A nurse is assessing a client who is postoperative following a coronary artery bypass graft surgery. The nurse should identify that which of the following findings is an early indication of cardiac tamponade?

A. Widening pulse pressure. This is typically associated with conditions like increased intracranial pressure or severe aortic regurgitation, not cardiac tamponade. Tamponade usually results in narrowed pulse pressure.
B. Coarse lung sounds. These may indicate fluid overload or pulmonary congestion, but they are not specific to cardiac tamponade and occur later or in different conditions.
C. Muffled heart sounds. This is a classic early sign of cardiac tamponade, caused by fluid accumulation in the pericardial sac, which dampens heart sounds on auscultation. It is part of Beck’s triad (muffled heart sounds, hypotension, and jugular vein distention).
D. Decreased jugular vein distention. In cardiac tamponade, jugular vein distention increases due to impaired venous return to the heart. Decreased JVD would be an unexpected finding in this condition.

A. Choose a vein that is palpable and straight. A palpable, straight vein provides the best access for successful IV catheter insertion. It allows for easier threading of the catheter and reduces the risk of complications like infiltration.
B. Select a site on the client's dominant arm. The non-dominant arm is usually preferred to minimize interference with daily activities and reduce the risk of dislodgement due to frequent use.
C. Elevate the client's arm prior to insertion. Elevating the arm can decrease venous filling, making veins less prominent and harder to access. Instead, the arm should be placed in a dependent position to promote vein distention.
D. Apply a tourniquet below the venipuncture site. The tourniquet should always be placed above the insertion site to restrict venous return and make the veins more prominent and easier to access.