A nurse is assisting with teaching a newly licensed nurse about heart sounds. Which of the following sounds is heard when the aortic and pulmonic valves close?
S1
S2
S3
S4
The Correct Answer is B
Choice A reason : S1 represents the sound made by the closure of the atrioventricular valves (mitral and tricuspid valves) and is not the sound associated with the closure of the aortic and pulmonic valves.
Choice B reason : S2 is the sound heard when the aortic and pulmonic valves close. It is often described as a "dub" and occurs at the end of ventricular systole.
Choice C reason : S3 is a rare extra heart sound that follows S2 and usually indicates an increase in left ventricular filling pressure, which can be found in conditions such as heart failure.
Choice D reason : S4 is another extra heart sound that occurs just before S1. It is typically associated with a stiff or hypertrophic ventricle and is not related to the closure of the aortic and pulmonic valves
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason : This instruction is accurate because for a standard 12-lead ECG, electrodes are placed on the patient's chest and extremities to record the electrical activity of the heart. The placement of these electrodes is crucial for accurate readings and diagnosis. The electrodes do not emit electricity; they merely record and measure the electrical activity in your heart, providing essential information to the medical provider.
Choice B reason : Remaining still during an ECG is important to prevent artifacts that can interfere with the interpretation of the heart's electrical activity. Movement can cause the readings to be inaccurate, which is why patients are advised to remain still once the electrodes are in place.
Choice C reason : While the client might feel some pressure from the electrodes, the term 'tingling' is not accurate as the ECG is a painless procedure. The electrodes may cause mild irritation upon the skin, but there is otherwise no sensation associated with the test itself.
Choice D reason : The duration of the test is indeed short, typically only a few minutes, but this is not the primary instruction. The nurse should first inform the client about the electrode placement, which is essential for the procedure. The ECG will only take a few minutes in total once the procedure is underway, not counting equipment set-up time.
Correct Answer is D
Explanation
Choice A reason : Assisting the client into a standing position is part of the process for checking orthostatic hypotension, but it is not the first action to take. The initial measurement should be taken while the client is supine to establish a baseline blood pressure before any position changes.
Choice B reason : Determining the client's blood pressure 1 minute after each position change is important for diagnosing orthostatic hypotension, but it follows after the initial supine measurement. This step is to observe changes in blood pressure that may indicate orthostatic hypotension.
Choice C reason : Placing the client in a sitting position is another step in the process of checking for orthostatic hypotension. However, it is not the first action. The nurse should first measure the blood pressure in the supine position, then sitting, and finally standing.
Choice D reason : This is the correct first action. Checking the client's blood pressure in a supine position provides a baseline measurement. After this, the nurse can compare the blood pressure readings after the client sits and stands to identify any significant drops that would indicate orthostatic hypotension.
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