The nurse is performing a cardiac assessment on a 70-year-old client admitted with hypertension. The nurse determines that the apical impulse can be palpated in an area 2 cm in diameter at the point of maximal impulse. The nurse suspects that the client may have developed which of the following problems?
1. Left ventricular hypertrophy
2. Aortic stenosis
3. Right ventricular volume overload
4. Enlarged left atrium
1
Rationale 1: If the apical impulse can be palpated in an area greater than 1 cm in diameter or is laterally displaced, the conditions that may be present include left ventricular hypertrophy, severe left ventricular volume overload, or severe aortic regurgitation.
Rationale 2: Clients with aortic stenosis often have heaves present at the right sternal border, second intercostal space.
Rationale 3: The presence of heaves or thrills in the subxiphoid area suggests the presence of right ventricular volume overload.
Rationale 4: Pulsations or heaves in the left sternal border, second intercostal space, are associated with an enlarged left atrium.
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