Physical Examination and Health Assessment
Exam| Questions with 100% Verified Answers
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: - ✔ ✔ ANS: displacement of the heart from elevation of the diaphragm.
Palpation of the apical impulse is higher and more lateral compared with the normal position
because the enlarging uterus elevates the diaphragm and displaces the heart up and to the
left and rotates it on its long axis.
In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the: -
✔ ✔ ANS: bell at the apex with the patient in the left lateral position.
The S4 is a ventricular filling sound. It occurs when atria contract late in diastole. It is heard
immediately before S1. This is a very soft sound with a very low pitch. The nurse needs a good
bell and must listen for it. It is heard best at the apex, with the person in the left lateral
position.
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 S1. The sound is heard only with the bell 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): - ✔ ✔ ANS: atrial gallop.
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. It is heard best at the apex with the patient in the left lateral position.
The nurse is performing a cardiac assessment on a 65-year-old patient 3 days after her
myocardial infarction. Heart sounds are normal when she is supine, but when she is sitting
and leaning forward, the nurse hears a high-pitched, scratchy sound with the diaphragm of
the stethoscope at the apex. It disappears on inspiration. The nurse suspects: - ✔ ✔ ANS:
inflammation of the precordium.
Inflammation of the precordium gives rise to a friction rub. The sound is high pitched and
scratchy, like sandpaper being rubbed. It is best heard with the diaphragm of the stethoscope,
with the person sitting up and leaning forward, and with the breath held in expiration. A
friction rub can be heard any place on the precordium but usually is best heard at the apex and
left lower sternal border, which are places where the pericardium comes in close contact with
the chest wall.
The mother of a 10-month-old infant tells the nurse that she has noticed that her son
becomes blue when he is crying and that the frequency of this is increasing. He is also not
crawling yet. During the examination the nurse palpates a thrill at the left lower sternal border
and auscultates a loud systolic murmur in the same area. What would be the most likely cause
of these findings? - ✔ ✔ ANS: Tetralogy of Fallot
Tetralogy of Fallot subjective findings include (1) severe cyanosis, not in the first months of life
but developing as the infant grows, and right ventricle outflow (i.e., pulmonic) stenosis gets
worse; (2) cyanosis with crying and exertion at first, then at rest; and (3) slowed development.
Objective findings include (1) thrill palpable at left lower sternal border; (2) S1 normal, S2 has
A2 loud and P2 diminished or absent; and (3) murmur is systolic, loud, crescendo-decrescendo.
A 30-year-old woman with a history of mitral valve problems states that she has been "very
tired." She has started waking up at night and feels like her "heart is pounding." During the
assessment, the nurse palpates a thrill and lift at the fifth left intercostal space midclavicular
line. In the same area the nurse also auscultates a blowing, swishing sound right after S1.
These findings would be most consistent with: - ✔ ✔ ANS: mitral regurgitation.
Exam| Questions with 100% Verified Answers
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: - ✔ ✔ ANS: displacement of the heart from elevation of the diaphragm.
Palpation of the apical impulse is higher and more lateral compared with the normal position
because the enlarging uterus elevates the diaphragm and displaces the heart up and to the
left and rotates it on its long axis.
In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the: -
✔ ✔ ANS: bell at the apex with the patient in the left lateral position.
The S4 is a ventricular filling sound. It occurs when atria contract late in diastole. It is heard
immediately before S1. This is a very soft sound with a very low pitch. The nurse needs a good
bell and must listen for it. It is heard best at the apex, with the person in the left lateral
position.
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 S1. The sound is heard only with the bell 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): - ✔ ✔ ANS: atrial gallop.
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. It is heard best at the apex with the patient in the left lateral position.
The nurse is performing a cardiac assessment on a 65-year-old patient 3 days after her
myocardial infarction. Heart sounds are normal when she is supine, but when she is sitting
and leaning forward, the nurse hears a high-pitched, scratchy sound with the diaphragm of
the stethoscope at the apex. It disappears on inspiration. The nurse suspects: - ✔ ✔ ANS:
inflammation of the precordium.
Inflammation of the precordium gives rise to a friction rub. The sound is high pitched and
scratchy, like sandpaper being rubbed. It is best heard with the diaphragm of the stethoscope,
with the person sitting up and leaning forward, and with the breath held in expiration. A
friction rub can be heard any place on the precordium but usually is best heard at the apex and
left lower sternal border, which are places where the pericardium comes in close contact with
the chest wall.
The mother of a 10-month-old infant tells the nurse that she has noticed that her son
becomes blue when he is crying and that the frequency of this is increasing. He is also not
crawling yet. During the examination the nurse palpates a thrill at the left lower sternal border
and auscultates a loud systolic murmur in the same area. What would be the most likely cause
of these findings? - ✔ ✔ ANS: Tetralogy of Fallot
Tetralogy of Fallot subjective findings include (1) severe cyanosis, not in the first months of life
but developing as the infant grows, and right ventricle outflow (i.e., pulmonic) stenosis gets
worse; (2) cyanosis with crying and exertion at first, then at rest; and (3) slowed development.
Objective findings include (1) thrill palpable at left lower sternal border; (2) S1 normal, S2 has
A2 loud and P2 diminished or absent; and (3) murmur is systolic, loud, crescendo-decrescendo.
A 30-year-old woman with a history of mitral valve problems states that she has been "very
tired." She has started waking up at night and feels like her "heart is pounding." During the
assessment, the nurse palpates a thrill and lift at the fifth left intercostal space midclavicular
line. In the same area the nurse also auscultates a blowing, swishing sound right after S1.
These findings would be most consistent with: - ✔ ✔ ANS: mitral regurgitation.
