CH 8

The charge nurse is supervising the care of four critical care patients being monitored using invasive hemodynamic modalities. Which patient should the charge nurse evaluate first? a. A patient in cardiogenic shock with a cardiac output (CO) of 2.0 L/min b. A patient with a pulmonary artery systolic pressure (PAP) of 20 mm Hg c. A hypovolemic patient with a central venous pressure (CVP) of 6 mm Hg d. A patient with a pulmonary artery occlusion pressure (PAOP) of 10 mm Hg

a. A patient in cardiogenic shock with a cardiac output (CO) of 2.0 L/min

The nurse is caring for a patient with a left radial arterial line, and a pulmonary artery catheter inserted into the right subclavian vein. Which action by the nurse best ensures the safety of the patient being monitored with invasive hemodynamic monitoring lines? a. Document all waveform values. b. Limit the pressure tubing length. c. Zero reference the system daily. d. Ensure alarm limits are turned on.

d. Ensure alarm limits are turned on.

A patient with a right subclavian triple lumen catheter has a CVP reading of 18 mm Hg. The nurse would further assess the patient for symptoms of: 1. Peripheral edema and jugular vein distention 2. Decreased peripheral pulses and cool extremities 3. Hypovolemia and hypotension 4. Orbital edema and disorientation

Correct Answer: 1 Rationale 1: An elevated CVP indicates hypervolemia and/or right ventricular failure because it is a direct measurement of pressure in the right side of the heart. This is manifested by jugular vein distention and peripheral edema. Rationale 2: These are not symptoms associated with hypervolemia or right ventricular failure. Rationale 3: An elevated CVP would not occur with hypovolemia or hypotension. Rationale 4: These are not symptoms associated with hypervolemia or right ventricular failure.

The health care provider is preparing to insert a PA catheter. The nurse should ensure that: 1. The patient is in the Trendelenburg position to prevent air embolism. 2. The patient has received a dose of IV lidocaine. 3. The site has been cleaned with soap and water. 4. A tourniquet has been applied to the neck.

Correct Answer: 1 Rationale 1: The Trendelenburg position promotes venous filling in the upper body for easier catheter insertion and prevention of air embolism. Rationale 2: This is not a part of the procedure. Rationale 3: The site should be prepped with antiseptic solution according to agency protocol. Rationale 4: No tourniquet is necessary.

Which nursing intervention ensures an accurate cardiac output reading for a patient? 1. Administer the injectate within 4 seconds. 2. Use 5 cc of iced saline as the injectate. 3. Ensure that there is a difference of 10°C between the injectate temperature and the patient's body temperature. 4. Inject the fluid into the pulmonary artery distal port.

Correct Answer: 1 Rationale 1: This time frame is necessary to ensure accuracy because the injectate will be pumped out during one cardiac cycle.

The nurse wants to assess the oxygenation status of a patient who has been experiencing a gastrointestinal bleed. How will the nurse complete this assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Use pulse oximetry 2. Send a blood sample for arterial blood gas analysis 3. Auscultate lung sounds 4. Evaluate cardiac rhythm strip 5. Calculate mean arterial pressure

Correct Answer: 1,2 Rationale 1: At the bedside the arterial oxygen saturation can be estimated by pulse oximetry. Rationale 2: At the bedside the arterial oxygen saturation can be measured via an arterial blood gas analysis. Rationale 3: Auscultating lung sounds will not provide information about a patient's oxygenation status. Rationale 4: The cardiac rhythm strip will not provide information about a patient's oxygenation status. Rationale 5: The mean arterial pressure will not provide information about a patient's oxygenation status.

After assessing a patient's hemodynamic parameters the nurse determines that preload and afterload are both elevated. These findings are consistent with which health problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Pericardial tamponade 2. Constrictive pericarditis 3. Hypovolemia 4. Neurogenic shock 5. Mitral stenosis

Correct Answer: 1,2 Rationale 1: Both right and left preload are elevated in conditions that cause increases in pericardial pressures such as pericardial tamponade. Rationale 2: Both right and left preload are elevated in conditions that cause increases in pericardial pressures such as constrictive pericarditis. Rationale 3: Preload is decreased in hypovolemia. Rationale 4: Afterload is decreased in neurogenic shock. Rationale 5: Preload is elevated in mitral stenosis.

