The nurse is having difficulty hearing his patient's apical pulse with his stethoscope. Which action will help the nurse hear the heartbeat more clearly?
Positioning the bell very lightly over the patient's sternum
Placing the diaphragm firmly against the patient's skin
Utilizing a stethoscope with the longest possible tubing
Making sure that the earpieces fit loosely in the nurse's ear canals
The Correct Answer is B
A. Positioning the bell very lightly over the patient's sternum. The bell is best for low-pitched sounds like murmurs, but heartbeats (especially S1 and S2) are better heard with the diaphragm over the apex of the heart, not the sternum.
B. Placing the diaphragm firmly against the patient's skin. The diaphragm is designed to pick up high-pitched sounds like the normal S1 and S2 heart sounds. Pressing firmly helps eliminate external noise and improves sound clarity.
C. Utilizing a stethoscope with the longest possible tubing. Longer tubing can reduce sound transmission quality. Shorter tubing (about 14-18 inches) provides clearer sound.
D. Making sure that the earpieces fit loosely in the nurse's ear canals. Earpieces should fit snugly, not loosely, to ensure optimal sound conduction and block external noise.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Bradypnea refers to an abnormally slow respiratory rate, typically below 12 breaths per minute in an adult. A rate of 32 breaths/min is too fast to be considered bradypnea.
B. Apnea is the absence of breathing for a prolonged period. Since the patient has a respiratory rate of 32 breaths/min, apnea does not apply.
C. Tachypnea is defined as a rapid respiratory rate exceeding 20 breaths per minute in an adult. A rate of 32 breaths/min indicates tachypnea, which may be caused by conditions such as fever, anxiety, or respiratory distress.
D. Eupnea refers to normal breathing, with a respiratory rate between 12–20 breaths per minute. A rate of 32 breaths/min is too high to be considered eupnea.
Correct Answer is ["2"]
Explanation
Calculation:
Formula:
Capsulesperdose = Dose ordered/ Dose available
Given:
- Ordered dose = 2 mg
- Available dose = 1 mg per capsule
Capsulesperdose = 2mg/(1mg/capsule)
= 2 capsules
Thus, the nurse will administer 2 capsules per dose.
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