Ch 35: Hemodynamic Instability Flashcards
pages 779-785
1
Q
A nurse is caring for a patient who is receiving hemodynamic monitoring. The physician orders measurements of systemic and pulmonary arterial pressures, central venous pressure (CVP), and pulmonary artery wedge pressure (PAWP). What is the primary purpose of these measurements?
A) To assess the effectiveness of medication therapy
B) To measure heart function, fluid balance, and the effects of fluids and drugs on cardiac output
C) To monitor electrolyte imbalances and kidney function
D) To assess respiratory status and lung compliance
A
B) To measure heart function, fluid balance, and the effects of fluids and drugs on cardiac output
Rationale: Hemodynamic monitoring is primarily used to assess heart function, fluid balance, and the effects of fluids and medications on cardiac output (CO). These measurements provide valuable data on the cardiovascular system’s status and help guide treatment decisions.
2
Q
A nurse is caring for a patient who has a central venous catheter in place for hemodynamic monitoring. The nurse notes a central venous pressure (CVP) reading of 12 mmHg. Which of the following is the most appropriate interpretation of this CVP value?
A) The patient is experiencing hypovolemia
B) The patient is in shock
C) The patient has normal cardiac output
D) The patient may have fluid overload or right-sided heart failure
A
D) The patient may have fluid overload or right-sided heart failure
Rationale: A CVP value of 12 mmHg is above the normal range (2-8 mmHg), indicating possible fluid overload or right-sided heart failure. Elevated CVP reflects increased venous pressure, which can occur with fluid retention or poor right ventricular function.
3
Q
A patient with sepsis is undergoing hemodynamic monitoring, and their mixed venous oxygen saturation (SvO2) is measured at 40%. The nurse understands that this value suggests:
A) Increased tissue oxygenation and adequate perfusion
B) Decreased tissue oxygenation and inadequate oxygen delivery
C) Normal oxygen delivery and consumption
D) Adequate tissue oxygenation despite low cardiac output
A
B) Decreased tissue oxygenation and inadequate oxygen delivery
Rationale: A SvO2 of 40% is lower than the normal range (60-75%), indicating decreased tissue oxygenation and inadequate oxygen delivery. This could be related to poor perfusion and low cardiac output, which are often seen in septic patients.
4
Q
A nurse is assessing a patient with a pulmonary artery catheter. The pulmonary artery wedge pressure (PAWP) is 18 mmHg. What is the nurse’s primary concern regarding this PAWP value?
A) The patient may be experiencing left-sided heart failure or fluid overload
B) The patient is hypovolemic and may need fluid resuscitation
C) The patient may be experiencing right-sided heart failure
D) The patient’s cardiac output is normal and stable
A
A) The patient may be experiencing left-sided heart failure or fluid overload
Rationale: A PAWP value of 18 mmHg is elevated (normal range is 4-12 mmHg), indicating that the patient may be experiencing left-sided heart failure or fluid overload. PAWP is a reflection of left atrial pressure and can help diagnose left-sided heart failure or pulmonary edema.
5
Q
A nurse is caring for a patient receiving an intravenous infusion of fluids. Hemodynamic monitoring shows a cardiac output (CO) of 3 L/min and a cardiac index (CI) of 1.8 L/min/m². What is the nurse’s interpretation of these values?
A) Normal cardiac output and normal cardiac index
B) Decreased cardiac output and normal cardiac index
C) Decreased cardiac output and decreased cardiac index, indicating poor perfusion
D) Increased cardiac output and normal cardiac index
A
C) Decreased cardiac output and decreased cardiac index, indicating poor perfusion
Rationale: A CO of 3 L/min is low, and the CI of 1.8 L/min/m² is also below the normal range (2.5-4.0 L/min/m²), indicating poor perfusion. This suggests that the heart is not pumping enough blood to meet the body’s needs.
6
Q
A nurse is monitoring a patient’s hemodynamic parameters, which include systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR). The nurse understands that these measurements are used to assess which of the following?
A) The resistance of the systemic and pulmonary arterial vasculature
B) The effectiveness of the patient’s respiratory therapy
C) The levels of oxygen saturation in the patient’s blood
D) The volume of blood circulating in the body
A
A) The resistance of the systemic and pulmonary arterial vasculature
Rationale: Systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) assess the resistance of the arterial vasculature in the systemic and pulmonary circuits. These values help evaluate the hemodynamic status of the patient and guide therapy.
7
Q
A nurse is caring for a patient who is receiving hemodynamic monitoring. The patient’s cardiac output (CO) is stable, but the nurse notices that the oxygen saturation of hemoglobin in arterial blood (SaO2) has dropped to 85%. What is the nurse’s priority action?
A) Continue to monitor the SaO2 levels, as they may fluctuate
B) Administer supplemental oxygen to increase oxygen saturation
C) Increase the intravenous fluid rate to improve circulation
D) Assess the patient’s central venous pressure (CVP) to check for fluid overload
A
B) Administer supplemental oxygen to increase oxygen saturation
Rationale: A SaO2 of 85% is below the normal range (95-100%) and indicates that the patient is not receiving enough oxygen. Administering supplemental oxygen is the priority action to improve oxygenation and prevent hypoxia.
8
Q
A patient with a history of heart failure is undergoing hemodynamic monitoring. The nurse notices that the systemic arterial pressure is low, and the pulmonary artery wedge pressure (PAWP) is elevated. What does this combination of findings most likely indicate?
A) Right-sided heart failure with low systemic vascular resistance
B) Left-sided heart failure with decreased cardiac output
C) Fluid overload with poor perfusion
D) Hypovolemia with inadequate oxygenation
A
B) Left-sided heart failure with decreased cardiac output
Rationale: In left-sided heart failure, the PAWP is elevated due to increased pressure in the left atrium and pulmonary circulation. A low systemic arterial pressure indicates poor perfusion, which is commonly seen in patients with decreased cardiac output from left-sided heart failure.
9
Q
A nurse is caring for a patient with heart failure. The patient’s cardiac output (CO) is measured at 3.5 L/min, and the cardiac index (CI) is calculated to be 2.2 L/min/m². How should the nurse interpret these findings?
A) The patient’s CO is normal, but the CI is low, indicating poor perfusion for the patient’s body size.
B) The CO is low, but the CI is normal, indicating adequate perfusion for the patient’s body size.
C) Both CO and CI are normal, indicating adequate perfusion.
D) The CO and CI are both low, indicating inadequate perfusion for the patient’s body size.
A
A) The patient’s CO is normal, but the CI is low, indicating poor perfusion for the patient’s body size.
Rationale: The normal CI range is 2.8-4.2 L/min/m². A CI of 2.2 L/min/m² is below the normal range, suggesting poor perfusion relative to the patient’s body size. Despite the CO being within the normal range, the low CI indicates that the blood flow is insufficient for the body size.
10
Q
A patient’s stroke volume (SV) is measured at 75 mL, and their body surface area (BSA) is 1.8 m². The nurse calculates the stroke volume index (SVI) using the formula SVI = SV/BSA. What is the patient’s SVI?
A) 35 mL/m²
B) 50 mL/m²
C) 42 mL/m²
D) 67 mL/m²
A
C) 42 mL/m²
Rationale: The SVI is calculated as SV (75 mL) divided by BSA (1.8 m²). Therefore, 75 mL ÷ 1.8 m² = 41.7 mL/m², which rounds to 42 mL/m². The SVI is a measure of the stroke volume adjusted for body size.
11
Q
A nurse is caring for a patient with high blood pressure. The nurse understands that systemic vascular resistance (SVR) is one of the factors that influence blood pressure (BP). Which of the following is true regarding SVR?
A) SVR is the opposition encountered by the left ventricle in pumping blood.
B) SVR is the volume of blood pumped by the heart in one minute.
C) SVR reflects the resistance to blood flow from the pulmonary circulation.
D) SVR has no significant impact on blood pressure.
A
A) SVR is the opposition encountered by the left ventricle in pumping blood.
Rationale: SVR is the resistance that the left ventricle must overcome to pump blood into the systemic circulation. It is a key determinant of blood pressure, as increased SVR raises BP, and decreased SVR lowers BP.
12
Q
A patient with sepsis has a low stroke volume (SV) and cardiac output (CO). The nurse understands that which of the following factors is most likely contributing to the decrease in CO?
A) Decreased preload due to dehydration
B) Increased contractility from compensatory mechanisms
C) Increased afterload from systemic vasodilation
D) Increased systemic vascular resistance (SVR) from inflammation
A
C) Increased afterload from systemic vasodilation
Rationale: In sepsis, systemic vasodilation occurs due to inflammatory responses, leading to decreased SVR and increased afterload. This increases the resistance against which the heart must pump, ultimately decreasing cardiac output and stroke volume.
13
Q
A nurse is caring for a patient in shock and notes that the patient’s cardiac index (CI) is measured at 1.5 L/min/m². Which of the following is the most appropriate intervention for this patient?
A) Administer IV fluids to increase preload and improve perfusion.
B) Increase the afterload by administering vasodilators to enhance circulation.
C) Administer inotropes to improve contractility and increase CO.
D) Decrease the preload by reducing fluid intake to decrease cardiac workload.
A
A) Administer IV fluids to increase preload and improve perfusion.
Rationale: A CI of 1.5 L/min/m² is significantly below the normal range, indicating poor perfusion. Administering IV fluids increases preload, which can help improve cardiac output and perfusion. Fluids are essential in shock states where preload is often low.
14
Q
A nurse is reviewing a patient’s hemodynamic data, which shows a cardiac output (CO) of 4.5 L/min, stroke volume (SV) of 90 mL, and systemic vascular resistance (SVR) of 1300 dynes·sec·cm⁻⁵. Based on these values, what can the nurse infer about the patient’s cardiovascular status?
A) The patient has adequate cardiac output with normal vascular resistance.
B) The patient may have poor perfusion due to low stroke volume and high vascular resistance.
C) The patient’s cardiac output is normal, but the vascular resistance is low.
D) The patient’s stroke volume is high, indicating hyperdynamic circulation.
A
B) The patient may have poor perfusion due to low stroke volume and high vascular resistance.
Rationale: Despite a normal cardiac output (4.5 L/min), the low stroke volume (90 mL) and high systemic vascular resistance (SVR) (normal range is 800-1200 dynes·sec·cm⁻⁵) suggest that the heart is working against high resistance, potentially compromising perfusion and increasing the workload on the heart.
15
Q
A nurse is caring for a patient who has been diagnosed with heart failure. The patient has a pulmonary artery wedge pressure (PAWP) of 18 mmHg. How should the nurse interpret this finding?
A) The PAWP is normal, indicating optimal preload and heart function.
B) The PAWP is elevated, suggesting increased left ventricular preload.
C) The PAWP is low, indicating reduced left ventricular preload and inadequate filling.
D) The PAWP is within the normal range, suggesting no issues with preload
A
B) The PAWP is elevated, suggesting increased left ventricular preload.
Rationale: The normal PAWP is typically between 6-12 mmHg. A PAWP of 18 mmHg is elevated, suggesting increased left ventricular preload. This may be due to heart failure or fluid overload, leading to poor heart function.
16
Q
A nurse is monitoring a patient with sepsis. The patient’s central venous pressure (CVP) is measured at 12 mmHg. How does the nurse interpret this CVP value?
A) The CVP is elevated, indicating increased right ventricular preload.
B) The CVP is normal, suggesting adequate venous return and preload.
C) The CVP is low, indicating hypovolemia and reduced preload.
D) The CVP is high, suggesting left ventricular failure.
A
A) The CVP is elevated, indicating increased right ventricular preload.
