S2 is heard best with the diaphragm of the stethoscope in this area:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
(d) mitral area.
Answer: b
Rationale: It is best heard in the pulmonic area.
37.
A fixed split S2 is:
(a) longer with inspiration than with expiration.
(b) longer with expiration than with inspiration.
(c) the same length during inspiration and expiration.
(d) of variable lengths during inspiration and expiration.
Answer: c
Rationale: The adjective “fixed” refers to the length being unchanged throughout the respiratory cycle.
Heart Activities, page 7 of 20
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38.
A paradoxical split S2 (choose two):
(a) occurs during expiration and disappears during inspiration.
(b) occurs during inspiration and disappears during expiration.
(c) occurs when the aortic valve closes after the pulmonic valve.
(d) occurs when the pulmonic valve closes after the aortic valve.
Answer: a, c
Rationale: Normally, the aortic valve closes before the pulmonic valve.
39.
A paradoxical split S2 is best heard with the diaphragm of the stethoscope over the:
(a) aortic area.
(b) pulmonic area.
(c) tricuspid area.
(d) mitral area.
Answer: b
Rationale: It is best heard over the pulmonic area.
40.
Split sounds are best heard with the diaphragm of the stethoscope over the (choose two):
(a) valve sites that close first during each sound.
(b) valve sites that close last during each sound.
(c) tricuspid and pulmonic valves.
(d) aortic and mitral valves.
Answer: b, c
Rationale: Split sounds are best heard over the valves that close last, the tricuspid and pulmonic.
Directions:
 Read the section on Auscultation, pages 513-515 in Health Assessment & Physical Examination,
third edition.
 Listen to Heart Sounds, Systolic Sounds (Clicks) on Delmar’s Heart & Lung Sounds CD-ROM.
41.
Ejection clicks are (choose two):
(a) high-pitched sounds heard during systole.
(b) low-pitched sounds heard during diastole.
(c) caused by the closing of a diseased heart valve.
(d) caused by the opening of a diseased heart valve.
Answer: a, d
Rationale: Ejection clicks are high-pitched, as the name indicates, and are caused by the opening of a
diseased valve.
42.
A midsystolic click is formed by:
(a) the aortic valve opening.
(b) the pulmonic valve opening.
(c) the tricuspid valve reopening.
(d) the mitral valve reopening.
Answer: d
Rationale: The midsystolic click is heard halfway between the S1 and S2 sounds, as the mitral valve fails.
43.
Early ejection clicks are caused by a diseased (choose two):
(a) aortic valve.
(b) mitral valve.
(c) pulmonic valve.
(d) tricuspid valve.
Heart Activities, page 8 of 20
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Answer: a, c
Rationale: Early ejection clicks are caused by diseased aortic and pulmonic valves.
44.
An aortic ejection click (choose two):
(a) is low-pitched and does not radiate into the chest wall.
(b) is high-pitched and can radiate into the chest wall.
(c) varies with the respiratory cycle.
(d) does not vary with the respiratory cycle.
Answer: b, d
Rationale: It is high-pitched, can radiate, and does not vary with respiration.
45.
An aortic ejection click is best heard with the diaphragm of the stethoscope over the:
(a) aortic area.
(b) pulmonic area.
(c) mitral area.
(d) tricuspid area.
Answer: a
Rationale: An aortic sound is best heard over the aortic area.
46.
A pulmonic ejection click (choose two):
(a) does not vary with the respiratory cycle.
(b) varies markedly with the respiratory cycle.
(c) may indicate pulmonary stenosis or hypertension.
(d) is heard late in the systolic cycle.
Answer: b, c
Rationale: It is heard early in the systolic cycle, is louder on expiration than on inspiration, and may
indicate pulmonary stenosis or hypertension.
47.
A pulmonic ejection click:
(a) is best heard with the bell of the stethoscope.
(b) is best heard over the pulmonic site.
(c) can radiate through the chest wall.
