A nurse is auscultating a client's heart sounds and hears a third heart sound (S3). Which finding is consistent with the presence of an S3 sound in a client with congestive heart failure?
High-pitched, scratchy sound heard during inhalation
Extra heart sound heard immediately after S1 and S2
Prolonged, whooshing sound heard during systole
Irregular heart rhythm with varying intensity
The Correct Answer is B
A) This choice is incorrect because a high-pitched, scratchy sound heard during inhalation is called a pleural friction rub and is associated with pleuritis or inflammation of the pleura, not congestive heart failure.
B) This choice is correct. An S3 heart sound is an extra heart sound heard immediately after S1 and S2, often described as a "ventricular gallop." It is associated with congestive heart failure and indicates increased fluid volume and strain on the ventricles.
C) This choice is incorrect because a prolonged, whooshing sound heard during systole is a heart murmur, which can be caused by various conditions, but it is not specific to the presence of an S3 sound.
D) This choice is incorrect because an irregular heart rhythm with varying intensity is characteristic of cardiac arrhythmias or irregular heartbeats and is not specific to the presence of an S3 sound.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A) This choice is incorrect because an electrocardiogram (ECG) is a valuable diagnostic tool for assessing the heart's electrical activity and rhythm, but it is not the gold standard for diagnosing CHF. It can provide information about possible cardiac hypertrophy or rhythm disturbances associated with heart failure.
B) This choice is incorrect because a chest X-ray is helpful in evaluating heart size and the presence of pulmonary congestion, but it is not the gold standard for diagnosing CHF.
C) This choice is correct. An echocardiogram is the gold standard for diagnosing CHF. It uses ultrasound waves to assess the heart's structure and function, including ejection fraction and valve function, providing critical information to confirm the diagnosis of heart failure.
D) This choice is incorrect because a brain natriuretic peptide (BNP) level is a blood test that can aid in the diagnosis of CHF. Elevated BNP levels indicate heart strain, but it is not the gold standard for diagnosing CHF.
Correct Answer is C
Explanation
A) This choice is incorrect because a complete blood count (CBC) is a general blood test that measures different components of the blood, such as red blood cells, white blood cells, and platelets. It is not specifically used to measure heart strain or diagnose CHF.
B) This choice is incorrect because a basic metabolic panel (BMP) is a blood test that measures electrolytes, kidney function, and glucose levels. It is not specific to diagnosing CHF.
C) This choice is correct. A brain natriuretic peptide (BNP) level is a blood test specifically used to measure heart strain. Elevated BNP levels can indicate heart failure, making it a valuable diagnostic tool in assessing suspected CHF.
D) This choice is incorrect because a C-reactive protein (CRP) level is a marker of inflammation and is not specific to diagnosing CHF.
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