The advanced practice nurse (APRN) is examining a healthy 50 year-old patient with no significant past medical history. The APRN notes a soft grade I out of VI mid-systolic murmur between the left sternal border and the apex. The APRN assumes this is an innocent murmur. What other findings on cardiac exam help to confirm this diagnosis? SELECT ALL THAT APPLY
Murmur intensity decreases with sitting
Normal spitting of 52 with inspiration
Absence of a diastolic murmur
Murmur intensity increases with sitting
The Correct Answer is ["A","B","C"]
A. Murmur intensity decreases with sitting is correct because innocent (or physiologic) murmurs often become softer or disappear when the patient sits upright. This helps differentiate them from pathologic murmurs, which may remain unchanged or become louder with positional changes.
B. Normal splitting of S2 with inspiration is correct because physiologic splitting of the second heart sound is a normal finding and is consistent with a healthy cardiac examination. An innocent murmur is typically not associated with abnormal heart sounds.
C. Absence of a diastolic murmur is correct because innocent murmurs are exclusively systolic. The presence of a diastolic murmur would suggest a pathologic valvular lesion, such as aortic or mitral regurgitation, rather than an innocent murmur.
D. Murmur intensity increases with sitting is incorrect because an increase in murmur intensity with sitting or standing is more consistent with pathologic conditions, such as hypertrophic cardiomyopathy, rather than a benign or innocent murmur.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Direct reaction is incorrect because the direct pupillary light reflex refers specifically to the constriction of the pupil that is directly exposed to light. It does not describe the behavior of the opposite pupil, which is responding indirectly. Assessing the direct reaction helps evaluate the function of the afferent pathway (optic nerve, CN II) and the efferent pathway (oculomotor nerve, CN III) of the illuminated eye.
B. Consensual reaction is correct because the consensual pupillary light reflex describes the simultaneous constriction of the pupil opposite to the one being directly stimulated by light. When light enters one eye, afferent signals travel via the optic nerve (CN II) to the pretectal nuclei in the midbrain, which then communicate bilaterally with the Edinger-Westphal nuclei. Efferent signals are sent via the oculomotor nerves (CN III) to both pupils, resulting in constriction of both the directly exposed pupil and the contralateral pupil. The consensual reflex demonstrates bilateral integrity of the optic and oculomotor pathways, even when only one eye is exposed to light.
C. Near reaction is incorrect because it refers to pupillary constriction that occurs when the eyes focus on a near object, as part of the accommodation reflex, and is not triggered by light. It is primarily a test of focusing ability rather than pupillary light response.
D. Accommodation is incorrect because it involves a triad of responses—pupillary constriction, lens thickening, and convergence of the eyes—when shifting focus from a distant to a near object. While pupillary constriction occurs, it is not in response to light and therefore is distinct from the consensual light reflex.
Correct Answer is A
Explanation
A. CN VII - Facial is correct because Bell palsy results from a peripheral lesion of the facial nerve (cranial nerve VII). This nerve controls the muscles of facial expression, including forehead movement, eyelid closure, and mouth movement. A peripheral lesion causes paralysis of the entire side of the face, unlike a central lesion, which typically spares the forehead due to bilateral cortical innervation.
B. CN IX - Glossopharyngeal is incorrect because this nerve primarily innervates the posterior third of the tongue, pharynx, and parotid gland, affecting swallowing and taste, not facial movement. Lesions of CN IX would not cause hemifacial paralysis.
C. CN X - Vagus is incorrect because the vagus nerve controls laryngeal and pharyngeal muscles, autonomic function of the thorax and abdomen, and some palatal muscles. A lesion would cause hoarseness, dysphagia, or impaired gag reflex, not facial paralysis.
D. CN V - Trigeminal is incorrect because it primarily provides sensory innervation to the face and motor function for mastication. A lesion of CN V may cause facial numbness or difficulty chewing, but it does not cause paralysis of facial expression.
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