Certified Medical Assistant (CMA AAMA)Clinical Workflow and Patient IntakeEasy
A medical assistant is asked to obtain an apical pulse on a patient with an irregular heart rhythm. Where should the stethoscope be placed, and for how long should the pulse be counted?
- ASecond intercostal space, right sternal border, for 15 seconds and multiply by four
- BRadial artery at the wrist, for a full 60 seconds
- CFifth intercostal space, midclavicular line, for a full 60 seconds
- DFifth intercostal space, midclavicular line, for 30 seconds and multiply by two
Show answer & explanationAnswer & explanation
Correct answer: C. Fifth intercostal space, midclavicular line, for a full 60 seconds
The apical pulse is auscultated at the fifth intercostal space, midclavicular line (the point of maximal impulse). When a rhythm is irregular, the pulse must be counted for a full minute to accurately capture rate and irregularity.
Why the other options are wrong
- A. Incorrect site; this is not the apical auscultation point.
- B. Incorrect; the radial pulse is not the apical pulse site.
- D. Incorrect location is right but counting only 30 seconds can miss irregularities.
Apical Pulse Assessment
The apical pulse is auscultated at the fifth intercostal space, midclavicular line, and should be counted for a full 60 seconds when irregular.
- Located at point of maximal impulse (PMI)
- Full minute count needed for irregular rhythms
- Used often in infants and cardiac patients
Memory trick: Apex needs a full sixty seconds