Your patient has been diagnosed with right ventricular failure. Which of the following abnormalities is not a direct result of this problem? \[ \begin{array}{l}\text { Liver margin palpable two finger breadths below the right costal margin } \\ \text { Swelling of the lower extremities } \\ \text { Pulmonary edema (fluid in the alveoli) } \\ \text { Distension of the jugular veins of the neck }\end{array} \]

Pulmonary edema, which is the accumulation of fluid in the alveoli, is primarily associated with left ventricular failure rather than isolated right ventricular (RV) failure. **Explanation of Each Option:** 1. **Liver margin palpable two finger breadths below the right costal margin:** In RV failure, there is systemic venous congestion which can cause hepatomegaly (enlarged liver), making the liver margin more palpable. 2. **Swelling of the lower extremities:** RV failure leads to increased venous pressure, resulting in peripheral edema, especially in the lower extremities. 3. **Pulmonary edema (fluid in the alveoli):** This is typically a consequence of left ventricular failure, where the left heart cannot effectively pump blood out to the body, causing a backlog of blood in the pulmonary circulation and fluid leakage into the alveoli. 4. **Distension of the jugular veins of the neck:** RV failure causes elevated central venous pressure, which manifests as jugular venous distension (JVD). **Conclusion:** Among the listed abnormalities, pulmonary edema is **not** a direct result of isolated right ventricular failure. **Answer:** Pulmonary edema (fluid in the alveoli) is not directly caused by right ventricular failure.