Adult Critical Care Specialty (ACCS) Practice Exam

What condition should be treated upon assessment of a 66-year-old woman presenting with shortness of breath, bilateral crackles, jugular venous distension, and peripheral edema?

1. Acute renal failure

2. Congestive heart failure

3. Pneumonia

4. Acute respiratory distress syndrome

The correct answer is: Congestive heart failure

The presence of shortness of breath, bilateral crackles upon auscultation, jugular venous distension, and peripheral edema strongly indicates congestive heart failure (CHF). Each of these symptoms provides insight into the underlying pathophysiology of CHF. Shortness of breath is commonly associated with fluid accumulation in the lungs, a hallmark of heart failure, particularly left-sided heart failure, where fluid backs up into the pulmonary circulation. Bilateral crackles are indicative of pulmonary congestion caused by this fluid, resulting from impaired heart function. Jugular venous distension suggests increased central venous pressure, which is often seen in right-sided heart failure or volume overload situations, reinforcing the diagnosis of CHF. Additionally, peripheral edema reflects systemic fluid retention due to the heart's inability to effectively pump blood, leading to increased pressure in the veins and resultant leakage of fluid into the surrounding tissues. In context, other options such as acute renal failure, pneumonia, and acute respiratory distress syndrome do not account for all the symptoms presented as effectively as congestive heart failure does. Acute renal failure might lead to fluid overload and edema but does not directly explain the crackles or jugular distention. Pneumonia would typically cause localized crackles rather than diffuse bilateral crackles and