Deck 8: Basic Hemodynamic Monitoring

Question 1

The nurse is caring for a patient whose pulmonary artery wedge pressure (PAWP)is 16 mmHg.The patient's neck veins are distended,lungs have crackles,and an S4 gallop is audible.Which intervention would the nurse anticipate?

A)Administer a 500-mL normal saline fluid bolus.
B)Repeat the reading after recalibrating the system.
C)Repeat the reading after repositioning the patient.
D)Administer a diuretic and a vasodilator.

Answer 1

Administer a diuretic and a vasodilator.

Question 2

The preceptor nurse is assisting a newly hired nurse with completion of hemodynamic assessment using a pulmonary artery catheter.Which action would require the preceptor to intervene?

A)Inflating the pressure bag to 300 mmHg
B)Infusing a vasoactive drug through the proximal injectate port
C)Obtaining a pulmonary artery wedge pressure reading through the distal port
D)Using iced normal saline to obtain a cardiac output

Answer 2

Infusing a vasoactive drug through the proximal injectate port

Question 3

Which nursing actions are necessary to collect information needed to figure the patient's cardiac index? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Weigh the patient.
B)Take the patient's temperature.
C)Measure the patient's blood pressure.
D)Measure the patient's height.
E)Determine the patient's age.

Answer 3

Weigh the patient.
Measure the patient's height.

Question 4

A patient who has a pulmonary artery catheter in place is to receive the drug nitroprusside (Nipride).The nurse would assess for which indicator of the drug's effectiveness?

A)Decreased systemic vascular resistance
B)Decreased cardiac output
C)Increased right atrial pressure
D)Increased pulmonary artery wedge pressure

Question 5

A patient is being prepared for impedance cardiography.Which information will the nurse provide?

A)"This technology will use ultrasound to measure your heart rate and blood flow."
B)"We are preparing to measure the oxygenation of your peripheral tissues."
C)"A catheter will be inserted into a vein in your neck."
D)"Electrodes will be placed on your neck and your lateral chest."

Question 6

While assisting with insertion of a central line,the nurse notes bright red blood flashing back into the tubing.The physician inserting the device removes it immediately.Which nursing action is indicated?

A)Replace the contaminated syringe and tubing.
B)Re-prime the set with sterile normal saline.
C)Call for the rapid response team.
D)Apply direct pressure to the insertion site.

Question 7

The nurse is performing an assessment on a patient whose right atrial pressure is 12 mmHg.Which findings would the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Jugular vein distention
B)Weak,thready pulse
C)Presence of rales and rhonchi
D)Poor skin turgor
E)Hepatomegaly

Question 8

While caring for a patient being hemodynamically monitored,the nurse notices that the systemic vascular resistance has risen to 1800 dynes/sec/cm⁵,whereas the patient's cardiac output remains at 6 liters per minute.What would the nurse expect the patient's blood pressure to be?

A)Increased
B)Unchanged
C)Decreased
D)Initially decreased,and then increased

Question 9

A patient is admitted to the emergency department after fainting.Vital signs are blood pressure 86/60,heart rate 160 bpm,and respirations 20.The patient's skin is cool to the touch.The nurse suspects which underlying problem?

A)The patient has poor glucose control.
B)The patient has deficient fluid volume.
C)The patient has decreased cardiac output.
D)The patient has poor oxygenation.

Question 10

The nurse is assessing a patient's arterial waveform and notes a notch on the descending portion of the waveform.The nurse associates this notch with which physiological events? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Closure of the aortic valve
B)The highest systolic pressure
C)Systolic ejection of blood
D)The diastolic pressure
E)Beginning of ventricular diastole

Question 11

A patient is admitted for evaluation of hypotension.Which assessment by the nurse would require immediate attention?

A)Pulmonary artery wedge pressure of 2 mmHg
B)Heart rate of 112
C)Urine output of 25 mL/hr
D)Presence of rales at both lung bases

Question 12

The nurse is caring for a patient with sepsis.On completing the hemodynamic assessment,the nurse notes that the patient's afterload,measured by the systemic vascular resistance,is 400 dynes/sec/cm^-5.The nurse evaluates this finding to be primarily the result of which change associated with sepsis?

A)Decreased circulating volume
B)Reaction to antibiotics used to treat sepsis
C)Marked vasodilation
D)Decreased ventricular contractility

Question 13

The nurse is reviewing the results of a patient's cardiac output curve and notes that the size of the curve is small.Which of the following does this finding indicate?

A)A low cardiac output
B)Poor injection technique
C)Incorrect placement of the catheter
D)A high cardiac output

Question 14

A patient who has a radial artery catheter in place is complaining of numbness and tingling in the fingers.What is the nurse's priority assessment?

A)Is there a palpable pulse?
B)Is blood is easily obtained from the catheter?
C)Does the patient have a fever?
D)Does the waveform have a characteristic appearance?

Question 15

While evaluating a patient's pulmonary artery waveforms,the nurse notes a sudden onset of right ventricular waves.Which nursing intervention is indicated?

A)Assist the patient to a left side-lying position.
B)Notify the physician for repositioning.
C)Increase intravenous fluids.
D)Nothing,since this is an expected occurrence.

Question 16

A patient who was stabbed multiple times in the chest and abdomen has just returned from emergency surgery.Hemodynamic monitoring was initiated during surgery and now reveals that the patient's right atrial pressure has dropped to 2 mmHg.The nurse would assess for findings of which conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Internal hemorrhage
B)Fluid loss during surgery
C)Vasodilation from drugs administered during surgery
D)Left heart failure
E)Cardiac tamponade

Question 17

The nurse is caring for a patient who is being monitored with a pulmonary artery catheter.Which change requires immediate intervention?

A)Systemic vascular resistance of 900 dynes/sec/cm⁵
B)Appearance of an "a" wave on the pulmonary artery waveform
C)Pulmonary artery wedge pressure of 10 mmHg
D)Spontaneous development of a pulmonary artery wedge pressure waveform

Question 18

A patient with congestive heart failure is receiving scheduled doses of an intravenous diuretic.After administering the drug,which finding would indicate to the nurse that the drug was effective?

A)A pulmonary artery wedge pressure of 16 mmHg
B)Pulmonary artery pressure of 34/16 mmHg
C)Systemic vascular resistance of 1400 dynes/sec/cm^-5
D)A right atrial pressure of 5 mmHg

Question 19

The nurse is preparing to use the intermittent fluid bolus thermodilution method to obtain the patient's cardiac output via the pulmonary artery (PA)catheter.Which nursing action is indicated?

A)Zero the transducer at the phlebostatic axis.
B)Place the patient in Trendelenburg position.
C)Warm cardiac output injectate fluid to body temperature.
D)Prepare 20 mL of injectate.

Question 20

Which nursing interventions are indicated when measuring pulmonary artery wedge pressure (PAWP)? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Use a volume of no more than 1.25 mL to inflate the balloon.
B)Pull back on the syringe to deflate the balloon.
C)Leave the balloon slightly inflated to maintain integrity.
D)Maintain balloon inflation for 3 to 5 minutes to obtain a stable reading.
E)If there is any resistance during inflation do not continue.