When the nurse is auscultating the carotid artery for bruits, ...

[bcretired]

When the nurse is auscultating the carotid artery for bruits, which of these statements reflects the correct technique?
 
  a. While listening with the bell of the stethoscope, the patient is asked to take a deep breath and hold it.
  b. While auscultating one side with the bell of the stethoscope, the carotid artery is palpated on the other side to check pulsations.
  c. While lightly applying the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.
  d. While firmly placing the bell of the stethoscope over the carotid artery and listening, the patient is asked to take a breath, exhale, and briefly hold it.

Question 2

During an assessment, the nurse notes that the patient's apical impulse is laterally displaced and is palpable over a wide area. This finding indicates:
 
  a. Systemic hypertension.
  b. Pulmonic hypertension.
  c. Pressure overload, as in aortic stenosis.
  d. Volume overload, as in heart failure.

[Dominic]

Answer to Question 1

ANS: C
The correct technique for auscultating the carotid artery for bruits involves the nurse lightly applying the bell of the stethoscope over the carotid artery at three levels. While listening, the nurse asks the patient take a breath, exhale, and briefly hold it. Holding the breath on inhalation will also tense the levator scapulae muscles, which makes it hard to hear the carotid arteries. Examining only one carotid artery at a time will avoid compromising arterial blood flow to the brain. Pressure over the carotid sinus, which may lead to decreased heart rate, decreased blood pressure, and cerebral ischemia with syncope, should be avoided.

Answer to Question 2

ANS: D
With volume overload, as in heart failure and cardiomyopathy, cardiac enlargement laterally displaces the apical impulse and is palpable over a wider area when left ventricular hypertrophy and dilation are present.

[bcretired]

Excellent

[xiazhe]

Gracias!