Vital Signs
Assessing the Apical Pulse
Review Questions
1. During the admissions process, the nurse initially assesses the patient’s apical pulse primarily
for the purpose of:
1. Assessing the patient’s cardiac function.
2. Providing a baseline as part of the patient’s vital signs.
3. Assessing the patient for the risk of cardiovascular disease.
4. Determining the rate, rhythm, and strength of cardiac contractions.
2. Which of the following statements made by the nurse will be most effective in instructing
ancillary staff regarding the appropriate technique for monitoring the adult patient’s apical
pulse?
1. “Remember to document the patient’s pulse rate and rhythm.”
2. “Make sure the patient is comfortable before measuring the pulse.”
3. “Please review the patient’s previous apical pulse measurements.”
4. “Place your stethoscope at the fifth intercostal space over midclavicle.”
3. Which of the following actions would have priority when determining that the apical pulse
has an irregular rhythm?
1. Reassess the pulse for a full minute.
2. Assess the patient for a pulse deficit.
3. Wait 5 minutes and reassess the apical pulse.
4. Review documentation regarding an irregular rhythm.
Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.
Review Questions
4. Which of the following statements made by ancillary staff assigned to measure the apical
pulse of an elderly patient shows the best understanding of the importance of
communicating the patient’s reactions to the intervention with the nurse?
1. “I recorded the patient’s apical pulse on the flow sheet as you asked.”
2. “Her apical pulse was four beats faster than it was the last time I took it.”
3. “Her apical pulse is usually slower in the morning than it is in the afternoon.”
4. “Her apical pulse was a little faster, but she had just returned from the bathroom.”
5. The nurse can best determine the effect of emotions, such as crying, on a patient’s apical
pulse by:
1. Measuring the patient’s apical pulse before and after crying.
2. Assessing the patient’s apical pulse 30 minutes after crying.
3. Comparing the patient’s radial and apical pulses after crying.
4. Comparing the patient’s post-crying apical rate with her baseline.
Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.
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