BCEN CFRN Practice Question

The findings of hypertension, tachycardia, orthopnea, jugular venous distention, bibasilar crackles, and peripheral edema indicate elevated left-sided filling pressures with pulmonary venous congestion. These are hallmark signs of acute decompensated left-sided heart failure, often precipitated by ischemia or uncontrolled hypertension. A massive pulmonary embolism more commonly presents with sudden pleuritic pain, tachycardia, right-sided strain, and clear lung fields; COPD exacerbation produces wheezing without jugular venous distention or crackles; and acute ST-elevation myocardial infarction causing cardiogenic shock typically manifests with hypotension rather than severe hypertension. Therefore, acute decompensated left-sided heart failure is the most likely diagnosis.