Which assessment finding alerts the nurse to the possibility of decreased cardiac output in the patient who suddenly develops atrial fibrillation?

Increase capillary refill time.

Rumbling heart murmur.

Intermittent claudication.

Jugular venous distension.

Answer and Explanation

The Correct Answer is A

A. An increased capillary refill time suggests reduced perfusion and may indicate decreased cardiac output, which is critical to assess in patients with atrial fibrillation as it can lead to hemodynamic instability.

B. A rumbling heart murmur may suggest valvular disease but is not specifically indicative of decreased cardiac output in this scenario.

C. Intermittent claudication typically indicates peripheral arterial disease and is not a direct sign of decreased cardiac output.

D. Jugular venous distension can indicate fluid overload or right-sided heart failure, but it is not the most direct indicator of decreased cardiac output compared to capillary refill time.

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Free Nursing Study Resources

Correct Answer is B

Explanation

A. Smoking is the leading cause of COPD, but it also significantly impacts the circulatory system, increasing the risk for cardiovascular diseases such as atherosclerosis and hypertension.

B. Kyphosis can alter lung expansion, potentially decreasing the V/Q (ventilation/perfusion) ratio to 0.6 by restricting air intake to the alveoli. This reduced ventilation impacts the V/Q balance, confirming decreased inhalation ability.

C. Respiratory acidosis typically causes bradypnea (slow breathing) due to CO₂ retention, rather than tachypnea. Tingling of the fingers is more associated with respiratory alkalosis.

D. For venous insufficiency, elevating the legs (higher than the heart) promotes venous return, not lowering the feet.

A. expiratory wheeze; PCO₂ 36 B. respiratory rate of 42; SO₂ 79% C. respiratory rate of 24; pH 7.46 D. barking cough; PO₂ 90

Correct Answer is B

Explanation

A. An expiratory wheeze with a PCO₂ of 36 (within normal range) does not typically indicate respiratory failure.

B. A respiratory rate of 42 and a low oxygen saturation (SO₂) of 79% indicate hypoxemia and respiratory distress, which are hallmarks of respiratory failure.

C. A respiratory rate of 24 with a pH of 7.46 suggests mild hyperventilation or anxiety rather than respiratory failure.

D. A barking cough and a PO₂ of 90 are not indicative of respiratory failure; PO₂ of 90 is within normal limits.

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Which assessment finding alerts the nurse to the possibility of decreased cardiac output in the patient who suddenly develops atrial fibrillation?

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