Question

The nurse is assessing the heart sounds of a client with mitral stenosis following a history of rheumatic fever. To hear a mitral murmur, the nurse should place the stethoscope at:

The third intercostal space right of the sternum
The third intercostal space left of the sternum
The fourth intercostal space beneath the sternum
The fourth intercostal space mid-clavicular line

Answer 1

The nurse should place the stethoscope at the fourth intercostal space mid-clavicular line to best hear a mitral murmur in a client with mitral stenosis. Accurate placement is key in detecting murmurs, which are unusual sounds that result from turbulent blood flow through the heart.

Step-by-step explanation:

To hear a mitral murmur in a client with mitral stenosis post rheumatic fever, the nurse should place the stethoscope at the fourth intercostal space mid-clavicular line. This is because, during auscultation, the mitral valve sounds are best heard in this location due to the anatomical position of the heart within the thoracic cavity. The mitral valve, being on the left side of the heart, has its sounds amplified during expiration as this restricts blood flow into the left side of the heart, thereby amplifying left-sided murmurs such as those found in mitral stenosis.

Auscultation is a key diagnostic technique to assess heart conditions and by placing the stethoscope at the correct location, murmurs can be detected which are unusual sounds caused by turbulent flow of blood. These murmurs are graded on a scale of 1 to 6, where 1 is the least serious and 6 the most severe. The heart's position with the apex pointing leftward and slightly downward is important for clinicians to consider for accurate stethoscope placement.