A 72-year-old client has exertional syncope and a harsh systolic crescendo-decrescendo murmur radiating to the carotids. Click the location where this murmur is best heard.
Hot Spot
Choose your responses, then check the answer.
Explanation
Aortic area is the best answer. Aortic stenosis is heard best at the right second intercostal space at the upper sternal border. Other marked areas do not best match the cue in this item.
Quick answer Aortic area is the best answer. Aortic stenosis is heard best at the right second intercostal space at the upper sternal border. Other marked areas do not best match the cue in this item.
Why this is correct Valve sounds are identified at standard chest-wall listening points where their vibrations are heard most clearly. The side, intercostal space, and sternal or midclavicular landmark must all match before selecting the area.
Easy analogy or mental picture Picture the precordium as a five-stop map: aortic at the upper right sternal border, pulmonic at the upper left, Erb point one space lower, tricuspid at the lower left sternal border, and mitral at the apex.
Memory hook Right second intercostal space plus carotid radiation points to the aortic area.
NCLEX decision rule When a murmur or heart-sound cue names a valve or radiation pattern, match it to the standard auscultation landmark; verify side and intercostal space before clicking.
Why the other choices are wrong The other regions are valid cardiac listening points, but each emphasizes a different valve or sound. Choosing a nearby point without matching the cue is the common hotspot error.
References
[1]
NCBI Bookshelf: Cardiovascular assessment and cardiac auscultation areas
Clinical situationA 72-year-old client has exertional syncope and a harsh systolic crescendo-decrescendo murmur radiating to the carotids.
What the nurse should noticeAortic area is the best answer. Aortic stenosis is heard best at the right second intercostal space at the upper sternal border. Other marked areas do not best match the cue in this item.
Transfer to practiceWhen a murmur or heart-sound cue names a valve or radiation pattern, match it to the standard auscultation landmark; verify side and intercostal space before clicking.
Aortic area — Right 2nd intercostal space.
Aortic stenosis — Narrowing of the aortic valve that obstructs left-ventricular outflow.
Carotid radiation — Murmur transmission to the neck.