During the precordial assessment on an patient who is 8 months ...

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During the precordial assessment on an patient who is 8 months pregnant, the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line. This finding would indicate:
 
  a. Right ventricular hypertrophy.
  b. Increased volume and size of the heart as a result of pregnancy.
  c. Displacement of the heart from elevation of the diaphragm.
  d. Increased blood flow through the internal mammary artery.

Question 2

Which of these findings would the nurse expect to notice during a cardiac assessment on a 4-year-old child?
 
  a. S3 when sitting up
  b. Persistent tachycardia above 150 beats per minute
  c. Murmur at the second left intercostal space when supine
  d. Palpable apical impulse in the fifth left intercostal space lateral to midclavicular line

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Answer to Question 1

ANS: C
Palpation of the apical impulse is higher and more lateral, compared with the normal position, because the enlarging uterus elevates the diaphragm and displaces the heart up and to the left and rotates it on its long axis.

Answer to Question 2

ANS: C
Some murmurs are common in healthy children or adolescents and are termed innocent or functional. The innocent murmur is heard at the second or third left intercostal space and disappears with sitting, and the young person has no associated signs of cardiac dysfunction.