Author Question: The nurse is preparing to auscultate for heart sounds. Which technique is correct? a. Listening ... (Read 103 times)

appyboo · **on:** Jun 25, 2018

The nurse is preparing to auscultate for heart sounds. Which technique is correct?

a. Listening to the sounds at the aortic, tricuspid, pulmonic, and mitral areas
b. Listening by inching the stethoscope in a rough Z pattern, from the base of the heart across and down, then over to the apex
c. Listening to the sounds only at the site where the apical pulse is felt to be the strongest
d. Listening for all possible sounds at a time at each specified area

Question 2

The nurse is examining a patient who has possible cardiac enlargement. Which statement about percussion of the heart is true?

a. Percussion is a useful tool for outlining the heart's borders.
b. Percussion is easier in patients who are obese.
c. Studies show that percussed cardiac borders do not correlate well with the true cardiac border.
d. Only expert health care providers should attempt percussion of the heart.

vickybb89 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: B
Auscultation of breath sounds should not be limited to only four locations. Sounds produced by the valves may be heard all over the precordium. The stethoscope should be inched in a rough Z pattern from the base of the heart across and down, then over to the apex; or, starting at the apex, it should be slowly worked up (see Figure 19-22). Listening selectively to one sound at a time is best.

Answer to Question 2

ANS: C
Numerous comparison studies have shown that the percussed cardiac border correlates only moderately with the true cardiac border. Percussion is of limited usefulness with the female breast tissue, in a person who is obese, or in a person with a muscular chest wall. Chest x-ray images or echocardiographic examinations are significantly more accurate in detecting heart enlargement.