The nurse is concerned that a patient's pulmonary artery has slipped into the right ventricle. What are the hallmarks of the waveform that the nurse observes on the monitor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Low diastolic pressure 2. No dicrotic notch 3. Continuous wedge waveform 4. Sharp upstroke, a plateau, and a rapid downstroke extending below the baseline 5. Smooth upstroke followed by a gradual downslope to the baseline

Correct Answer: 1,2 Rationale 1: One hallmark of right ventricular pressure is low diastolic pressure. Rationale 2: One hallmark of right ventricular pressure is a lack of dicrotic notch. Rationale 3: A continuous wedge waveform indicates the catheter is wedged in a pulmonary vessel. Rationale 4: This describes the waveform caused by the square wave test. Rationale 5: This describes a cardiac output curve.

While caring for a patient in the intensive care unit, when would the nurse plan to conduct the square wave test on the patient's arterial pressure monitoring system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. At the beginning of the shift 2. After drawing blood 3. When the arterial tracing is not consistent with an auscultated blood pressure 4. When the monitoring cable is disconnected from the flush system 5. Any time the patient's position is changed

Correct Answer: 1,2,3 Rationale 1: The square wave test should be performed during every shift. Rationale 2: The square wave test should be performed after opening the system, such as when drawing blood. Rationale 3: The square wave test should be performed when values are suspected to be inaccurate. Rationale 4: Zeroing should be done when the monitoring cable is disconnected from the flush system. Rationale 5: Releveling is to be done any time the patient's position is changed.

A patient has a central line for fluid management and antibiotic therapy. What interventions will the nurse utilize to reduce the risk of infection in the access site? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Practice thorough hand hygiene. 2. Use chlorhexidine skin asepsis. 3. Review the continued need for the line daily. 4. Cover the insertion site with an opaque gauze dressing. 5. Change the dressing over the insertion site using clean technique.

Correct Answer: 1,2,3 Rationale 1: This is a best practice within the central line bundle to prevent central line infections. Rationale 2: This is a best practice within the central line bundle to prevent central line infections. Rationale 3: This is a best practice within the central line bundle to prevent central line infections. Rationale 4: This approach would restrict the nurse's ability to observe the insertion site for infection and should not be done. Rationale 5: Central line dressings should be changed using sterile technique to reduce the risk of infection.

The nurse is planning to assess the blood pressure of a patient with a BMI of 40. Which approaches will the nurse use to correctly obtain this patient's blood pressure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Use a cuff with a bladder that is 80% of the patient's arm circumference. 2. Use a thigh cuff. 3. Use an adult cuff on the patient's forearm. 4. Assess the blood pressure using the same approach each time. 5. Use an adult cuff on the patient's thigh.

Correct Answer: 1,2,3,4 Rationale 1: A cuff with a bladder that is 80% of the patient's arm circumference should be chosen. Rationale 2: A thigh cuff can be used. Rationale 3: An adult cuff may be used on the patient's forearm. Rationale 4: The blood pressure should be taken in the same way each time. Rationale 5: This is not a recommended approach to obtain the blood pressure on an obese patient.

The health care provider is planning to insert a pulmonary artery catheter into a patient. The nurse realizes this monitoring device is used to: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Determine hemodynamic stability in heart failure 2. Monitor the effects of vasodilator administration 3. Monitor cardiac function during vascular surgical procedures 4. Assess cardiac output 5. Continuously monitor blood pressure

Correct Answer: 1,2,3,4 Rationale 1: A pulmonary artery is used to determine hemodynamic stability in cardiac disorders such as heart failure. Rationale 2: The pulmonary artery catheter is used to guide medication effects such as vasodilators. Rationale 3: The pulmonary artery catheter is used to monitor cardiac function during vascular procedures such as abdominal aneurysm repair. Rationale 4: The pulmonary artery catheter is used to assess cardiac output. Rationale 5: The pulmonary artery catheter is not used to continuously monitor blood pressure.

