RN Nursing · Thorax, Heart, and Abdomen · Practice question
Which finding does the nurse expect during the auscultation of the heart of an adult male patient?
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A low-pitched blowing sound is heard over the apex of the heart
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The S3 heart sound sounds like "Tennessee"
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✓
The S1 heart sound is louder at the apex of the heart
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A high-pitched vibration is heard over the base of the heart
Answer & explanation
Correct: The S1 heart sound is louder at the apex of the heart
During auscultation of the heart, the S1 heart sound — produced by the closure of the mitral and tricuspid valves — is the loudest at the apex of the heart (the mitral area, located at the fifth intercostal space, midclavicular line). This is a normal and expected finding in any adult patient. S1 represents the beginning of systole, and its loudness at the apex is a well-established clinical principle. A low-pitched blowing sound heard over the apex of the heart would suggest a murmur, which is not a normal expected finding. The S3 heart sound is described as sounding like "Ken-tucky" (lub-dub-by), not "Tennessee," which is used to describe the S4 sound (the extra beat coming before S1); this option is therefore incorrect. A high-pitched vibration heard over the base of the heart would suggest a murmur related to aortic or pulmonic valve pathology and is not a normal expected finding in a healthy adult male. Students should memorize the auscultation landmarks: S1 is loudest at the apex, and S2 is loudest at the base.
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