Question 1

The ICU charge nurse will evaluate that teaching about hemodynamic monitoring for a new staff nurse has been effective when the new nurse

Accepted Answer

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 position of the limb and the catheter insertion site are not useful in zeroing the monitoring equipment.

Question 2

A patient is admitted to the emergency department comatose and apneic with suspected head and neck injuries after falling from a roof. Which equipment will the nurse anticipate needing for emergency airway maintenance?

Accepted Answer

Nasal ETs are indicated when head and neck injury is suspected to avoid further trauma. Oral ETs are used most commonly in an emergency but not when there is head/neck trauma. Tracheostomy placement is done when long-term artificial airways are needed. Oropharyngeal airways do not permit mechanical ventilation, which will be needed for this patient.

Question 3

A patient with hemodynamic monitoring has a blood pressure of 94/68, heart rate of 130, and a cardiac output (CO) of 4.8 L/min. In analyzing the patient's hemodynamic measurements, the nurse calculates the stroke volume (SV) at ____ ml/beat.

Accepted Answer

The formula for CO is heart rate multiplied by stroke volume. Because the patient's CO is 4.8 L/min and the heart rate is 130, the stroke volume must be 37 ml/beat.

Question 4

A patient in heart failure following an acute myocardial infarction has a pulmonary artery catheter inserted. To determine whether the administration of drugs to decrease preload and afterload has been effective, the nurse should monitor the

Accepted Answer

Although all of these parameters will change after administration of drugs to reduce preload and afterload, a decrease in PAWP would be the best indicator of a decrease in pressure and volume in the left ventricle at the end of diastole (and of resolving heart failure).

Question 5

A patient admitted to the ICU after experiencing a massive pulmonary embolism has an arterial catheter and a pulmonary artery catheter in place. When evaluating whether treatment has been effective in improving pulmonary hypertension, the nurse will monitor for

Accepted Answer

Pulmonary vascular resistance (PVR) is a major contributor to pulmonary hypertension, and a decrease would indicate that pulmonary hypertension was improving. An increased pulmonary artery pressure (PAP) would indicate that the pulmonary hypertension was worsening. Mean arterial pressure (MAP) is a reflection of systemic pressure and does not provide any direct evidence of any improvement in pulmonary hypertension. Pulmonary artery wedge pressure (PAWP) reflects pressure in the left ventricle and is not useful in monitoring pulmonary pressures.

Question 6

An intra-aortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. An assessment finding indicating to the nurse that the goals of treatment with the IABP are being met is a

Accepted Answer

A urine output of 100 ml/hour indicates good renal perfusion and CO. The CO and SV are lower than normal signify continued cardiogenic shock. The tachycardia also suggests continued poor SV and inadequate CO.

Question 7

The nurse identifies a nursing diagnosis of disturbed sensory perception related to sleep deprivation for a patient in the ICU. An appropriate nursing intervention for this problem is to

Accepted Answer

Clustering nursing activities and providing uninterrupted rest periods will minimize sleep-cycle disruption. Sedative and opioids medications tend to decrease the amount of rapid eye movement (REM) sleep and can contribute to sleep disturbance and disturbed sensory perception. Silencing the alarms on the cardiac monitors would be unsafe in a critically ill patient, as would discontinuing assessments during the night.

Question 8

The mixed venous oxygen saturation (SvO₂) is decreasing in a patient with hemodynamic monitoring who has severe pancreatitis. The patient's PaO₂ and cardiac output are stable. To determine the possible cause of the decreased SvO₂, the nurse assesses the patient's

Accepted Answer

Elevated temperature increases metabolic demands and oxygen use by tissues, resulting in a drop in oxygen saturation of mixed venous blood. Information about the patient's weight, urinary output, and amylase will not help in determining the cause of the patient's drop in SvO₂.

Question 9

The nurse identifies a collaborative problem of potential for arterial trauma secondary to displacement of the balloon for a patient with an intraaortic balloon pump (IABP). An appropriate action by the nurse for this problem is to

Accepted Answer

Displacement of the balloon might occlude the renal arteries, which would decrease renal perfusion and urine output. The other actions are also appropriate for this patient but would not address the complication of balloon displacement.

Question 10

A patient with left ventricular failure is admitted to the coronary care unit (CCU). When monitoring for the effectiveness of treatment, the most important information for the nurse to obtain is

Accepted Answer

Pulmonary artery wedge pressure (PAWP) reflects left ventricular end diastolic pressure (or left ventricular preload). Because the patient in left ventricular failure will have a high PAWP, a decrease in this value will be the best indicator of patient improvement. The other values would also provide useful information, but the most definitive measurement of improvement is a drop in PAWP.

Question 11

A patient has an arterial pressure catheter placed in the right radial artery for access for frequent arterial sampling for blood gas analysis. When the low-pressure alarm is activated, the nurse's most appropriate action would be to

Accepted Answer

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 right hand would be caused by occlusion of the radial artery by the arterial catheter, not by low pressure. There is no indication that the patient is experiencing pain.

