A 16-year-old female client presents with complaints of palpitations. While the nurse is auscultating heart sounds, asking the client to get into a seated position and leaning forward, would help the nurse assess the presence of which of the following?
Mitral stenosis
Atrial repolarization
The first heart sound
Aortic murmurs
The Correct Answer is D
A) Mitral stenosis: Mitral stenosis is best assessed in the left lateral decubitus position, not by asking the client to lean forward. This position brings the mitral valve closer to the chest wall, allowing for better auscultation of the mitral valve area.
B) Atrial repolarization: Atrial repolarization, which is not typically auscultated as a distinct sound, occurs during the repolarization phase of the atria and is not specifically assessed by positioning the client in any particular way.
C) The first heart sound: The first heart sound (S1) is best heard over the mitral and tricuspid areas of the heart and does not specifically require the client to lean forward. It is associated with the closure of the atrioventricular valves and can be assessed in various positions.
D) Aortic murmurs: Aortic murmurs, including those associated with aortic stenosis or regurgitation, are often best heard with the client sitting and leaning forward. This position brings the aortic valve closer to the chest wall and can enhance the auscultation of murmurs or abnormal heart sounds associated with the aortic area.
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Explanation
Answer: The hot spot in the right lower quadrant that corresponds to this location.
Locate the right anterior superior iliac spine (the bony prominence on the right side of the pelvis). Identify the umbilicus (navel). McBurney's point is roughly one-third of the distance from the anterior superior iliac spine to the umbilicus.
Correct Answer is B
Explanation
A) Lateralization of the sound/vibration to both ears equally: The Weber test is used to assess unilateral hearing loss and would not show equal lateralization in the presence of unilateral sensorineural hearing loss. Equal lateralization would suggest normal hearing or symmetrical hearing loss, which is not the case here.
B) Lateralization of the sound/vibration to the left ear: In sensorineural hearing loss, sound is perceived to lateralize to the unaffected ear. Therefore, with right ear sensorineural hearing loss, the sound will lateralize to the left ear, indicating that the left ear has better hearing capability.
C) Bone conduction (BC) is greater than air conduction (AC): This finding is characteristic of conductive hearing loss, not sensorineural hearing loss. In sensorineural hearing loss, air conduction is typically greater than or equal to bone conduction, but the Weber test focuses on lateralization rather than BC versus AC.
D) Lateralization of the sound/vibration to the right ear: If the sound were to lateralize to the affected ear in sensorineural hearing loss, it would suggest that the affected ear is hearing better, which contradicts the nature of sensorineural hearing loss. The sound will actually lateralize to the better-hearing, unaffected ear.
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