To auscultate for S3 or S4 gallops in the mitral area, the nurse ...

[futuristic]

To auscultate for S3 or S4 gallops in the mitral area, the nurse listens with the
 
  a. bell of the stethoscope with the patient in the left lateral position.
  b. diaphragm of the stethoscope with the pa-tient in a supine position.
  c. bell of the stethoscope with the patient sitting and leaning forward.
  d. diaphragm of the stethoscope with the pa-tient lying flat on the left side.

Question 2

During a physical examination of a 74-year-old patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appro-priate action for the nurse to take next will be to
 
  a. ask the patient about risk factors for ath-erosclerosis.
  b. document that the PMI is in the normal anatomic location.
  c. auscultate both the carotid arteries for the presence of a bruit.
  d. assess the patient for symptoms of left ventricular hypertrophy.

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Answer to Question 1

ANS: A
Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the steth-oscope. Sounds associated with the mitral valve are accentuated by turning the patient to the left side, which brings the heart closer to the chest wall. The diaphragm of the stethoscope is best to use for the higher-pitched sounds such as S1 and S2.

Answer to Question 2

ANS: D
The PMI should be felt at the intersection of the fifth intercostal space and the left midclavicular line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy. Cardiac enlargement is not necessarily associated with atherosclero-sis or carotid artery disease.

[futuristic]

Excellent

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