(d) is louder on inspiration.
Answer: b
Rationale: A pulmonic ejection click is best heard with the diaphragm, does not radiate, and is louder
during expiration.
48.
The midsystolic click is (choose two):
(a) early in systole.
(b) diagnostic for mitral valve prolapse.
(c) caused by failure of the aortic valve.
(d) often accompanied by a murmur.
Answer: b, d
Rationale: As the name suggests, it occurs in midsystole, and it is caused by a diseased mitral, not aortic,
valve.
49.
The midsystolic click is best heard using the diaphragm of the stethoscope over the:
(a) aortic site.
(b) pulmonic site.
(c) mitral site.
(d) tricuspid site.
Heart Activities, page 9 of 20
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Answer: c
Rationale: Because it is caused by the mitral valve, it is logical to listen at that site.
Directions:
 Read the sections on Auscultation, Mitral Area and Mitral and Tricuspid Area (S3) on pages 515516, Heart and Peripheral Vasculature, page 746, and Auscultation, Heart Sounds, page 818 in
Health Assessment & Physical Examination, third edition.
 Listen to Heart Sounds, Diastolic Sounds, Gallops on Delmar’s Heart & Lung Sounds CD-ROM.
50.
Gallops are caused by:
(a) opening of diseased valves.
(b) closing of diseased valves.
(c) turbulence in blood flow.
(d) smooth passage of blood flow.
Answer: c
Rationale: Gallops sound like a horse’s gallop and are due to turbulent blood flow.
51.
The S3 sound, or ventricular gallop, is (choose two):
(a) caused by rapid filling and over-distension of the ventricle.
(b) always normal.
(c) normal in children and during the third trimester of pregnancy.
(d) often indicative of congestive heart failure and fluid overload in adults over 40.
Answer: a, c
Rationale: When the ventricle is over-filled for a cause, it is normal, but in the absence of cause, it is a
sign of heart disease.
52.
The right ventricular S3 gallop is best heard:
(a) with the diaphragm at the tricuspid site.
(b) with the bell at the tricuspid site.
(c) with the bell at the mitral site.
(d) with the diaphragm at the mitral site.
Answer: b
Rationale: It is a low-pitched sound best heard over the valve on the right.
53.
The left ventricular S3 gallop is best heard:
(a) with the diaphragm at the tricuspid site.
(b) with the bell at the tricuspid site.
(c) with the bell at the mitral site with the patient in the left lateral decubitus position.
Answer: c
Rationale: It is a low-pitched sound best heard over the valve on the left.
54.
The S4 gallop occurs:
(a) just before S1.
(b) just after S1.
(c) just before S2.
(d) just after S2.
Answer: a
Rationale: It is caused by turbulence secondary to atria contracting against stiff, noncompliant ventricles.
Heart Activities, page 10 of 20
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55.
The S4 gallop may indicate (choose two):
(a) right ventricular hypertrophy.
(b) right ventricular ischemia.
(c) left ventricular hypertrophy.
(d) left ventricular ischemia.
Answer: c, d
Rationale: It is caused by turbulence secondary to atria contracting against stiff, noncompliant ventricles.
56.
The right ventricular S4 gallop is best heard:
(a) with the diaphragm at the tricuspid site.
(b) with the bell at the tricuspid site.
(c) with the bell at the mitral site.
(d) with the diaphragm at the mitral site.
Answer: b
Rationale: It is a low-pitched sound best heard over the tricuspid site.
57.
The left ventricular S4 gallop is best heard:
(a) with the diaphragm at the tricuspid site.
(b) with the bell at the tricuspid site.
(c) with the bell at the mitral site with the patient in the left lateral decubitus position.
(d) with the diaphragm at the mitral site.
Answer: c
Rationale: It is a low-pitched sound best heard over the mitral area.
58.
The sounds of a quadruple gallop are in this order:
(a) S1, S2, S3, S4.
(b) S2, S3, S4, S1.