The nurse is concerned that the hand with an arterial line in the wrist is becoming ischemic. What did the nurse assess in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Delayed capillary refill 2. Pale skin color of the wrist and hand 3. Reduced pulses in the brachial artery 4. Hand cold to touch 5. Blood pressure discrepancy of 15 mm Hg

Correct Answer: 1,2,4 Rationale 1: Evidence of tissue ischemia in the cannulated extremity includes delayed capillary refill. Rationale 2: Evidence of tissue ischemia in the cannulated extremity includes pallor. Rationale 3: Evidence of tissue ischemia in the cannulated extremity includes a reduction in pulses distal to the cannula. Rationale 4: Evidence of tissue ischemia in the cannulated extremity includes cool temperature. Rationale 5: This is not evidence of tissue ischemia in the cannulated extremity.

A patient is experiencing reduced afterload. The nurse realizes that causes of reduced afterload include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Sepsis 2. Mitral stenosis 3. Reduced circulating blood volume 4. Vasodilator medications 5. Myocarditis

Correct Answer: 1,4 Rationale 1: Sepsis causes vasodilation due to the release of endotoxins. Rationale 2: Mitral stenosis causes increased preload. Rationale 3: Reduced circulating blood volume contributes to decreased preload. Rationale 4: Vasodilators enlarge the vessels and reduce resistance. Rationale 5: Myocarditis contributes to elevated preload.

The nurse is monitoring a patient's pulmonary vascular resistance. Which value is the normal value? 1. 100-250 mm Hg 2. 10-250 dynes/sec/cm2 3. 400-800 mm Hg 4. 800-1,400 dynes/sec/cm2

Correct Answer: 2 Rationale 1: A measurement in mm Hg is used to measure pressure only. Rationale 2: The pulmonary system is a low-pressure system. The pressure of the vascular system is measured in dynes/sec/cm2 due to factors of flow, resistance, and time. This is the normal value for pulmonary vascular resistance. Rationale 3: A measurement in mm Hg is used to measure pressure only. Rationale 4: This is the value for SVR.

A patient has a blood pressure of 134/70 per blood pressure cuff and a blood pressure of 90/50 per arterial line. The nurse should: 1. Discontinue the arterial line immediately. 2. Check the level of the transducer and relevel and rezero the system. 3. Do nothing because this is a normal variation between the two methods of measurement. 4. Begin the infusion of a dopamine drip.

Correct Answer: 2 Rationale 1: The system needs to be assessed first. Rationale 2: The placement of the transducer is essential for accurate measurement. It must be level with the phlebostatic axis in order for the monitoring system to be accurate. Rationale 3: This is not a normal variation between the two methods of measurement. Rationale 4: More information and data are needed before administering medication therapy.

A patient with a PA catheter has an SVO2 of 90%. The nurse should assess the patient for: 1. Fever 2. Pain 3. Hypothermia 4. Anemia

Correct Answer: 3 Rationale 1: Fever causes a drop in the SVO2. Rationale 2: Pain causes a drop in the SVO2. Rationale 3: Normal SVO2 is 60% to 75%. This is a high SVO2, which means that there is not enough extraction of O2 from the hemoglobin to the tissues. This can occur with hypothermia. Rationale 4: Anemia causes a drop in the SVO2.

A patient's systemic vascular resistance (SVR) has dangerously decreased. The nurse would expect to administer which medications? 1. Furosemide (Lasix) and dopamine 2. Nitroprusside and furosemide (Lasix) 3. Dopamine and norepinephrine (Levophed) 4. Nitroglycerin and digoxin (Lanoxin)

Correct Answer: 3 Rationale 1: Furosemide (Lasix) is a diuretic that reduces fluid volume and is a mild vasodilator. The systemic vascular resistance will be further decreased. Rationale 2: Furosemide (Lasix) is a diuretic that reduces fluid volume and is a mild vasodilator. The systemic vascular resistance will be further decreased. Rationale 3: If the SVR is low, there is massive peripheral vasodilation. These meds will increase vasomotor tone as well as increase blood pressure. Rationale 4: Nitroglycerin is a potent vasodilator. The systemic vascular resistance will be further decreased.

