Where should the nurse place the stethoscope to assess an adult patient’s apical pulse?
Correct answer: A. Over the fifth intercostal space at the midclavicular line
- A. Over the fifth intercostal space at the midclavicular line
- B. Over the second intercostal space at the right sternal border
- C. Over the sixth intercostal space at the midaxillary line
- D. Over the third intercostal space at the left sternal border
Explanation
The adult apical pulse is heard at the fifth intercostal space on the left midclavicular line. The other locations are associated with other cardiac auscultation areas or are not the standard apical site.
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About Vital Signs and Monitoring
Vital signs include temperature, pulse, respiration, blood pressure, oxygen saturation and pain assessment. Coverage includes correct measurement sites and techniques, normal adult ranges, factors that alter readings, trends in patient observations, and the difference between an abnormal finding that needs reassessment and one requiring immediate reporting.
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