A nurse is assessing a client for tactile fremitus. The nurse should recognize that it is normal to feel tactile fremitus most intensely over which location?

Fifth intercostal space, midaxillary line

Between the scapulae

Third intercostal space, midaxillary line

Over the lobes, posterior side

Answer and Explanation

The Correct Answer is B

A) Fifth intercostal space, midaxillary line:
This is incorrect. The fifth intercostal space at the midaxillary line is a location that can be assessed for tactile fremitus, but it is not typically where fremitus is felt most intensely. Fremitus tends to be stronger near the midline structures, such as over the trachea, rather than at this lateral position, which is more peripheral.

B) Between the scapulae:
This is the correct answer. Tactile fremitus is usually most intense over the area between the scapulae and near the sternum. This is because the bronchi and trachea are located close to the chest wall in these regions, creating more intense vibrations that can be palpated during assessment. The fremitus is transmitted through the airways and is easiest to feel when the lung tissue is close to the chest wall, as in the area between the scapulae.

C) Third intercostal space, midaxillary line:
This is incorrect. The third intercostal space at the midaxillary line is not typically the site where tactile fremitus is most prominent. This area is more peripheral, and fremitus tends to be weaker here compared to regions closer to the sternum or between the scapulae where the lungs are nearer to the chest wall.

D) Over the lobes, posterior side:
This is incorrect. While tactile fremitus can be assessed over the posterior lobes of the lungs, it is not generally felt most intensely here. Fremitus is usually stronger near the midline of the chest (sternum) or between the scapulae, and tends to be weaker as you move laterally or toward the lower lobes of the lungs.

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Correct Answer is B

Explanation

A) The third heart sound (S3): The third heart sound (S3) occurs early in diastole, immediately following S2. It is often associated with conditions that cause increased volume and pressure in the ventricles, such as heart failure or dilated cardiomyopathy. S3 is not heard late in diastole, so it does not match the described timing of the extra heart sound.

B) The fourth heart sound (S4): The fourth heart sound (S4) is heard late in diastole, just before S1. It is caused by the atria contracting forcefully to push blood into a non-compliant or stiff ventricle, often associated with conditions like left ventricular hypertrophy or ischemic heart disease. The timing of S4, occurring just before S1, makes it the correct identification of the described extra heart sound.

C) A split second heart sound S2: A split S2 occurs when the aortic and pulmonic valves do not close simultaneously, causing the second heart sound (S2) to be heard as two distinct components. This split can vary with respiration but does not occur late in diastole. Therefore, it does not align with the extra heart sound heard just before S1.

D) A friction rub: A friction rub is a sound associated with pericarditis, caused by the rubbing of inflamed pericardial layers. It has a distinct, grating quality and can be heard throughout the cardiac cycle. A friction rub is not a late diastolic sound, making it an incorrect identification for the extra heart sound described.

A. AV node-• SA node-• bundle of His -• Erb's Point B. Bundle of His -• AV node -• SA node -• Erb's Point C. AV node -• SA node -• bundle of His -• bundle branches D. SA node -• AV node -• bundle of His -• bundle branches

Correct Answer is D

Explanation

A) AV node → SA node → bundle of His → Erb's Point:
This sequence is incorrect because the electrical impulse of the heart starts at the SA (sinoatrial) node, not the AV (atrioventricular) node. The SA node is the natural pacemaker of the heart, initiating the electrical signal. The correct order of conduction is SA node → AV node → bundle of His → bundle branches, and finally, the Purkinje fibers. Erb's Point is an anatomical reference point for auscultation, not part of the electrical conduction pathway.

B) Bundle of His → AV node → SA node → Erb's Point:
This sequence is also incorrect. The electrical impulse originates at the SA node, not the bundle of His. The SA node stimulates the AV node, which in turn sends the signal to the bundle of His and then to the bundle branches. This pathway is essential for coordinating the contraction of the heart muscle, starting from the atria and moving to the ventricles.

C) AV node → SA node → bundle of His → bundle branches:
This sequence is reversed and incorrect. The impulse starts at the SA node, not the AV node. The SA node fires first, sending the electrical signal to the AV node, and then the signal travels down the bundle of His, into the left and right bundle branches, and finally to the Purkinje fibers.

D) SA node → AV node → bundle of His → bundle branches:
This is the correct sequence of the electrical conduction pathway of the heart. The electrical impulse originates at the SA node (the heart's natural pacemaker), then travels to the AV node, where it is delayed to allow the atria to contract and fill the ventricles. From there, the impulse moves down the bundle of His, which splits into the left and right bundle branches, leading to the Purkinje fibers that transmit the impulse throughout the ventricles, causing them to contract. This sequence ensures proper coordination and timing of the heart's contractions.

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A nurse is assessing a client for tactile fremitus. The nurse should recognize that it is normal to feel tactile fremitus most intensely over which location?

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Naxlex Comprehensive Predictor Exams

A nurse is auscultating heart sounds on a client and hears an extra sound late in diastole, just before the S1. How should the nurse document this finding?

Correct Answer is B

Explanation

A nurse is reviewing the sequence of the cardiac cycle. The nurse recognizes that the electrical stimulus of the cardiac cycle follows which sequence?

Correct Answer is D

Explanation

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