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In assessing a client's neck, the nurse hears a blowing swish when auscultating the area over the left carotid artery, but hears no sound over the right carotid artery. How should the nurse document this finding?

 

A.

Left carotid pulse volume of 4+; right carotid pulse volume of 0.

B.

Left carotid artery bruit present; no bruit heard in right carotid artery.

C.

Left carotid artery has strong pulse; right carotid artery occluded.

D.

Left carotid artery occlusion present; no occlusion of right carotid artery.

Answer and Explanation

The Correct Answer is B

Rationale:

 

A. Pulse volume and bruit are different assessments; pulse volume is not graded in the context of auscultation findings.

 

B. A bruit is an abnormal sound heard over an artery, indicating turbulent blood flow, often due to stenosis or narrowing. Documenting a "left carotid artery bruit present" accurately reflects the findings.

 

C. The presence of a bruit does not necessarily mean the pulse is strong or that there is occlusion.

 

D. A bruit indicates turbulent flow, not necessarily complete occlusion.


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