PRACTICE QUESTIONS for the Certified Nurse in Critical Care – Canada examination

1. Shortly after insertion of a right subclavian catheter, he develops worsening shortness of breath and bibasilar crackles. Blood is noted to be backing up from the central venous catheter and his oxygen saturation decreases with supine positioning. Which one of the following problems is consistent with these findings? a. Pulmonary embolus b. Right heart failure c. Cardiac pulmonary edema d. Hemopneumothorax Rationale for Correct Response: c) Anterior wall MI is typically associated with left ventricular dysfunction with increased left ventricular pressures. High left ventricular pressures back up to the pulmonary system, causing pulmonary congestion. Hallmarks of cardiac pulmonary edema include bibasilar crackles and orthostatic hypoxemia or distress. Elevated pulmonary pressures are transmitted to the right side of the heart and cause CVP elevation (blood backing up from central line) and peripheral edema.