Question

The nurse has completed an assessment on a client with a decreased cardiac output. Which findings should receive the highest priority?

1. blood pressure 110/62 mm Hg, atrial fibrillation with heart rate 82, bilateral basilar crackles
2. confusion, urine output 15 mL over the last 2 hours, orthopnea
3. SpO2 92% on 2 L nasal cannula, respirations 20 breaths/min, 1+ edema of lower extremities
4. weight gain of 1 kg in 3 days, blood pressure 130/80 mm Hg, mild dyspnea with exercise

Answer 1

The findings that should receive the highest priority in a client with decreased cardiac output are confusion, urine output 15 mL over the last 2 hours, and orthopnea. These findings indicate potential fluid overload and compromised respiratory function, which could worsen the client's condition and require immediate intervention.

Step-by-step explanation:

The findings that should receive the highest priority in a client with decreased cardiac output are:

1. Blood pressure: 110/62 mm Hg, atrial fibrillation with heart rate 82, bilateral basilar crackles
2. Confusion, urine output 15 mL over the last 2 hours, orthopnea
3. SpO2 92% on 2 L nasal cannula, respirations 20 breaths/min, 1+ edema of lower extremities
4. Weight gain of 1 kg in 3 days, blood pressure 130/80 mm Hg, mild dyspnea with exercise

Out of these options, the findings that should receive the highest priority are confusion, urine output 15 mL over the last 2 hours, and orthopnea. These findings indicate potential fluid overload and compromised respiratory function, which could worsen the client's condition and require immediate intervention.