Basic Test 7
What is the normal range for CVP in a healthy adult?
0 to 8 mm Hg
What is the normal range for right atrial pressure in a healthy adult?
0 to 8 mm Hg
The CVP can be used to estimate left ventricular filling pressures if there is no left ventricular dysrhythmia and the ejection fraction is greater than:
0.50
A difference between the pulmonary artery diastolic pressure and the pulmonary capillary wedge pressure greater than 5 mm Hg is seen in which of the following conditions? 1. ARDS 2. Sepsis 3. Excessive PEEP
1. ARDS 2. Sepsis 3. Excessive PEEP
Which of the following can be measured directly via a pulmonary artery catheter? 1. CVP 2. RAP 3. PCWP 4. PVR
1. CVP 2. RAP 3. PCWP
A shift to zone I or II may occur if which of the following conditions is present? 1. Hypovolemia 2. Increased PEEP 3. Hemorrhage 4. Decrease in PEEP
1. Hypovolemia 2. Increased PEEP 3. Hemorrhage
Which of the following may cause a decrease in ventricular compliance? 1. Inotropic drugs 2. Vasodilator drugs 3. Myocardial infarction 4. Positive end-expiratory pressure
1. Inotropic drugs 3. Myocardial infarction 4. Positive end-expiratory pressure
Which of the following abbreviations indicate the intermittent pressure measurement obtained when a pulmonary artery catheter is advanced into the PA and the balloon on the catheter tip is inflated? 1. PCWP 2. PAW 3. PAO 4. PVR
1. PCWP 2. PAW 3. PAO
Large fluctuations in the net distending pressures within the left ventricle, also known as the transmural pressure, are seen in which of the following situations? 1. Positive pressure ventilation 2. Labored respiratory effort 3. Coughing 4. Valsva maneuver
1. Positive pressure ventilation 2. Labored respiratory effort 3. Coughing 4. Valsva maneuver
Which of the following has a direct effect on stroke volume? 1. Preload 2. Heart rate 3. Afterload 4. Contractility
1. Preload 3. Afterload 4. Contractility
Which of the following agents are considered to be negative inotropic drugs? 1. Propranolol 2. Dobutamine 3. Isoproterenol 4. Atenolol
1. Propranolol 4. Atenolol
Which the following are true about the ejection fraction? 1. The normal value is about 65% to 70%. 2. It can be calculated from a nomogram. 3. The percentage is the end-diastolic volume ejected with each beat. 4. It represents the difference between end-diastolic and end-systolic volumes.
1. The normal value is about 65% to 70%. 3. The percentage is the end-diastolic volume ejected with each beat. 4. It represents the difference between end-diastolic and end-systolic volumes.
Which of the following can be used to assess cardiac output noninvasively? 1. The pulse pressure 2. Echocardiography 3. Doppler ultrasound 4. Transthoracic electrical bioimpedance
1. The pulse pressure 2. Echocardiography 4. Transthoracic electrical bioimpedance
Which of the following make up the peripheral component of afterload? 1. The radius of the vessels 2. The length of the vessels 3. The viscosity of the blood 4. The elasticity or compliance of the vessels
1. The radius of the vessels 3. The viscosity of the blood 4. The elasticity or compliance of the vessels
The pulmonary artery catheter allows assessment of which of the following? 1. the left ventricular preload 2. the mixed venous oxygen saturation (SvO2) 3. the cardiac output
1. left ventricular preload 2. mixed venous oxygen saturation (SvO2) 3. cardiac output
Monitoring of the CVP is indicated when there is a need to assess which of the following? 1. the circulating blood volume 2. the degree of venous return 3. the right ventricular function
1. the circulating blood volume 2. the degree of venous return 3. the right ventricular function
The CVP represents which of the following? 1. the right ventricular preload 2. the pressure of blood in the right atrium 3. the right ventricular end-diastolic pressure
1. the right ventricular preload 2. the pressure of blood in the right atrium 3. the right ventricular end-diastolic pressure
What is the normal adult BSA?
