The nurse is completing a cardiac assessment on a client. The pulmonic valve would best be assessed by auscultating at the:
second intercostal space, left sternal border.
third intercostal space, left sternal border.
second intercostal space, right sternal border
fourth intercostal space, left sternal border.
The Correct Answer is A
A. The pulmonic valve is best auscultated at the second intercostal space (ICS) on the left sternal border. This is where the area corresponding to the pulmonic valve is most accurately heard due to the anatomical positioning of the heart.
B. This area does not correspond to any valvular area.
C. This location corresponds to the aortic valve, not the pulmonic valve. The aortic valve is best auscultated at the second ICS, right sternal border.
D. This location corresponds to the tricuspid valve, not the pulmonic valve. The tricuspid valve is best auscultated at the fourth or fifth ICS along the left sternal border.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. Range-of-motion (ROM) exercises are essential in preventing contractures. These exercises aim to maintain or improve joint mobility by moving each joint through its full range of movement. They help stretch tight muscles and maintain flexibility, thereby preventing the progression of contractures.
A. While muscle strengthening exercises are beneficial for overall muscle health, in the context of contractures, the primary issue is the shortened and tight muscles. Strengthening exercises alone may not effectively address the contractures and could potentially exacerbate them.
B. Frequent repositioning is crucial to prevent and potentially reverse contractures. By changing the client's position regularly, pressure and stress on specific muscle groups are relieved, which can help prevent further tightening and promote flexibility. This intervention helps maintain joint mobility and prevents contractures from worsening.
D. Weight-bearing activities can be beneficial for joint health and bone density but may not directly address contractures. Contractures involve structural changes in the muscle-tendon unit rather than joint stiffness alone.
Correct Answer is ["1700"]
Explanation
To calculate the time when a new IV bag will be needed, we can divide the total volume left in the bag by the infusion rate.
With 500 ml remaining and an infusion rate of 100 ml per hour, it will take 5 hours for the current bag to be depleted.
Since the report was given at 1200 (which is noon in military time), adding 5 hours brings us to 1700, or 5:00 PM.
Therefore, the nurse should expect to hang a new IV bag at 1700 hours in military time.
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