In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the:

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.

Question 2

During the precordial assessment on an patient who is 8 months pregnant, the nurse palpates the apical impulse at the fourth left intercostal space lateral to the midclavicular line. This finding would indicate:
 
  a. Right ventricular hypertrophy.
  b. Increased volume and size of the heart as a result of pregnancy.
  c. Displacement of the heart from elevation of the diaphragm.
  d. Increased blood flow through the internal mammary artery.

Question 3

Which of these findings would the nurse expect to notice during a cardiac assessment on a 4-year-old child?
 
  a. S3 when sitting up
  b. Persistent tachycardia above 150 beats per minute
  c. Murmur at the second left intercostal space when supine
  d. Palpable apical impulse in the fifth left intercostal space lateral to midclavicular line

Question 4

While auscultating heart sounds on a 7-year-old child for a routine physical examination, the nurse hears an S3, a soft murmur at the left midsternal border, and a venous hum when the child is standing.
 
  What would be a correct interpretation of these findings?
  a.
  S3 is indicative of heart disease in children.
  b.
  These findings can all be normal in a child.
  c.
  These findings are indicative of congenital problems.
  d.
  The venous hum most likely indicates an aneurysm.

Question 5

While counting the apical pulse on a 16-year-old patient, the nurse notices an irregular rhythm. His rate speeds up on inspiration and slows on expiration. What would be the nurse's response?
 
  a. Talk with the patient about his intake of caffeine.
  b. Perform an electrocardiogram after the examination.
  c. No further response is needed because sinus arrhythmia can occur normally.
  d. Refer the patient to a cardiologist for further testing.