Question 12

A patient with severe heart failure has a ventricular assist device (VAD) implanted. When developing the plan of care, the nursing actions should include

Accepted Answer

The insertion site for the VAD provides a source for transmission of infection to the circulatory system and requires frequent monitoring. Patient's with VADs are able to have some mobility and may not be on bed rest. A VAD is a bridge to transplantation, not a permanent device. Immunosuppression is not necessary for nonbiologic devices like the VAD.

Question 13

To verify the correct placement of an endotracheal tube (ET) after insertion, the best initial action for the nurse to take is

Accepted Answer

End-tidal CO₂ monitors are currently recommended for rapid verification of ET placement. Auscultation for bilateral breath sounds and checking chest expansion are also used, but they are not as accurate as end-tidal CO₂ monitoring. A chest x-ray confirms the placement but is done after the tube is secured.

Question 14

An arterial catheter is inserted in the right brachial artery to monitor a patient's blood pressure. Which information obtained by the nurse indicates that a complication of arterial pressure monitoring may be occurring?

Accepted Answer

Numbness in the right hand suggests that the perfusion distal to the insertion site is decreased. The Allen test is performed before arterial line insertion, and a positive test indicates normal ulnar artery perfusion. A MAP of 102 is elevated, but this would not be caused by the arterial line. The dicrotic notch is normally seen on the arterial waveform.

Question 15

When assisting with insertion of a pulmonary artery (PA) catheter, the nurse identifies that the catheter is correctly placed when the

Accepted Answer

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. The length of catheter needed for insertion will vary with patient size.

Question 16

To inflate the cuff of an endotracheal tube (ET) when the patient is on mechanical ventilation, the nurse

Accepted Answer

The minimal occluding volume technique involves injecting air into the cuff until no air leak is present at the peak inspiratory pressure. The volume to inflate the cuff varies with the ET and the patient's size. Cuff pressure should be maintained at 20 to 25 mm Hg. An accurate assessment of cuff pressure cannot be obtained by palpating the pilot balloon.

Question 17

Several family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?

Accepted Answer

Lack of information is a major source of anxiety for family members and should be addressed first. Family members should be prepared for the patient's appearance and the ICU environment before visiting the patient for the first time. ICU visiting should be individualized to each patient and family rather than being dictated by rigid visitation policies. Inviting the family to participate in a multidisciplinary conference is appropriate but should not be the initial action by the nurse.

Question 18

Which assessment data obtained by the nurse when caring for a patient with a left radial arterial line indicates a need for the nurse to take action?

Accepted Answer

The change in temperature of the left hand suggests that blood flow to the left hand is impaired. The flush system needs to be changed every 96 hours. A mean arterial pressure (MAP) of 75 mm Hg is normal. Flush systems for hemodynamic monitoring are set up to deliver 3 to 6 ml/hour of flush solution.

Question 19

During hemodynamic monitoring, the nurse finds that a patient has decreased cardiac output (CO) without changes in pulmonary artery wedge pressure (PAWP) or systemic vascular resistance (SVR). The nurse anticipates assisting with interventions to

Accepted Answer

The formula for CO is stroke volume *
f. heart rate. Because the PAWP and SVR are unchanged, the patient's stroke volume is stable, so a drop in heart rate has occurred to decrease the CO. Measures to improve heart rate should be implemented. Interventions to reduce stroke volume, lowering right atrial pressure, or reduce CVP are not indicated because the problem is the patient's heart rate.

Question 20

When preparing to assist with the insertion of a pulmonary artery catheter, the nurse will anticipate the need to

Accepted Answer

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 pressure (PAP) lines are usually inserted to determine fluid status, so diuretics would not be given until after the PAP line was inserted and the patient's fluid status was determined. Cardiac enzymes are not needed before the procedure, and heart sounds are not monitored during insertion.

Quiz 66: Nursing Management: Critical Care

The ICU charge nurse will evaluate that teaching about hemodynamic monitoring for a new staff nurse has been effective when the new nurse

A patient is admitted to the emergency department comatose and apneic with suspected head and neck injuries after falling from a roof. Which equipment will the nurse anticipate needing for emergency airway maintenance?

A patient with hemodynamic monitoring has a blood pressure of 94/68, heart rate of 130, and a cardiac output (CO) of 4.8 L/min. In analyzing the patient's hemodynamic measurements, the nurse calculates the stroke volume (SV) at ____ ml/beat.

A patient in heart failure following an acute myocardial infarction has a pulmonary artery catheter inserted. To determine whether the administration of drugs to decrease preload and afterload has been effective, the nurse should monitor the

A patient admitted to the ICU after experiencing a massive pulmonary embolism has an arterial catheter and a pulmonary artery catheter in place. When evaluating whether treatment has been effective in improving pulmonary hypertension, the nurse will monitor for

An intra-aortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. An assessment finding indicating to the nurse that the goals of treatment with the IABP are being met is a

The nurse identifies a nursing diagnosis of disturbed sensory perception related to sleep deprivation for a patient in the ICU. An appropriate nursing intervention for this problem is to

The mixed venous oxygen saturation (SvO₂) is decreasing in a patient with hemodynamic monitoring who has severe pancreatitis. The patient's PaO₂ and cardiac output are stable. To determine the possible cause of the decreased SvO₂, the nurse assesses the patient's