Rationale: The normal CVP is between 2-6 mmHg. A CVP of 12 mmHg is elevated and indicates increased right ventricular preload. In sepsis, fluid shifts and increased blood volume may lead to higher CVP, suggesting an increased workload on the right ventricle.
17
Q
A nurse is caring for a patient with mitral valve dysfunction. The patient’s left ventricular end-diastolic pressure (LVEDP) is being monitored. Which of the following best describes how mitral valve dysfunction affects preload?
A) Mitral valve dysfunction increases preload by allowing blood to flow back into the left atrium.
B) Mitral valve dysfunction decreases preload by preventing blood from entering the left ventricle.
C) Mitral valve dysfunction has no impact on preload or the LVEDP.
D) Mitral valve dysfunction causes a decrease in LVEDP due to regurgitation.
A
A) Mitral valve dysfunction increases preload by allowing blood to flow back into the left atrium.
Rationale: Mitral valve dysfunction, particularly mitral regurgitation, allows blood to flow back into the left atrium, increasing the volume of blood returning to the left ventricle. This increased volume results in higher left ventricular end-diastolic pressure (LVEDP) and increased preload.
18
Q
A nurse is assessing a patient who has been administered diuretics for fluid overload. Which of the following is the most likely outcome of diuretic therapy on preload?
A) Increased preload due to increased venous return from reduced fluid volume.
B) Decreased preload due to reduced circulating blood volume and venous return.
C) Increased preload due to enhanced myocardial contractility from diuresis.
D) No effect on preload as diuretics primarily affect the kidneys and not the heart.
A
B) Decreased preload due to reduced circulating blood volume and venous return.
Rationale: Diuretics reduce the circulating blood volume by increasing urinary output. This leads to a decrease in venous return and preload, which reduces the volume in the ventricles at the end of diastole.
19
Q
A nurse is monitoring a patient who has been given fluids to increase preload. Which of the following is the most likely outcome of fluid administration on preload?
A) Preload will decrease due to the body’s compensatory mechanisms.
B) Fluid administration has no effect on preload or vascular tone.
C) Preload will increase due to an increase in circulating blood volume.
D) Preload will decrease as a result of decreased systemic vascular resistance.
A
C) Preload will increase due to an increase in circulating blood volume.
Rationale: Administering fluids increases the circulating blood volume, which increases venous return to the heart. This leads to an increase in preload, which in turn increases the volume in the ventricles at the end of diastole.
20
Q
A nurse is caring for a patient with dysrhythmia. The nurse understands that dysrhythmias can affect preload in what way?
A) Dysrhythmias can cause irregular heart rhythms that impair the filling of the ventricles, reducing preload.
B) Dysrhythmias have no effect on preload or ventricular filling.
C) Dysrhythmias increase preload by enhancing the heart’s filling capacity.
D) Dysrhythmias increase preload by increasing venous return.
A
A) Dysrhythmias can cause irregular heart rhythms that impair the filling of the ventricles, reducing preload.
Rationale: Dysrhythmias can result in ineffective or irregular contractions, impairing ventricular filling during diastole. This leads to a reduction in preload because the ventricles do not fill properly, resulting in less blood being returned to the heart.
21
Q
A nurse is reviewing a patient’s hemodynamic data and notices that the left ventricular end-diastolic pressure (LVEDP) is increased. Which of the following conditions is most likely contributing to the elevated LVEDP?
A) Hypervolemia, causing excessive fluid in the ventricles.
B) Mitral valve stenosis, preventing blood from flowing out of the left ventricle.
C) Hypovolemia, leading to a decreased volume in the ventricles.
D) Right heart failure, leading to an increased pressure in the right ventricle.
A
B) Mitral valve stenosis, preventing blood from flowing out of the left ventricle.
Rationale: Mitral valve stenosis causes a narrowing of the mitral valve, obstructing blood flow from the left atrium to the left ventricle. This leads to increased pressure in the left ventricle at the end of diastole, resulting in elevated LVEDP and increased preload.
22
Q
A nurse is caring for a patient who has been given vasodilators. The nurse understands that vasodilation affects preload by which of the following mechanisms?
A) Vasodilation increases venous return, thus increasing preload.
B) Vasodilation has no effect on preload.
C) Vasodilation increases contractility and decreases preload.
D) Vasodilation decreases venous return, thus reducing preload.
A
D) Vasodilation decreases venous return, thus reducing preload.
Rationale: Vasodilators cause the blood vessels to relax and widen, which reduces venous return to the heart. This decreases the volume of blood returning to the heart, reducing preload.
23
Q
A nurse is caring for a patient with a history of cardiac surgery. The nurse notes that the patient’s CVP is low at 2 mmHg. Which of the following interventions would be most appropriate for this patient?
A) Administer diuretics to decrease fluid overload.
B) Administer vasodilators to reduce afterload.
C) Increase fluid administration to raise the CVP and improve preload.
D) Perform a fluid restriction to prevent further preload reduction.
A
C) Increase fluid administration to raise the CVP and improve preload.
Rationale: A low CVP (below the normal range of 2-6 mmHg) suggests reduced venous return or hypovolemia. Administering fluids helps to raise the CVP by increasing circulating blood volume and improving preload, which is necessary for optimal heart function.
24
Q
A patient with hypertension is experiencing increased systemic vascular resistance (SVR). How does this affect afterload and cardiac output?
A) Increased SVR decreases afterload and increases cardiac output.
B) Increased SVR increases afterload and decreases cardiac output.
C) Increased SVR has no impact on afterload or cardiac output.
D) Increased SVR decreases afterload but has no effect on cardiac output.
A
B) Increased SVR increases afterload and decreases cardiac output.
Rationale: Systemic vascular resistance (SVR) reflects the resistance the left ventricle must overcome to eject blood. When SVR increases, afterload also increases, making it harder for the heart to pump blood effectively, leading to decreased cardiac output.
25
A nurse is caring for a patient with pulmonary hypertension. Which hemodynamic parameter would best indicate an increase in right ventricular afterload?
A) Increased pulmonary vascular resistance (PVR)
B) Decreased systemic vascular resistance (SVR)
C) Increased pulmonary capillary wedge pressure (PCWP)
D) Decreased central venous pressure (CVP)
A) Increased pulmonary vascular resistance (PVR)
Rationale: Pulmonary vascular resistance (PVR) reflects the resistance the right ventricle must overcome to pump blood into the pulmonary circulation. In pulmonary hypertension, PVR increases, which raises right ventricular afterload and can eventually lead to right ventricular failure.
26
A patient is receiving milrinone for heart failure. What is the primary effect of this medication on afterload?
A) It increases SVR and raises afterload.
B) It decreases SVR and lowers afterload.
C) It decreases contractility but has no effect on afterload.
D) It increases pulmonary vascular resistance (PVR) and right ventricular afterload.
B) It decreases SVR and lowers afterload.
Rationale: Milrinone is a phosphodiesterase inhibitor that acts as a vasodilator, reducing systemic vascular resistance (SVR). This decreases afterload, allowing the heart to pump more efficiently and reducing myocardial oxygen demand.
27
A nurse is caring for a patient in cardiogenic shock. The patient has a significantly elevated systemic vascular resistance (SVR). What intervention would be most effective in reducing afterload?
A) Administering vasopressors to increase vascular tone
B) Administering a vasodilator such as nitroprusside
C) Increasing fluid intake to raise preload
D) Encouraging the patient to perform isometric exercises
B) Administering a vasodilator such as nitroprusside
Rationale: Nitroprusside is a potent vasodilator that reduces systemic vascular resistance (SVR) and, consequently, afterload. Lowering afterload helps improve cardiac output and reduces myocardial oxygen consumption in patients with cardiogenic shock.
28
A patient with severe aortic stenosis is admitted for evaluation. How does aortic stenosis affect left ventricular afterload?
A) It decreases afterload by reducing SVR.
B) It has no effect on afterload because the aortic valve is unrelated to ventricular ejection.
C) It increases afterload by creating resistance to left ventricular ejection.
D) It decreases afterload by increasing stroke volume.
C) It increases afterload by creating resistance to left ventricular ejection.
Rationale: Aortic stenosis causes narrowing of the aortic valve, increasing resistance to blood ejection from the left ventricle. This raises left ventricular afterload, making it harder for the heart to pump blood forward, which can lead to left ventricular hypertrophy and heart failure.
29
A nurse is monitoring a patient with an intra-aortic balloon pump (IABP). How does the IABP help reduce afterload?
A) By inflating during systole, increasing SVR
B) By deflating during diastole, increasing myocardial oxygen consumption
C) By inflating during diastole and deflating during systole, reducing LV workload
D) By increasing pulmonary vascular resistance (PVR), lowering right ventricular afterload
C) By inflating during diastole and deflating during systole, reducing LV workload
Rationale: The intra-aortic balloon pump (IABP) inflates during diastole to improve coronary artery perfusion and deflates just before systole, reducing left ventricular afterload. This decreases myocardial oxygen demand and improves cardiac output.
30
A patient with left-sided heart failure is experiencing an increase in afterload. Which physiological response is likely to occur as a result?
A) Increased stroke volume and improved cardiac output
B) Decreased myocardial oxygen demand and improved efficiency
C) Decreased systemic vascular resistance (SVR) and reduced cardiac workload
D) Increased myocardial workload and risk of ventricular hypertrophy
D) Increased myocardial workload and risk of ventricular hypertrophy
Rationale: Increased afterload means the left ventricle must work harder to eject blood, leading to increased myocardial oxygen demand. Over time, this increased workload can result in ventricular hypertrophy, which may eventually progress to heart failure.
31
A patient with septic shock is experiencing decreased afterload. Which hemodynamic change is most likely occurring?
A) Increased pulmonary vascular resistance (PVR)
B) Increased mean arterial pressure (MAP)
C) Decreased cardiac output due to increased afterload
D) Decreased systemic vascular resistance (SVR)
D) Decreased systemic vascular resistance (SVR)
Rationale: In septic shock, widespread vasodilation occurs due to inflammatory mediators, leading to a significant drop in systemic vascular resistance (SVR). This results in decreased afterload, which can lead to hypotension and inadequate organ perfusion.
32
A patient with heart failure is prescribed dobutamine. What is the primary effect of this medication on myocardial contractility?
A) It decreases contractility and reduces myocardial oxygen demand.
B) It increases contractility and improves stroke volume.
C) It causes vasodilation, decreasing systemic vascular resistance (SVR).
D) It directly decreases heart rate and contractility.
B) It increases contractility and improves stroke volume.
Rationale: Dobutamine is a beta-adrenergic agonist that acts as a positive inotrope, increasing myocardial contractility. This results in improved stroke volume (SV) and cardiac output (CO), which are beneficial for patients with heart failure.
33
A nurse is reviewing a patient’s hemodynamic parameters. The patient’s preload, heart rate, and afterload remain constant, but cardiac output has decreased. What does this suggest?
A) Increased contractility
B) Decreased contractility
C) Increased systemic vascular resistance (SVR)
D) Decreased preload
B) Decreased contractility
Rationale: Contractility is inferred by changes in cardiac output (CO) when preload, heart rate, and afterload remain unchanged. A decrease in CO despite stable hemodynamic parameters suggests decreased myocardial contractility, which can be seen in conditions like heart failure or myocardial ischemia.
34
Which of the following clinical conditions is most likely to decrease myocardial contractility?
A) Hypercalcemia
B) Administration of epinephrine
C) Myocardial ischemia
D) Sympathetic nervous system activation
C) Myocardial ischemia
Rationale: Myocardial ischemia reduces oxygen delivery to cardiac muscle, impairing its ability to contract effectively. This leads to decreased contractility, which can worsen cardiac output and contribute to heart failure.
