A nurse is auscultating a client's heart sounds and hears an extra heart sound before what should be considered the first heart sound S1. The nurse should document this finding as which of the following heart sounds?

A friction rub

A split second heart sound S₂

The third heart sound (S3)

The fourth heart sound (S4)

Answer and Explanation

The Correct Answer is D

A. A friction rub: A friction rub is a sound caused by the rubbing of inflamed pericardial layers and is not classified as a heart sound like S1 or S2. It is unrelated to the sequence of heart sounds.

B. A split second heart sound S₂: A split S₂ occurs during the closure of the aortic and pulmonary valves and is heard after S1, not before.

C. The third heart sound (S3): S3, or the ventricular gallop, occurs shortly after S2 during early diastole and indicates rapid ventricular filling. It is not heard before S1.

D. The fourth heart sound (S4): S4, known as the "atrial gallop," occurs just before S1 during atrial contraction. It is associated with a stiff or hypertrophied ventricle and is often indicative of underlying heart disease, especially in older adults.

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Correct Answer is A

Explanation

A. Schilling test: This is the correct answer. The Schilling test is used to diagnose pernicious anemia, which is caused by vitamin B12 deficiency. The test measures the absorption of vitamin B12 in the gastrointestinal tract.

B. Haptoglobin: Haptoglobin is a test used to assess hemolysis and is not specific for pernicious anemia.

C. Sweat test: The sweat test is used to diagnose cystic fibrosis and is not relevant to the diagnosis of pernicious anemia.

D. Antinuclear antibodies: Antinuclear antibodies are tested to diagnose autoimmune disorders, such as systemic lupus erythematosus (SLE), and are not specific to pernicious anemia.

A. Hypertension B. Diarrhea C. Fatigue D. Bradycardia

Correct Answer is C

Explanation

A. Hypertension: Anemia is more likely to be associated with hypotension rather than hypertension. The body often responds to anemia by increasing heart rate and cardiac output to compensate for reduced oxygen-carrying capacity.

B. Diarrhea: Anemia itself is not directly associated with diarrhea. Excess blood loss can lead to anemia, but diarrhea is not a typical manifestation of anemia.

C. Fatigue: This is the correct answer. Fatigue is a common symptom of anemia, as reduced oxygen delivery to tissues can lead to feelings of weakness, tiredness, and lack of energy.

D. Bradycardia: Anemia is more likely to be associated with compensatory tachycardia (increased heart rate) rather than bradycardia. The body attempts to maintain oxygen delivery to tissues by increasing cardiac output.

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A nurse is auscultating a client's heart sounds and hears an extra heart sound before what should be considered the first heart sound S1. The nurse should document this finding as which of the following heart sounds?

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