In the context of interprofessional care of the client and family, where should a nurse position the stethoscope on the chest to assess a client’s apical heart rate?

Choice A rationale
Low urine osmolarity and creatinine clearance are not the primary indicators of inadequate renal perfusion in a patient being stabilized after an acute coronary syndrome. These measures reflect the concentration of the urine and the kidney’s ability to filter waste from the blood, respectively. While they can be affected by renal perfusion, they are not the most direct or reliable indicators.
Choice B rationale
A decreasing serum blood urea nitrogen (BUN) level is not typically associated with inadequate renal perfusion. In fact, a high BUN level may indicate that the kidneys aren’t working properly. However, BUN levels can be influenced by many factors, including protein intake and liver function, so they are not the most reliable indicator of renal perfusion.
Choice C rationale
A urine output of less than 30 mL/hr is a common sign of inadequate renal perfusion. The kidneys need adequate blood flow to filter waste products from the blood and produce urine. If renal perfusion is inadequate, urine output can decrease.
Choice D rationale
A urine-specific gravity of less than 1.010 is not typically associated with inadequate renal perfusion. Specific gravity is a measure of the concentration of solutes in the urine. It can be influenced by hydration status and certain kidney disorders, but it is not a direct measure of renal perfusion.

Choice A rationale
Cramping of the toes is not typically associated with a positive Homans sign. Homans sign is a test used to check for deep vein thrombosis (DVT), a blood clot in a deep vein of the leg. While cramping can occur with DVT, it is not specific to this condition and can occur with many other conditions.
Choice B rationale
Blanching of the sole is not associated with a positive Homans sign. Blanching, or whitening of the skin, can occur with various conditions, but it is not a typical sign of DVT45.
Choice C rationale
Resisting dorsiflexion is not a typical response indicating a positive Homans sign. While pain or resistance during dorsiflexion of the foot can occur with various conditions, it is not a specific sign of DVT45.
Choice D rationale
Pain in the calf area during dorsiflexion of the foot (Homans sign) can indicate a positive sign for DVT. However, it’s important to note that Homans sign is not a reliable or definitive test for DVT. Other diagnostic tests, such as ultrasound, are needed to confirm the diagnosis.