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    ATI Health Assessment Proctored Exam
    Select All That Apply

    A nurse is auscultating heart sounds and hears a murmur. What should be included in the nurse's documentation? Select all that apply.

    Explanation & Rationale

    A. Client's blood pressure is relevant as it can help correlate the murmur with potential cardiac conditions. B. Client's weight is not directly related to documenting a heart murmur. C. Client's respiratory rate is also not relevant to the murmur documentation unless respiratory symptoms are present. D. Intensity of the murmur is important to document, as it helps assess the severity. E. Location of the murmur is important for identifying which valve or area of the heart is involved. F. Client's temperature is not directly related to documenting a heart murmur. G. Timing of the murmur helps in identifying whether it occurs during systole or diastole, aiding in diagnosis.

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