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Author Question: The nurse is auscultating heart sounds for a pregnant client in the third trimester of pregnancy. ... (Read 56 times)

joblessjake

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The nurse is auscultating heart sounds for a pregnant client in the third trimester of pregnancy. The client wants to know why her doctor told her she had an extra heart sound at the last visit. Which response by the nurse is appropriate?
 
  A) You will need to have an echocardiogram to determine the reason for extra sound.
  B) You are likely experiencing heart failure due to the extra fluid that accumulates during this time in pregnancy.
  C) You have what is known as a ventricular gallop and it can be a normal finding during this trimester of pregnancy.
  D) You have what is known as atrial gallop and this is cause for concern.

Question 2

The nurse working in the emergency department provides care to an infant who arrived in cardiac and respiratory arrest. Resuscitative efforts failed and the infant's cause of death is sudden infant death syndrome (SIDS).
 
  The parents are grieving and will need collaborative interventions. Which interventions does the nurse plan for when providing care to these parents?
  Select all that apply.
  A) A psychosocial assessment
  B) A grief counselor referral
  C) A psychotherapist referral
  D) A visit from the chaplain
  E) A social services consult



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alexanderhamilton

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Answer to Question 1

Answer: C

Two other heart sounds may be present in some healthy individuals. The third heart sound (S3) may be heard in children, in young adults, or in pregnant Females during the third trimester. It is heard after S2 and is termed a ventricular gallop. When the AV valves open, blood flow into the ventricles may cause vibrations. These vibrations create the S3 sound during diastole. There is no need for an echocardiogram. While the S3 sound can be associated with heart failure, this is not the case during pregnancy. S4, also known as an atrial gallop, can also be present in health individuals.

Answer to Question 2

Answer: A, B, C, D

Collaborative care for the parents may include grief counselors, chaplains and religious leaders, nurses (including school nurses working with older children who lose a sibling), and psychotherapists. In particular, the parents' grief will be acute, and they should receive a psychosocial assessment at each healthcare interaction. A social services consult is necessary for incidences of child abuse and is not appropriate for an infant who died from SIDS.





 

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