A client with worsening peripheral edema and jugular venous distension has a blowing holosystolic murmur that becomes louder during inspiration. Click the site where the nurse should focus auscultation to further assess this pattern.

D. D is the lower left sternal area, the typical focus for a tricuspid regurgitant murmur.

Combine a holosystolic quality, inspiratory intensification and systemic venous congestion. These cues support focused assessment of tricuspid regurgitation rather than choosing an apical site simply because the murmur is systolic. Further diagnostic evaluation is needed to confirm the cause.

The observations are fictional teaching data. Apply the stated context; the selected feature does not by itself replace a complete bedside assessment.

Use timing, respiratory response and associated findings together before choosing the listening site.

Use timing, respiratory response and associated findings together before choosing the listening site.

A and B are upper sternal listening areas, and C is higher on the left border. E is the apical mitral area; a mitral regurgitant murmur can be holosystolic, but inspiratory intensification and venous congestion favor D in this case.

• Respiratory change distinguishes a right-sided regurgitant murmur — Use timing, respiratory response and associated findings together before choosing the listening site.
• Comparison with context — E is plausible for another holosystolic regurgitant murmur, but the respiratory response differentiates it.