Which is the best position in which to place the patient to hear ...

[jho37]

Which is the best position in which to place the patient to hear low-pitched cardiovascular sounds?
 
  a. Supine
  b. Sitting up
  c. Dorsal recumbent
  d. Left lateral recumbent

Question 2

While performing a cardiovascular assessment on a patient with suspected left-sided congestive heart failure, the nurse is unable to palpate the PMI with the patient lying supine. What might her next step be?
 
  a. Have the patient turn onto his left side.
  b. Have the patient lean forward.
  c. Have the patient move to a sitting position.
  d. Palpate the PMI to the right of the midclavicular line.

[djpooyouma]

Answer to Question 1

D
Different positions help to clarify types of sounds heard. Sitting position is best to hear high-pitched murmurs (if present). Supine is a common position to hear all sounds. Left lateral recumbent is the best position to hear low-pitched sounds.

Answer to Question 2

A
If palpating the PMI is difficult, turn the patient onto the left side. This maneuver moves the heart closer to the chest wall. Different positions help to clarify the types of sounds heard. Sitting position is best to hear high-pitched murmurs (if present). In the presence of serious heart disease, the PMI will be located to the left of the midclavicular line if related to an enlarged left ventricle. In chronic lung disease, the PMI is often to the right of the midclavicular line as a result of right ventricular enlargement.