1.5 to 2 m2
PEEP levels lower than what value will have a limited effect on intrapleural pressure?
10 cm H2O
Tachycardia in an adult is defined as a heart rate greater than _____ beats/min.
100
What will the MAP be if the systolic blood pressure is 140 mm Hg and the diastolic blood pressure is 80 mm Hg?
100 mm Hg
Which would the SVR equal (dynes x sec x cm-5) if MAP equals 90 mm Hg, CVP is 8 mmHg, and CO is 4.5 L/min?
1457
Which of the following can cause an increase in pulmonary vascular resistance? 1. Exercise 2. Acidosis 3. Hypoxemia 4. Release of histamine because of allergic response
2. Acidosis 3. Hypoxemia 4. Release of histamine because of allergic response
Which of the following can affect cardiac output? 1. Race 2. Body size 3. Hematocrit 4. Tissue demand for oxygen
2. Body size 3. Hematocrit 4. Tissue demand for oxygen
Which hemodynamic parameters would be decreased if a lung collapsed? 1. CVP 2. CO 3. SVI 4. PVR
2. CO 3. SVI
Which of the following is used in continuous cardiac output monitoring? 1. Echocardiography 2. Doppler ultrasound 3. Pulse contour cardiac output monitoring 4. Thermal dilution
2. Doppler ultrasound 3. Pulse contour cardiac output monitoring 4. Thermal dilution
In a healthy adult at rest, what is the normal range for cardiac index?
2.5-4.2 L/beat/m2
In a healthy adult at rest, what is the normal range for PVR in dynes x sec x cm-5 ?
20 to 120
The normal range for pulmonary artery systolic pressure is _____ mm Hg.
20 to 30
Approximately how much blood can be lost before circulatory function and pressures are affected?
25%
In a healthy adult at rest, what is the normal range for stroke volume index?
30-65 mL/beat/m2
The normal pulmonary capillary wedge pressure is _____ mm Hg.
4 to 12
What is the normal range for pulmonary capillary wedge pressure in a healthy adult?
4 to 12 mm Hg
What is the normal range for cardiac output in a healthy adult at rest?
4 to 8 Lpm
In a healthy adult at rest, what is the normal range for left ventricular stroke work index ?
40-60 g m/m2
The average cardiac output for adult men and women at rest is _____ L/min.
5
What would the LVSWI index equal if SVI is 42 mL/beat/m2, MAP is 105 mm Hg, PCWP is 12 mm Hg?
53 g m/ m2
Bradycardia in an adult is defined as a heart rate less than _____ beats/min.
60
Circulation to the vital organs (kidneys, coronary arteries) may be compromised if the MAP falls to below _____ mm Hg.
60
In a healthy adult at rest, what is the normal range for stroke volume?
60 to 130 mL
At rest, approximately what percentage of total blood volume is stored in the venous system?
64%
The normal ejection fraction is approximately:
65% to 70%.
In a healthy adult at rest, what is the normal range for right ventricular stroke work index?
7-12 g m/m2
If a patient has a heart rate of 70 beats/min and a cardiac output of 4.9 L/min, what would the SV equal?
70 mL/beat
The normal range for pulmonary artery diastolic pressure is _____ mm Hg.
8 to 15
In a healthy adult at rest, what is the normal range for SVR in dynes x sec x cm-5 ?
800 to 1500
What is the normal range for mean pulmonary artery pressure in a healthy adult?
9 to 18 mm Hg
Positive-pressure ventilation with PEEP has what effect on preload?
A dampening effect
What effect does an increase in intrathoracic pressure have on venous return?
A dampening effect
How does the Finometer measure arterial pressure?
A finger cuff and an inflatable bladder in combination with an infrared plethysmograph
What is the most important factor in assessment of the ability of the cardiovascular system to meet the body's metabolic demands?
Adequacy of perfusion
Positive-pressure ventilation with positive end-expiratory pressure (PEEP) has what effect on afterload?
An enhancing effect
What effect does spontaneous deep inspiration have on venous return?
An enhancing effect
What does the dicrotic notch represent on an arterial pressure waveform?
