While percussing the borders of the heart, the nurse picks up an area of dullness beginning at the 5th left intercostal space and moving upward to the 2nd left intercostal space at the sternal border. What do these findings indicate?

Expected finding.

Cardiac enlargement.

Benign variation.

Cardiac atrophy.

None

Answer and Explanation

The Correct Answer is B

Rationale:

A. An area of dullness extending from the 2nd to the 5th intercostal space along the left sternal border is an expected finding during a physical examination. This dullness represents the precise anatomical location of the myocardial mass beneath the chest wall, where it displaces resonant lung tissue. Because the heart is a solid organ, it produces a flat, thud-like sound compared to the hollow resonance of the surrounding lobes.

B. Cardiac enlargement, or cardiomegaly, would be indicated if the area of dullness extended lateral to the midclavicular line or shifted significantly downward. In such cases, the displaced apex would reflect ventricular hypertrophy or dilation, typically seen in chronic heart failure. Since the dullness described in the question remains within the standard 2nd to 5th intercostal boundaries, it does not suggest a pathological increase in heart size.

C. A benign variation usually refers to anatomical anomalies like dextrocardia or situs inversus, which would alter the location of dullness to the right side of the thorax. The findings provided describe a perfectly centralized and standard cardiac silhouette on the left side of the mediastinum. Therefore, characterizing this as a variation is incorrect, as it perfectly aligns with the standard clinical baseline for a healthy adult.

D. Cardiac atrophy involves a reduction in myocardial muscle mass and overall heart volume, which would likely result in a smaller area of dullness than described. This condition is often associated with severe wasting diseases or advanced aging and would cause the borders of cardiac dullness to recede inward. The measurement from the 5th up to the 2nd intercostal space represents a robust, normal heart size rather than a diminished or atrophied state.

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Correct Answer is D

Explanation

Answer: D

Rationale:

A) Tenderness:

Tenderness upon palpation is not considered a normal finding. It may indicate inflammation, injury, or other underlying conditions affecting the thoracic region. Tenderness requires further investigation to determine the cause and appropriate treatment.

B) Crepitus:

Crepitus, which is a crackling or popping sensation felt under the skin, is not a normal finding. It can be associated with subcutaneous air or gas, often resulting from trauma or infection. Identifying crepitus prompts further evaluation to determine the underlying issue.

C) Thrill:

A thrill is a palpable vibration or sensation over the chest, typically felt over an area of turbulent blood flow, such as a heart murmur. It is not considered a normal finding in the thoracic region and usually indicates an abnormal cardiovascular condition that requires further assessment.

D) Non-tender:

A non-tender thoracic region is considered a normal finding. Absence of tenderness upon palpation indicates no immediate signs of inflammation or injury in the thoracic area, suggesting that the palpation findings are within the expected range of normal physical examination.

A. Suggest that the client schedule a mammogram after her next menstrual period. B. Explain to the client that an ultrasound of the breast will likely be necessary. C. Assure the client that her breasts are normal, and advise annual evaluations. D. Request a return visit after her menstrual period for a breast exam re-check.

Correct Answer is C

Explanation

Answer: C. Assure the client that her breasts are normal, and advise annual evaluations.

Rationale:

A. Suggest that the client schedule a mammogram after her next menstrual period:
A mammogram is generally not indicated for adolescents unless there are specific concerns such as a family history of breast cancer or the presence of abnormal findings. Given the client's age and the findings of generalized lumpiness without discrete masses, a mammogram would not be the most appropriate action at this stage.

B. Explain to the client that an ultrasound of the breast will likely be necessary:
An ultrasound is typically used for further evaluation if discrete masses are found or if there are unusual characteristics in the breast tissue. In this case, the generalized lumpiness is likely related to normal physiological changes, making an ultrasound unnecessary at this time.

C. Assure the client that her breasts are normal, and advise annual evaluations:
The findings of generalized lumpiness and tenderness before menstruation are consistent with normal physiological changes associated with the menstrual cycle, often due to hormonal fluctuations. Providing reassurance and advising annual evaluations is appropriate, as it addresses the client's concerns and promotes confidence in her breast health without unnecessary interventions.

D. Request a return visit after her menstrual period for a breast exam re-check:
While a follow-up can be beneficial, it may not be necessary in this case since the findings are typical of normal breast tissue changes associated with the menstrual cycle. Reassuring the client and encouraging annual evaluations is a more effective approach than suggesting an unnecessary follow-up visit.

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While percussing the borders of the heart, the nurse picks up an area of dullness beginning at the 5th left intercostal space and moving upward to the 2nd left intercostal space at the sternal border. What do these findings indicate?

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Naxlex Comprehensive Predictor Exams

The nurse completes palpation of the thoracic region on an adult client. Which finding is considered normal for this client?

Correct Answer is D

Explanation

An adolescent female client comes to the clinic troubled by breast tenderness before her menstrual periods. On examination, the nurse notes generalized lumpiness of both breasts with no discrete masses and no nipple discharge. Which action should the nurse take?

Correct Answer is C

Explanation

Rationale:

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