The nurse is assessing a new admission and hears a murmur at the second left intercostal space along the left sternal border. The nurse anticipates the client has a murmur of which valve?
Pulmonic
Aortic
Tricuspid
Mitral
The Correct Answer is A
A. Pulmonic: The pulmonic valve is best auscultated at the second left intercostal space along the left sternal border. A murmur heard in this location is most likely associated with pulmonic valve abnormalities such as pulmonary stenosis or pulmonary regurgitation.
B. Aortic: The aortic valve is auscultated at the second right intercostal space at the right sternal border. A murmur at this site may indicate aortic stenosis or regurgitation, but not when heard on the left side as in this scenario.
C. Tricuspid: Tricuspid valve murmurs are typically heard best at the lower left sternal border, around the fourth or fifth intercostal space. This location is more inferior than where the nurse auscultated the murmur in the current assessment.
D. Mitral: The mitral valve is best heard at the fifth intercostal space at the midclavicular line (the cardiac apex). Murmurs related to mitral stenosis or regurgitation would not typically be heard at the second intercostal space near the sternum.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["35"]
Explanation
Calculate the total infusion time in minutes.
Infusion time in minutes = 2 hours × 60 minutes/hour
= 120 minutes
Calculate the total number of drops to be infused.
The total volume remaining is 350 mL
Drip factor is 12 gtts/mL.
Total drops = Total volume (mL) × Drop factor (gtts/mL)
Total drops = 350 mL × 12 gtts/mL
= 4200 gtts
Calculate the IV flow rate in drops per minute (gtts/min).
IV rate (gtts/min) = Total drops / Total infusion time (minutes)
= 4200 gtts / 120 minutes
= 35
=35 gtts/min
Correct Answer is D
Explanation
A. Maintain the infusion because the client had a cardiac arrest: While epinephrine is essential during cardiac arrest, continuing a high-dose infusion post-resuscitation without reassessment may lead to complications like tachycardia, hypertension, and increased myocardial oxygen demand.
B. Continue to monitor the client's rhythm closely: Ongoing monitoring is important, but it is a passive intervention. The heart rate of 120 bpm may reflect excessive adrenergic stimulation from epinephrine, and further action is needed to prevent deterioration.
C. Suggest that the client's medication be changed to norepinephrine: Norepinephrine is another vasopressor that has less of a beta-1 adrenergic effect compared to epinephrine. It is primarily used for hypotension and septic shock, not as a direct substitute for epinephrine post-cardiac arrest. Changing to another vasopressor without indication is not the best initial step.
D. Ask the physician if the dose can be decreased: A heart rate of 120 bpm may indicate that the epinephrine dose is too high, causing sympathetic overstimulation. Prolonged or excessive tachycardia increases myocardial oxygen demand, which can be detrimental, especially in a post-arrest heart. Decreasing the dose can help prevent arrhythmias or myocardial ischemia, making this the most appropriate and proactive action.
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