(c) S3, S4, S1, S2.
(d) S4, S1, S2, S3.
Answer: d
Rationale: In this order, the sound is like that of a galloping horse.
59.
The heart rate associated with a quadruple gallop is:
(a) less than 120 bpm.
(b) less than 60 bpm.
(c) greater than 120 bpm.
(d) between 100 and 160 bpm.
Answer: a
Rationale: Rates higher than 120 bpm would make it difficult to hear the rhythm.
60.
The quadruple gallop is generally heard in subjects with:
(a) acute myocardial infarction.
(b) mitral valve prolapse.
(c) severe congestive heart failure.
(d) peripheral vascular disease.
Rationale: The sounds are caused by rapid filling of a stiff, noncompliant ventricle.
Heart Activities, page 11 of 20
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61.
The quadruple gallop is best heard:
(a) with the diaphragm at the tricuspid site.
(b) with the bell at the tricuspid site.
(c) with the bell at the mitral site.
(d) with the diaphragm at the mitral site.
Answer: c
Rationale: It is a low-pitched sound best heard over the mitral area.
62.
The summation gallop is best heard:
(a) with the diaphragm at the tricuspid site.
(b) with the bell at the tricuspid site.
(c) with the bell at the mitral site.
(d) with the diaphragm at the mitral site.
Answer: c
Rationale: It is a low-pitched sound best heard over the mitral area and may be mistaken for an S3 gallop.
63.
An opening snap is caused by disease in this valve:
(a) aortic
(b) pulmonic
(c) mitral
(d) tricuspid
Answer: c
Rationale: Snaps occur shortly after the S2 sound by a diseased mitral valve.
64.
An opening snap:
(a) follows S2.
(b) alters the S1 sound.
(c) alters the S2 sound.
(d) occurs after the S3 sound.
Answer: a
Rationale: The opening snap occurs before the S3 sound but does not alter S1 or S2.
65.
An opening snap:
(a) may be accompanied by the mid diastolic murmur of mitral stenosis.
(b) can indicate mitral valve stenosis.
(c) can indicate mitral fibrosis.
(d) all of the above
Answer: d
Rationale: All of the above are true.
66.
The opening snap is best heard with the diaphragm of the stethoscope over the:
(a) aortic area.
(b) pulmonary area.
(c) tricuspid area.
(d) mitral area.
Answer: d
Rationale: It is a high-pitched sound best heard at the site of its cause, and it is usually heard shortly after
the S2.
Heart Activities, page 12 of 20
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Directions:
 Read the sections on Murmurs, pages 516-517, Table 16-6 on page 518, Auscultation, 817-819,
and Heart and Peripheral Vasculature, page 746 in Health Assessment & Physical Examination,
third edition.
 Listen to Heart Sounds, Murmurs on Delmar’s Heart & Lung Sounds CD-ROM.
67.
Murmurs are caused by turbulent blood flow secondary to:
(a) blood flow across a complete obstruction or into a constricted chamber.
(b) backward or regurgitant flow across competent valves.
(c) shunting of blood from a high-pressure chamber through an abnormal passageway.
(d) decreased flow through normal structures.
Answer: c
Rationale: It may also be caused by blood flow across a partial obstruction or into a dilated chamber,
regurgitant flow across incompetent valves, or increased flow through normal structures.
68.
Systolic murmurs are caused by (choose two):
(a) failure of the mitral or tricuspid valves to open completely.
(b) failure of the aortic or pulmonic valves to close effectively.
(c) regurgitation or stenosis.
(d) abnormally high blood flow volumes across normal valves.
Answer: c, d
Rationale: Systolic murmurs are also caused by the failure of mitral or tricuspid valves to close effectively
or by the failure of aortic or pulmonic valves to open completely.
69.
Holosystolic murmurs:
(a) start early in systole, obliterating the S1 sound.
(b) may start in mid or late systole.
(c) may end well before the beginning of S2.
