護理師正在評估一位患有高輸出量心臟衰竭（High-output HF）的病人。護理師應預期出現哪種臨床表現？
The nurse is assessing a client with high-output heart failure. Which clinical finding should the nurse anticipate?
- ABounding peripheral pulses✓ 正解周圍脈搏強勁有力
- BCool, clammy extremities四肢冰冷且潮濕
- CWeak, thready peripheral pulses周圍脈搏微弱且細速
- DDecreased cardiac output on thermodilution熱稀釋法測得心輸出量減少
高輸出量心臟衰竭與常見的收縮性心衰竭不同，它發生在心輸出量雖然高於正常，但仍無法滿足身體極度增加的代謝需求時。常見原因包括甲狀腺亢進、嚴重貧血、維生素 B1 缺乏（腳氣病）或動靜脈廔管。在這種生理狀態下，由於全身血管阻力（SVR）降低，病人會表現出「溫暖且紅潤」的特徵。體檢時會發現脈搏強而有力（Bounding pulses），心率增快，且肢體末梢通常是溫暖的，而非一般心衰竭所見的冰冷。這題測驗護理師對特殊病理生理機轉的理解。臨床思路應區分：低輸出量（心肌無力，脈搏弱）與高輸出量（需求過高，脈搏強）。這類病人雖然心輸出量絕對值高，但相對仍處於代償衰竭狀態，最終仍會導致肺淤血等心衰症狀。
High-output heart failure differs from the more common systolic heart failure: cardiac output is higher than normal but still cannot meet the body's greatly increased metabolic demand. Common causes include hyperthyroidism, severe anemia, vitamin B1 deficiency (beriberi), and arteriovenous fistulas. In this physiologic state, systemic vascular resistance (SVR) is decreased, so the client appears warm and flushed. Examination reveals strong, bounding pulses, an increased heart rate, and warm extremities, rather than the cool extremities seen in typical heart failure. This item tests understanding of a special pathophysiologic mechanism. Clinically, one must distinguish low-output failure (myocardial weakness, weak pulses) from high-output failure (excessive demand, strong pulses). Although absolute cardiac output is high, these clients are still in a state of compensated failure and eventually develop symptoms such as pulmonary congestion.
在美國護理教育中，對於心衰竭的分類非常細緻（High vs Low output, Right vs Left），NCLEX 考題常出現這類病理生理邏輯題；台灣臨床實務則較常統一歸類為心衰竭處理，護理師對高輸出量的病理機轉辨識能力是區分進階護理師的關鍵。