35
A patient with hypertension is prescribed a beta-blocker. What effect will this medication have on contractility?
A) It will increase contractility and improve cardiac output.
B) It will decrease contractility, reducing myocardial oxygen demand.
C) It will have no effect on contractility but will increase stroke volume.
D) It will increase contractility while decreasing systemic vascular resistance (SVR).
B) It will decrease contractility, reducing myocardial oxygen demand.
Rationale: Beta-blockers are negative inotropes that reduce myocardial contractility. By doing so, they decrease myocardial oxygen consumption, making them beneficial in conditions like hypertension and heart failure.
36
A patient with acute decompensated heart failure has a severely reduced ejection fraction. Which medication would best improve contractility in this patient?
A) Metoprolol
B) Diltiazem
C) Digoxin
D) Lisinopril
C) Digoxin
Rationale: Digoxin is a positive inotropic agent that enhances myocardial contractility by increasing intracellular calcium availability. It is commonly used to improve cardiac output in patients with heart failure and reduced ejection fraction.
37
A nurse is monitoring a patient receiving dopamine for cardiogenic shock. Which finding would indicate that the drug is effectively improving contractility?
A) Decreased urine output
B) Increased systemic vascular resistance (SVR)
C) Increased cardiac output (CO)
D) Decreased heart rate
C) Increased cardiac output (CO)
Rationale: Dopamine is a positive inotrope that increases myocardial contractility, which should lead to an increase in cardiac output (CO). Improved CO enhances tissue perfusion and organ function.
38
A nurse is caring for a patient in metabolic acidosis. How does acidosis affect myocardial contractility?
A) It increases contractility by stimulating beta-adrenergic receptors.
B) It has no effect on contractility but increases preload.
C) It improves contractility by increasing intracellular calcium.
D) It decreases contractility, reducing cardiac output.
D) It decreases contractility, reducing cardiac output.
Rationale: Acidosis impairs myocardial contractility by disrupting calcium availability and interfering with energy metabolism in cardiac muscle cells. This results in reduced cardiac output (CO) and impaired perfusion.
39
A patient is receiving milrinone for heart failure. What is the mechanism by which milrinone improves contractility?
A) It blocks beta-adrenergic receptors, reducing heart rate and workload.
B) It decreases preload by increasing venous return to the heart.
C) It inhibits the sodium-potassium pump, increasing myocardial depolarization.
D) It increases intracellular calcium, enhancing myocardial contraction.
D) It increases intracellular calcium, enhancing myocardial contraction.
Rationale: Milrinone is a phosphodiesterase inhibitor that increases intracellular cyclic AMP (cAMP), leading to greater calcium availability for myocardial contraction. This enhances contractility and improves cardiac output.
40
A nurse is caring for a patient with suspected heart failure who is undergoing noninvasive hemodynamic monitoring. Which method would provide the most reliable measurement of cardiac output in this patient?
A) Pulse wave transit time
B) Transesophageal echocardiography (TEE)
C) Pulse oximetry
D) Central venous pressure monitoring
B) Transesophageal echocardiography (TEE)
Rationale: TEE is a noninvasive ultrasound method that provides highly accurate cardiac output (CO) measurements, similar to the thermodilution method. It is more reliable than other noninvasive techniques, especially in critically ill patients.
41
Which of the following noninvasive methods estimates stroke volume by detecting changes in the electrical conductivity of the blood?
A) Bioimpedance
B) Pulse wave analysis
C) Arterial line monitoring
D) Pulmonary artery catheterization
A) Bioimpedance
Rationale: Bioimpedance uses electrodes to detect changes in electrical conductivity in the blood, which helps estimate stroke volume (SV) and cardiac output (CO).
42
A patient in the ICU requires continuous cardiac output monitoring. The provider orders a noninvasive method using pulse wave analysis. What is the basis of this technology?
A) Changes in intrathoracic pressure
B) Analysis of pressure waveform in the digital arteries
C) Measurement of central venous pressure
D) Detection of oxygen saturation changes
B) Analysis of pressure waveform in the digital arteries
Rationale: Pulse wave analysis uses a noninvasive finger cuff or radial artery sensor to analyze pressure waveforms in digital arteries, estimating cardiac output and blood pressure.
43
Which noninvasive hemodynamic monitoring technique provides an estimate of cardiac output by measuring the time it takes for a pulse wave to travel from the heart to the peripheral arteries?
A) Thoracic electrical bioimpedance
B) Pulmonary artery wedge pressure (PAWP)
C) Mixed venous oxygen saturation (SvO2)
D) Pulse wave transit time
D) Pulse wave transit time
Rationale: Pulse wave transit time measures how long the pulse wave takes to travel from the heart to the peripheral arteries, allowing an estimation of cardiac output.
44
A patient with heart failure is undergoing bioimpedance monitoring. The nurse understands this method works by:
A) Measuring changes in electrical conductivity of the blood
B) Detecting changes in central venous pressure
C) Assessing systemic vascular resistance (SVR)
D) Analyzing arterial blood gas levels
A) Measuring changes in electrical conductivity of the blood
Rationale: Bioimpedance hemodynamic monitoring estimates stroke volume and cardiac output by detecting changes in the electrical conductivity of circulating blood.
45
Which of the following is a major limitation of noninvasive cardiac output monitoring using ultrasound?
A) It cannot detect pulmonary artery pressure.
B) It has a high risk of sepsis.
C) It cannot be used for continuous monitoring.
D) It is less reliable in patients with structural heart abnormalities.
D) It is less reliable in patients with structural heart abnormalities.
Rationale: Noninvasive ultrasound-based cardiac output monitoring may be inaccurate in patients with structural heart abnormalities due to altered hemodynamics.
46
A nurse is using noninvasive hemodynamic monitoring to evaluate a patient with hypotension. Which of the following noninvasive techniques would provide the most accurate estimation of preload?
A) Thoracic electrical bioimpedance
B) Pulse oximetry
C) Central venous pressure (CVP) measurement
D) Pulse wave analysis
A) Thoracic electrical bioimpedance
Rationale: Thoracic electrical bioimpedance can estimate preload by assessing stroke volume and cardiac output through changes in electrical conductivity.
47
A patient is undergoing noninvasive hemodynamic monitoring after removal of a pulmonary artery catheter. What is the primary advantage of noninvasive monitoring over invasive methods?
A) It provides real-time oxygen saturation monitoring.
B) It is more accurate than invasive hemodynamic measurements.
C) It eliminates the risk of infection.
D) It allows direct measurement of central venous pressure (CVP).
C) It eliminates the risk of infection.
Rationale: Noninvasive hemodynamic monitoring reduces the risk of infection and complications associated with invasive procedures like pulmonary artery catheterization.
48
Which of the following is a clinical indication for noninvasive hemodynamic monitoring?
A) Diagnosing mitral valve stenosis
B) Detecting early signs of pulmonary or cardiac problems
C) Direct measurement of pulmonary artery pressure
D) Measuring preload in real-time
B) Detecting early signs of pulmonary or cardiac problems
Rationale: Noninvasive monitoring is useful for detecting early signs of pulmonary or cardiac issues, evaluating dyspnea, and managing hypotension.
49
Which of the following findings would most likely suggest the need to switch from noninvasive to invasive hemodynamic monitoring?
A) The patient has stable vital signs and mild dyspnea.
B) The patient has worsening hypotension despite fluid resuscitation.
C) The patient’s cardiac index remains within normal limits.
D) The patient is undergoing routine postoperative monitoring
B) The patient has worsening hypotension despite fluid resuscitation.
Rationale: Invasive monitoring may be necessary for patients with persistent hypotension unresponsive to treatment to obtain more precise hemodynamic data.
50
A nurse is reviewing a patient’s noninvasive cardiac output readings and notices significant fluctuations. Which factor is most likely to affect the accuracy of noninvasive hemodynamic measurements?
A) The patient’s hydration status
B) The patient’s use of anticoagulant therapy
C) The patient’s blood glucose level
D) The patient’s lung function
A) The patient’s hydration status
Rationale: Hydration status can impact blood conductivity and vascular resistance, which can alter noninvasive hemodynamic readings.
51
A physician orders noninvasive hemodynamic monitoring for a post-heart transplant patient. What is the primary reason for using this technology in this setting?
A) To detect signs of organ rejection
B) To diagnose valvular disorders
C) To directly measure preload
D) To monitor systemic vascular resistance (SVR)
A) To detect signs of organ rejection
Rationale: Noninvasive hemodynamic monitoring is used in heart transplant patients to detect early signs of graft rejection by evaluating changes in cardiac output and stroke volume.
52
A patient receiving noninvasive hemodynamic monitoring has a decreased stroke volume index (SVI). What is the most likely cause?
A) Increased preload
B) Increased contractility
C) Decreased afterload
D) Decreased cardiac output
D) Decreased cardiac output
Rationale: Stroke volume index (SVI) is directly related to cardiac output (CO). A decrease in CO results in reduced SVI, impacting overall perfusion.
53
Which of the following noninvasive monitoring methods uses a combination of pulse oximetry and electrical sensors to estimate cardiac output?
A) Pulmonary artery catheterization
B) Pulse wave transit time
C) Mixed venous oxygen saturation (SvO2)
D) Transpulmonary thermodilution
B) Pulse wave transit time
Rationale: Pulse wave transit time measures the time it takes for the pulse wave to travel from the heart to peripheral arteries, using pulse oximetry and electrical sensors to estimate cardiac output.
54
A nurse is assessing a patient’s hemodynamic status using noninvasive monitoring. Which of the following values would indicate the need for immediate intervention?
A) Cardiac index of 3.5 L/min/m²
B) Stroke volume index of 45 mL/m²
C) Mean arterial pressure of 50 mmHg
D) Systemic vascular resistance of 1200 dynes/sec/cm⁵
C) Mean arterial pressure of 50 mmHg
Rationale: A mean arterial pressure (MAP) below 60 mmHg suggests inadequate organ perfusion and requires immediate intervention to prevent organ failure.
55
The nurse is preparing to level the transducer for invasive arterial blood pressure monitoring. Which anatomical landmark should the nurse use to ensure accurate readings?
A) Midaxillary line at the 5th intercostal space
B) Midclavicular line at the 4th intercostal space
C) Phlebostatic axis at the 4th intercostal space, mid-chest level
D) Anterior axillary line at the 2nd intercostal space
C) Phlebostatic axis at the 4th intercostal space, mid-chest level
Rationale: The phlebostatic axis, found at the 4th intercostal space and midway between the anterior and posterior chest walls, is used to reference invasive hemodynamic monitoring systems.
56
A nurse is troubleshooting an arterial line and notes inaccurate readings. What is the priority nursing action?
A) Flush the line with 10 mL of normal saline
B) Perform a square wave test
C) Reposition the patient’s arm
D) Deflate the arterial line pressure bag
B) Perform a square wave test
Rationale: The square wave test assesses the system’s dynamic response to ensure accurate waveform reproduction. This should be done every 8-12 hours or when readings are questionable.
57
Which of the following steps is essential when zeroing an invasive pressure monitoring system?
A) Open the stopcock to the patient
B) Open the reference stopcock to air
C) Increase the flush solution to 10 mL/hr
D) Lower the transducer below the phlebostatic axis
B) Open the reference stopcock to air
Rationale: Zeroing is performed by opening the stopcock to air to allow the monitor to use atmospheric pressure as a reference for 0 mmHg.
58
A nurse needs to assess the accuracy of an arterial pressure monitoring system. Which test should be performed?
A) Square wave test
B) Capillary refill test
C) Modified Allen test
D) Apnea test
A) Square wave test
Rationale: The square wave test ensures that the invasive pressure monitoring system provides an accurate, undistorted reading by checking for an appropriate waveform response after a fast flush.