(d) may last throughout systole.
Answer: d
Rationale: Answers (a), (b), and (c) are timing characteristics of non-holosystolic murmurs.
70.
The innocent flow murmur (choose two):
(a) is benign, even with clinical symptoms.
(b) is seen in children.
(c) is seen with low cardiac output states.
(d) is seen with pregnancy.
Answer: b, d
Rationale: It is benign in the absence of clinical symptoms and is seen in high cardiac output states, such
as fever, stress, or pregnancy.
71.
The innocent flow murmur (choose two):
(a) should be auscultated in the pulmonic area with the diaphragm.
(b) should be auscultated in the pulmonic area with the bell.
(c) should be auscultated in the pulmonic area with both the diaphragm and the bell.
(d) may disappear with changes in position, respirations, or heart rate.
Answer: c, d
Rationale: It is medium pitched and should be auscultated with both the bell and diaphragm.
Heart Activities, page 13 of 20
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72.
The innocent flow murmur (choose two):
(a) is generally grade V/VI.
(b) has a vibratory, reedy quality.
(c) is generally grade 1 or 2.
(d) has a harsh quality.
Answer: b, c
Rationale: It is heard faintly, and it has a vibratory, reedy, musical quality.
73.
Mitral regurgitation occurs when:
(a) the mitral valve fails to open completely, trapping blood in the left atrium.
(b) the mitral valve fails to open completely, and the left ventricle takes longer to fill.
(c) the mitral valve fails to close completely, allowing blood to flow back into the left atrium.
(d) the mitral valve fails to close completely, allowing blood to flow into the left ventricle
throughout the cardiac cycle.
Answer: c
Rationale: The backward flow of blood into the left atrium is regurgitation.
74.
A mitral regurgitation murmur:
(a) occurs in mid systole.
(b) is of a soft grade.
(c) has a blowing quality.
(d) is low-pitched.
Answer: c
Rationale: It is holosystolic, often loud, and is high-pitched.
75.
Mitral regurgitation is best heard:
(a) with a bell in the mitral area.
(b) with a diaphragm in the mitral area.
(c) with a bell in the tricuspid area.
(d) with a diaphragm in the tricuspid area.
Answer: b
Rationale: It is high-pitched and best heard in the mitral area. It also radiates into the left axilla.
76.
Tricuspid regurgitation occurs when:
(a) the tricuspid valve fails to open completely, trapping blood in the right atrium.
(b) the tricuspid valve fails to open completely, and the right ventricle takes longer to fill.
(c) the tricuspid valve fails to close completely, allowing blood to flow back into the right
atrium.
(d) the tricuspid valve fails to close completely, allowing blood to flow into the right ventricle
throughout the cardiac cycle.
Answer: c
Rationale: The backward flow of blood into the right atrium is regurgitation.
77.
The murmur of tricuspid regurgitation (choose two):
(a) increases with inspiration.
(b) decreases with inspiration.
(c) may radiate to the left axilla.
(d) may radiate to the right sternal border.
Answer: a, d
Rationale: The increase with inspiration and radiation to the right sternal border are characteristic of
tricuspid regurgitation.
Heart Activities, page 14 of 20
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78.
The murmur of tricuspid regurgitation:
(a) occurs in mid systole.
(b) is always of a soft grade.
(c) has a blowing quality.
(d) is low-pitched.
Answer: c
Rationale: Tricuspid regurgitation is holosystolic, is of a varying grade, and is high-pitched.
79.
The murmur of tricuspid regurgitation is best heard:
(a) in the mitral area with a diaphragm.
(b) in the mitral area with a bell.
(c) in the tricuspid area with a diaphragm.
(d) in the tricuspid area with a bell.
Answer: c
Rationale: It is high-pitched and best heard in the tricuspid area. It also increases with inspiration.
80.
A ventricular septal defect murmur:
(a) allows the abnormal flow of blood from the right to the left ventricle during systole.
