Fundamentals of Nursing Q 340

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The nurse should use the diaphragm of the stethoscope to auscultate which of the following?

  

     A. Heart murmurs

     B. Jugular venous hums

     C. Bowel sounds

     D. Carotid bruits

    

    

Correct Answer: C. Bowel sounds

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The bell of the stethoscope should be used to hear low-pitched sounds, such as murmurs, bruits, and jugular hums. The diaphragm should be used to hear high-pitched sounds that normally occur in the heart, lungs, and abdomen. The diaphragm is best for higher-pitched sounds, like breath sounds and normal heart sounds. The bell is best for detecting lower pitch sounds, like some heart murmurs, and some bowel sounds.

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Option A: Earpieces should be angled forwards to match the direction of the practitioner’s external auditory meatus. The bell is used to hear low-pitched sounds. Use for mid-diastolic murmur of mitral stenosis or S3 in heart failure.

Option B: The stethoscope bell is lightly applied in each supraclavicular fossa over the subclavian artery. As usual, the examiner’s free hand palpates the contralateral carotid pulse for timing purposes. If a bruit is appreciated, firmly compress the patient’s ipsilateral radial artery, noting the effect on the murmur.

Option D: If the intensity of sound is greater above the clavicle it is most likely a carotid bruit. If it is louder below the clavicle it is most likely a heart murmur. Use either the bell or the diaphragm when listening for the carotid bruit, at a point just lateral to Adam’s apple.

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