Aortic valve closure
The "A" wave would be absent in which of the following dysrhythmias?
Atrial fibrillation
Complications involving the use of CVP catheters include all of the following EXCEPT:
Atrial septal puncture.
What effect would hypovolemia and CHF have on the RVSWI?
Both would decrease it
What effect does late stage septic shock and decreased PCO2 have on SVR?
Both would increase SVR
What impact would dobutamine and dopamine have on LVSWI?
Both would increase it
Which hemodynamic value is derived by dividing cardiac output by BSA?
CI
With a properly inserted and positioned pulmonary artery catheter, a systolic pressure reading in the pulmonary artery of 50 mm Hg could be due to:
COPD
Which of the hemodynamic parameters are most affected by cor pulmonale?
CVP and RAP
When ventricular function curves are performed on a patient with a suspected failing left ventricle, how does cardiac output typically change as the pulmonary capillary wedge pressure increases?
Cardiac output increases at first and then decreases.
When ventricular function curves are performed on a patient with a suspected failing right ventricle, how does cardiac output typically change as central venous pressure increases?
Cardiac output increases at first and then decreases.
To obtain the coronary perfusion pressure, what two values are needed?
Diastolic blood pressure and pulmonary capillary wedge pressure
The CVP is most likely to correlate well with left ventricular filling pressure in which of the following patients?
Female, age 25, recovering well after abdominal surgery
Blood flow is directed to organs that have the highest metabolic needs when at rest. Which of the following organs would have the lowest metabolic needs when at rest?
Heart
Cardiac output is a product of which two variables?
Heart rate and stroke volume
According to the Fick equation, what could cause the C(a − v)O2 to decrease?
High cardiac output
According to West, which zone is dominant in the supine position?
II
For the pulmonary capillary wedge pressure to reflect pulmonary venous and left atrial pressures, blood flow must be uninterrupted between the catheter tip and the left heart. This condition exists only in West zone:
III
Which hemodynamic parameter is a reflection of the contractility of the left ventricle?
LVSWI
Which hemodynamic parameter is most significantly impacted by CHF?
PCWP
Which measurement reflects the afterload of the right ventricle?
PVR
What effect do propranolol and isoproterenol have on CI?
Propranolol will decrease CI; isoproterenol will increase CI
Which of the following is used to determine the afterload of the right ventricle?
Pulmonary vascular resistance
Which hemodynamic value reflects the amount of work required by the right ventricle to pump blood?
RVSWI
What does CO divided by HR equal?
SV
What effects would late stage septic shock and CHF have on SV and CO?
SV and CO would both decrease
What value is derived when SV is divided by BSA?
SVI
Which of the following techniques is used most commonly to insert an arterial pressure monitoring catheter?
Seldinger technique
Why has use of the pulmonary artery catheter diminished in many ICUs?
Some experts believe it increases death rates.
The strength of contraction of the myocardial muscle fibers is related directly to the amount of stretch on the fiber before contraction is a definition of:
Starling law.
What is "best PEEP"?
The level that has the least hemodynamic compromise and the maximum total oxygen delivery
Which of the following best describes preload?
The stretch on the ventricular muscle fibers before contraction
What method of measuring cardiac output is most popular in intensive care units (ICUs) around the country?
Thermodilution
How is PVR affected by acidemia, hypercapnia, and alveolar hypoxia?
They cause PVR to increase
What effect would myocardial infarction and pulmonary emboli have on SVI?
They would decrease SVI
An exaggerated v wave would be found in which of the following conditions?
Tricuspid regurgitation
Which of the following is NOT an advantage of using the internal jugular vein as the insertion site for the central venous catheter?
Tubing is more stable and less likely to kink in a patient who is awake.
The resistance to ventricular ejection also is known as:
afterload.
All of the following are potential hazards of pulmonary artery catheter migration EXCEPT:
air embolus.
What effect would epinephrine have on CI and RVSWI?
both would increase
What effect would early septic shock and hyperthermia have on stroke volume?
both would increase the stroke volume
The amount of blood pumped out of the left ventricle in 1 min is the definition of:
cardiac output.
