The nurse is preparing to assess the heart rate on an adult female client. The nurse recognizes that the apical pulse can be assessed in an adult female at which of the following anatomical position?
A.
Fifth left intercostal space at the midclavicular line
B.
Third left intercostal space at the midclavicular line
C.
Fourth left intercostal space at the sternal border
D.
Under the left breast at the midclavicular line
The Correct answer and Explanation is:
The correct answer is:
A. Fifth left intercostal space at the midclavicular line
Explanation:
The apical pulse is the point of maximal impulse (PMI) where the heartbeat can be most clearly heard and felt. It is the location where the apex of the heart, which is the bottom tip of the left ventricle, is closest to the chest wall. For accurate assessment of the apical pulse in an adult female client, it is important to understand the correct anatomical location to place the stethoscope.
Anatomy of the Apical Pulse
- Location: The apical pulse is best assessed at the fifth left intercostal space at the midclavicular line. This specific location is approximately where the apex of the heart is positioned, just below the nipple line. The fifth intercostal space is one rib space below the fourth, and the midclavicular line is an imaginary vertical line running down from the midpoint of the clavicle (collarbone).
- Why Not Other Options:
- Option B (Third left intercostal space at the midclavicular line): This location is typically used to assess the second heart sound, which is related to the aortic and pulmonic valves. It is too high up to accurately capture the apical pulse, which is located lower.
- Option C (Fourth left intercostal space at the sternal border): This space is closer to the sternum, which is not ideal for assessing the apical pulse as it may be obscured by the sternum itself. It is more relevant for listening to heart sounds associated with the aortic and pulmonary valves.
- Option D (Under the left breast at the midclavicular line): This location might be too low and could be less effective for accurately assessing the apical pulse due to anatomical variations and the position of the breast tissue. The correct placement is slightly above this area.
Technique for Assessment
To assess the apical pulse:
- Position the patient in a supine or sitting position.
- Locate the fifth left intercostal space at the midclavicular line by palpating the ribs and identifying the correct intercostal space.
- Place the diaphragm of the stethoscope firmly but comfortably at this location.
- Count the heartbeats for a full minute to assess the rate and rhythm accurately.
Proper placement and technique ensure that the apical pulse is assessed accurately, providing crucial information about the heart’s functioning.