Difficulty: Medium
Average Score: 82%
Simulated
A nurse is caring for a client in a critical care unit who is 4 hours post operative coronary artery bypass surgery. The nurse performs the reassessment and suspects the client may be developing a pericardial effusion. What assessment findings would the nurse note in this case?
Correct answer
C
Rationale
Diminished heart sounds are noted due to fluid accumulation around the heart in pericardial effusion.