59
Which of the following findings suggests overdamping of an arterial pressure waveform?
A) Exaggerated oscillations after a square wave test
B) Distorted baseline with frequent artifact
C) Flattened waveform with fewer oscillations
D) Sharp upstroke with increased systolic pressure
C) Flattened waveform with fewer oscillations
Rationale: Overdamping is characterized by a blunted, less responsive waveform and fewer oscillations after a square wave test, leading to falsely low systolic pressures.
60
A nurse notes that the invasive pressure monitoring system is underdamped. What waveform characteristic would the nurse expect to see?
A) Flattened waveform with fewer oscillations
B) Exaggerated oscillations after a square wave test
C) Absent dicrotic notch
D) Diminished arterial pressure tracing
B) Exaggerated oscillations after a square wave test
Rationale: An underdamped system will have excessive oscillations and may falsely elevate systolic readings. This typically occurs with overly long or stiff tubing.
61
The nurse is assessing a patient’s invasive arterial pressure waveform and suspects overdamping. Which of the following could be a potential cause?
A) Blood clot in the catheter
B) Excessively stiff pressure tubing
C) Increased cardiac output
D) Transducer positioned above the phlebostatic axis
A) Blood clot in the catheter
Rationale: Overdamping can result from blood clots, air bubbles, or kinks in the tubing, which reduce the responsiveness of the pressure system.
62
Which of the following actions ensures accuracy when setting up an invasive arterial blood pressure monitoring system?
A) Positioning the transducer above the level of the heart
B) Filling the flush system with heparinized saline
C) Ensuring continuous pressure of 300 mmHg in the flush system
D) Flushing the arterial line every hour manually
C) Ensuring continuous pressure of 300 mmHg in the flush system
Rationale: The flush system must maintain 300 mmHg pressure to prevent clot formation and ensure continuous flow through the catheter.
63
The nurse is caring for a patient with an arterial line. The pressure transducer is positioned below the phlebostatic axis. What effect will this have on the readings?
A) Readings will be falsely high
B) Readings will be falsely low
C) There will be no effect on accuracy
D) The waveform will be overdamped
A) Readings will be falsely high
Rationale: If the transducer is placed below the phlebostatic axis, it will register a higher pressure than the actual value due to hydrostatic pressure effects.
64
Which of the following is the correct indication for using invasive arterial pressure monitoring?
A) Assessing pulmonary artery wedge pressure (PAWP)
B) Evaluating response to vasoactive medications
C) Measuring central venous pressure (CVP)
D) Monitoring mixed venous oxygen saturation (SvO2)
B) Evaluating response to vasoactive medications
Rationale: Invasive arterial pressure monitoring is used to assess hemodynamic status and response to vasoactive medications in critically ill patients.
65
The nurse is caring for a patient with an invasive arterial line. Which finding requires immediate intervention?
A) Dicrotic notch visible on the waveform
B) Dampened arterial waveform with absent oscillations
C) Pressure bag inflated to 300 mmHg
D) Mean arterial pressure of 85 mmHg
B) Dampened arterial waveform with absent oscillations
Rationale: A dampened waveform suggests occlusion (e.g., clot or air bubble), which can compromise accuracy and perfusion. Immediate troubleshooting is required.
66
During a square wave test, the nurse observes no oscillations and a slow return to baseline. What is the most likely cause?
A) Air bubbles in the line
B) Excessive tubing length
C) Under-responsiveness of the system
D) Loose pressure connections
A) Air bubbles in the line
Rationale: A slow return to baseline with absent oscillations suggests overdamping, which leads to falsely low readings. Possible causes include blood clots, air bubbles, or tubing kinks.
67
Which action should the nurse take when discontinuing an invasive arterial catheter?
A) Deflate the pressure bag before removal
B) Flush the catheter with 5 mL of heparinized saline before removal
C) Allow the site to clot naturally without pressure
D) Apply pressure to the site for at least 5 minutes
D) Apply pressure to the site for at least 5 minutes
Rationale: Applying pressure for at least 5 minutes prevents excessive bleeding, as arterial lines are placed in high-pressure vessels.
68
A nurse is caring for a patient with a radial arterial line for continuous blood pressure monitoring. Which assessment finding requires immediate intervention?
A) Dicrotic notch present on the arterial waveform
B) Blood pressure reading of 120/75 mmHg
C) Capillary refill time of 6 seconds in the hand
D) Slight redness at the insertion site
C) Capillary refill time of 6 seconds in the hand
Rationale: Prolonged capillary refill suggests compromised distal perfusion, possibly due to arterial occlusion or thrombosis. This requires immediate intervention to prevent ischemia.
69
Which patient would most likely benefit from continuous arterial blood pressure monitoring?
A) A patient with stable hypertension controlled by oral medication
B) A patient requiring frequent arterial blood gas (ABG) sampling
C) A patient receiving subcutaneous heparin therapy
D) A patient with mild dehydration and an IV fluid bolus order
B) A patient requiring frequent arterial blood gas (ABG) sampling
Rationale: Continuous arterial BP monitoring is indicated for patients requiring frequent ABG draws, as it allows for repeated sampling without repeated arterial punctures.
70
The nurse is assisting with the insertion of a radial arterial line. Which action is essential before catheter placement?
A) Administering a bolus of IV normal saline
B) Performing the Allen test to assess collateral circulation
C) Inflating the pressure bag to 200 mmHg
D) Applying a tourniquet to the radial artery
B) Performing the Allen test to assess collateral circulation
Rationale: The Allen test ensures that the ulnar artery can provide sufficient blood flow to the hand in case radial artery occlusion occurs after catheter insertion.
71
A nurse is caring for a patient with a femoral arterial catheter. Which intervention is most important to prevent complications?
A) Keep the patient in high Fowler’s position to improve circulation
B) Flush the catheter every 2 hours with heparinized saline
C) Encourage early ambulation to promote blood flow
D) Frequently assess distal pulses and capillary refill in the affected leg
D) Frequently assess distal pulses and capillary refill in the affected leg
Rationale: Since femoral artery catheterization can impair circulation, frequent assessment of distal pulses and perfusion is crucial to detect early signs of ischemia.
72
The nurse is caring for a patient receiving norepinephrine via continuous infusion. Why is an arterial line preferred for blood pressure monitoring in this patient?
A) It allows for real-time assessment of the patient’s hemodynamic response
B) It prevents blood pressure fluctuations
C) It reduces the need for vasoactive medications
D) It eliminates the need for a central venous catheter
A) It allows for real-time assessment of the patient’s hemodynamic response
Rationale: Patients on vasoactive drugs like norepinephrine require continuous arterial blood pressure monitoring to adjust medication dosages quickly and maintain hemodynamic stability.
73
A nurse is reviewing care for a patient with an arterial line. Which statement by a new graduate nurse requires correction?
A) “I will immobilize the arterial line to prevent dislodgement.”
B) “I will assess the insertion site frequently for signs of infection.”
C) “I will ensure the pressure bag is inflated to 300 mmHg.”
D) “I will use the arterial line for blood pressure monitoring and medication administration.”
D) “I will use the arterial line for blood pressure monitoring and medication administration.”
Rationale: Arterial lines are used for blood pressure monitoring and blood sampling but should never be used for medication administration due to the risk of severe complications, including tissue necrosis.
74
A nurse is monitoring a patient’s blood pressure using an arterial line. Which action ensures the most accurate measurement?
A) Keeping the transducer at the level of the phlebostatic axis
B) Positioning the patient in a high Fowler’s position
C) Placing the transducer at the level of the radial artery
D) Zeroing the transducer every 24 hours
A) Keeping the transducer at the level of the phlebostatic axis
Rationale: The transducer must be at the phlebostatic axis (4th ICS, midaxillary line) to ensure accurate pressure measurements. Incorrect positioning can lead to falsely high or low readings.
75
A patient’s arterial line waveform shows a slow systolic upstroke. Which condition is most likely causing this change?
A) Heart failure
B) Hypovolemia
C) Hypertension
D) Atrial fibrillation
A) Heart failure
Rationale: In heart failure, reduced contractility leads to a slower rise in arterial pressure, causing a delayed or blunted systolic upstroke on the arterial waveform.
76
The nurse is assessing an arterial pressure tracing in a patient receiving mechanical ventilation. Which finding indicates volume depletion?
A) Elevated systolic pressure with inspiration
B) Systolic pressure variation with inspiration
C) Diminished diastolic pressure throughout
D) Flattened dicrotic notch
B) Systolic pressure variation with inspiration
Rationale: In volume depletion, systolic pressure fluctuates with mechanical ventilation, decreasing during inspiration due to reduced preload.
77
A patient with an arterial line develops an irregular ECG rhythm. Why is it important for the nurse to observe simultaneous arterial pressure tracings?
A) To monitor the patient’s cardiac output
B) To confirm blood pressure accuracy with ECG readings
C) To assess for dysrhythmias that may significantly decrease arterial BP
D) To evaluate fluid responsiveness in volume-depleted states
C) To assess for dysrhythmias that may significantly decrease arterial BP
Rationale: Some dysrhythmias, such as ventricular tachycardia or atrial fibrillation with rapid response, can significantly decrease arterial BP. The nurse must correlate ECG and arterial tracings for early intervention.
78
The nurse notes that a patient’s MAP is 55 mmHg on an arterial line reading. What is the priority nursing action?
A) Lower the head of the bed to 30 degrees
B) Reposition the transducer to the phlebostatic axis
C) Increase the pressure bag inflation to 350 mmHg
D) Assess for signs of inadequate organ perfusion
D) Assess for signs of inadequate organ perfusion
Rationale: A MAP below 60 mmHg can lead to poor organ perfusion. The nurse should assess for signs of hypoperfusion, such as altered mental status, decreased urine output, or cool extremities.
79
The nurse is setting high- and low-pressure alarms for an arterial line. Which factor should guide alarm settings?
A) Manufacturer’s preset alarm ranges
B) The patient’s baseline blood pressure
C) Standard hospital protocol for all arterial lines
D) The nurse’s judgment based on the patient’s condition
B) The patient’s baseline blood pressure
Rationale: Alarm settings should be individualized based on the patient’s baseline BP to detect clinically significant changes while avoiding excessive false alarms.
80
A nurse is troubleshooting an arterial line that is showing dampened waveforms. Which action should the nurse take first?
A) Flush the arterial line with a fast flush
B) Zero the transducer again
C) Increase the pressure bag to 400 mmHg
D) Lower the transducer below the phlebostatic axis
A) Flush the arterial line with a fast flush
Rationale: A dampened waveform may be due to clot formation or air bubbles in the line. Flushing the line with a fast flush can restore an accurate waveform.
81
Which statement by a nursing student about arterial line measurements requires correction?
A) “I will document arterial waveforms in the patient’s health record.”
B) “I will position the patient at a 45-degree angle for accuracy.”
C) “I will set high- and low-pressure alarms based on the patient’s status.”
D) “I will use the arterial line for continuous infusion of vasopressors.”
D) “I will use the arterial line for continuous infusion of vasopressors.”
Rationale: Arterial lines are used for blood pressure monitoring and blood sampling, not for medication administration, due to the risk of severe complications such as limb ischemia.
82
A nurse is caring for a patient with an arterial line. Which assessment finding requires immediate intervention?
A) Warm, pink skin distal to the insertion site
B) Capillary refill of less than 2 seconds
C) Hand blanching with no return of color after 10 seconds
D) A pressure bag inflated to 300 mmHg
C) Hand blanching with no return of color after 10 seconds
Rationale: Delayed return of color after release of the ulnar artery in the Allen test suggests inadequate collateral circulation, which can lead to ischemia if an arterial line is inserted in that limb.
