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A client asks the nurse to describe what causes a murmur. What would be the correct response by the nurse?

A.

"Poor electric impulse conduction through the heart

B.

"Turbulent blood flow through the heart valves"

C.

"Enlargement of the left ventricle."

D.

"Weak contraction of the atria."

E.

"Long-term systemic hypertension."

Answer and Explanation

The Correct Answer is B

A. Poor electrical impulse conduction may lead to arrhythmias but does not cause a murmur.

 

B. A heart murmur is caused by turbulent blood flow, often through narrowed or leaking valves, creating an abnormal heart sound.

 

C. Left ventricular enlargement can contribute to other cardiac issues but does not directly cause murmurs.

 

D. Weak atrial contractions may lead to decreased cardiac output but not necessarily to a murmur.

 

E. While hypertension can affect the heart, it is not the direct cause of a murmur.


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View Related questions

Correct Answer is E

Explanation

A. Music can be a soothing nonpharmacologic method to reduce pain and may help with relaxation, even for confused patients, as it typically doesn’t require cognitive engagement.

B. Aromatherapy is generally safe and may offer calming effects for older adults without relying heavily on cognitive processing.

C. Heat application is a physical pain relief method, and as long as safety precautions are taken, it can be used effectively in confused patients.

D. Distraction can be a beneficial technique for pain relief and is often effective without requiring cognitive engagement.

E. Guided Imagery should be avoided in confused older adults, as it relies on the patient's ability to follow instructions and visualize mental images, which can be challenging and potentially frustrating for someone with cognitive impairment.

Correct Answer is E

Explanation

A. Palpate, inspect, percuss, and then auscultate is not the correct order, as inspection is always performed first.

B. Percuss, palpate, auscultate, and then inspect is incorrect, as inspection should come first.

C. Auscultate, inspect, percuss, and then palpate is also incorrect, as auscultation is typically the last step.

D. Inspect, auscultate, palpate, and then percuss is close but does not follow the standard order.

E. Inspect, palpate, percuss, then auscultate is the correct order for respiratory assessment, allowing for a thorough and systematic approach.

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