The nurse is caring for a newborn diagnosed with patent ductus arteriosus (PDA). Which of the following assessment findings would be consistent with this diagnosis? (Select All that Apply.)

Choice A rationale Cyanosis of the extremities, or acrocyanosis, is commonly observed in healthy newborns due to immature peripheral circulation and vasomotor instability. While severe PDA can lead to systemic hypoxemia and cyanosis, isolated extremity cyanosis is not a specific indicator of PDA and is more often a normal physiological finding in the immediate postnatal period. Choice B rationale A continuous "machinery-like" heart murmur is the classic auscultatory finding in patent ductus arteriosus. This murmur results from the continuous shunting of blood from the higher-pressure aorta to the lower-pressure pulmonary artery throughout both systole and diastole, creating turbulent flow that generates the characteristic sound. Choice C rationale Wide pulse pressure in PDA is caused by the runoff of blood from the aorta into the pulmonary artery during diastole. This reduces the diastolic blood pressure while systolic pressure remains relatively normal, leading to a significant difference between the systolic and diastolic readings and a widened pulse pressure. Choice D rationale Decreased urine output can be a sign of reduced renal perfusion secondary to decreased cardiac output or fluid imbalance. While severe PDA can impact cardiac output, decreased urine output is a general sign of circulatory compromise and not a specific or primary diagnostic finding directly attributable to the pathophysiology of PDA in most cases. Normal urine output for an infant is typically 1-3 mL/kg/hr. Choice E rationale Bounding peripheral pulses are a direct consequence of the wide pulse pressure seen in PDA. The rapid runoff of blood into the pulmonary artery during diastole causes a sharp decrease in diastolic pressure, leading to a strong, palpable pulse that quickly collapses, resulting in bounding peripheral pulses. Choice F rationale Bradycardia, a slow heart rate, is not typically associated with patent ductus arteriosus. In fact, infants with significant PDA may exhibit tachycardia (elevated heart rate) as a compensatory mechanism to maintain cardiac output in the presence of the left-to-right shunt, not bradycardia.