While auscultating the patient's heart sounds, the nurse hears an additional sound immediately following S2. The nurse would conduct further assessment for which condition?
1. Ventricular volume overload
2. Ventricular hypertrophy from hypertension
3. Atrial fibrillation
4. A stenotic aortic valve
1
Rationale 1: S3 is an abnormal (pathologic) heart sound heard immediately following S2 in adults. It is often called a ventricular gallop and results from conditions such as congestive heart failure (CHF) and mitral or tricuspid valve regurgitation.
Rationale 2: S4 immediately precedes S1 and can result from conditions such as hypertension-associated ventricular hypertrophy.
Rationale 3: S3 heart sounds are not associated with atrial fibrillation.
Rationale 4: Aortic stenosis is associated with S4 heart sounds.
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The nurse works on a preoperative unit. For which of the following conditions does the nurse recognize urgent surgery is needed?
a. Ruptured appendix b. Hernia repair c. Fracture repair d. Aortic aneurysm
A nurse writes the following outcomes for a patient who has chronic obstructive pulmonary disease to improve activity level: Diastolic blood pressure will remain below 70 mm Hg with systolic below 130 mm Hg
Resting heart rate will range between 65 and 75. The last goal is that the patient will exercise 3 times a week. Which evaluative findings indicate successful goal achievement? (Select all that apply.) a. Resting heart rate 70 b. Blood pressure 126/64 c. Blood pressure 140/90 d. Reports doing stretching and flexibility exercises 2 times this week e. Reports doing resistive training 1 time and aerobics 2 times this week