Therapeutic vs Non‑Therapeutic
This technique repeats the patient’s words to show understanding.
restating- verifies accuracy and encourages clarification without interpretation.
•This heart sound marks the beginning of systole.
S1
Rationale: Closure of AV valves (mitral & tricuspid).
Best location to auscultate the aortic valve.
2nd intercostal space, right sternal border (2ICS RSB)
Which cranial nerve controls facial expression?
Cranial Nerve VII – Facial
Why should the room be quiet during cardiac assessment?
To accurately auscultate heart sounds and murmurs
Is this therapeutic? 'Your family needs you to have surgery.'
No – Non-therapeutic
Rationale: Uses guilt, persuasion, and removes patient autonomy.
What is a rumbling sounding murmur from s2 to s1 is indicative of what kind of murmur?
A diastolic murmur
A diastolic murmur is an abnormal "swishing" or "rumbling" sound heard during the resting phase of the heart cycle (diastole), occurring between the second (S2) and first (S1) heart sounds. Unlike some systolic murmurs, diastolic murmurs almost always indicate underlying heart disease or structural valve abnormalities.
Which intercostal space and line is the mitral valve heard?
5th intercostal space, midclavicular line (5ICS MCL)
Mnemonic: M = Midclavicular
This cranial nerve is responsible for hearing and balance.
Cranial Nerve VIII – Vestibulocochlear
What should you assume when communicating with critically ill patients?
They can hear you
Rationale: Hearing is often the last sense to diminish.
Name one goal of culturally sensitive communication
(any of the following):
Treating each patient as an individual
Avoiding stereotyping
Respecting beliefs and values
Incorporating cultural knowledge into care
Which valve is affected in mitral regurgitation?
Where is it best heard?
Mitral valve
Best heard at the apex.
What exam technique is NOT routinely used in cardiac assessment?
Percussion
Rationale: Inspection, palpation, auscultation are standard.
Name one expected deficit with CN XII damage.
(any of the following):
Tongue deviation
Slurred speech
Difficulty swallowing
Inability to move tongue side to side
Teaching pearl: Tongue deviates toward the side of injury.
Demonstrate assessment of Cranial Nerve VII.
Ask patient to:
Smile
Frown
Raise eyebrows
Puff cheeks
Close eyes tightly
Assess for symmetry and strength.
Order: Amoxicillin 500 mg PO
Available: 250 mg tablets
How many tablets will you administer?
2
Order: 1000 mL NS over 8 hours
Drop factor: 15 gtt/mL
Calculate gtt/min.
Set-up:
(1000 mL ÷ 480 min) × 15
A:
31 gtt/min
Math:
1000 ÷ 480 = 2.08
2.08 × 15 = 31.2 → round to 31 gtt/min
gtt/min is ALWAYS a whole number
Order: Levothyroxine 75 mcg PO
Available: 150 mcg tablets
How many tablets?
½ tablet
Teaching Pearl:
Micrograms still follow the same formula — desired ÷ available
Order: 750 mL over 5 hours
Drop factor: 20 gtt/mL
Calculate gtt/min.
Set-up:
(750 ÷ 300) × 20
A:
50 gtt/min
Name three assessment findings on clinical exam for a patient in heart failure
S3
Lung Sounds with Crackles or rales
Increased Jugular Venous Distension
Pedal Edema
Shortness of Breath
Order: NS at 125 mL/hr
How many mL will infuse in 8 hours?
1000 ml
Order: LR 500 mL over 4 hours
Drop factor: 20 gtt/mL
Calculate gtt/min and state how you round.
Set-up:
(500 mL ÷ 240 min) × 20
A:
42 gtt/min
Math:
500 ÷ 240 = 2.08
2.08 × 20 = 41.6 → round UP to 42
✔ Rule: If ≥ 0.5, round UP
Order: 1000 mL NS over 10 hours
Drop factor: 15 gtt/mL
Calculate gtt/min.
Set-up:
(1000 ÷ 600) × 15
A:
25 gtt/min
✔ Always a whole number
Which Cranial Nerve is the major nerve of the parasympathetic nervous system for rest and digest?
The Vagus nerve- CN X
Which pulse is on the top surface of the foot, typically in the first intermetatarsal space, just lateral to the extensor hallucis longus tendon of the great toe
Dorsalis Pedis