When assessing the heart, the nurse inspects and palpitates which of the following?
Peritoneum and tricuspid area
Precordium and PMI
Precordium and apical heart rate
Peritoneum and left sternal border.
The Correct Answer is B
When assessing the heart, the nurse will inspect and palpate the precordium, which is the area of the chest overlying the heart, and the PMI (point of maximal impulse), which is the point on the chest where the heartbeat is the strongest. These assessments allow the nurse to gather information about the size, shape, and location of the heart and to detect any abnormalities in the heartbeat or rhythm. The peritoneum is a membrane lining the abdominal cavity and has no relevance in the assessment of the heart. The tricuspid area and left sternal border are areas of the chest that may be auscultated to assess heart sounds but are not palpated during a heart assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The SBAR (Situation, Background, Assessment, Recommendation) system is a standardized way of communicating critical information between healthcare professionals, particularly during patient handoffs or when escalating a concern.
The recommendation component is where the healthcare professional providing the report suggests a course of action or plan for the patient based on the situation, background, and assessment. For example, a recommendation might be, "I recommend increasing Mr. Smith's pain medication to manage his discomfort," or "I recommend a consult with the nutritionist to address Mrs. Brown's malnutrition."
Of the options provided, (a) provides the situation, (c) provides the assessment, and (d) provides a specific finding from the assessment. Option (b) is a specific recommendation or plan.
Correct Answer is D
Explanation
The motor system refers to the parts of the nervous system that control voluntary movements, including the muscles, nerves, and brain. Rapid alternating movements are movements that require the coordination of multiple muscle groups, such as tapping fingers or rotating the wrist. By observing the patient's ability to perform these movements, the nurse can assess the integrity and function of the motor system.
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