(b) allows the abnormal flow of blood from the left to the right ventricle during systole.
(c) allows the abnormal flow of blood from the right to the left ventricle during diastole.
(d) allows the abnormal flow of blood from the left to the right ventricle during diastole.
Answer: b
Rationale: This is a systolic murmur, and with the left ventricle being larger and more muscular, blood
would tend to flow left to right.
81.
Aortic stenosis is secondary to:
(a) the laxness of the aortic valve such that it does not close fully during systole.
(b) the restriction of the aortic valve such that it does not open fully during systole.
(c) the laxness of the aortic valve such that it does not close fully during diastole.
(d) the restriction of the aortic valve such that it does not open fully during diastole.
Answer: b
Rationale: It is a systolic murmur, and stenosis refers to a narrowing or contraction. It may be caused by
congenital heart disease or an age-related calcification of the valve.
82.
Aortic stenosis (choose two):
(a) may radiate into the neck and left sternal border.
(b) may radiate into the axilla and right sternal border.
(c) may be accompanied by a left-sided S4, a paradoxical split S2, or a diminished S2.
(d) may be accompanied by a left-sided S3, a paradoxical split S1, or a diminished S1.
Answer: a, c
Rationale: The aortic valve is closer to the neck and left sternal border.
83.
Aortic stenosis is best heard:
(a) over the right sternal border with both the stethoscope’s bell and diaphragm.
(b) over the aortic area with the stethoscope’s bell.
(c) over the aortic area with the stethoscope’s diaphragm.
(d) over the aortic area with both the stethoscope’s bell and diaphragm.
Answer: d
Rationale: Being of medium pitch, it is best to listen with both the bell and the diaphragm. It is not heard
over the right sternal border.
Heart Activities, page 15 of 20
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84.
Pulmonic stenosis (choose two):
(a) is due to the failure of the pulmonic valve to fully open.
(b) is due to the failure of the pulmonic valve to fully close.
(c) often resembles the sound of aortic stenosis.
(d) often resembles the sound of an innocent murmur.
Answer: a, d
Rationale: Stenosis refers to a narrowing or contraction. It may be confused with an innocent murmur.
85.
Pulmonic stenosis (choose two):
(a) may radiate into the back, neck, and left shoulder.
(b) may radiate into the back, neck, and right shoulder.
(c) may be accompanied by a right-sided S4, a split S2, or a diminished P2.
(d) may be accompanied by a right-sided S3, a split S1, or a diminished P1.
Answer: a, c
Rationale: The pulmonary valve is closer to the left shoulder.
86.
Pulmonic stenosis is best heard:
(a) over the right sternal border with both the stethoscope’s bell and diaphragm.
(b) over the pulmonic area with the stethoscope’s bell.
(c) over the pulmonic area with the stethoscope’s diaphragm.
(d) over the pulmonic area with both the stethoscope’s bell and diaphragm.
Answer: d
Rationale: Being of medium grade, it is best to listen with both the stethoscope’s diaphragm and bell.
87.
Mitral valve prolapse (choose two):
(a) is a form of mitral stenosis.
(b) is a form of mitral regurgitation.
(c) is due to the mitral valve’s failure to open completely.
(d) is due to the failure of the valve’s chordae tendinae with increased intraventricular pressure.
Answer: b, d
Rationale: During early systole, the mitral valve closes, but increased intraventricular pressure causes the
valve to balloon upward.
88.
Mitral valve prolapse (choose two):
(a) may radiate to the left sternal border.
(b) may radiate to the right sternal border.
(c) decreases with the Valsalva maneuver.
(d) increases with the Valsalva maneuver.
Answer: a, d
Rationale: It may radiate to the left sternal border, increases with the Valsalva maneuver, and is often
preceded by a midsystolic click.
89.
Mitral valve prolapse:
(a) is mid systolic.
(b) varies in grade.
(c) is low-pitched.
(d) has a harsh quality.
