The advanced practice registered nurse (APRN) is examining a 70-year-old patient with pulmonary hypertension. On cardiac exam they auscultate a grade II/VI pansystolic (holosystolic) murmur of medium pitch at left lower sternal border which radiates to the right of the sternum (xiphoid area). The APRN asks the patient to inspire and notes an increase in the intensity of the murmur. Which is the most likely physiological cause of the murmur?
Tricuspid valve regurgitation
Pulmonic valve regurgitation
Mitral valve regurgitation
Aortic valve regurgitation
The Correct Answer is A
A. Tricuspid valve regurgitation is correct because a holosystolic murmur at the left lower sternal border that increases with inspiration is classic for tricuspid regurgitation. Inspiration increases venous return to the right heart, augmenting right ventricular stroke volume and thus intensity of right-sided murmurs. The murmur radiates toward the xiphoid area or right sternal border, consistent with the anatomical location of the tricuspid valve.
B. Pulmonic valve regurgitation is incorrect because it produces a diastolic murmur, usually early diastolic, best heard at the upper left sternal border and often increases with expiration, not inspiration. It does not present as a holosystolic murmur at the left lower sternal border.
C. Mitral valve regurgitation is incorrect because it causes a holosystolic murmur at the apex of the heart, radiating to the axilla, and its intensity does not increase with inspiration. Mitral regurgitation is a left-sided murmur, so it is not affected by inspiration in the same way as right-sided murmurs.
D. Aortic valve regurgitation is incorrect because it produces an early diastolic decrescendo murmur best heard at the right upper sternal border. It is a left-sided diastolic murmur, not holosystolic, and does not increase with inspiration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Rhonchi is incorrect because rhonchi are low-pitched, snoring or gurgling sounds typically heard during expiration and are caused by secretions in larger airways, such as in chronic bronchitis or pneumonia. They do not indicate upper airway obstruction.
B. Crackles is incorrect because crackles (rales) are discontinuous, popping sounds heard on inspiration, usually due to alveolar fluid, pulmonary edema, or atelectasis. Crackles are not high-pitched nor typically audible without a stethoscope.
C. Wheezing is incorrect because wheezing is a high-pitched, musical sound heard primarily during expiration caused by lower airway narrowing, as in asthma or bronchospasm. Wheezing generally reflects bronchial constriction rather than obstruction of the upper airway.
D. Stridor is correct because stridor is a high-pitched, inspiratory sound that occurs due to partial obstruction of the upper airway, such as the larynx or trachea. It is often audible without a stethoscope and is a medical emergency because it can indicate significant airway compromise, especially in post-anesthesia patients who may have laryngospasm, edema, or retained secretions.
Correct Answer is A
Explanation
A. Upper respiratory tract infection 5 days ago is correct because acute otitis media commonly develops as a complication of a recent upper respiratory tract infection (URTI). The infection causes eustachian tube dysfunction, leading to fluid accumulation in the middle ear, which becomes infected. This results in a bulging, erythematous (red), and distorted tympanic membrane, along with ear pain, especially in children.
B. Missed Measles, Mumps, Rubella (MMR) vaccine is incorrect because although vaccines prevent serious viral illnesses, missing the MMR vaccine is not a direct cause of acute otitis media. The child’s symptoms are consistent with a bacterial middle ear infection, not a vaccine-preventable viral illness.
C. Constant chewing of sugar free gum is incorrect because chewing gum may affect the temporomandibular joint (TMJ) or ear pressure slightly, but it does not cause a bulging tympanic membrane or infection.
D. Increased intake of sweets for the last 3 days is incorrect because diet, including sugar intake, does not directly cause middle ear infections. While excessive sugar may impact general health, it is not associated with acute otitis media.
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