A patient's hemodynamic parameters include the following: right atrial pressure (RAP) of 13 mm Hg, pulmonary artery wedge pressure (PAWP) of 8 mm Hg, systemic vascular resistance (SVR) of 1,000 dynes/sec/cm2, cardiac output (CO) of 4.9 L/min, cardiac index (CI) of 3.5 L/min, and pulmonary vascular resistance (PVR) of 280 dynes/sec/cm2. Which heart function should cause the nurse concern? 1. Afterload 2. Left heart contractility 3. Right heart contractility 4. Heart rate

Correct Answer: 3 Rationale 1: The CO, CI, and SVR are within normal limits and are indicators of left ventricular function. Rationale 2: The CO, CI, and SVR are within normal limits and are indicators of left ventricular function. Rationale 3: The RAP reflects the amount of blood returning to the right atrium and is a measurement of preload. The elevated PVR is a reflection of the pressure within the right ventricle and is the amount of pressure needed for the right ventricle to eject blood into the PA. The elevated RAP and PVR indicate a problem with right heart contractility and is most likely related to right heart failure. Rationale 4: No data is available about the patient's heart rate.

The nurse identifies pulsus paradoxus on a patient's arterial pressure waveform monitoring when: 1. The waveform has tall, tented waves. 2. The pulse pressure is above 20 mm Hg on exhalation. 3. There is a decrease of more than 10 mm Hg in the arterial waveform before inhalation. 4. There is a single, nonperfused beat.

Correct Answer: 3 Rationale 1: This does not indicate a change in intrathoracic pressure. Rationale 2: This does not cause a change in intrathoracic pressure. Rationale 3: There is a change in intrathoracic pressure that affects the filling of the ventricles, which is reflected in the arterial pressure. Rationale 4: This does not cause a change in intrathoracic pressure.

The nurse notices that a patient with an arterial line has an elevated partial thromboplastin time (PTT) and is not on anticoagulation therapy. The nurse would: 1. Take the patient for an immediate V/Q scan. 2. Assess for the presence of a deep vein thrombosis. 3. Change the heparinized saline solution in the pressure bag for the arterial line to a normal saline solution. 4. Ask for an order to begin Lovenox therapy.

Correct Answer: 3 Rationale 1: This does not need to be done. Rationale 2: The elevated partial thromboplastin time would be desired for this situation. Rationale 3: Heparinized solutions are contraindicated in patients with coagulation deficiencies or heparin-induced thrombocytopenia. Rationale 4: This does not need to be done.

A patient asks the nurse, "What is blood pressure?" The nurse would most appropriately respond: 1. "A measurement that should always be 120/80 unless complications are present." 2. "The amount of pressure exerted on your veins by the blood." 3. "A measurement that takes into consideration the amount of blood that your heart is pumping and the size of the vessel diameter the heart must pump against." 4. "A complex measurement that should only be discussed with your health care provider."

Correct Answer: 3 Rationale 1: This is not an accurate statement. Rationale 2: This is not the best response. Rationale 3: This is understandable to the patient as well as accurate. Rationale 4: This is not an accurate response.

The nurse is monitoring the PA pressure of a mechanically ventilated patient. In order to accurately measure this pressure, the nurse should obtain the measurement: 1. Whenever because the timing does not matter 2. At the last clear waveform before the baseline drops 3. At the last clear waveform before the baseline rises 4. With the patient off the ventilator

Correct Answer: 3 Rationale 1: Timing does matter because the measurement can be elevated because of the ventilator. Timing is crucial for accuracy. Rationale 2: If it is measured before the baseline drops, this reading is high as the result of increased thoracic pressure in the chest from the positive pressure given by the ventilator. Rationale 3: The positive pressure of the ventilator causes an abnormally high reading during inspiration. The accurate measurement is the reading seen before the baseline rises. Rationale 4: Taking the patient off the ventilator is not an option.

Prior to the insertion of an arterial line in the radial artery, which assessment would the nurse perform? 1. Homan's test 2. Kernig's test 3. Allen's test 4. Leopold's maneuver

Correct Answer: 3 Rationale 3: The Allen's test detects the patency of the ulnar artery. This is to ensure that there is adequate blood flow to the hand in the event the radial artery becomes occluded.

When observing the waveform of an arterial line, the nurse notes the presence of a dicrotic notch. The nurse knows this due to: 1. Pulmonic valve opening 2. Mitral valve closure 3. Aortic valve closure 4. Tricuspid valve closure

Correct Answer: 3 Rationale 3: The aortic valve closes and the mitral and tricuspid valves open in preparation for ventricular filling. The pulmonic valve closes at the same time as the aortic valve.