The filling pressure of the right heart is also known as the _____ pressure.
central venous
If, when the pulmonary artery catheter is inserted, there is a rapid increase in the height of the pressure waveforms with the downstroke dropping near zero, the respiratory therapist should:
continue the insertion because the catheter now has entered the right ventricle.
When vasodilators such as sodium nitroprusside are administered, it is important to monitor the fall in blood pressure because low blood pressure can:
decrease blood flow to the coronary arteries.
Arterial cannulation is indicated for all of the following EXCEPT:
determining cardiac output
When the water manometer is used to measure the CVP, the reading usually is taken at:
end of expiration with patient in supine position.
In patients with pulmonary hypertension, the right ventricular stroke work index will be:
greater than normal.
What is the term for the study of forces that influence the circulation of blood?
hemodynamics
Complications of direct arterial monitoring include all the following EXCEPT:
hypotension.
During systole, the CVP v waveform is exaggerated and the CVP increases. This most likely is due to:
incompetent tricuspid valve.
In left ventricular failure, the pulmonary capillary wedge pressure is expected to:
increase to above the normal range.
What intervention is intended to minimize central line-associated bloodstream infections?
infection prevention measures and daily line review
A drug that increases the contractility of the heart is known as a positive:
inotrope.
The pulse pressure is important hemodynamically because it is an indication of:
left ventricular stroke volume.
When the Fick method is used to calculate cardiac output, if C(a − v)O2 is greater than expected and VO2 is normal, cardiac output probably will be:
less than expected.
The cardiac output of the right ventricle is the same as the cardiac output of the left ventricle. Compared with the left ventricle, the cardiac work index of the right ventricle is:
less.
What primary therapeutic effect does nitroprusside have on hemodynamic parameters?
lowers afterload
In COPD, which hemodynamic parameter is most increased?
mean pulmonary artery pressure (mPAP)
Which hemodynamic measurement would be most increased when a pulmonary embolism is present?
mean pulmonary pressure
An increase in CVP during inspiration most likely is caused by:
mechanical breath.
The purpose of the balloon at the tip of the pulmonary artery catheter is to:
obtain wedge pressure measurements.
All of the following cause a decrease in the CVP EXCEPT:
peripheral vasodilation.
What is the correct catheter placement to obtain the PCWP?
pulmonary artery
The filling pressure of the left heart is also known as the _____ pressure.
pulmonary capillary wedge
Pulmonary artery catheter monitoring is likely to be considered for patients with any of the following conditions EXCEPT:
pulmonary embolus.
A patient with a newly inserted pulmonary catheter begins to cough up blood-tinged sputum. The most likely cause for this is:
pulmonary infarction.
The periodic, noninvasive measurement of cardiac performance that requires only the use of a sphygmomanometer is called:
pulse pressure.
The most common site for arterial catheterization is the:
radial artery
An increase in pulmonary artery systolic pressure is seen in patients with all of the following EXCEPT:
right ventricular failure
All of the following cause an increase in the CVP EXCEPT:
spontaneous inspiration.
What vein insertion site for the CVP catheter insertion site provides both stability after placement and accurate hemodynamic information?
subclavian vein
To enable the heart of a well-trained athlete to produce a cardiac output of up to 35 L/min, stimulation of the heart muscle is needed through the:
sympathetic nervous system.
To standardize the measurement of cardiac output in individuals of different sizes, the value for cardiac output is divided by the person's body surface area. The result is known as:
the cardiac index.
The greatest determinant of peripheral resistance to blood flow is:
the radius of the vessels.
When the pulmonary artery catheter is inserted, the balloon is inflated in the right atrium before it is inserted further. Why is this done?
to allow the catheter to float.
At rest, approximately 64% of the total blood volume is stored in the:
venous system.
What change is seen on the CVP waveform when the patient takes a spontaneous deep breath?
waveform falls to below baseline.
Both the CVP and the pulmonary artery wedge pressure waveforms have three waves for each cycle, namely:
waves a, c, and v.