83
Which action is most important in preventing hemorrhage in a patient with an arterial line?
A) Keeping the patient in a supine position
B) Using Luer-Lok connections on all arterial tubing
C) Flushing the line every 4 hours
D) Applying a sterile dressing over the insertion site
B) Using Luer-Lok connections on all arterial tubing
Rationale: Luer-Lok connections secure the arterial line and prevent accidental disconnection, which could lead to rapid blood loss.
84
A patient with an arterial line suddenly develops cool, pale fingers with a capillary refill greater than 3 seconds. What is the priority nursing action?
A) Increase the pressure bag to 350 mmHg
B) Remove the arterial catheter immediately
C) Notify the HCP and assess for neurovascular impairment
D) Apply a warm compress to the affected limb
C) Notify the HCP and assess for neurovascular impairment
Rationale: These findings suggest compromised arterial flow, which could lead to limb loss if not addressed promptly. The HCP must be notified immediately.
85
Which intervention is essential to reduce the risk of catheter-related infection in a patient with an arterial line?
A) Changing the flush solution every 24 hours
B) Inspecting the insertion site regularly for signs of inflammation
C) Avoiding blood sampling from the arterial line
D) Keeping the patient’s arm elevated at all times
B) Inspecting the insertion site regularly for signs of inflammation
Rationale: Regular inspection helps detect early signs of infection, allowing for prompt intervention before systemic complications develop.
86
What is the purpose of the Allen test before inserting a radial arterial line?
A) To determine if ulnar circulation is adequate
B) To assess the patient’s pain tolerance
C) To confirm the presence of a venous thrombus
D) To check for arterial stiffness
A) To determine if ulnar circulation is adequate
Rationale: The Allen test ensures that collateral circulation via the ulnar artery is sufficient to perfuse the hand if the radial artery becomes occluded.
87
A nurse is caring for a patient with an arterial line. Which flush system assessment finding requires intervention?
A) The pressure bag is inflated to 300 mmHg
B) The flush system delivers 2 mL/hr of solution
C) The flush bag is nearly empty
D) The arterial line tubing is free of visible air bubbles
C) The flush bag is nearly empty
Rationale: An empty flush bag can lead to clot formation in the arterial line. The bag should be replaced before it runs out.
88
A patient with an arterial line develops a systemic infection. What is the nurse’s priority action?
A) Administer IV antibiotics immediately
B) Remove the arterial catheter and replace the equipment
C) Change the pressure tubing and transducer
D) Notify the HCP and obtain blood cultures
B) Remove the arterial catheter and replace the equipment
Rationale: The arterial line is a potential source of infection. It should be removed immediately to prevent further complications.
89
Which action by the nurse helps prevent thrombus formation in a patient with an arterial line?
A) Flushing the line with heparin every 8 hours
B) Keeping the patient’s arm in a dependent position
C) Ensuring the flush system delivers 1-3 mL/hr of solution
D) Applying a tourniquet above the insertion site every 4 hours
C) Ensuring the flush system delivers 1-3 mL/hr of solution
Rationale: A continuous slow flush prevents clot formation without causing excessive heparin exposure.
90
Which finding suggests a complication of an arterial line?
A) Bounding radial pulse
B) Capillary refill less than 2 seconds
C) Diminished sensation in fingers distal to the insertion site
D) A dicrotic notch on the arterial waveform
C) Diminished sensation in fingers distal to the insertion site
Rationale: Diminished sensation suggests neurovascular impairment, which could indicate ischemia or thrombus formation.
91
A nurse is assessing a patient’s arterial line flush system. Which finding requires immediate action?
A) The transducer is level with the phlebostatic axis
B) The pressure bag is inflated to 250 mmHg
C) The flush system is delivering 2 mL/hr of solution
D) The flush bag contains normal saline without heparin
B) The pressure bag is inflated to 250 mmHg
Rationale: The pressure bag must be maintained at 300 mmHg to ensure continuous flushing and prevent clot formation.
92
A patient’s arterial line is accidentally disconnected, and bright red blood is spurting from the site. What is the nurse’s priority action?
A) Apply direct pressure over the insertion site
B) Reconnect the arterial line tubing
C) Lower the patient’s arm below heart level
D) Notify the HCP immediately
A) Apply direct pressure over the insertion site
Rationale: Arterial lines are high-pressure systems, and disconnection can cause rapid blood loss. Immediate direct pressure is needed to prevent hemorrhage.
93
What is the most appropriate action to reduce the risk of arterial spasm after catheter insertion?
A) Apply warm compresses to the insertion site
B) Keep the patient’s arm elevated for 6 hours
C) Administer IV fluids rapidly after insertion
D) Avoid excessive manipulation of the catheter
D) Avoid excessive manipulation of the catheter
Rationale: Excessive movement of the catheter can trigger arterial spasm, leading to decreased perfusion.
94
Which patient is at the highest risk for arterial line complications?
A) A patient receiving IV fluids at 75 mL/hr
B) A patient with severe peripheral vascular disease
C) A patient with a history of controlled hypertension
D) A patient with a low platelet count
B) A patient with severe peripheral vascular disease
Rationale: Patients with peripheral vascular disease have compromised circulation, increasing the risk for ischemic complications.
95
How often should the nurse assess neurovascular status distal to an arterial line insertion site?
A) Every 30 minutes
B) Every hour
C) Every 4 hours
D) Every 8 hours
B) Every hour
Rationale: Hourly assessments help detect early signs of neurovascular impairment and prevent complications.
96
A nurse suspects an arterial line infection. What is the priority nursing intervention?
A) Increase the flush rate to 5 mL/hr
B) Remove the arterial catheter and notify the HCP
C) Apply antibiotic ointment to the insertion site
D) Flush the line with heparinized saline
B) Remove the arterial catheter and notify the HCP
Rationale: If an infection is suspected, the catheter should be removed immediately to prevent sepsis.
97
Which arterial line complication requires emergency intervention to prevent limb loss?
A) Mild redness at the insertion site
B) Bruising around the catheter site
C) Numbness and pallor in the affected limb
D) Dampened arterial waveform on the monitor
C) Numbness and pallor in the affected limb
Rationale: These symptoms indicate neurovascular impairment, which can lead to ischemia and tissue necrosis.
98
Which practice is recommended for maintaining arterial line patency?
A) Heparinizing the flush bag daily
B) Flushing the line with 10 mL of saline every 4 hours
C) Clamping the line when not in use
D) Keeping the pressure bag at 300 mmHg
D) Keeping the pressure bag at 300 mmHg
Rationale: Maintaining proper pressure ensures continuous flushing and prevents clot formation.
99
A nurse is using arterial pressure-based cardiac output (APCO) monitoring to assess a patient’s preload responsiveness. Which finding indicates that the patient may benefit from additional IV fluid boluses?
A) Decreased stroke volume variation (SVV)
B) Increased SVV
C) Stable stroke volume (SV) after fluid administration
D) Increased cardiac output without changes in SVV
B) Increased SVV
Rationale: Increased SVV indicates significant arterial pulsation variability, suggesting that the patient is preload responsive and may benefit from additional IV fluids.
100
What is the primary advantage of using APCO monitoring over other cardiac output measurement techniques?
A) It does not require an invasive catheter
B) It eliminates the need for arterial blood pressure monitoring
C) It directly measures left ventricular ejection fraction
D) It provides continuous cardiac output (CCO) measurements
D) It provides continuous cardiac output (CCO) measurements
Rationale: APCO monitoring continuously assesses cardiac output trends, allowing for real-time hemodynamic management.
101
A patient with APCO monitoring has a stable cardiac index (CI) but a high SVV. What is the most appropriate intervention?
A) Administer a fluid bolus
B) Increase the patient’s ventilator rate
C) Reduce IV fluid administration
D) Discontinue APCO monitoring
A) Administer a fluid bolus
Rationale: A high SVV suggests preload responsiveness, meaning the patient may benefit from additional fluids to optimize stroke volume and cardiac output.
102
The nurse is reviewing arterial pressure-based cardiac output (APCO) data. Which finding suggests that a patient has adequate preload and does not need further fluid resuscitation?
A) Decreasing cardiac output with increasing SVV
B) Stable stroke volume with a low SVV
C) Widening pulse pressure with increasing SVV
D) Decreasing stroke volume with a high SVV
B) Stable stroke volume with a low SVV
Rationale: A low SVV and stable stroke volume indicate that the patient is not preload responsive and does not require additional fluid resuscitation.
103
Which factor may interfere with the accuracy of stroke volume variation (SVV) in APCO monitoring?
A) Patient’s ventilator settings
B) Use of IV vasoactive medications
C) Patient’s hemoglobin level
D) Central venous pressure readings
A) Patient’s ventilator settings
Rationale: SVV is influenced by heart-lung interactions and may be inaccurate in patients with irregular breathing patterns or those on mechanical ventilation with low tidal volumes.
104
A patient receiving APCO monitoring is found to have a decreasing cardiac output (CO) despite fluid administration. What is the nurse’s priority action?
A) Continue administering fluid boluses
B) Assess for signs of fluid overload or heart failure
C) Increase the patient’s ventilator tidal volume
D) Lower the patient’s arterial line transducer
B) Assess for signs of fluid overload or heart failure
Rationale: If cardiac output does not improve with fluids, the patient may have impaired cardiac function or fluid overload, requiring further assessment.
105
Which patient would be the best candidate for arterial pressure-based cardiac output (APCO) monitoring?
A) A patient in cardiogenic shock with severe mitral regurgitation
B) A patient on high-dose vasopressors with fluctuating blood pressure
C) A patient with hypovolemic shock requiring fluid resuscitation
D) A patient with atrial fibrillation and a rapid ventricular response
C) A patient with hypovolemic shock requiring fluid resuscitation
Rationale: APCO is most effective in assessing fluid responsiveness in patients with hypovolemia, helping guide fluid resuscitation decisions.
106
The nurse is monitoring APCO data and notes a sharp increase in SVV. What does this finding most likely indicate?
A) The patient has increased myocardial contractility
B) The patient is experiencing worsening heart failure
C) The patient has excessive preload and needs diuresis
D) The patient is hypovolemic and may benefit from fluids
D) The patient is hypovolemic and may benefit from fluids
Rationale: A sharp increase in SVV suggests increased variation in stroke volume due to decreased circulating volume, indicating preload responsiveness and the need for fluid administration.
107
Which physiologic factor primarily determines the arterial pressure measured by APCO monitoring?
A) Stroke volume (SV)
B) Central venous pressure (CVP)
C) Systemic vascular resistance (SVR)
D) Mixed venous oxygen saturation (SvO2)
A) Stroke volume (SV)
Rationale: Arterial pressure is generated by the ejection of blood from the left ventricle, making SV a key determinant in APCO monitoring.
108
A nurse is reviewing APCO data and notes a decrease in cardiac output (CO). Which compensatory response would the body initiate to maintain perfusion?
A) Increased systemic vascular resistance (SVR)
B) Decreased heart rate (HR)
C) Decreased stroke volume index (SVI)
D) Increased central venous pressure (CVP)
A) Increased systemic vascular resistance (SVR)
Rationale: When CO decreases, the body compensates by increasing SVR to maintain adequate blood pressure and perfusion.
109
Which variable is used in APCO monitoring to calculate continuous cardiac output (CCO)?
A) Stroke volume and heart rate
B) Central venous pressure and pulmonary artery pressure
C) Mixed venous oxygen saturation and pulse pressure
D) Ejection fraction and mean arterial pressure
A) Stroke volume and heart rate
Rationale: CO is calculated as CO = SV × HR, with SV being derived from arterial waveform characteristics.