Which of the following actions has the highest priority for maintaining safety when caring for a patient with a PA catheter? 1. Obtain pressures per protocol. 2. Administer fluids and medications via pump. 3. Maintain asepsis when providing line care. 4. Obtain lab values as ordered.

Correct Answer: 3 Rationale 3: The presence of all invasive lines can lead to infection and sepsis. Preventing infection is the highest priority in maintaining patient safety.

A patient has mixed venous oxygen saturation (SVO2) of 52% with the following hemodynamic findings: CO of 4.8 L/min, SaO2 of 95%, and an unchanged hemoglobin level. The nurse should assess the patient for: 1. Excessive sedation 2. Position of the PA catheter 3. Hypothermia 4. Pain

Correct Answer: 4 Rationale 1: Excessive sedation contributes to a higher than normal SVO2 level due to a lower level of oxygen extracted by the tissues. Rationale 2: This would not influence the patient's blood levels of oxygen and carbon dioxide. Rationale 3: Hypothermia contributes to a higher than normal SVO2 level due to a lower level of oxygen extracted by the tissues. Rationale 4: Pain causes an increased consumption of oxygen; therefore, the SVO2 level will decrease.

A patient has a lactate level of 8 mmol/L. The nurse realizes that this finding indicates: 1. Carbon dioxide exchange 2. Underuse of oxygen 3. Glucose metabolism 4. Tissue hypoxia

Correct Answer: 4 Rationale 1: Lactate level does not indicate carbon dioxide exchange. Rationale 2: Lactate level does not indicate the underuse of oxygen. Rationale 3: Lactate level does not indicate glucose metabolism. Rationale 4: When cells become oxygen deprived, anaerobic metabolism of glucose occurs, causing lactate formation instead of carbon dioxide and water. Elevated levels of lactate are a reliable indicator of tissue hypoxia.

What should the nurse monitor in response to a change in SVO readings? 1. Potassium level 2. Glucose level 3. Sodium level 4. Hemoglobin level

Correct Answer: 4 Rationale 1: Potassium does not influence oxygen saturation of venous blood. Rationale 2: Glucose does not influence oxygen saturation of venous blood. Rationale 3: Sodium does not influence oxygen saturation of venous blood. Rationale 4: Oxygen is carried by hemoglobin; this value can influence and is reflected by the SVO2 level.

How will the nurse calculate a patient's mean arterial pressure (MAP)? 1. Dividing the systolic pressure by the diastolic pressure 2. Averaging three of the patient's blood pressures over a 6-hour period 3. Dividing the diastolic pressure by the pulse pressure 4. Adding the systolic pressure and two diastolic pressures and then dividing by 3

Correct Answer: 4 Rationale 1: This is not the way to calculate mean arterial pressure. Rationale 2: This is not the way to calculate mean arterial pressure. Rationale 3: This is not the way to calculate mean arterial pressure. Rationale 4: This is the gold standard for measuring MAP and it reflects the time the heart is in diastole during the cardiac cycle.

What will the nurse use to measure the contractility of the left side of a patient's heart? 1. Left atrial pressure 2. Pulmonary artery wedge pressure 3. Systemic vascular resistance 4. Left ventricular stroke work index

Correct Answer: 4 Rationale 4: This reflects the stretch and force of contraction of the heart muscle.

The nurse is caring for a 100-kg patient being monitored with a pulmonary artery catheter. The nurse assesses a blood pressure of 90/60 mm Hg, heart rate 110 beats/min, respirations 36/min, oxygen saturation of 89% on 3 L of oxygen via nasal cannula. Bilateral crackles are audible upon auscultation. Which hemodynamic value requires immediate action by the nurse? a. Cardiac index (CI) of 1.2 L/min/m3 b. Cardiac output (CO) of 4 L/min c. Pulmonary vascular resistance (PVR) of 80 dynes/sec/cm-5 d. Systemic vascular resistance (SVR) of 1800 dynes/sec/cm-5

a. Cardiac index (CI) of 1.2 L/min/m3

Upon entering the room of a patient with a right radial arterial line, the nurse assesses the waveform to be slightly dampened and notices blood to be backed up into the pressure tubing. What is the best action by the nurse? a. Check the inflation volume of the flush system pressure bag. b. Disconnect the flush system from the arterial line catheter. c. Zero reference the transducer system at the phlebostatic axis. d. Reduce the number of stopcocks in the flush system tubing.

a. Check the inflation volume of the flush system pressure bag.

