Progressive Care Nursing Certification (PCCN) Practice Exam

Which symptom may indicate early fluid overload and pulmonary edema?

1. Chest pain with ST elevation

2. Complaints of shortness of breath and orthopnea

3. Presence of rales and hypoxia

4. Tachycardia and S3 heart sound

The correct answer is: Complaints of shortness of breath and orthopnea

Shortness of breath and orthopnea are classic symptoms that can indicate early fluid overload and the development of pulmonary edema. In fluid overload, the increased volume of fluid in the bloodstream can lead to congestion in the lungs, causing difficulty in breathing, especially when lying flat, which is experienced as orthopnea. This symptom arises from the redistribution of fluid and increase in hydrostatic pressure in the pulmonary capillaries, leading to interstitial edema and, if severe enough, alveolar edema. Other symptoms associated with pulmonary edema, such as rales and hypoxia, may also be present, but they typically indicate a more advanced stage of volume overload. Chest pain with ST elevation would suggest myocardial ischemia rather than fluid overload, and while tachycardia and the presence of an S3 heart sound can be indicative of heart failure, they are less specific for early fluid overload compared to shortness of breath and orthopnea. Thus, the combination of shortness of breath and orthopnea serves as a key early warning sign for potential fluid overload and pulmonary edema.