When auscultating heart sounds, which technique should the nurse use?

A) Listen with the bell.
B) Listen with the diaphragm.
C) Listen with both the diaphragm and bell working from apex to base in a Z pattern.
D) Listen with both the bell and diaphragm comparing sides of the heart as progress from apex to base.

The nurse should auscultate the heart with the diaphragm of the stethoscope to study heart sounds, inching from the apex up to the base or vice versa in a rough "Z" pattern and then auscultate with the bell of the stethoscope again inching through all locations, noting any murmurs or abnormal sounds. The nurse should not be comparing "sides" but the sounds at the different sites (aortic, pulmonic, Erb's point, tricuspid, and mitral).