A nurse is performing a cardiac assessment on a client and auscultates an S3 sound. The nurse should recognize that this sound represents which of the following heart conditions?
Closure of pulmonic valve
Closure of the mitral valve
Ventricular gallop
Atrial gallop
The Correct Answer is C
Ventricular gallop is another name for the S3 sound, which is a low-pitched sound heard at the end of diastole, just after the S2 sound. It is caused by the rapid filling of the ventricles and the vibration of the ventricular walls.
Closure of the pulmonic valve is one of the components of the S2 sound, which is a high-pitched sound heard at the end of the systole, just before the S1 sound. It is caused by the closure of the semilunar valves (pulmonic and aortic).
Closure of the mitral valve is one of the components of the S1 sound, which is a high-pitched sound heard at the beginning of systole, just after the S2 sound. It is caused by the closure of the atrioventricular valves (mitral and tricuspid).
d. Atrial gallop is another name for the S4 sound, which is a low-pitched sound heard at the end of diastole, just before the S1 sound. It is caused by atrial contraction and increased resistance to ventricular filling.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Asthma typically presents with wheezing, shortness of breath, and chest tightness. While dyspnea is a symptom, tachycardia and weak peripheral pulses are not characteristic findings associated with asthma.
B. Aortic valve regurgitation may cause dyspnea and fatigue, but it is more commonly associated with bounding pulses and diastolic murmur rather than weak peripheral pulses.
C. Heart failure is characterized by symptoms such as dyspnea, fatigue, tachycardia, and weak peripheral pulses due to reduced cardiac output and poor perfusion to the extremities. The nurse should recognize these signs as indicative of heart failure.
D. Aortic stenosis can lead to symptoms like dyspnea and fatigue; however, it typically presents with a triad of symptoms including exertional dyspnea, angina, and syncope, rather than weak peripheral pulses.
Correct Answer is D
Explanation
Hemorrhagic stroke is a type of stroke that occurs when a blood vessel ruptures in the brain, causing bleeding and increased intracranial pressure. The client's symptoms of sudden, severe headache, vomiting, seizure, and
unresponsiveness are consistent with hemorrhagic stroke. The client's elevated blood pressure and temperature are also risk factors for hemorrhagic stroke.
Thrombotic stroke is a type of stroke that occurs when a blood clot forms in an artery that supplies blood to the brain, causing ischemia and tissue damage. The client's symptoms are not typical of thrombotic stroke, which usually has a gradual onset and affects one side of the body.
Transient ischemic atack (TIA) is a temporary interruption of blood flow to the brain, causing neurologic deficits that resolve within 24 hours. The client's symptoms are not indicative of TIA, which does not cause loss of consciousness or permanent brain damage.
Embolic stroke is a type of stroke that occurs when a blood clot or other debris travels from another part of the body to the brain, causing occlusion and ischemia. The client's symptoms are not characteristic of embolic stroke, which usually has a sudden onset and affects one side of the body.
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