The nurse identifies a collaborative problem of potential for arterial trauma secondary to displacement of the balloon for a patient with an intraaortic balloon pump (IABP) . An appropriate action by the nurse for this problem is to

A patient with left ventricular failure is admitted to the coronary care unit (CCU) . When monitoring for the effectiveness of treatment, the most important information for the nurse to obtain is

A patient has an arterial pressure catheter placed in the right radial artery for access for frequent arterial sampling for blood gas analysis. When the low-pressure alarm is activated, the nurse's most appropriate action would be to

A patient with severe heart failure has a ventricular assist device (VAD) implanted. When developing the plan of care, the nursing actions should include

To verify the correct placement of an endotracheal tube (ET) after insertion, the best initial action for the nurse to take is

An arterial catheter is inserted in the right brachial artery to monitor a patient's blood pressure. Which information obtained by the nurse indicates that a complication of arterial pressure monitoring may be occurring?

When assisting with insertion of a pulmonary artery (PA) catheter, the nurse identifies that the catheter is correctly placed when the

To inflate the cuff of an endotracheal tube (ET) when the patient is on mechanical ventilation, the nurse

Several family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?

Which assessment data obtained by the nurse when caring for a patient with a left radial arterial line indicates a need for the nurse to take action?

During hemodynamic monitoring, the nurse finds that a patient has decreased cardiac output (CO) without changes in pulmonary artery wedge pressure (PAWP) or systemic vascular resistance (SVR) . The nurse anticipates assisting with interventions to

When preparing to assist with the insertion of a pulmonary artery catheter, the nurse will anticipate the need to

Quiz 66: Nursing Management: Critical Care

The ICU charge nurse will evaluate that teaching about hemodynamic monitoring for a new staff nurse has been effective when the new nurse

A patient is admitted to the emergency department comatose and apneic with suspected head and neck injuries after falling from a roof. Which equipment will the nurse anticipate needing for emergency airway maintenance?

A patient with hemodynamic monitoring has a blood pressure of 94/68, heart rate of 130, and a cardiac output (CO) of 4.8 L/min. In analyzing the patient's hemodynamic measurements, the nurse calculates the stroke volume (SV) at ____ ml/beat.

A patient in heart failure following an acute myocardial infarction has a pulmonary artery catheter inserted. To determine whether the administration of drugs to decrease preload and afterload has been effective, the nurse should monitor the

A patient admitted to the ICU after experiencing a massive pulmonary embolism has an arterial catheter and a pulmonary artery catheter in place. When evaluating whether treatment has been effective in improving pulmonary hypertension, the nurse will monitor for

An intra-aortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. An assessment finding indicating to the nurse that the goals of treatment with the IABP are being met is a

The nurse identifies a nursing diagnosis of disturbed sensory perception related to sleep deprivation for a patient in the ICU. An appropriate nursing intervention for this problem is to

The mixed venous oxygen saturation (SvO2) is decreasing in a patient with hemodynamic monitoring who has severe pancreatitis. The patient's PaO2 and cardiac output are stable. To determine the possible cause of the decreased SvO2, the nurse assesses the patient's

The nurse identifies a collaborative problem of potential for arterial trauma secondary to displacement of the balloon for a patient with an intraaortic balloon pump (IABP) . An appropriate action by the nurse for this problem is to

A patient with left ventricular failure is admitted to the coronary care unit (CCU) . When monitoring for the effectiveness of treatment, the most important information for the nurse to obtain is

A patient has an arterial pressure catheter placed in the right radial artery for access for frequent arterial sampling for blood gas analysis. When the low-pressure alarm is activated, the nurse's most appropriate action would be to

A patient with severe heart failure has a ventricular assist device (VAD) implanted. When developing the plan of care, the nursing actions should include

To verify the correct placement of an endotracheal tube (ET) after insertion, the best initial action for the nurse to take is

An arterial catheter is inserted in the right brachial artery to monitor a patient's blood pressure. Which information obtained by the nurse indicates that a complication of arterial pressure monitoring may be occurring?

When assisting with insertion of a pulmonary artery (PA) catheter, the nurse identifies that the catheter is correctly placed when the

To inflate the cuff of an endotracheal tube (ET) when the patient is on mechanical ventilation, the nurse

Several family members of a patient who has just been admitted to the intensive care unit (ICU) with multiple traumatic injuries have just arrived in the ICU waiting room. Which action should the nurse take first?

Which assessment data obtained by the nurse when caring for a patient with a left radial arterial line indicates a need for the nurse to take action?

During hemodynamic monitoring, the nurse finds that a patient has decreased cardiac output (CO) without changes in pulmonary artery wedge pressure (PAWP) or systemic vascular resistance (SVR) . The nurse anticipates assisting with interventions to

When preparing to assist with the insertion of a pulmonary artery catheter, the nurse will anticipate the need to

The mixed venous oxygen saturation (SvO₂) is decreasing in a patient with hemodynamic monitoring who has severe pancreatitis. The patient's PaO₂ and cardiac output are stable. To determine the possible cause of the decreased SvO₂, the nurse assesses the patient's