During a physical examination of a 74-year-old patient, the nurse palpates the point of maximal impulse (PMI) in the sixth intercostal space lateral to the left midclavicular line. The most appro-priate action for the nurse to take next will be to
a. ask the patient about risk factors for ath-erosclerosis.
b. document that the PMI is in the normal anatomic location.
c. auscultate both the carotid arteries for the presence of a bruit.
d. assess the patient for symptoms of left ventricular hypertrophy.
ANS: D
The PMI should be felt at the intersection of the fifth intercostal space and the left midclavicular line. A PMI located outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy. Cardiac enlargement is not necessarily associated with atherosclero-sis or carotid artery disease.
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