Which nursing actions are most important for a patient with a right radial arterial line? (Select all that apply.) a. Checking the circulation to the right hand every 2 hours b. Maintaining a pressurized flush solution to the arterial line setup c. Monitoring the waveform on the monitor for dampening d. Restraining all four extremities with soft limb restraints

a. Checking the circulation to the right hand every 2 hours b. Maintaining a pressurized flush solution to the arterial line setup c. Monitoring the waveform on the monitor for dampening

The nurse is preparing to obtain a right atrial pressure (RAP/CVP) reading. What are the most appropriate nursing actions? (Select all that apply.) a. Compare measured pressures with other physiological parameters. b. Flush the central venous catheter with 20 mL of sterile saline. c. Inflate the balloon with 3 mL of air and record the pressure tracing. d. Obtain the right atrial pressure measurement during end exhalation. e. Zero reference the transducer system at the level of the phlebostatic axis.

a. Compare measured pressures with other physiological parameters. d. Obtain the right atrial pressure measurement during end exhalation. e. Zero reference the transducer system at the level of the phlebostatic axis.

The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which assessment finding 2 hours after insertion by the nurse warrants immediate action? a. Diminished breath sounds over left lung field b. Localized pain at catheter insertion site c. Measured central venous pressure of 5 mm Hg d. Slight bloody drainage around insertion site

a. Diminished breath sounds over left lung field

When performing an initial pulmonary artery occlusion pressure (PAOP), what are the best nursing actions? (Select all that apply.) a. Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change. b. Inflate the balloon with air, recording the volume necessary to obtain a reading. c. Maintain the balloon in the inflated position for 8 hours following insertion. d. Zero reference and level the air-fluid interface of the transducer at the level of the phlebostatic axis.

a. Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change. b. Inflate the balloon with air, recording the volume necessary to obtain a reading. d. Zero reference and level the air-fluid interface of the transducer at the level of the phlebostatic axis.

The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best reduces the risk of catheter- related bloodstream infection (CRBSI)? a. Review daily the necessity of the central venous catheter. b. Cleanse the insertion site daily with isopropyl alcohol. c. Change the pressurized tubing system and flush bag daily. d. Maintain a pressure of 300 mm Hg on the flush bag.

a. Review daily the necessity of the central venous catheter.

The nurse is educating a patient's family member about a pulmonary artery catheter (PAC). Which statement by the family member best indicates understanding of the purpose of the PAC? a. "The catheter will provide multiple sites to give intravenous fluid." b. "The catheter will allow the physician to better manage fluid therapy." c. "The catheter tip comes to rest inside my brother's pulmonary artery." d. "The catheter will be in position until the heart has a chance to heal."

b. "The catheter will allow the physician to better manage fluid therapy."

The nurse is preparing to measure the thermodilution cardiac output (TdCO) in a patient being monitored with a pulmonary artery catheter. Which action by the nurse best ensures the safety of the patient? a. Ensure the transducer system is zero referenced at the level of the phlebostatic axis. b. Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement. c. Maintain a pressure of 300 mm Hg on the flush solution using a pressure bag. d. Limit the length of the noncompliant pressure tubing to a maximum 48 inches.

b. Avoid infusing vasoactive agents in the port used to obtain the TdCO measurement.

Following insertion of a pulmonary artery catheter (PAC), the physician orders the nurse to obtain a blood sample for mixed venous oxygen saturation (SvO2). Which action by the nurse best ensures the obtained value is accurate? a. Zero referencing the transducer at the level of the phlebostatic axis following insertion b. Calibrating the system with a central venous blood sample and arterial blood gas value c. Ensuring patency of the catheter using a 0.9% normal saline solution pressurized at 300 mm Hg d. Using noncompliant pressure tubing that is no longer than 36 to 48 inches and has minimal stopcocks

b. Calibrating the system with a central venous blood sample and arterial blood gas value

The nursing is caring for a patient who has had an arterial line inserted. To reduce the risk of complications, what is the priority nursing intervention? a. Apply a pressure dressing to the insertion site. b. Ensure all tubing connections are tightened. c. Obtain a portable x-ray to confirm placement. d. Restrain the affected extremity for 24 hours.

b. Ensure all tubing connections are tightened.

