A nurse is assessing a 2-month-old infant with a patent ductus arteriosus. Which finding is most concerning?

Choice A rationale An oxygen saturation of 88. Choice B rationale Bounding peripheral pulses are a classic finding in Patent Ductus Arteriosus (PDA) due to the wide pulse pressure, which results from the run-off of blood from the aorta back into the pulmonary artery during diastole. This finding supports the diagnosis but is not typically the most concerning indicator of impending decompensation. Choice C rationale The machinery-like murmur is the pathognomonic sign of a Patent Ductus Arteriosus, caused by continuous blood flow from the high-pressure aorta to the low-pressure pulmonary artery. This is an expected diagnostic finding for PDA, confirming the presence of the defect, but it is not an indicator of acute distress. Choice D rationale A respiratory rate of 60 breaths per minute in a 2-month-old infant is a significant indicator of tachypnea and potential respiratory distress, likely due to pulmonary overcirculation and the resulting congestive heart failure (CHF) caused by the PDA. This elevated rate signals a critical effort to compensate for decreased pulmonary compliance and is the most immediate concern.