Answer: b
Rationale: It is late systolic, high-pitched, and has a blowing quality.
Heart Activities, page 16 of 20
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90.
Mitral valve prolapse is best heard:
(a) over the mitral site using the diaphragm of the stethoscope.
(b) over the mitral site using the bell of the stethoscope.
(c) over the tricuspid site using the diaphragm of the stethoscope.
(d) over the tricuspid site using the bell of the stethoscope.
Answer: a
Rationale: Being high-pitched, it is best to use the diaphragm.
91.
Diastolic murmurs are caused by (choose two):
(a) failure of the mitral or tricuspid valves to close effectively.
(b) failure of the aortic or pulmonic valves to open completely.
(c) regurgitation or stenosis.
(d) abnormally high blood flow volumes across normal valves.
Answer: c, d
Rationale: They are also caused by the failure of the mitral and tricuspid valves to open completely or the
failure of the aortic or pulmonic valves to close effectively.
92.
Aortic regurgitation occurs when:
(a) the aortic valve fails to open completely, causing difficulty for the blood to leave the left
ventricle.
(b) the aortic valve fails to open completely, causing difficulty for the left ventricle to fill.
(c) the aortic valve fails to close completely, allowing blood to flow back into the left ventricle
during diastole.
(d) the aortic valve fails to close completely, allowing blood to flow back into the left atrium
during diastole.
Answer: c
Rationale: During diastole, the pressure in the aorta is higher than the left ventricle, and if the aortic valve
does not close completely, blood can flow back.
93.
Aortic regurgitation is best heard:
(a) over the aortic area with the bell of the stethoscope.
(b) over the aortic area with the diaphragm of the stethoscope.
(c) over the mitral area with the bell of the stethoscope.
(d) over the mitral area with the diaphragm of the stethoscope.
Answer: b
Rationale: As a high-pitched murmur, it is best heard with the diaphragm.
94.
Pulmonic regurgitation occurs when:
(a) the pulmonic valve fails to open completely, causing difficulty for the blood to leave the right
ventricle.
(b) the pulmonic valve fails to open completely, causing difficulty for the right ventricle to fill.
(c) the pulmonic valve fails to close completely, allowing blood to flow back into the right
ventricle.
(d) the pulmonic valve fails to close completely, allowing blood to flow back into the right
atrium.
Answer: c
Rationale: During diastole, pressures in the pulmonary artery are higher than the right ventricle, and if the
pulmonic valve fails to close completely, blood can flow back.
Heart Activities, page 17 of 20
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95.
Pulmonic regurgitation is best heard:
(a) over the aortic area with the diaphragm of the stethoscope.
(b) over the aortic area with the bell of the stethoscope.
(c) over the pulmonic area with the diaphragm of the stethoscope.
(d) over the pulmonic area with the bell of the stethoscope.
Answer: c
Rationale: It is a high-pitched murmur.
96.
The murmur of mitral stenosis can be caused by (choose two):
(a) a stenotic mitral valve.
(b) a low volume of blood flowing across a normal mitral valve.
(c) a high volume of blood flowing across a normal mitral valve.
(d) a prolapsed mitral valve.
Answer: a, c
Rationale: It is caused by turbulence across a narrowed or contracted valve, or by a high volume of blood
through a normal valve.
97.
Mitral stenosis:
(a) can be accompanied by atrial fibrillation.
(b) often can’t be heard if the subject is bradycardic.
(c) will decrease after mild exercise.
(d) may be accompanied by a decreased P2.
Answer: a
Rationale: Mitral stenosis often can’t be heard if the subject is tachycardic, increases after mild exercise,
and may be accompanied by an increased P2.
98.
Mitral stenosis is best heard:
(a) over the mitral area with the bell of the stethoscope.
(b) over the mitral area with the diaphragm of the stethoscope.
(c) over the aortic area with the bell of the stethoscope.
(d) over the aortic area with the diaphragm of the stethoscope.
