A nurse is performing a cardiovascular assessment on a healthy client. In which of the following anatomical landmarks would the nurse expect to palpate the client's Point of Maximal Impulse (PMI)?
Left fourth intercostal space at the sternal border.
Left third intercostal space at the sternal border.
Left second intercostal space at the midclavicular line.
Left fifth intercostal space at the midclavicular line.
The Correct Answer is D
The correct answer is: d. Left fifth intercostal space at the midclavicular line.
Choice A: Left fourth intercostal space at the sternal border
The fourth intercostal space at the sternal border is not the typical location for the Point of Maximal Impulse (PMI). This area is more commonly associated with the tricuspid valve auscultation point. The PMI is usually found more laterally and inferiorly.
Choice B: Left third intercostal space at the sternal border
The third intercostal space at the sternal border is also not the correct location for the PMI. This area is generally used for auscultating the pulmonic valve. The PMI is located further down and towards the midclavicular line.
Choice C: Left second intercostal space at the midclavicular line
The second intercostal space at the midclavicular line is typically where the aortic valve is auscultated. The PMI is not found this high up on the chest.
Choice D: Left fifth intercostal space at the midclavicular line
This is the correct location for palpating the Point of Maximal Impulse (PMI). The PMI is usually located at the apex of the heart, which is found at the left fifth intercostal space along the midclavicular line. This is where the left ventricle is closest to the chest wall and can be felt most strongly during systole.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Using an internet webpage translator might seem convenient, but it can lead to inaccuracies in communication due to language nuances and medical terminology. Direct communication with a human translator is more reliable.
Choice B rationale:
Arranging to complete the assessment with only the client and a translator present is the best option. This approach ensures accurate and confidential communication, allowing the nurse to gather essential information directly from the client without potential bias or misinterpretation from family members.
Choice C rationale:
Asking the client's husband to translate questions and answers for the client can lead to inaccurate or biased information. Additionally, it might not provide a safe environment for the client to openly share her concerns.
Choice D rationale:
Asking a male student nurse to translate for the client does not necessarily address the language barrier adequately. The gender of the translator is not the primary concern here. Ensuring effective communication through a professional translator is more important.
Correct Answer is D
Explanation
Choice A rationale:
Requiring the child to be free from nits before returning to school might not be an accurate understanding of the situation. Nits are the eggs of head lice and may remain attached to the hair even after effective treatment. The presence of live lice is a more crucial factor to consider.
Choice B rationale:
Throwing out toys that can't be dry cleaned or washed is an unnecessary and extreme measure. Head lice do not survive long away from the human scalp, so the risk of transmission through inanimate objects like toys is minimal. Thoroughly cleaning and vacuuming the environment is more effective.
Choice C rationale:
Treating all family members is indeed a prudent approach. Head lice can spread easily within households, especially among close contacts. Treating everyone helps prevent re-infestation and disrupts the lice life cycle.
Choice D rationale:
Washing recently used clothing, bedding, and towels in hot water is a correct understanding of how to manage head lice. The high temperature kills lice and their eggs. It is an essential step in preventing the spread of lice and re-infestation.
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