Progressive Care Nursing Certification (PCCN) Practice Exam

What cardiac condition does the presence of rales, cool extremities, and elevated JVD indicate in a patient?

1. No pulmonary congestion, normal perfusion

2. No pulmonary congestion, low perfusion

3. Pulmonary congestion, normal perfusion

4. Pulmonary congestion, low perfusion

The correct answer is: Pulmonary congestion, low perfusion

The combination of rales, cool extremities, and elevated jugular venous distention (JVD) strongly suggests the presence of pulmonary congestion alongside low perfusion. Rales are often indicative of fluid in the lungs, commonly seen in conditions such as heart failure where pulmonary congestion occurs due to the heart's inability to adequately pump blood. When fluid accumulates in the alveoli, it leads to impaired gas exchange and can manifest as rales upon auscultation. Elevated JVD further points toward heart failure by indicating increased central venous pressure, a sign that fluid is overloaded in the system. This condition often results from the heart's inability to maintain adequate blood flow, resulting in poor perfusion to the extremities—which is evidenced by cool extremities. In summary, the combination of pulmonary congestion marked by rales, signs of fluid overload such as elevated JVD, and the body’s response to decreased perfusion leads to the conclusion that the patient is experiencing pulmonary congestion alongside low perfusion.