What findings does the nurse expect when assessing the cardiovascular system of a healthy adult? Select the 3 correct answers. (Select All that Apply.)
Pulse of smooth contour with 2+ amplitude
Heart rate of 62 beats/min
S1 and S2 present with regular rhythm
Mild, pedal edema
Correct Answer : A,B,C
A. Pulse of smooth contour with 2+ amplitude. A normal pulse should have a smooth upstroke and downstroke with a moderate (2+) amplitude, indicating adequate blood flow and cardiac function.
B. Heart rate of 62 beats/min. A normal resting heart rate for a healthy adult range from 60 to 100 beats per minute. A heart rate of 62 bpm is within this normal range.
C. S1 and S2 present with regular rhythm. The first (S1) and second (S2) heart sounds should be audible and regular, indicating normal closure of the heart valves and a steady cardiac rhythm.
D. Mild, pedal edema. Pedal edema is not a normal finding in a healthy adult and may indicate fluid retention or cardiovascular issues such as heart failure or venous insufficiency.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "The top number is the systolic blood pressure and reflects the pressure on the arteries when the heart contracts." The systolic pressure (118 mmHg) represents the force exerted on the arterial walls when the heart contracts and pumps blood.
B. "The numbers are within normal range and nothing to worry about." While 118/82 mmHg is within the normal range, this response does not explain what the numbers mean, which was the patient’s question.
C. "The concept of blood pressure is difficult to understand. The main thing to be concerned about is the top number, or systolic blood pressure." While the systolic pressure is important, the diastolic pressure is also crucial for assessing cardiovascular health. This response also discourages patient education.
D. "The bottom number is the diastolic pressure and reflects the stroke volume of the heart." Diastolic pressure (82 mmHg) represents the pressure in the arteries when the heart is at rest, not stroke volume, which refers to the amount of blood ejected per heartbeat.
Correct Answer is A
Explanation
A. 104.4°F. This temperature is consistent with heatstroke, a life-threatening condition characterized by hot, dry skin, confusion, and tachycardia. Heatstroke occurs when the body fails to regulate temperature, often exceeding 104°F (40°C).
B. 99.2°F. A temperature of 99.2°F is only slightly elevated and does not match the severe hyperthermia expected in heatstroke.
C. 100.8°F. While this temperature is above normal, it is not high enough to indicate heatstroke, which typically involves temperatures above 104°F.
D. 102.2°F. This temperature suggests heat exhaustion, a milder form of heat-related illness, but heatstroke involves higher temperatures exceeding 104°F.
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