Certified Registered Nurse Anesthetist (CRNA) Practice Exam

What is an important clinical finding for the assessment of heart failure?

1. Increased sugar levels

2. Increased blood pressure

3. Presence of S3 and S4 sounds

4. Normal pulse oximetry levels

The correct answer is: Presence of S3 and S4 sounds

The presence of S3 and S4 heart sounds is a significant clinical finding when assessing heart failure. These sounds are associated with different stages of heart function and can provide insight into the filling pressures of the heart. An S3 sound, also known as a ventricular gallop, typically indicates increased filling pressures in the ventricles due to volume overload. It is commonly associated with heart failure, particularly in the setting of systolic dysfunction where the heart cannot pump effectively. This sound is often detected in patients with congestive heart failure or in cases where there is rapid diastolic filling, reflecting a stressed myocardium. An S4 sound, or atrial gallop, arises from vigorous atrial contraction against a stiffened or hypertrophied ventricle, indicative of diastolic dysfunction. The presence of this sound suggests that the left ventricle is not compliant, which often occurs in conditions such as hypertensive heart disease or ischemic heart disease. Together, the presence of these abnormal heart sounds can signal pathophysiological changes in the heart that contribute to the symptoms of heart failure, making them crucial findings to recognize during clinical assessment. In contrast, increased sugar levels and increased blood pressure, while potentially relevant in broader cardiovascular assessments or in