apical pulse

Well they are not easily palpable on all adults. Especially somone who is bigger/overweight and sometimes I have found it difficult to feel on women because of the breasts being in the way. And I was taught to feel for it with the patient supine. So depending on what answer D was, it looks like the answer is B.

I'd go with B. It's not easily palpable on all adults and like the PP, I was taught to palpate it while the patient was sitting or supine. Also, on someone that has an enlarged heart, the PMI isn't necessarily going to be at the 5th ICS, midclavicular line. That's why you document where you were able to palpate it on the patient's chart. If it's not where you'd expect to find it, that can indicate an enlarged heart...that's how I understood it anyway.

What answer did you choose and why?

My guts tells me to pick b) b/c it states the location of the apical pulse may indicate a larger heart size..although i changed my answer later to choice a)

i'd go with b. it's not easily palpable on all adults and like the pp, i was taught to palpate it while the patient was sitting or supine. also, on someone that has an enlarged heart, the pmi isn't necessarily going to be at the 5th ics, midclavicular line. that's why you document where you were able to palpate it on the patient's chart. if it's not where you'd expect to find it, that can indicate an enlarged heart...that's how i understood it anyway.

what answer did you choose and why?

ding, ding, ding.

the location of the ap in the 5th ics/mcl or lack there of is an important observation. there is actually someone in town with situs inversus with dextrocardia, wouldn't catch it until you listen for the ap.