110
A patient undergoing APCO monitoring has a persistently low stroke volume (SV) despite normal heart rate (HR). What could be a potential cause?
A) Decreased preload
B) Increased cardiac output
C) Decreased systemic vascular resistance
D) Increased mixed venous oxygen saturation (SvO2)
A) Decreased preload
Rationale: Stroke volume is directly affected by preload, and low SV suggests insufficient ventricular filling.
111
How frequently does APCO monitoring update and display continuous cardiac output (CCO) values?
A) Every 5 seconds
B) Every 10 seconds
C) Every 20 seconds
D) Every 60 seconds
C) Every 20 seconds
Rationale: APCO monitoring updates CCO, CI, SV, and SVI data every 20 seconds, allowing for real-time assessment.
112
A nurse is caring for a patient with APCO monitoring and a central venous oximetry catheter. Which additional hemodynamic parameter can be continuously monitored?
A) Pulmonary artery pressure (PAP)
B) Central venous oxygen saturation (ScvO2)
C) Left ventricular end-diastolic pressure (LVEDP)
D) Right atrial pressure (RAP)
B) Central venous oxygen saturation (ScvO2)
Rationale: APCO monitoring combined with a central venous oximetry catheter allows for continuous monitoring of ScvO2, an indicator of oxygen delivery and consumption balance.
113
The nurse is evaluating a patient’s arterial pressure waveform in APCO monitoring. What could cause inaccurate stroke volume (SV) calculations?
A) Use of a femoral arterial catheter
B) Regular respiratory cycles on mechanical ventilation
C) Irregular heart rhythms, such as atrial fibrillation
D) Use of central venous catheters for monitoring
C) Irregular heart rhythms, such as atrial fibrillation
Rationale: Atrial fibrillation and other arrhythmias cause beat-to-beat variability, leading to inaccurate SV calculations in APCO monitoring.
114
Which demographic factors does APCO monitoring use to refine stroke volume (SV) calculations?
A) Age, gender, weight, height
B) Blood type, ethnicity, BMI, hydration status
C) Respiratory rate, body temperature, diastolic BP, muscle mass
D) Cardiac index, hemoglobin level, oxygen saturation, body fat percentage
A) Age, gender, weight, height
Rationale: APCO monitoring integrates these demographic factors to improve the accuracy of SV and CO calculations based on arterial waveform analysis.
115
A patient’s arterial pressure-based cardiac output (APCO) readings show a sudden increase in systemic vascular resistance (SVR). What condition could this indicate?
A) Septic shock
B) Neurogenic shock
C) Cardiogenic shock
D) Anaphylactic shock
C) Cardiogenic shock
Rationale: Increased SVR is commonly seen in cardiogenic shock as the body attempts to compensate for decreased CO by vasoconstriction.
116
A nurse is caring for a patient with a pulmonary artery (PA) catheter. Which parameter is the most sensitive indicator of left ventricular preload?
A) Pulmonary artery systolic pressure (PASP)
B) Pulmonary artery diastolic pressure (PADP)
C) Pulmonary artery wedge pressure (PAWP)
D) Central venous pressure (CVP)
C) Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP reflects left ventricular end-diastolic pressure, making it the most accurate indicator of left ventricular preload.
117
Which patient condition is most likely to cause an increase in pulmonary artery wedge pressure (PAWP)?
A) Hypovolemic shock
B) Left-sided heart failure
C) Pulmonary embolism
D) Severe dehydration
B) Left-sided heart failure
Rationale: In left-sided HF, blood backs up into the pulmonary circulation, increasing PAWP due to elevated left ventricular pressures.
118
What is the primary purpose of inflating the balloon on a pulmonary artery catheter?
A) To allow measurement of PAWP
B) To assist with cardiac output measurement
C) To prevent catheter migration
D) To monitor mixed venous oxygen saturation (SvO2)
A) To allow measurement of PAWP
Rationale: Balloon inflation momentarily occludes pulmonary blood flow, allowing measurement of left-sided preload (PAWP).
119
Which factor must be assessed before inserting a PA catheter to minimize complications?
A) Hemoglobin and hematocrit levels
B) Serum creatinine and BUN levels
C) Liver function tests
D) Electrolyte and acid-base status
D) Electrolyte and acid-base status
Rationale: Hypokalemia, hypomagnesemia, hypoxemia, and acidosis increase the risk of ventricular dysrhythmias during catheter insertion.
120
A PA catheter is advanced into the right ventricle. What is the priority nursing intervention?
A) Monitor the patient’s oxygen saturation
B) Assess the patient’s urine output
C) Closely monitor the ECG for dysrhythmias
D) Administer IV fluids to maintain preload
C) Closely monitor the ECG for dysrhythmias
Rationale: PA catheter passage through the right ventricle can trigger ventricular dysrhythmias, requiring continuous ECG monitoring.
121
Which parameter measured by a PA catheter is most useful for assessing right ventricular function?
A) Pulmonary artery wedge pressure (PAWP)
B) Right ventricular ejection fraction (RVEF)
C) Pulmonary artery diastolic pressure (PADP)
D) Stroke volume index (SVI)
B) Right ventricular ejection fraction (RVEF)
Rationale: RVEF provides direct information about right ventricular contractility and function.
122
A patient with a PA catheter has a PAWP of 20 mmHg. What should the nurse suspect?
A) Hypovolemia
B) Left-sided heart failure
C) Pulmonary embolism
D) Normal fluid balance
B) Left-sided heart failure
Rationale: Normal PAWP is 6-12 mmHg. A PAWP of 20 mmHg suggests left ventricular failure or fluid overload.
123
Why is a chest x-ray required after PA catheter insertion?
A) To assess pulmonary artery pressure (PAP)
B) To evaluate lung compliance
C) To detect cardiomegaly
D) To confirm proper catheter placement
D) To confirm proper catheter placement
Rationale: A chest x-ray ensures the PA catheter tip is correctly positioned and rules out complications like pneumothorax.
124
Which action is essential before obtaining a pulmonary artery wedge pressure (PAWP) reading?
A) Place the patient in a prone position
B) Deflate the balloon before measuring pressure
C) Inflate the balloon slowly until waveform changes
D) Flush the catheter with heparinized saline
C) Inflate the balloon slowly until waveform changes
Rationale: The balloon must be inflated just enough to obtain PAWP readings, but overinflation can cause pulmonary artery rupture.
125
A nurse is caring for a patient with a PA catheter. Which sign indicates a possible catheter-related infection?
A) Decreased cardiac output
B) Increased SvO2
C) Fever and leukocytosis
D) Decreased pulmonary artery pressures
C) Fever and leukocytosis
Rationale: Fever and leukocytosis suggest a catheter-related bloodstream infection (CRBSI), requiring immediate intervention.
126
Which PA pressure is most closely correlated with left ventricular end-diastolic pressure?
A) Pulmonary artery diastolic pressure (PADP)
B) Pulmonary artery systolic pressure (PASP)
C) Pulmonary artery wedge pressure (PAWP)
D) Right atrial pressure (RAP)
C) Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP directly reflects left ventricular end-diastolic pressure (LVEDP) in normal conditions.
127
Which complication is the greatest concern during PA catheter insertion?
A) Myocardial infarction
B) Ventricular dysrhythmias
C) Pulmonary edema
D) Acute respiratory distress syndrome (ARDS)
B) Ventricular dysrhythmias
Rationale: PA catheter passage through the right ventricle can trigger ventricular tachycardia or fibrillation.
128
Which nursing action helps prevent catheter-related infections in patients with PA catheters?
A) Applying an occlusive sterile dressing
B) Flushing the catheter every 12 hours
C) Administering prophylactic antibiotics
D) Repositioning the catheter every shift
A) Applying an occlusive sterile dressing
Rationale: A sterile occlusive dressing prevents bacterial contamination at the insertion site.
129
A nurse notes that a PA catheter waveform changes abruptly. What should be the priority action?
A) Inflate the balloon to confirm placement
B) Increase IV fluids to optimize preload
C) Obtain a stat chest x-ray
D) Check for kinks or dislodgement in the line
D) Check for kinks or dislodgement in the line
Rationale: Sudden waveform changes suggest catheter displacement, occlusion, or migration.
130
What is the main reason for the decline in PA catheter use?
A) Invasive nature and risk of complications
B) High cost compared to alternative methods
C) Need for frequent recalibration
D) Inability to measure right ventricular function
A) Invasive nature and risk of complications
Rationale: Risks such as dysrhythmias, infection, and pulmonary artery rupture have led to decreased PA catheter use.
131
Which patient is most likely to benefit from PA pressure monitoring?
A) A patient with chronic hypertension
B) A patient recovering from an appendectomy
C) A patient with mild dehydration
D) A patient with acute respiratory distress syndrome (ARDS)
D) A patient with acute respiratory distress syndrome (ARDS)
Rationale: PA catheters are useful in ARDS to assess fluid management and pulmonary vascular pressures.
132
Which parameter is obtained directly from the PA catheter to assess tissue oxygenation?
A) Stroke volume index (SVI)
B) Right ventricular ejection fraction (RVEF)
C) Cardiac output (CO)
D) Mixed venous oxygen saturation (SvO2)
D) Mixed venous oxygen saturation (SvO2)
Rationale: SvO2 reflects oxygen delivery vs. consumption, a key indicator of tissue oxygenation.
133
Which of the following conditions is most likely to cause an elevated central venous pressure (CVP)?
A. Hypovolemia
B. Right ventricular failure
C. Acute blood loss
D. Severe dehydration
B. Right ventricular failure
Rationale: CVP is a measurement of right ventricular preload. A high CVP suggests volume overload or right ventricular failure due to the heart’s inability to effectively pump blood forward, leading to increased venous pressure.
134
A nurse is caring for a patient with a central venous catheter in the internal jugular vein for CVP monitoring. When should the nurse obtain an accurate CVP measurement?
A. During inspiration
B. During expiration
C. During patient movement
D. When the patient is sitting upright
B. During expiration
Rationale: CVP is measured as a mean pressure at the end of expiration because intrathoracic pressures are most stable at that point, ensuring an accurate reflection of right atrial pressure.
135
Which of the following findings in a patient with a central venous catheter is most concerning and requires immediate intervention?
A. CVP reading of 4 mmHg in a postoperative patient
B. CVP reading of 6 mmHg in a patient with mild dehydration
C. CVP reading of 8 mmHg in a patient receiving IV fluids
D. CVP reading of 18 mmHg with jugular vein distension
D. CVP reading of 18 mmHg with jugular vein distension
Rationale: A CVP above normal (2-8 mmHg) suggests volume overload or right ventricular failure. Jugular vein distension further indicates increased right-sided pressures, requiring immediate assessment and possible intervention.
136
A patient with suspected hypovolemia has a central venous catheter placed for CVP monitoring. Which of the following CVP readings would confirm hypovolemia?
A. 14 mmHg
B. 10 mmHg
C. 6 mmHg
D. 1 mmHg
D. 1 mmHg
Rationale: A low CVP (<2 mmHg) indicates hypovolemia, suggesting insufficient preload due to decreased circulating blood volume. This requires fluid resuscitation to restore adequate perfusion.
137
Which of the following statements about central venous pressure (CVP) monitoring is correct?
A. A high CVP always indicates the need for diuretics
B. CVP is measured using the distal lumen of a PA catheter
C. CVP monitoring helps assess right ventricular preload
D. A low CVP indicates left ventricular failure
C. CVP monitoring helps assess right ventricular preload
Rationale: CVP reflects right ventricular preload and provides valuable information about a patient’s fluid volume status. It is measured using the proximal lumen of a PA catheter or a central venous catheter.
138
Which clinical sign should the nurse monitor to assess for decreased cardiac output (CO) in a critically ill patient?
