Question 1

What sign indicates the pulmonary artery catheter is in the correct location?

Accepted Answer

When the catheter floats through the pulmonary semilunar valve into the pulmonary artery,a pulmonary artery tracing should appear on the monitor.This waveform has a steep upstroke at the beginning from right ventricular ejection and opening of the pulmonic valve,followed by a dicrotic notch on the downstroke at the closing of the pulmonic valve.

Question 2

Where can a core temperature probe be placed?

Accepted Answer

An esophageal probe is responsive to changes in body heat.A rectal probe is slow to detect changes in body temperatures.A bladder probe is placed in the tip of a Foley catheter.

Question 3

Which is a contraindication to proceeding with intracranial pressure (ICP)monitoring?

Accepted Answer

Contraindications to ICP monitoring include coagulopathies,anticoagulation therapy,cerebral edema with ventricular collapse or shift,and known scalp infection.

Question 4

When sending an arterial blood gas sample to the laboratory for analysis,never place the specimen on ice because that will cause the sample to coagulate and not be usable.

Accepted Answer

If there is a delay in getting the blood gas sample analyzed,the syringe with the blood should be immersed in ice immediately and refrigerated at near freezing temperature.Iced specimen bags may be used.

Question 5

Which is a condition that may occur during a surgical procedure,resulting in an altered physiology?

Accepted Answer

During extensive surgery the body is subjected to physiologic stress.Bleeding,tissue trauma,potent drugs,large extravascular fluid shifts,multiple transfusions,surgical positions that can inhibit breathing and circulation.All of these can contribute to altered physiology.

Question 6

What is the normal hourly urinary output?

Accepted Answer

Urinary output of 30 to 60 mL/hr usually shows adequate intravascular volume and blood pressure.Low urinary output can result from stress of the surgical procedure,antidiuresis from the anesthetic agent,impending renal failure,or reduced circulating blood volume.

Question 7

Which is a type of data that can be obtained from pulmonary artery monitoring?

Accepted Answer

Right atrial pressure,pulmonary artery pressure,pulmonary capillary wedge pressure,and cardiac output can be obtained from pulmonary artery monitoring.This information about the pressures can reveal the hemodynamic status of cardiovascular and pulmonary functions and serves as a guideline for administration of fluids,diuretics,and cardiotonic drugs.

Question 8

What does an electrocardiogram (ECG)show?

Accepted Answer

An ECG shows electrical forces produced by the heart and translated as waveforms.It shows changes in rhythm,rate,and conduction.

Question 9

Which is a result that may occur when using the bispectral index (BIS)monitor during a surgical procedure?

Accepted Answer

The BIS monitors the patient through processed EEG parameters by placing an electrode patch on the forehead and relaying brain signals to a monitor.The results are reduced drug use,faster wake-up time,and decreased risk of patient awareness during the surgical procedure.This potentially translates into faster discharge for ambulatory surgery patients.Potential benefits include a faster discharge when used with ambulatory patients.

Question 10

Which is an example of an invasive monitoring device?

Accepted Answer

Invasive monitors penetrate skin or mucosa.They can be inserted percutaneously or by cutdown depending on the vessel and catheter.An intracardiac monitor is an example of an invasive monitor.

Question 11

Which is the most common complication during insertion of a pulmonary artery catheter?

Accepted Answer

The most common complication during insertion of the catheter is cardiac dysrhythmia,especially premature contractions.Other problems include infection,thrombus,pulmonary emboli,pulmonary infarction,pneumothorax,hemothorax,and vessel or heart perforation.

Question 12

Which device provides a two-dimensional color image of the beating heart?

Accepted Answer

Sound waves from a sonar-like device provide two-dimensional color images of the beating heart.

Question 13

Central venous pressure (CVP)

Accepted Answer

CVP assesses function of the heart's right side.It represents the amount of venous return and filling pressure of the right ventricle.

Question 14

Which is an indication for using pulmonary artery monitoring?

Accepted Answer

Indications for pulmonary artery monitoring include preexisting cardiac or pulmonary disease in a patient undergoing a major vascular,intraabdominal,or neurosurgical procedure,and a potential risk of development of cardiopulmonary instability from the stress of the surgical procedure.Other conditions may include shock,burns with large fluid shifts,renal failure with low CO,or pulmonary emboli.Pulmonary artery catheters may be used in patients who require long-term monitoring.

Question 15

What could cause a sudden change in the configuration of a pulmonary artery pressure tracing?

Accepted Answer

Potential causes of changes in a pulmonary artery pressure tracing configuration include the following: The transducer is not at the right atrial level,the transducer is in need of calibration,the transducer connection to the catheter is not secure,the catheter is no longer in proper position,or there is a loss of pressure in the pressure bag.By troubleshooting,the circulating nurse can quickly remedy the problem and apply appropriate interventions.The circulating nurse should be knowledgeable of the patient problems as well as the monitoring problems to maximize patient safety.

Question 16

Which is a benefit of indwelling arterial,venous,or intracardiac catheters?

Accepted Answer

In high-risk patients,indwelling catheters placed in an arterial,venous,or intracardiac locations can give health care providers quick information regarding the patient's condition.

Question 17

Which is a true statement about blood pressure (BP)measurement?

Accepted Answer

Blood pressure measures the contraction and relaxation of the heart.Blood pressure is higher in systole than in diastole and is measured in millimeters of mercury; the arm used for measurements should be opposite the one used for IV fluid therapy.Measurement can be direct or indirect,and can be continuous or intermittent.

Question 18

Which statement regarding pulse oximetry is false?

Accepted Answer

A pulse oximeter measures arterial oxyhemoglobin saturation.The pulse oximeter reading should remain over 95%; cigarette smokers have false high readings because carboxyhemoglobin (carbon dioxide),which closely resembles oxyhemoglobin,can be perceived by the sensor to be oxygenated.For accuracy,avoid placing the sensor over an area with fingernail polish.

Question 19

Which is a positioning consideration that must be ensured when assisting a physician in placing a subclavian or jugular vein catheter?

Accepted Answer

To reduce the potential for air embolism,place the patient in a 25- to 30-degree Trendelenburg's position,elevate the scapular area with padding or a rolled towel,and turn the head away from the insertion site.

Question 20

Which statement about CVP is true?

Accepted Answer

Normal CVP readings range from 2 to 8 mm Hg and respiratory inspiration creates negative pressure.CVP may be monitored with a single-lumen or multilumen radiopaque catheter.A double- or triple-lumen Hickman or Broviac catheter is used most commonly.

Quiz 27: Physiologic Maintenance and Monitoring of the Perioperative Patient