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
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.
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.