A nurse is caring for a 65-year-old female client in the emergency department.

Select the landmarks that are used to find the PMI to auscultate the apical pulse.

Angle of Louis

Second intercostal space

Fifth intercostal space

Left midclavicular line

Sternum

Answer and Explanation

Correct Answer : A,B,C,D

Choice A rationale: The angle of Louis, or the sternal angle, is an important anatomical landmark located at the junction of the manubrium and body of the sternum. It helps locate the second rib and second intercostal space, providing a starting point for counting ribs and spaces to identify the correct level for PMI assessment.

Choice B rationale: The second intercostal space lies just below the second rib, identified by palpating down from the angle of Louis. It is the reference point used to count down to the fifth intercostal space where the PMI is located, enabling accurate localization of cardiac landmarks during auscultation.

Choice C rationale: The fifth intercostal space is the level where the PMI is typically found. This space lies below the fourth rib and corresponds to the apex of the heart in most adults. Locating this space is essential for accurate auscultation of the apical pulse.

Choice D rationale: The left midclavicular line is a vertical line drawn down from the midpoint of the left clavicle. The PMI is most often located at the intersection of the fifth intercostal space and this line, making it a critical landmark for cardiac examination.

Choice E rationale: The sternum itself is a midline bone and not used directly to locate the PMI. While it provides structural support and serves as a reference for the angle of Louis, it is not a landmark for auscultating the apical impulse, which is lateral to the sternum.

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Correct Answer is A

Explanation

Choice A rationale

Missed menstrual periods (amenorrhea) in a nulliparous female with a negative pregnancy test warrant assessment for endocrine imbalances. Changes in body weight, hirsutism (excessive hair growth), and thyroid enlargement (goiter) can indicate hormonal disorders such as polycystic ovary syndrome (PCOS) or thyroid dysfunction, which commonly disrupt menstrual cycles.

Choice B rationale

Urinary frequency, unsteady gait, and dental enamel erosion are not directly associated with amenorrhea in the absence of pregnancy. Urinary frequency might suggest a urinary tract infection or diabetes. Unsteady gait can indicate neurological issues, and dental enamel erosion is often linked to bulimia, none of which primarily cause missed periods.

Choice C rationale

Vaginal discharge and genital warts are indicative of sexually transmitted infections (STIs), while abdominal tenderness could suggest pelvic inflammatory disease or other abdominal pathology. While STIs can impact reproductive health, they are not primary causes of amenorrhea. Abdominal tenderness might be a symptom but not the most important assessment for this presentation.

Choice D rationale

Breast tenderness, tremors, and high blood pressure are less specific for the evaluation of amenorrhea. Breast tenderness can be a premenstrual symptom or related to hormonal fluctuations. Tremors might indicate thyroid issues, and high blood pressure is a cardiovascular concern. These are not the most direct assessments for the presenting complaint of missed periods.

A. Forearm pronation. B. Hyperextension and palmar flexion. C. Forearm supination. D. Plantar flexion.

Correct Answer is B

Explanation

Choice A rationale

Forearm pronation involves rotating the forearm so the palm faces posteriorly or downward. While a component of upper extremity assessment, it primarily assesses the radioulnar joints and is not the most direct or specific motion for evaluating the integrity and mobility of the wrist joint itself.

Choice B rationale

Hyperextension and palmar flexion are fundamental movements of the wrist joint, directly assessing its range of motion in the sagittal plane. Ecchymosis often indicates soft tissue injury, and evaluating these specific movements helps pinpoint potential ligamentous or bony involvement, guiding subsequent diagnostic steps.

Choice C rationale

Forearm supination involves rotating the forearm so the palm faces anteriorly or upward. Similar to pronation, this movement primarily assesses the radioulnar joints and is not the primary motion used to evaluate the specific flexion and extension capabilities of the carpal bones and wrist ligaments.

Choice D rationale

Plantar flexion is a movement of the ankle joint, referring to the pointing of the toes downward. This motion is completely unrelated to assessing wrist mobility and is an inappropriate assessment for a client presenting with wrist pain and ecchymosis.

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A nurse is caring for a 65-year-old female client in the emergency department. Select the landmarks that are used to find the PMI to auscultate the apical pulse.

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Correct Answer is A

Explanation

A client is seen in the emergent care clinic for right wrist pain with a pattern of ecchymosis observed on the wrist. Which motion should the nurse instruct the client to perform to assess the wrist mobility?

Correct Answer is B

Explanation

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A nurse is caring for a 65-year-old female client in the emergency department.

Select the landmarks that are used to find the PMI to auscultate the apical pulse.