A. Warm, flushed skin
B. Increased capillary refill time
C. Increased peripheral pulses
D. Increased urine output
B. Increased capillary refill time
Rationale: Decreased CO often leads to poor perfusion, which can result in delayed capillary refill. Warm, flushed skin and increased peripheral pulses are generally signs of good circulation, while increased urine output indicates adequate perfusion to the kidneys.
139
A patient with septic shock has a warm, pink appearance but is experiencing tachycardia and BP instability. What is the most likely cause of these symptoms?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
C. Septic shock
Rationale: In septic shock, the patient often presents with warm, pink skin due to peripheral vasodilation, despite experiencing tachycardia and BP instability. In contrast, hypovolemic shock typically results in cold, pale skin due to vasoconstriction.
140
Why is it important to monitor trends in hemodynamic values rather than focusing on a single value?
A. To determine the patient’s pain level
B. To assess the patient’s response to medications
C. To evaluate the overall stability and progression of the patient’s condition
D. To predict the patient’s length of stay in the hospital
C. To evaluate the overall stability and progression of the patient’s condition
Rationale: Single hemodynamic values can fluctuate and may not provide a comprehensive view of the patient’s condition. Monitoring trends over time helps identify worsening or improving conditions, allowing for timely interventions.
141
What is the primary nursing action if a patient shows signs of decreased cerebral perfusion (e.g., changes in mental status)?
A. Administer oxygen and monitor vital signs
B. Increase fluid intake
C. Reduce the patient’s environmental stressors
D. Assess for peripheral edema
A. Administer oxygen and monitor vital signs
Rationale: Decreased cerebral perfusion can result from inadequate oxygen delivery to the brain. Administering oxygen helps improve oxygenation, and closely monitoring vital signs allows for timely detection of changes in the patient’s condition.
142
What condition may present with hypotension and tachycardia, but with an initially stable BP in a patient who is bleeding?
A. Anemia
B. Cardiogenic shock
C. Hypovolemic shock
D. Septic shock
C. Hypovolemic shock
Rationale: In hypovolemic shock, especially during acute blood loss, BP may remain stable initially due to compensatory mechanisms like vasoconstriction. However, tachycardia is a compensatory response to maintain perfusion, and BP may eventually drop as shock progresses.
143
How does sustained tachycardia negatively impact a patient with decreased cardiac output?
A. It increases myocardial oxygen demand, potentially decreasing CO further
B. It decreases the patient’s blood pressure
C. It increases urine output
D. It improves tissue perfusion
A. It increases myocardial oxygen demand, potentially decreasing CO further
Rationale: Sustained tachycardia increases the heart’s demand for oxygen. This may worsen the already compromised cardiac output, especially in a critically ill patient, as the heart struggles to meet its oxygen demands.
144
In a critically ill patient, which change in urine output is an early indicator of impaired renal perfusion?
A. Increased urine output
B. Decreased urine output or oliguria
C. Increased urinary frequency
D. No change in urine output
B. Decreased urine output or oliguria
Rationale: Decreased urine output or oliguria is an early sign of impaired renal perfusion, indicating that the kidneys are not receiving enough blood flow to maintain normal function. Increased urine output typically indicates good perfusion.
145
A nurse observes a patient with hypotension, tachycardia, and cool, pale skin. What action should the nurse prioritize?
A. Prepare the patient for surgery
B. Administer pain medication
C. Increase the patient’s room temperature
D. Increase IV fluid infusion
D. Increase IV fluid infusion
Rationale: These symptoms indicate possible hypovolemic shock, where inadequate fluid volume is causing poor perfusion. Administering IV fluids is the first step in improving circulation and restoring perfusion to vital organs.
146
What is the nurse’s role in assessing hemodynamic status using invasive technology?
A. Provide medications as ordered
B. Observe waveforms and correlate them with clinical findings
C. Perform diagnostic tests for electrolyte imbalances
D. Administer blood products
B. Observe waveforms and correlate them with clinical findings
Rationale: The nurse’s role includes interpreting the waveforms generated by invasive monitoring devices (e.g., PA catheter) and correlating them with the patient’s clinical condition. This helps guide interventions and ensures timely adjustments to care.
147
What is the primary reason for performing continuous ECG monitoring during the insertion of a PA catheter?
A. To assess the patient’s heart rate
B. To monitor for dysrhythmias
C. To evaluate the patient’s oxygenation status
D. To determine the patient’s cardiac output
B. To monitor for dysrhythmias
Rationale: The insertion of a PA catheter can irritate the heart and provoke dysrhythmias, especially when the catheter reaches the right ventricle. Continuous ECG monitoring is necessary to detect any abnormal rhythms immediately.
148
Which of the following electrolyte imbalances could increase the risk of dysrhythmias during PA catheter insertion?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypophosphatemia
B. Hypokalemia
Rationale: Hypokalemia is known to increase the risk of dysrhythmias, as it can make the heart more irritable and prone to abnormal rhythms. Maintaining balanced electrolytes is crucial when managing critically ill patients.
149
How is PAWP used to assess a patient’s fluid volume status?
A. An increase in PAWP indicates fluid volume overload
B. An increase in PAWP indicates dehydration
C. A decrease in PAWP indicates heart failure
D. A decrease in PAWP indicates fluid retention
A. An increase in PAWP indicates fluid volume overload
Rationale: PAWP (Pulmonary Artery Wedge Pressure) is a sensitive indicator of heart function and fluid volume status. An increase in PAWP suggests fluid volume overload, which can occur in conditions like heart failure.
150
What is the risk associated with invasive hemodynamic monitoring?
A. Skin breakdown from prolonged monitoring
B. Bleeding or infection at catheter insertion sites
C. Anxiety from the complexity of the equipment
D. Nausea from continuous monitoring
B. Bleeding or infection at catheter insertion sites
Rationale: Invasive procedures like PA catheter insertion carry risks such as bleeding or infection at the catheter insertion site, making careful monitoring and sterile technique crucial during and after insertion.
151
What is the importance of obtaining a chest x-ray after PA catheter insertion?
A. To monitor for signs of heart failure
B. To evaluate oxygenation levels
C. To assess for catheter placement and avoid complications
D. To assess for lung cancer
C. To assess for catheter placement and avoid complications
Rationale: A chest x-ray confirms that the PA catheter is properly positioned within the pulmonary artery. Improper placement can lead to complications like catheter-related infections or inaccurate pressure readings.
152
What should be done before using the PA catheter after insertion?
A. Administer intravenous fluids
B. Initiate blood transfusion
C. Start a continuous ECG
D. Obtain a chest x-ray to confirm proper placement
D. Obtain a chest x-ray to confirm proper placement
Rationale: After catheter insertion, a chest x-ray is essential to ensure the catheter is in the correct position in the pulmonary artery. This helps avoid complications and ensures accurate readings for hemodynamic monitoring.
153
Which action should the nurse prioritize to ensure accurate invasive arterial blood pressure (ABP) measurement?
A. Position the patient in a seated position
B. Confirm that the zero reference stopcock is at the level of the phlebostatic axis
C. Ensure the patient’s arm is elevated above the heart level
D. Administer a bolus of IV fluids
B. Confirm that the zero reference stopcock is at the level of the phlebostatic axis
Rationale: Proper positioning of the zero reference stopcock at the level of the phlebostatic axis is crucial for obtaining accurate ABP measurements. Any deviation from this position can lead to incorrect readings, as it ensures the pressure readings are aligned with the heart’s level.
154
Why is it necessary to obtain an analog printout or freeze the oscilloscope tracing during invasive ABP monitoring?
A. To assess the patient’s cardiac rhythm
B. To measure systolic and diastolic pressures at end expiration
C. To document the patient’s oxygenation levels
D. To confirm catheter placement
B. To measure systolic and diastolic pressures at end expiration
Rationale: The systolic and diastolic pressures should be measured at end expiration to avoid inaccuracies due to respiratory variation. Freezing the tracing or obtaining an analog printout allows precise measurement at this point.
155
What should be done if the patient’s arterial waveform tracing is poor or unreliable during invasive ABP measurement?
A. Wait for the waveform to stabilize and then measure again
B. Decrease the patient’s IV fluids to reduce pressure fluctuations
C. Increase the patient’s respiratory rate
D. Immediately stop the procedure and notify the healthcare provider
A. Wait for the waveform to stabilize and then measure again
Rationale: If the arterial waveform is poor or unreliable, it is important to allow it to stabilize before taking measurements. A dynamic response test can help assess the quality of the waveform before obtaining accurate readings.
156
When performing invasive arterial blood pressure monitoring, how should the nurse position the patient to ensure accurate readings?
A. Position the patient in a seated position with the head of the bed elevated 30 degrees
B. Place the patient in a lateral position
C. Position the patient with the head of the bed elevated 90 degrees
D. Position the patient supine and flat, or with the head of the bed less than 45 degrees
D. Position the patient supine and flat, or with the head of the bed less than 45 degrees
Rationale: Proper positioning is essential to ensure that the pressure readings are not influenced by gravity or body position. The patient should be positioned flat or with minimal head elevation (less than 45 degrees).
157
What is the purpose of performing a dynamic response test during invasive arterial blood pressure monitoring?
A. To assess the accuracy of the monitor’s ECG readings
B. To check for any signs of infection at the catheter insertion site
C. To verify that the system responds properly to pressure changes
D. To confirm the patient’s blood type
C. To verify that the system responds properly to pressure changes
Rationale: The dynamic response test evaluates the system’s ability to accurately respond to pressure fluctuations, ensuring that the arterial pressure monitor is functioning correctly and providing reliable readings.
158
What should be included in the documentation when measuring invasive arterial blood pressure?
A. The patient’s age and weight
B. The pressure measurements along with a marked analog printout or the screen tracing
C. The patient’s medication list
D. The results of any diagnostic imaging performed
B. The pressure measurements along with a marked analog printout or the screen tracing
Rationale: Proper documentation should include the exact pressure measurements as well as a marked printout or frozen tracing that identifies the points read. This ensures accurate record-keeping and provides a reference for future assessments.
159
Which factor can affect the accuracy of invasive arterial blood pressure measurement?
A. Administering oxygen therapy
B. Elevating the head of the bed to 45 degrees
C. Using a disposable catheter
D. Improper positioning of the zero reference stopcock
D. Improper positioning of the zero reference stopcock
Rationale: If the zero reference stopcock is not positioned correctly at the level of the phlebostatic axis, it can cause inaccuracies in the arterial pressure readings. Proper positioning is essential to obtaining accurate measurements.
160
Which of the following is an appropriate indication for pulmonary artery catheterization?
A. Chronic obstructive pulmonary disease (COPD) exacerbation
B. Cardiogenic shock with complications
C. Hypertension without organ damage
D. Acute asthma attack
B. Cardiogenic shock with complications
Rationale: Pulmonary artery catheterization is indicated in cases of cardiogenic shock with complications, as it allows for direct measurement of hemodynamics to guide therapy and improve outcomes.
161
Why is pulmonary artery catheterization contraindicated in patients with coagulopathy?
A. The catheter may cause excessive bleeding during insertion
B. It can exacerbate thrombus formation in the lungs
C. It requires continuous anticoagulation therapy
D. It increases the risk of mechanical valve failure
A. The catheter may cause excessive bleeding during insertion
Rationale: Coagulopathy increases the risk of bleeding, and pulmonary artery catheterization involves invasive procedures that could lead to significant hemorrhage.
162
In which patient scenario would a pulmonary artery catheter likely be used to assess response to therapy?
A. A patient in stable sinus rhythm
B. A patient with controlled hypertension
C. A patient experiencing mixed types of shock
D. A patient with uncomplicated pneumonia
C. A patient experiencing mixed types of shock
Rationale: Pulmonary artery catheterization is useful for assessing the response to therapy in mixed types of shock, where hemodynamic monitoring is essential to guide treatment.
