Exam 3 part 1

Question 1

a blood pressure cuff that is too small will:

Answer 1

incorrectly OVERESTIMATE the true blood pressure

Question 2

the diastolic blood pressure measured with an automated BP cuff using the oscillometric method will be:

Answer 2

approximately 10 mm Hg higher when compared to direct arterial measurement

Question 3

which artery is the principal source of blood flow to the hand?

Answer 3

ulnar

Question 4

risk of brachial artery cannulation

Answer 4

damage to the median nerve

Question 5

risks of femoral artery cannulation

Answer 5

local and retroperitoneal hematoma

Question 6

which artery is commonly used during emergencies and low flow states?

Answer 6

femoral

Question 7

when interpreting a CVP waveform, the end of systole best coincides with the:

Answer 7

C wave

represents bulging of the tricuspid valve into the atrium during the beginning of systole

Question 8

a wave of the CVP waveform

Answer 8

atrial contraction

Question 9

X descent of the CVP waveform and when does it occur?

Answer 9

atrial relaxation
occurs during systole

Question 10

V wave of the CVP waveform

Answer 10

filling of the atrium when the tricuspid valve is closed

Question 11

Y descent on the CVP waveform

Answer 11

when the tricuspid valve opens and the atrium starts to empty

Question 12

CVP tracing with prominent C-V waves suggests

Answer 12

tricuspid regurgitation

a much larger C wave represents blood flowing retrograde into the right atrium due to the incompetent tricuspid valve. the increased V wave size is due to the retrograde flow continuing throughout systole.

Question 13

loss of Y descent on the CVP tracing with elevated filling pressures

Answer 13

cardiac tamponade

note: elevated filling pressures in a trauma patient is a red flag, it is unlikely that a bleeding trauma patient (i.e. chest stab wounds) would have elevated filling pressures

Question 14

Which of the following is a key step in arterial cannulation for blood pressure monitoring?

A. Use of a large-bore catheter.
B. Avoidance of aseptic techniques.
C. Cannulation of the femoral artery in all cases.
D. Monitoring for complications such as thrombosis and infection.

Answer 14

D. Monitoring for complications such as thrombosis and infection.

Question 15

Which characteristic is indicative of an over-dampened arterial pressure waveform?

A. High systolic peak.
B. Exaggerated dicrotic notch.
C. Falsely narrow pulse pressure.
D. Tall, sharp waveform.

Answer 15

C. Falsely narrow pulse pressure.

Question 16

Which of the following is a common complication associated with CVP catheter placement?

A. Pulmonary embolism.
B. Arterial puncture.
C. Myocardial infarction.
D. Cerebral edema.

Answer 16

B. Arterial puncture.

Question 17

What is a potential complication of pulmonary artery catheter insertion?

A. Hypertension.
B. Pneumothorax.
C. Hyperglycemia.
D. Kidney failure.

Answer 17

B. Pneumothorax.

Question 18

ulse pressure variation (PPV) is most reliable under which condition?

A. Patient in atrial fibrillation.
B. Spontaneous breathing.
C. Mechanical ventilation without spontaneous breaths.
D. Use of vasodilators.

Answer 18

C. Mechanical ventilation without spontaneous breaths.

Question 19

You are preparing to insert a radial artery catheter in a patient with a history of vasospastic arterial disease. What step should you take to minimize complications?

A. Choose a smaller gauge catheter.
B. Avoid use of heparinized saline.
C. Utilize ultrasound guidance.
D. Select the femoral artery instead.

Answer 19

C. Utilize ultrasound guidance.

Question 20

During surgery, the arterial pressure waveform shows signs of over-damping with a falsely narrow pulse pressure. What could be a potential cause?

A. Incorrect zeroing of the transducer.
B. Air bubbles in the tubing.
C. Excessive systemic vascular resistance.
D. Low cardiac output.

Answer 20

B. Air bubbles in the tubing.

Question 21

A patient with severe emphysema requires CVP monitoring via the internal jugular vein. Why is this site preferred over the subclavian vein?

A. Lower risk of infection.
B. Easier access for repeated measurements.
C. Less risk of pneumothorax.
D. Better patient comfort.

Answer 21

C. Less risk of pneumothorax.

Question 22

Before inserting a pulmonary artery catheter in a patient with a left bundle branch block (LBBB), what precaution should you take?

A. Administer prophylactic antibiotics.
B. Ensure availability of a defibrillator.
C. Monitor for ventricular arrhythmias.
D. Pre-treat with antiarrhythmic drugs.

Answer 22

B. Ensure availability of a defibrillator.

Question 23

A mechanically ventilated patient in the ICU has a PPV of 20%. What does this indicate about the patient’s fluid status?

