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?

Diminished breath sounds

Increased blood pressure

Diminished heart sounds

New systolic murmur

Answer and Explanation

The Correct Answer is C

Rationale:

A. Diminished breath sounds are not typically associated with a pericardial effusion.

B. Increased blood pressure is not typically associated with a pericardial effusion but it can instead result in hypotension due to decreased cardiac output due to compression of the heart by the accumulated fluid.

C. The heart sounds may become faint or distant due to fluid accumulation around the heart.

D. A new systolic murmur may indicate a pericardial effusion and should be further evaluated.

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Correct Answer is D

Explanation

Rationale:

A. Hypertensive crisis is not a common complication of atrial fibrillation.

B. Cardiogenic shock is not a common complication of atrial fibrillation.

C. Flash pulmonary edema is not a common complication of atrial fibrillation.

D. Atrial fibrillation can lead to the formation of blood clots in the atria, which can then travel to the brain and cause a stroke or embolic cerebral vascular accident.

A. Obstructive sleep apnea (OSA) B. Taking benazepril C. High-density lipoprotein (HDL) level of 70 mg/dL D. A regular exercise routine

Correct Answer is A

Explanation

Rationale:

A. Obstructive sleep apnea is a risk factor for the development of hypertension.

B. Benazepril is an antihypertensive medication and is not a risk factor for hypertension.

C. A high HDL level is a protective factor against the development of hypertension.

D. A regular exercise routine is a protective factor against the development of hypertension.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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