Chapter 3: Pulse and Respiration
1. What is the apical pulse rate?
Listen to the audio-clip of the apical pulse. Count the pulse for 30 seconds and report the rate as beats per minute (NOTE: although this clip only allows you to count for 30 seconds, remember, it is best to count the apical pulse for one minute).
The pulse rate is 76 bpm (38 x 2) with a regular rhythm
2. What is the apical pulse rate?
The pulse rate is 114 bpm (57 x 2) with a regular rhythm
2. How should a healthcare provider respond when a newborn has an apical heart rate of 120 beats per minute?
a. Re-take the rate at the brachial location
b. Document the rate and assess it as normal **
c. Document the rate and identify it as tachycardia
d. Notify the physician and identify it as bradycardia
Rationale: The correct answer is b (document the rate and assess it as normal). An apical heart rate of 120 bpm falls within the normal range for newborns. Newborns have a faster apical heart rate than adults because they have smaller and less muscular hearts. As a result, their stroke volume (volume of blood per contraction) is smaller than that of adults and their hearts must beat faster to pump sufficient blood, oxygen, and nutrients to the body.
3. Which findings in an adolescent client is of most concern to a healthcare provider?
a. Pulse 40 bpm and respiration 34 **
b. Respiration 16 and pulse 82 bpm
c. Pulse 68 bpm and sinus arrhythmia
d. Pulse 2+, 78 bpm, and regular rhythm
Rationale: The correct answer is a (pulse 40 bpm and respiration 34). In adolescents, a pulse of 40 bpm is low and a respiration rate of 34 is high. All of the other findings are normal for adolescents, including sinus arrhythmia, which is common in children and adolescents.
4. Match the findings that are typically normal for the person listed:
Rationale: Bradycardia (low pulse) is common in athletes because their hearts are more muscular and pump a larger stroke volume per contraction. As a result, the heart contracts/beats less to pump sufficient blood, oxygen and nutrients. Newborns are abdominal breathers, meaning that the abdomen moves up and down when breathing, as opposed to the thorax. Sinus arrhythmia is common in adolescents. It involves an irregular pulse rhythm in which the pulse rate varies with the respiratory cycle; the heart speeds up at inspiration and decreases back to normal upon expiration. The underlying physiology of sinus arrhythmia is that the heart rate increases to compensate for the decreased stroke volume from the left side of the heart upon inspiration.