163
Which of the following conditions would contraindicate the use of a pulmonary artery catheter due to the potential for mechanical complications?
A. Cardiogenic shock
B. Right heart mass
C. Pulmonary hypertension
D. Severe chronic heart failure
B. Right heart mass
Rationale: The presence of a right heart mass, such as a thrombus or tumor, can obstruct catheter placement and increase the risk of embolism or damage to the heart structures, making the procedure contraindicated.
164
Which of the following is a primary indication for pulmonary artery catheterization in a patient with severe chronic heart failure (HF)?
A. Assessment of lung compliance
B. Monitoring of blood gases
C. Requirement for vasoactive drug therapy
D. Monitoring of oxygen saturation only
C. Requirement for vasoactive drug therapy
Rationale: Pulmonary artery catheterization is indicated for patients with severe chronic HF who require vasoactive drug therapy, as it helps assess hemodynamic status and guide treatment adjustments.
165
Which condition is most likely to necessitate the use of a pulmonary artery catheter for transplantation workup?
A. Non-cardiogenic pulmonary edema
B. Severe chronic heart failure
C. Aortic valve stenosis
D. Uncontrolled hypertension
B. Severe chronic heart failure
Rationale: Pulmonary artery catheterization is used in the transplantation workup of patients with severe chronic heart failure to assess their hemodynamic status and determine eligibility for transplant.
166
What is the rationale for using a pulmonary artery catheter in the differential diagnosis and response to therapy of pulmonary hypertension?
A. It provides a direct measurement of pulmonary artery pressure
B. It assesses fluid balance during therapy
C. It helps evaluate oxygenation levels during treatment
D. It measures cardiac output directly
A. It provides a direct measurement of pulmonary artery pressure
Rationale: Pulmonary artery catheterization directly measures pulmonary artery pressure, which is crucial for diagnosing pulmonary hypertension and monitoring therapy effectiveness.
167
Which of the following would be an absolute contraindication for the insertion of a pulmonary artery catheter?
A. Potentially reversible systolic heart failure
B. Myocardial infarction with complications
C. Severe pulmonary hypertension
D. Endocarditis
D. Endocarditis
Rationale: Endocarditis is a contraindication for pulmonary artery catheterization because the procedure could increase the risk of infecting the heart valves or other structures, leading to further complications.
168
In which of the following scenarios would a pulmonary artery catheterization be most beneficial in managing a patient with myocardial infarction (MI)?
A. In the absence of cardiogenic shock
B. In a patient with uncomplicated MI
C. To assess the risk of arrhythmias in the early phase
D. When complications such as heart failure or cardiogenic shock develop
D. When complications such as heart failure or cardiogenic shock develop
Rationale: Pulmonary artery catheterization is used when complications like heart failure or cardiogenic shock develop after an MI, as it helps guide management and assess the patient’s response to therapy.
169
Which of the following is the primary benefit of using a pulmonary artery catheter in patients with potentially reversible systolic heart failure?
A. It allows for continuous monitoring of blood glucose levels
B. It helps in managing oxygen therapy requirements
C. It provides detailed hemodynamic information to guide therapy
D. It reduces the risk of arrhythmias
C. It provides detailed hemodynamic information to guide therapy
Rationale: In patients with potentially reversible systolic heart failure, pulmonary artery catheterization provides critical hemodynamic data, such as cardiac output and pulmonary artery pressures, which guide therapeutic decisions.
170
Which item would the nurse zero to establish accurate hemodynamic monitoring for a patient?
a. Pressure monitoring system to phlebostatic axis
b. Pressure monitoring system to the level of the midclavicular line
c. Cardiac output monitoring system to the level of the left ventricle
d. Pressure monitoring system to the level of the catheter tip in the patient
a. Pressure monitoring system to phlebostatic axis
171
Which hemodynamic parameter most directly reflects the effectiveness of drugs given to reduce a patient‘s left ventricular afterload?
a. Cardiac output (CO)
b. Systemic vascular resistance (SVR)
c. Pulmonary vascular resistance (PVR)
d. Pulmonary artery wedge pressure (PAWP)
b. Systemic vascular resistance (SVR)
Rationale: SVR reflects the resistance to left ventricular ejection, or afterload. Other parameters may be monitored but do not reflect left-sided afterload as directly.
172
After surgery, a patient‘s central venous pressure (CVP) monitor indicates low pressures.
Which action would the nurse take?
a. Administer IV diuretic medications.
b. Increase the IV fluid infusion per protocol.
c. Increase the infusion rate of IV vasodilators.
d. Elevate the head of the patient‘s bed to 45 degrees.
b. Increase the IV fluid infusion per protocol.
Rationale: A low CVP indicates decreased preload from hypovolemia and a need for an increase in the infusion rate. Diuretic administration will contribute to hypovolemia and elevation of the head or increasing vasodilators may decrease cerebral perfusion.
173
Which parameter will the nurse use to evaluate changes in a patient‘s right ventricular afterload?
a. Central venous pressure (CVP)
b. Systemic vascular resistance (SVR)
c. Pulmonary vascular resistance (PVR)
d. Pulmonary artery wedge pressure (PAWP)
c. Pulmonary vascular resistance (PVR)
Rationale: PVR is a measure of right ventricular afterload, which is elevated in conditions such as pulmonary hypertension The other parameters do not directly assess for right ventricular afterload.
174
A patient requires arterial pressure monitoring. Which action would the nurse plan to take?
a. Balance and calibrate the monitoring equipment every 2 hours.
b. Position the zero-reference stopcock line level with the phlebostatic axis.
c. Disconnect the low pressure alarm to avoid disturbing the patient‘s sleep.
d. Ensure that the patient is supine with the head of the bed flat for all readings.
b. Position the zero-reference stopcock line level with the phlebostatic axis.
Rationale: For accurate measurement of pressures, the zero-reference level would be at the phlebostatic axis. There is no need to rebalance and recalibrate monitoring equipment every 2 hours. Accurate hemodynamic readings are possible with the patient‘s head raised to 45 degrees or in the prone position. Alarms should be activated; if the pressure in the line falls (e.g., when the line is disconnected), the low-pressure alarm sounds immediately and notifies staff to promptly correct the problem.
175
Which measurement would be the most sensitive indicator of cardiac function?
a. Central venous pressure (CVP)
b. Systemic vascular resistance (SVR)
c. Pulmonary vascular resistance (PVR)
d. Pulmonary artery wedge pressure (PAWP)
d. Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP reflects left ventricular end diastolic pressure (or left ventricular preload) and is a sensitive indicator of cardiac function. The other values would also provide useful information, but the most definitive measurement of changes in cardiac function is the PAWP.
176
Which action would the nurse take first when the low pressure alarm sounds for a patient who has an arterial line in the left radial artery?
a. Observe for dysrhythmias.
b. Fast flush the arterial line.
c. Check the left hand for pallor.
d. Re-zero the monitoring equipment.
a. Observe for dysrhythmias.
Rationale: The low pressure alarm indicates a drop in the patient‘s blood pressure, which may be caused by dysrhythmias or line disconnection. There is no indication to re-zero the equipment. Pallor of the left hand would be caused by occlusion of the radial artery by the arterial catheter. Flushing the line would be useful if there is a dampened waveform.
177
Which action would the nurse take when preparing to assist with the insertion of a pulmonary artery catheter?
a. Determine if the cardiac troponin level is elevated.
b. Place the patient on NPO status before the procedure.
c. Auscultate heart sounds before and during catheter insertion.
d. Assure that the cardiac monitor is visible during the procedure.
d. Assure that the cardiac monitor is visible during the procedure.
Rationale: Dysrhythmias can occur as the catheter is floated through the right atrium and ventricle, and it is important for the nurse to monitor for these during insertion. Pulmonary artery catheter insertion does not require anesthesia, and the patient will not need to be NPO. Changes in cardiac troponin or heart and breath sounds are not expected during pulmonary artery catheter insertion.
178
The nurse is assisting with the placement of a pulmonary artery (PA) catheter. What would the nurse expect to see on the monitor during the procedure as an indication that the catheter with inflated balloon is placed correctly?
a. PA pressure waveform
b. PA wedge pressure (PAWP) waveform
c. Tracing of the systemic arterial pressure
d. Tracing of the systemic vascular resistance
b. PA wedge pressure (PAWP) waveform
Rationale: The purpose of a PA line is to measure PAWP, so the catheter is floated through the pulmonary artery until the dilated balloon wedges in a distal branch of the pulmonary artery, and the PAWP readings are available. After insertion, the balloon is deflated, and the PA waveform will be observed. Systemic arterial pressures are obtained using an arterial line, and the systemic vascular resistance is a calculated value, not a waveform.
179
Which finding by the nurse caring for a patient with a right radial arterial line indicates a need for the nurse to take action?
a. The left hand feels warmer than the right hand.
b. The mean arterial pressure (MAP) is 77 mm Hg.
c. The system is delivering 3 mL of flush solution per hour.
d. The flush bag and tubing were changed 2 days previously.
a. The left hand feels warmer than the right hand.
Rationale: The cooler temperature of the right hand suggests that blood flow to the right hand may be impaired; further assessment may lead to plans for removal of the radial catheter to avoid permanent injury to the right hand. The flush system needs to be changed every 96 hours. A mean arterial pressure (MAP) of 70-105 mm Hg is normal. Flush systems for hemodynamic monitoring are set up to deliver 3 to 6 mL/hr of flush solution.
180
The nurse is caring for a patient who has an arterial catheter in the left radial artery for arterial pressure–based cardiac output (APCO) monitoring. Which information obtained by the nurse requires a report to the health care provider?
a. The patient has a positive Allen test result.
b. There is redness at the catheter insertion site.
c. The mean arterial pressure (MAP) is 86 mm Hg.
d. The dicrotic notch is visible in the arterial waveform.
b. There is redness at the catheter insertion site.
Rationale: Redness at the catheter insertion site indicates possible infection. The Allen test is performed before arterial line insertion, and a positive test result indicates normal ulnar artery perfusion. A MAP of 86 mm Hg is normal, and the dicrotic notch is normally present on the arterial waveform.
181
A patient with respiratory failure has arterial pressure–based cardiac output (APCO) monitoring and is receiving mechanical ventilation with peak end-expiratory pressure (PEEP) of 12 cm H 2 O. Which information indicates that a change in the ventilator settings may be required?
a. The arterial pressure is 90/46.
b. The heart rate is 58 beats/min.
c. The stroke volume is increased.
d. The stroke volume variation is 12%.
a. The arterial pressure is 90/46.
Rationale: The hypotension suggests that the high intrathoracic pressure caused by the PEEP may be decreasing venous return and (potentially) cardiac output. The other assessment data would not be a direct result of PEEP and mechanical ventilation.
182
Amount of blood pumped
out of the ventricle with
each beat or contraction
stroke volume
183
Force/strength
of contraction of
the heart muscle
contractility
184
% of blood expelled from the left
ventricle with every contraction
ejection fraction
185
Amount of blood returned to
the right side of the heart at
the end of diastole
preload
186
Pressure that the left ventricle has to pump against
(the resistance it must overcome to circulate blood)
afterload
187
cardiac output (CO) range
4 - 8 L/min
188
Normal EF%
50%-70%
189
cardiac index (CI) range
2.5 – 4.0 L/min/m2
190
central venous pressure (CVS) range
2 – 8 mmHg
191
mean arterial pressure (MAP) range
70 – 100 mmHg
192
system vascular resistance (SVR) range
800 – 1200 dynes/sec/cm
