A nurse is collecting data from a 1-week-old infant who is scheduled for a cardiac catheterization. Which of the following locations should the nurse palpate in order to identify the infant's point of maximal impulse? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)
A
B
C
None
None
None
The Correct Answer is B
Point A: Represents the third intercostal space at the right sternal border, which corresponds anatomically to the aortic valve area. This is a key auscultation site used during cardiac assessment to listen for murmurs and abnormalities related to the aortic valve. It is not used for palpation.
Point B: Fourth intercostal space at the left midclavicular line and is the correct location for palpating the point of maximal impulse (PMI) in infants and young children. In this age group, the PMI is typically found here due to the more horizontal position of the heart in the chest.
Point C: This location is at the 2nd or 3rd intercostal space, which is too high to assess the PMI in an infant. This area is used more for evaluating pulmonic valve sounds, not the apex of the heart.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. A school-age child who has Haemophilus influenzae type b disease: Haemophilus influenzae type b typically requires droplet precautions, not contact precautions, unless the infection is invasive like meningitis.
B. An adolescent who has pneumonia: Pneumonia caused by most pathogens does not require contact precautions unless there are specific indications such as a highly contagious organism or a superimposed infection that mandates isolation.
C. An infant who has respiratory syncytial virus (RSV): RSV is highly contagious and spreads through respiratory secretions. Contact precautions are necessary to prevent transmission, especially in healthcare settings.
D. A preschooler who has tuberculosis: TB is transmitted through the air via respiratory droplets, so airborne precautions (including a negative pressure room and an N95 respirator) are necessary to prevent transmission.
Correct Answer is A
Explanation
A. "Your baby has an increased risk for a heart defect.": Infants with Down syndrome have a significantly higher risk for congenital heart defects, such as atrioventricular septal defects (AVSD) and ventricular septal defects (VSD). It is important for the parents to be aware of this risk and have the infant screened by a cardiologist.
B. "Expect your baby to need factor replacement therapy every month.": Factor replacement therapy is typically associated with hemophilia, not Down syndrome. Down syndrome is a genetic condition that affects development, but it is not clotting disorders.
C. "Expect your baby to grow in height more rapidly than weight.": Infants with Down syndrome often experience growth delays, but there is no specific expectation that height will outpace weight.
D. "Your baby should have no issues with eyesight.": Children with Down syndrome are at higher risk for vision problems, including strabismus, refractive errors, and cataracts. Regular eye exams are important for early detection and management of these issues.
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