A nurse is assisting with teaching a newly licensed nurse about heart sounds. Which of the following sounds is heard when the aortic and pulmonic valves close?
S1
S2
S3
S4
The Correct Answer is B
Choice A reason : S1 represents the sound made by the closure of the atrioventricular valves (mitral and tricuspid valves) and is not the sound associated with the closure of the aortic and pulmonic valves.
Choice B reason : S2 is the sound heard when the aortic and pulmonic valves close. It is often described as a "dub" and occurs at the end of ventricular systole.
Choice C reason : S3 is a rare extra heart sound that follows S2 and usually indicates an increase in left ventricular filling pressure, which can be found in conditions such as heart failure.
Choice D reason : S4 is another extra heart sound that occurs just before S1. It is typically associated with a stiff or hypertrophic ventricle and is not related to the closure of the aortic and pulmonic valves
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: A barrel chest is typically not associated with mitral valve stenosis. It is more commonly seen in chronic obstructive pulmonary disease (COPD) due to hyperinflation of the lungs. Mitral valve stenosis affects the heart and not the lung structure.
Choice B reason: Clubbing of the fingers is a sign that can be associated with chronic hypoxia and certain types of congenital heart disease. While it can be seen in some heart conditions, it is not a specific finding for mitral valve stenosis.
Choice C reason: A heart murmur, specifically a diastolic murmur, is a classic finding in mitral valve stenosis. As the stenotic mitral valve obstructs blood flow from the left atrium to the left ventricle, a pressure gradient is created, which produces a murmur that can be heard upon auscultation.
Choice D reason: Bradycardia, or a slower than normal heart rate, is not a direct finding associated with mitral valve stenosis. Mitral valve stenosis may lead to arrhythmias such as atrial fibrillation due to atrial enlargement, but bradycardia is not typically induced by this condition.
Correct Answer is ["B","C","E"]
Explanation
Choice A reason : Documenting the frequency of blood pressure measurements is crucial for monitoring trends and identifying any changes that may indicate a health issue. It helps in assessing the effectiveness of interventions and in making informed clinical decisions.
Choice B reason : Recording the interventions implemented in response to a high blood pressure reading is important for continuity of care. It ensures that all healthcare providers are aware of the actions taken and can evaluate their effectiveness.
Choice C reason : Noting the patient's response to interventions provides insight into the efficacy of the treatment plan. It is essential for adjusting care plans and for healthcare providers to understand the patient's progress.
Choice D reason : Identifying the person who obtained the blood pressure reading is a part of proper documentation practices. It allows for accountability and follow-up if there are any questions or concerns about the reading.
Choice E reason : The site where the blood pressure was taken can affect the reading. Documenting this information helps to ensure that readings are consistent and comparable over time. It is also important in case an alternative site needs to be used in future measurements.
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