Answer: a
Rationale: As a low-pitched sound, it is best heard with the bell.
99.
Patent ductus arteriosus is caused by:
(a) a congenital anomaly where an opening exists between the pulmonary vein and the aorta.
(b) a congenital anomaly where an opening exists between the pulmonary artery and the aorta.
(c) a congenital anomaly where an opening exists between the pulmonary artery and the vena
cava.
(d) a congenital anomaly where an opening exists between the pulmonary vein and the vena
cava.
Answer: b
Rationale: In utero, blood is not oxygenated by the lungs, and this allows for some of the freshly
oxygenated blood to circulate systemically.
100.
Patent ductus arteriosus:
(a) occurs in mid systole.
(b) is low-grade.
(c) is high-pitched.
(d) has a machine-like quality.
Answer: d
Heart Activities, page 18 of 20
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Rationale: It is continuous, of variable grade, and is low-pitched.
101.
Patent ductus arteriosus is best heard:
(a) in the aortic area with the bell of the stethoscope.
(b) in the aortic area with the diaphragm of the stethoscope.
(c) in the pulmonic area with the bell of the stethoscope.
(d) in the pulmonic area with the diaphragm of the stethoscope.
Answer: c
Rationale: Being low-pitched, it is best heard with the bell and may be accompanied by a palpable thrill.
102.
When auscultating murmurs, the configuration quality refers to:
(a) where in the cardiac cycle a murmur is usually heard.
(b) where each murmur is best heard.
(c) where the sound may radiate.
(d) whether the sound increases, decreases, increases and then decreases, or stays the same.
Answer: d
Rationale: Answers (a), (b), and (c) refer to other qualities of auscultation.
103.
When auscultating murmurs, the following is true about the grade (choose two):
(a) Grade I is very loud and may have a palpable thrill.
(b) It uses a six-level scale.
(c) Grade VI is very faint.
(d) It should be recorded with “/6” or “/VI” following the number.
Answer: b, d
Rationale: Grade I is very faint. Grade VI is very loud.
104.
The pericardial friction rub (choose two):
(a) is caused by the rubbing together of inflamed visceral and parietal pericardial tissues.
(b) is only heard during systole.
(c) does not obliterate the S1 S2 sounds.
(d) is indicative of inflammation of the pericardium.
Answer: a, d
Rationale: It may be heard throughout the cardiac cycle and may obliterate the S1 S2 sounds.
105.
The pericardial friction rub (choose two):
(a) is best heard with the subject supine.
(b) is best heard with the subject in the knee-chest position, sitting, leaning forward, or reclining.
(c) is more likely to be a pleural rub if it disappears when the subject holds his breath.
(d) is less likely to be a pleural rub if it disappears when the subject holds his breath.
Answer: b, c
Rationale: A pleural rub will only be heard during respiration.
106.
The pericardial friction rub is best heard (choose two):
(a) over the aortic area with the diaphragm of the stethoscope.
(b) over the pulmonic area with the diaphragm of the stethoscope.
(c) over the tricuspid area with the diaphragm of the stethoscope.
(d) over the mitral area with the diaphragm of the stethoscope.
Answer: c, d
Rationale: Although the tricuspid and mitral areas are preferred, it may be heard throughout the chest.
Heart Activities, page 19 of 20
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107.
Which statement is not true of prosthetic valves?
(a) They can be mechanical or bioprosthetic.
(b) They always produce an audible click.
(c) They can replace incompetent or stenotic valves.
(d) They are best heard with the diaphragm of the stethoscope.
Answer: b
Rationale: Bioprosthetic valves can sound like natural valves.
108.
The more commonly replaced valves are the (choose two):
(a) aortic.
(b) pulmonic.
(c) tricuspid.
(d) mitral.
Answer: a, d
Rationale: Aortic and mitral valves are replaced more commonly than pulmonic or tricuspid valves.
Heart Activities, page 20 of 20
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