NUR 306 Midterm Exam Questions and

NUR 306 Midterm Exam Questions and Answers How does the nurse differentiate a pleural friction rub from a pericardial friction rub?

• Auscultate the upper back; if a rub is present, it is pleural
• Auscultate the base of the heart; if a rub is present, it is

pericardial

• Turn the client on the right side; if the rub persists, it is

pericardial

• Have the client hold his or her breath; if the rub persists, it

is pericardial - Correct Answers ✅D) Have the client hold his or her breath; if the rub persists, it is pericardial A student states that a client has a palpable rushing vibration in the area of the pulmonic valve. What should the instructor explain that the student is feeling?

• A thrill
• A normal finding
• A heave
• A thrust - Correct Answers ✅A) a thrill

Rationale:

Thrills are vibrations detected on palpation. A palpable, rushing vibration (thrill) is caused from turbulent blood flow with incompetent valves, pulmonary hypertension, or septal 1 / 4

NUR 306 Midterm Exam Questions and Answers defects. This vibration is usually in the location of the valve in which it is associated. A thrust or a heave is a forceful thrusting on the chest. This is not a normal finding.In order to palpate an apical pulse when performing a cardiac assessment, where should the nurse place the fingers?

• right of midclavicular line at the fifth intercostal space
• right of the midclavicular line at the third intercostal space
• left midclavicular line at the fifth intercostal space
• left midclavicular line at the third intercostal space -

Correct Answers ✅c. left midclavicular line at the fifth intercostal space Variations in the presentation of S1 are due to alterations in which heart valve?

• Pulmonic
• Aortic
• Tricuspid
• Mitral - Correct Answers ✅d. Mitral

The nurse's assessment of a client reveals jugular venous distention. The nurse should conduct further assessments related to what health problem? 2 / 4

NUR 306 Midterm Exam Questions and Answers

• Myocardial infarction
• Peripheral arterial disease (PAD)
• Heart failure
• Venous thromboembolism - Correct Answers ✅c. heart

failure

Rationale:

Jugular venous distention (JVD) is associated with heart failure, tricuspid regurgitation, and fluid volume overload. The neck veins appear full, and the level of pulsation may be have elevated jugular venous pressure greater than 3 cm (about 1 1/4 in.) above the sternal angle. About 75% of patients with elevated JVD have heart failure.A nurse auscultates a client's heart sounds and notes an accentuated first heart sound. The nurse would suspect which of the following?

• Heart murmur
• Mitral stenosis
• Fever
• Hypothyroidism - Correct Answers ✅b. mitral stenosis

rationale: 3 / 4

NUR 306 Midterm Exam Questions and Answers An accentuated S1 sound louder than S2 occurs when the mitral valve is wide open and closes quickly.The nurse is palpating in the right upper abdominal quadrant and feels an enlarged area. The nurse recognizes that she is most likely feeling what organ?

• Pancreas
• Liver
• Gallbladder
• Kidneys - Correct Answers ✅b. liver

The should nurse assess for kidney tenderness at what location?

• Costovertebral angle
• Umbilical region
• Hypogastric area
• Midclavicular line - Correct Answers ✅a. Costovertebral

angle To percuss the liver of an adult client, the nurse should begin

the abdominal assessment at the client's:

• / 4