The nurse auscultates a functional systolic murmur, grade II/IV, on a woman in week 30 of her pregnancy. The remainder of her physical assessment is within normal limits. The nurse would:
a. Consider this finding abnormal, and refer her for additional consultation.
b. Ask the woman to run briefly in place and then assess for an increase in intensity of the murmur.
c. Know that this finding is normal and is a result of the increase in blood volume during pregnancy.
d. Ask the woman to restrict her activities and return to the clinic in 1 week for re-evaluation.
ANS: C
Because of the increase in blood volume, a functional systolic murmur, grade II/IV or less, can be heard in 95% of pregnant women. The other actions are not appropriate.
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