A. The patient is likely hypovolemic.
B. The patient is likely hypervolemic.
C. The patient has normal fluid status.
D. The PPV value is inconclusive.

Answer 23

A. The patient is likely hypovolemic.

Question 24

in the normal CVP tracing, where does the tricuspid valve close?

Answer 24

between the a-wave and c-wave

the tricuspid valve closes after atrial contraction (a-wave) and before ventricular contraction (which has two components – the c wave and x-descent). thus, it occurs between the a-wave and c-wave

Question 25

which of the following conditions will mask the pulsus paradoxus commonly seen in cardiac tamponade?

Answer 25

a. positive pressure ventilation
b. mucous plug
c. stridor
d. chronic obstructive pulmonary disease (COPD)

Question 26

which of the following landmarks is appropriate for gaining subclavian venous access?

a. needle insertion medial to the sternocleidomastoid muscle, just medial to the carotid artery
b. needle insertion above the inguinal ligament, lateral to the femoral artery.
c. needle insertion at the midpoint of the clavicle with the needle directed toward the suprasternal notch
d. needle insertion at the lateral border of the clavicular head of the sternocleidomastoid muscle in the interscalene groove

Answer 26

c. needle insertion at the midpoint of the clavicle with the needle directed toward the suprasternal notch

a. = IJV (but LATERAL to the carotid)
b. = femoral (but MEDIAL to the fem artery)
d. = interscalene nerve block

Question 27

which nerve is at greatest risk of suffering an injury during arterial catheter insertion into the brachial artery?

Answer 27

median nerve

Question 28

a “flush test” is performed to assess damping of an arterial line pressure-monitoring system. a system with an appropriate dynamic response will have which of the following responses to rapid flushing?

a. one large oscillation before return to baseline
b. one large and one small oscillation before return to baseline
c. one large and 3 small oscillations before return to baseline
d. a square wave
e. several large and small oscillations before return to baseline

Answer 28

b. one large and one small oscillation before return to baseline

Question 29

natural frequency

Answer 29

how fast the pressure monitoring system vibrates when excited by a signal, such as the arterial pressure pulse or the pressure signal caused by a fast-flush test.

Question 30

damping coefficient

Answer 30

measures how quickly the oscillations of a shock-excited system dampen and eventually come to rest

Question 31

which of the following is most likely to produce underdamping in an arterial pressure monitoring system?

a. excessive tubing length
b. bubbles in the tubing
c. kink in arterial catheter
d. thrombus at the tip of the arterial catheter

Answer 31

a. excessive tubing length

obstruction of the arterial catheter with a thrombus, kink, or bubbles can cause OVERdamping.

Question 32

which component of the central venous pressure waveform is most likely to be absent in a patient with a junctional rhythm?

Answer 32

a wave

Question 33

a patient with severe tricuspid regurgitation is expected to have what CVP tracing abnormality?

Answer 33

tall c-v wave, diastole

Question 34

a square wave test is performed to measure the dynamic response of a radial arterial line. two oscillations are seen before the tracing returns to baseline. what best describes the state of the arterial pressure monitoring system?

Answer 34

adequately damped

Question 36

What is the insertion site for the brachial artery?

Answer 36

Medial to the biceps tendon

Question 37

What is the insertion site for the axillary artery?

Answer 37

Junction of pectoral is and deltoid muscle

Question 38

How does the systolic pressure measured at the dorsalis pediatric artery differ from that measured in the aorta?

Answer 38

Higher systolic pressure estimates

Question 39

Three components of an overdamped arterial waveform

Answer 39

1. Slurred upstroke
2. Absent dicrotic notch
3. Loss of fine detail

Question 40

Pulsus parvus

Answer 40

Waveform is small in amplitude (aortic stenosis)

Question 41

Pulsus tardus

Answer 41

Delayed peak in systole (aortic stenosis)

Question 42

Bisferiens pulse

Answer 42

Two systolic peaks (aortic regurg)

Question 43

Spike-and-dome

Answer 43

Mid-systolic obstruction (hypertrophic cardiomyopathy)

Question 44

Pulsus alterans

Answer 44

Alternation of larger and smaller pressure waves that vary with the respiratory cycle

Generally associated with severe LV systolic dysfunction or AS

Question 45

Pulsus paradoxus

Answer 45

Exaggerated variation in arterial pressure (>10-12 mm Hg) during quiet breathing. AKA an inspiratory fall in the systolic blood pressure greater than 10 mm Hg.

Common and important sign in cardiac tamponade!

Or anything that involves large swings in intrathoracic pressure: bronchospasm, severe airway obstruction, dyspnea

Question 46

Which site is most successful for CVP monitoring?

Answer 46

Right internal jugular vein

Question 47

Which CVP monitoring site is associated with high risk of pneumothorax?

Answer 47

Subclavian