Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)
Medical & Surgical Nursing
Medium
CVP is elevated in all the following conditions; EXCEPT:
Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)
Explanation
- Hypovolemic shock is defined by a critically low circulating blood volume.
- This reduced volume leads to decreased venous return to the right side of the heart.
- Consequently, the pressure in the central veins (CVP) falls significantly below the normal range.
- The key differentiator is that hypovolemia is a state of volume deficit, whereas the other options involve volume excess or increased intrathoracic pressure, both of which elevate CVP.
Why Other Options Were Wrong
- Option B: Overhydration, or hypervolemia, directly increases the total fluid volume within the vascular system, leading to increased pressure in the central veins and an elevated CVP.
- Option C: In heart failure, particularly right-sided heart failure, the heart cannot effectively pump blood forward. This causes blood to back up in the venous system, resulting in venous congestion and an elevated CVP.
- Option D: Positive pressure breathing, often from mechanical ventilation, increases the pressure within the thoracic cavity. This increased pressure is transmitted to the heart and great vessels, leading to a falsely or genuinely elevated CVP reading.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Interpretation of Central Venous Pressure (CVP) in various clinical conditions as background academic context rather than a clinical decision trigger.
- CVP monitoring is a crucial nursing skill in the ICU for assessing a patient's fluid status and guiding fluid resuscitation or diuresis.
- A low CVP in a hypotensive patient strongly suggests hypovolemia and the need for fluid administration, whereas a high CVP suggests that fluids may be harmful and vasopressors or inotropes might be needed.
- Accurate CVP measurement requires proper leveling of the transducer to the phlebostatic axis and understanding the influence of mechanical ventilation.
How to Approach the Question
- First, identify the negative framing of the question by spotting the word 'EXCEPT'. This means you are looking for the one option that does not fit the stated condition (elevated CVP).
- Define the key term: Central Venous Pressure (CVP) is the pressure of the blood in the central veins, reflecting right atrial pressure and preload.
- Consider the normal CVP range (2-8 mmHg) and what would cause it to increase or decrease.
- Evaluate each option's pathophysiology: Does it increase or decrease blood volume returning to the heart?
- Analyze 'Hypovolemic shock': 'Hypo-' means low, 'volemic' means volume. Low volume = low pressure. This is a likely candidate.
- Analyze 'Overhydration', 'Heart failure', and 'Positive pressure breathing': All these conditions lead to increased volume or pressure within the chest, which would elevate CVP.
Concept Tested & Keywords
- Concept Tested: Interpretation of Central Venous Pressure (CVP) in various clinical conditions.
- Stem keywords: CVP, elevated, conditions
- Lead-in keywords: EXCEPT
- Negative lead-in flag: Question is negatively framed (EXCEPT)
Question ID
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Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 140-142
E6 Medicine Harrison 22e Part 2 p. 197-199
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 652-654
Practise the full Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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