The nurse is preparing to use auscultation as part of a patient's physical examination. Which techniques should the nurse use? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Pressing the bell of the stethoscope firmly on the skin to hear muffled tones
2. Using the diaphragm of the stethoscope to hear normal lung sounds
3. Placing the diaphragm of the stethoscope firmly against the patient's gown
4. Focusing on one sound at a time
5. Using the bell of the stethoscope to hear low-pitched sounds
2,4,5
Rationale 1: The bell of the stethoscope becomes a diaphragm when pressed firmly on the skin. The skin under the bell stretches, creating a surface that reduces audible vibratory sensations.
Rationale 2: The diaphragm of the stethoscope is best for hearing high-pitched sounds such as normal lung sounds.
Rationale 3: The stethoscope should be placed on bare skin. The patient's gown or bed sheets will produce sounds that interfere with body sounds.
Rationale 4: A variety of sounds can be heard when the nurse listens at each auscultatory landmark. The nurse should focus on one sound at a time.
Rationale 5: The bell is the best side of the stethoscope for hearing low-pitched sounds such as heart murmurs.
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