Chapter 66 Hemodynamic Monitoring

Question 1

Which hemodynamic parameter is most appropriate for the nurse to monitor to determine the effectiveness of medications given to a patient to reduce left ventricular afterload?
Mean arterial pressure (MAP)
Systemic vascular resistance (SVR)
Pulmonary vascular resistance (PVR)
Pulmonary artery wedge pressure (PAWP)

Answer 1

ANS: B
Systemic vascular resistance reflects the resistance to ventricular ejection, or afterload. The other parameters will be monitored, but do not reflect afterload as directly.

Question 2

Following surgery for an abdominal aortic aneurysm, a patient’s central venous pressure (CVP) monitor indicates low pressures. Which action is a priority for the nurse to take?
Administer IV diuretic medications.
Increase the IV fluid infusion per protocol.
Document the CVP and continue to monitor. Elevate the head of the patient’s bed to 45 degrees.

Answer 2

ANS: B
A low CVP indicates hypovolemia and a need for an increase in the infusion rate. Diuretic administration will contribute to hypovolemia and elevation of the head may decrease cerebral perfusion. Documentation and continued monitoring is an inadequate response to the low CVP.

Question 3

When caring for a patient with pulmonary hypertension, which parameter is most appropriate for the nurse to monitor to evaluate the effectiveness of the treatment?
Central venous pressure (CVP)
Systemic vascular resistance (SVR)
Pulmonary vascular resistance (PVR)
Pulmonary artery wedge pressure (PAWP)

Answer 3

ANS: C
PVR is a major contributor to pulmonary hypertension, and a decrease would indicate that pulmonary hypertension was improving. The other parameters also may be monitored but do not directly assess for pulmonary hypertension.

Question 4

The intensive care unit (ICU) nurse educator will determine that teaching about arterial pressure monitoring for a new staff nurse has been effective when the nurse:
balances and calibrates the monitoring equipment every 2 hours.
positions the zero-reference stopcock line level with the phlebostatic axis.
ensures that the patient is supine with the head of the bed flat for all readings.
rechecks the location of the phlebostatic axis when changing the patient’s position.

Answer 4

ANS: B
For accurate measurement of pressures, the zero-reference level should be at the phlebostatic axis. There is no need to rebalance and recalibrate monitoring equipment hourly. Accurate hemodynamic readings are possible with the patient’s head raised to 45 degrees or in the prone position. The anatomic position of the phlebostatic axis does not change when patients are repositioned.

Question 5

When monitoring for the effectiveness of treatment for a patient with a large anterior wall myocardial infarction, the most important information for the nurse to obtain is
central venous pressure (CVP).
systemic vascular resistance (SVR).
pulmonary vascular resistance (PVR).
pulmonary artery wedge pressure (PAWP).

Answer 5

ANS: D
PAWP reflects left ventricular end diastolic pressure (or left ventricular preload) and is a sensitive indicator of cardiac function. Because the patient is high risk for left ventricular failure, the PAWP must be monitored. An increase will indicate left ventricular failure. The other values would also provide useful information, but the most definitive measurement of changes in cardiac function is the PAWP.

Question 6

hich action is a priority for the nurse to take when the low pressure alarm sounds for a patient who has an arterial line in the left radial artery?
Fast flush the arterial line.
Check the left hand for pallor. 
Assess for cardiac dysrhythmias. 
Rezero the monitoring equipment.

Answer 6

ANS: C
The low pressure alarm indicates a drop in the patient’s blood pressure, which may be caused by cardiac dysrhythmias. There is no indication to rezero the equipment. Pallor of the left hand would be caused by occlusion of the radial artery by the arterial catheter, not by low pressure. There is no indication of a need for flushing the line.