# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=397524&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

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.

![](https://mymerci.kr/data/nclex/hotspot/v2/v2_cardiac_landmarks.png)

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Hotspot v2 clinical education asset. Keep every option equally prominent; no title, answer label, marker, number, or highlighted correct region.
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## 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.

## In-depth explanation

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 scenario

Clinical situation
A 72-year-old client has exertional syncope and a harsh systolic crescendo-decrescendo murmur radiating to the carotids.

What the nurse should notice
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.

Transfer to practice
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.

## Key concepts

- **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.

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