A nurse is discussing the process of evidence-based practice with a newly licensed nurse. Which of the following information should the nurse include when discussing a PICOT question?

(A) Heart murmur: This is the most appropriate answer. Mitral valve stenosis can cause a heart murmur due to turbulent blood flow across the narrowed mitral valve. This is often heard best at the apex of the heart with the patient in the left lateral decubitus position.

(B) Clubbing of the fingers: Clubbing of the fingers is typically associated with conditions that cause chronic hypoxia, such as lung disease or congenital heart disease. It is not a common finding in mitral valve stenosis.

(C) Bradycardia: Mitral valve stenosis does not typically cause bradycardia. In fact, some patients may have a rapid heart rate (tachycardia) due to atrial fibrillation, which is a common complication of mitral valve stenosis.

(D) Barrel chest: A barrel chest is typically associated with chronic obstructive pulmonary disease (COPD) and is not a common finding in mitral valve stenosis. It refers to a rounded, bulging chest that resembles the shape of a barrel. This occurs due to overinflation of the lungs over a long period of time.

A. Arrange referral for family therapy to deal with home stressors:

While family therapy may be beneficial in addressing underlying issues, suspected abuse must be reported promptly to protect the client's safety. Referral for family therapy can be considered as part of a comprehensive intervention plan but should not delay reporting of suspected abuse.

B. Follow the agency's guidelines for reporting suspected abuse:

Reporting suspected abuse is the first priority when there are concerns about a client's safety. Following the agency's guidelines ensures that the appropriate authorities are notified and that the client receives the necessary protection and support.

C. Check the bruises at the next visit to the client's home:

Delaying action and waiting until the next visit to check the bruises could put the client at further risk of harm. Suspected abuse requires immediate attention, and the nurse should follow established protocols for reporting and intervening in such situations.

D. Institute more frequent visits to the client's home:

While more frequent visits may allow for closer monitoring of the client's condition, suspected abuse should be addressed immediately through appropriate reporting channels. Increasing visit frequency alone may not adequately address the safety concerns and may delay necessary intervention.