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.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

Choice A rationale

Obtaining a pulse oximeter reading from two extremities assesses peripheral perfusion and oxygen saturation, providing data on systemic oxygen delivery. This action is unrelated to identifying an extra heart sound, which originates from cardiac mechanics and blood flow dynamics within the heart's chambers and valves.

Choice B rationale

The bell of the stethoscope is designed to optimally transmit low-frequency sounds due to its larger surface area and lighter pressure application. Extra heart sounds, such as S3 or S4 gallops or certain murmurs, are typically low-pitched and therefore best appreciated with the bell, allowing for clearer differentiation from normal heart sounds.

Choice C rationale

Auscultating for one minute with the diaphragm primarily transmits high-frequency sounds due to its taut membrane and firm application. While useful for normal heart sounds (S1, S2) and high-pitched murmurs, it may obscure or poorly transmit the low-frequency characteristics of most extra heart sounds, leading to their non-detection.

Choice D rationale

Using a Doppler ultrasound primarily detects blood flow and its direction, often used to assess peripheral pulses or vascular patency. While it can detect cardiac motion, it does not provide the nuanced auditory information necessary to differentiate and characterize specific extra heart sounds based on their timing, pitch, and quality within the cardiac cycle.

A. Presence of metal implants. B. Duration of NPO status. C. Allergy to iodine-based dyes. D. History of myelogram.

Correct Answer is A

Explanation

Choice A rationale

The presence of metal implants, such as pacemakers, aneurysm clips, or prosthetic joints, is a critical contraindication for MRI due to the strong magnetic field. The magnetic forces can dislodge implants or cause burns, posing significant patient risk.

Choice B rationale

While NPO status is relevant for some diagnostic procedures, it is generally not a universal requirement for an MRI of the head and neck unless sedation or contrast agents are used that necessitate it. The primary concern for MRI is magnetic field interaction.

Choice C rationale

Allergy to iodine-based dyes is a crucial consideration for procedures involving iodinated contrast media, such as CT scans or angiography. MRI commonly uses gadolinium-based contrast agents, which have different allergenicity profiles.

Choice D rationale

A history of myelogram, which involves injecting contrast into the spinal canal, is relevant for procedures affecting the spine, but it is not a direct contraindication or primary concern for a head and neck MRI unless residual contrast is present.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

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.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse detects a possible extra heart sound while assessing an adult client. To verify this finding, which action should the nurse take?

Correct Answer is B

Explanation

The nurse is preparing a client for a magnetic resonance imaging (MRI) of the head and neck. Which information should the nurse obtain from the client?

Correct Answer is A

Explanation

After checking a client's pupillary response to light, the practical nurse (PN) tells the registered nurse (RN) that the client’s pupils are constricted with minimal response to light. Before verifying the PN’s findings, which action should the RN take?

The nurse notes an enlarged, visible lymph node on the client's neck. Which action should the nurse take next?

Which assessment finding, obtained during chest auscultation, should the nurse consider a normal finding?

When preparing a female client for an abdominal examination, the nurse should provide her with which instruction?

The nurse reviews a client's laboratory results for a client admitted with gastrointestinal (GI) bleeding who has no visible hemorrhoids on inspection of the anal area. Which laboratory test indicates that the client's bleeding is not yet resolved?

The nurse observes generalized weakness and diminished deep tendon reflexes on the right side of an older adult client who has a history of a cerebrovascular accident. Which deep tendon reflex response should the nurse document to support the client's clinical assessment?

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.