Ambulatory Care Nurse Certification Practice Exam

A scratching, creaking sound heard during auscultation of the heart is typically indicative of pericarditis. This condition involves inflammation of the pericardium, the protective sac surrounding the heart. The inflamed layers may rub against each other, producing a characteristic sound known as a pericardial friction rub. It is often described as sounding similar to the noise made when walking on fresh snow.

In contrast, congestive heart failure generally presents with a range of signs such as crackles in the lungs, due to fluid overload, rather than specific heart sounds. A benign heart murmur is usually a soft sound without a scratching quality and often does not indicate any underlying disease, while a pneumothorax might create sounds related to lung or pleural space issues rather than direct heart sounds. Therefore, pericarditis is clearly associated with the unique auditory phenomenon presented by the scratching or creaking sound during auscultation.