A 70-year-old patient with a history of hypertension has a blood ...

[natalie2426]

A 70-year-old patient with a history of hypertension has a blood pressure of 180/100 mm Hg and a heart rate of 90 beats per minute. The nurse hears an extra heart sound at the apex immediately before the S1.
 
  The sound is heard only with the bell of the stethoscope while the patient is in the left lateral position. With these findings and the patient's history, the nurse knows that this extra heart sound is most likely a(n):
 
  a.
  Split S1.
  b.
  Atrial gallop.
  c.
  Diastolic murmur.
  d.
  Summation sound.

Question 2

In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the:
 
  a. Bell of the stethoscope at the base with the patient leaning forward.
  b. Bell of the stethoscope at the apex with the patient in the left lateral position.
  c. Diaphragm of the stethoscope in the aortic area with the patient sitting.
  d. Diaphragm of the stethoscope in the pulmonic area with the patient supine.

[juwms]

Answer to Question 1

ANS: B
A pathologic S4 is termed an atrial gallop or an S4 gallop. It occurs with decreased compliance of the ventricle and with systolic overload (afterload), including outflow obstruction to the ventricle (aortic stenosis) and systemic hypertension. A left-sided S4 occurs with these conditions and is heard best at the apex with the patient in the left lateral position.

Answer to Question 2

ANS: B
The S4 is a ventricular filling sound that occurs when the atria contract late in diastole and is heard immediately before the S1. The S4 is a very soft sound with a very low pitch. The nurse needs a good bell and must listen for this sound. An S4 is heard best at the apex, with the person in the left lateral position.

[natalie2426]

Thank you

[juwms]

Happy to help you