The nurse auscultates a characteristic ______ murmur that becomes louder during inspiration, suggesting tricuspid stenosis.

A diastolic murmur that increases during inspiration (Carvallo's sign) is characteristic of tricuspid stenosis. The increased venous return during inspiration makes the murmur more prominent as blood flows through the stenotic tricuspid valve.

Tricuspid Stenosis:
- Diastolic murmur at left lower sternal border
- Carvallo's sign: increased intensity during inspiration
- Associated symptoms: right heart failure, hepatomegaly, ascites
- Causes: rheumatic heart disease, carcinoid syndrome

Physical Exam Findings:
- Prominent jugular venous distention
- Diastolic rumble at left lower sternal border
- Hepatomegaly
- Peripheral edema

Diagnostic Tests:
- Echocardiogram: valve thickening, reduced mobility
- ECG: right atrial enlargement
- Chest X-ray: right atrial enlargement

Treatment Options:
- Medical management: diuretics, anticoagulation
- Surgical: valve repair/replacement
- Balloon valvuloplasty in selected cases