# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=581203&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

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.

![](https://mymerci.kr/data/nclex/hotspot/regen_20260908_2350/HSR540.svg)

## Explanation

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

## In-depth explanation

Quick answer
D. D is the lower left sternal area, the typical focus for a tricuspid regurgitant murmur.
Why this is the best choice
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.
Clinical picture
The observations are fictional teaching data. Apply the stated context; the selected feature does not by itself replace a complete bedside assessment.
Memory hook
Use timing, respiratory response and associated findings together before choosing the listening site.
Decision rule
Use timing, respiratory response and associated findings together before choosing the listening site.
Why the other regions do not fit
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.
**Sources**
- Tricuspid regurgitation can produce a holosystolic murmur at the middle/lower left sternal border that increases with inspiration.

## Key concepts

- **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.

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