NCLEX Memory Hints: Heart Sounds
Thursday, February 20, 2025
Cardiovascular System: Heart Sounds
NCLEX Memory Hints © BrainyNurses.com
In listening to heart sounds, a systematic approach is important and should include auscultation at the four areas where abnormalities of the heart valves can be heard. In acute conditions, assessment should be done on presentation and then with subsequent encounters. If heart sounds change, it generally signifies a deterioration in condition.
During the assessment, S1 and S2 are identified the strength of the heart tones is evaluated. If more than two sounds are heard, it could indicate an S3 gallop (indicating heart failure) or an S4 gallop (heard in an acute MI).
In the four valvular areas, a “swish” sound would indicate a murmur. The murmur could be due to valvular regurgitation (insufficiency) or valvular stenosis.
Location of Heart Sounds
The location of heart sounds can be described in the text of a question or identified on a diagram for the NCLEX exam. The question will be like....”Where would you hear the murmur of aortic insufficiency?
Aortic valve: 2nd intercostal space (ICS), right sternal border.
Pulmonic valve: 2nd ICS, left sternal border (LSB).
Tricuspid valve: 4th ICS, LSB.
Mitral valve: 5th ICS, midclavicular line (site of PMI).
In listening to the heart sounds, start at the aortic valve and follow the above order while using the Memory Hint “All Providers (or Politicians😊) Take Money.
Friction Rubs
Friction rubs are caused by inflammation and can be transiently heard in pericarditis and pleurisy. A complication of the inflammation is the development of a pericardial effusion or a pleural effusion. When the effusion develops, the rub will disappear.
The friction rubs will sound very similar. The way to distinguish the origin of the rub is to have the patient hold their breath. If the rub persists with breath holding, it is pericardial. If the rub goes away with breath holding, it is pleural.
Audio Hint for Heart Sounds
Use of audio is another way which NCLEX questions can be formatted.
Some medical professionals feel like they want to “listen” to audio recordings of heart sounds. While this may be beneficial, it is difficult to translate what is heard on a demo into clinical practice.
Instead, try listening for “sounds” in words which can be used to describe the heart sounds.
“Lub, Dub” indicates S1 and S2 and normal heart sounds.
“Swish” sound is a murmur which indicates valvular dysfunction.
Extra heart sound is a gallop which could be an S3 (indicating heart failure) or S4 (heard in an acute MI). S3 sounds like “Ken-tuc’-ky” with the second sound being the loudest. S4 sounds like “Ten’-nes-see” with the first sound being the loudest.
Grating sound indicates a friction rub which will sound like sandpaper.
Irregular rhythm is atrial fibrillation or atrial flutter, and there is a risk for an embolic stroke. The patient should be on warfarin (Coumadin), unless they are pregnant, and then heparin is used because warfarin is teratogenic.
Skipped beat is a premature ventricular contraction (PVC) which signifies ventricular irritability.
Memory Hints for Heart Sounds
• All Providers (or Politicians😊) Take Money for the location of the heart valves.
• Swish sound is a murmur.
• Extra heart sound is a gallop.
• Grating sound is a friction rub.
• Pericardial friction rub is persistent with breath holding.
• Pleural friction sub disappears with breath holding.
• Irregular rhythm is atrial fibrillation or atrial flutter.
• Skipped beat is a PVC.
Summary
For the NCLEX exam, knowledge of the location of the heart sounds is essential. Using the “Memory Hint” and moving across the chest in an orderly fashion and repeating it is the easiest way to remember them. While this is important in testing, it is also important in nursing practice to elevate clinical competence. If there is an audio question, listen for S1 and S2, a swish, extra sound, grating sound, irregular rhythm, or a skipped beat.
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