The practical nurse (PN) is auscultating a client’s heart sounds. Which abnormal heart sound should the PN report to the charge nurse? (Please listen to the audio file to select the option that applies.)
A.
S4.
B.
S2.
C.
S1.
D.
S3.
The correct Answer and Explanations is:
The correct answer is D. S3.
Explanation:
When auscultating heart sounds, it is important to identify normal and abnormal findings to ensure proper care and treatment of the patient. Heart sounds are typically described as S1, S2, S3, and S4.
- S1: The first heart sound (S1) is the “lub” in the “lub-dub” sequence and is produced by the closure of the mitral and tricuspid valves at the start of systole. This sound is normal and indicates the beginning of ventricular contraction.
- S2: The second heart sound (S2) is the “dub” in the “lub-dub” and results from the closure of the aortic and pulmonic valves at the end of systole. This sound is also normal and signifies the end of ventricular systole.
- S3: The third heart sound (S3) occurs right after S2 during the rapid filling phase of the ventricles in early diastole. It is often described as a “ventricular gallop” and sounds like “lub-dub-ta.” While an S3 can be normal in children, young adults, and athletes, in older adults, it often indicates pathological conditions like heart failure, dilated cardiomyopathy, or severe mitral regurgitation. The presence of an S3 sound in an older adult should be reported to the charge nurse because it could signal ventricular dysfunction or fluid overload, requiring further evaluation and intervention.
- S4: The fourth heart sound (S4) occurs just before S1, during the late filling phase of the ventricles, known as atrial contraction. It is often called an “atrial gallop” and sounds like “ta-lub-dub.” S4 is usually associated with conditions that cause a stiffened ventricle, such as hypertension, aortic stenosis, or hypertrophic cardiomyopathy. It is abnormal but less commonly heard compared to S3.
Among the options provided, S3 is the abnormal heart sound that should raise concern, especially in a patient with a history of heart disease. It may suggest heart failure or volume overload, which requires prompt attention and possibly further diagnostic tests such as an echocardiogram. Reporting this finding to the charge nurse allows for timely intervention, which is crucial in managing potential complications related to heart disease.