A 56-year-old presents to his primary care provider for a checkup. Physical exam reveals edema, hepatomegaly, and muffled heart sounds. Which of the following is of greatest concern to the nurse?

a. Tamponade
b. Exudate
c. Aneurysm
d. Pulsus paradoxus

ANS: A
Muffled heart sounds are an indication of tamponade, and with tamponade the blood backs up into the venous system, leading to hepatomegaly. Muffled heart sounds with hepatomegaly are symptoms of tamponade, not exudates. An aneurysm would present without symptoms. Pulsus paradoxus is manifested by a change in blood pressure during inspiration and expiration.