Cardiac Tamponade Is Suspected in a Client Who Has Acute

question 20

Multiple Choice

Cardiac tamponade is suspected in a client who has acute pericarditis. Which of the following actions should the nurse implement to assess for the presence of pulsus paradoxus?

• A)Check the electrocardiogram (ECG) for variations in rate in relation to inspiration and expiration.
• B)Note when Korotkoff sounds are audible during both inspiration and expiration.
• C)Auscultate for a pericardial friction rub that increases in volume during inspiration.
• D)Subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).

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