Which of the following situations may result in a low cardiac output and low cardiac index? (Select all that apply.) a. Exercise b. Hypovolemia c. Myocardial infarction d. Shock

b. Hypovolemia c. Myocardial infarction d. Shock

While caring for a patient with a small bowel obstruction, the nurse assesses a pulmonary artery occlusion pressure (PAOP) of 1 mm Hg and hourly urine output of 5 mL. The nurse anticipates which therapeutic intervention? a. Diuretics b. Intravenous fluids c. Negative inotropic agents d. Vasopressors

b. Intravenous fluids

The nurse is caring for a patient with a left subclavian central venous catheter (CVC) and a left radial arterial line. Which assessment finding by the nurse requires immediate action? a. A dampened arterial line waveform b. Numbness and tingling in the left hand c. Slight bloody drainage at subclavian insertion site d. Slight redness at subclavian insertion site

b. Numbness and tingling in the left hand

The nurse is caring for a mechanically ventilated patient being monitored with a left radial arterial line. During the inspiratory phase of ventilation, the nurse assesses a 20 mm Hg decrease in arterial blood pressure. What is the best interpretation of this finding by the nurse? a. The mechanical ventilator is malfunctioning. b. The patient may require fluid resuscitation. c. The arterial line may need to be replaced. d. The left limb may have reduced perfusion.

b. The patient may require fluid resuscitation.

The nurse returns from the cardiac catheterization laboratory with a patient following insertion of a pulmonary artery catheter and assists in transferring the patient from the stretcher to the bed. Prior to obtaining a cardiac output, which action is most important for the nurse to complete? a. Document a pulmonary artery catheter occlusion pressure. b. Zero reference the transducer system at the phlebostatic axis. c. Inflate the pulmonary artery catheter balloon with 1 mL air. d. Inject 10 mL of 0.9% normal saline into the proximal port.

b. Zero reference the transducer system at the phlebostatic axis.

The charge nurse is supervising care for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the charge nurse evaluate first? a. A patient with a central venous pressure (RAP/CVP) of 6 mm Hg and 40 mL of urine output in the past hour b. A patient with a left radial arterial line with a BP of 110/60 mm Hg and slightly dampened arterial waveform c. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula d. A patient with a pulmonary artery pressure of 25/10 mm Hg and an oxygen saturation of 94% on 2 L of oxygen via nasal cannula

c. A patient with a pulmonary artery occlusion pressure of 25 mm Hg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula

After pulmonary artery catheter insertion, the nurse assesses a pulmonary artery pressure of 45/25 mm Hg, a pulmonary artery occlusion pressure (PAOP) of 20 mm Hg, a cardiac output of 2.6 L/min and a cardiac index of 1.9 L/min/m2. Which physician order is of the highest priority? a. Apply 50% oxygen via venture mask. b. Insert an indwelling urinary catheter. c. Begin a dobutamine (Dobutrex) infusion. d. Obtain stat cardiac enzymes and troponin.

c. Begin a dobutamine (Dobutrex) infusion.

While inflating the balloon of a pulmonary artery catheter (PAC) with 1.0 mL of air to obtain a pulmonary artery occlusion pressure (PAOP), the nurse encounters resistance. What is the best nursing action? a. Add an additional 0.5 mL of air to the balloon and repeat the procedure. b. Advance the catheter with the balloon deflated and repeat the procedure. c. Deflate the balloon and obtain a chest x-ray study to determine line placement. d. Lock the balloon in the inflated position and flush the distal port of the PAC with normal saline.

c. Deflate the balloon and obtain a chest x-ray study to determine line placement.

The nurse is caring for a mechanically ventilated patient with a pulmonary artery catheter who is receiving continuous enteral tube feedings. When obtaining continuous hemodynamic monitoring measurements, what is the best nursing action? a. Do not document hemodynamic values until the patient can be placed in the supine position. b. Level and zero reference the air-fluid interface of the transducer with the patient in the supine position and record hemodynamic values. c. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values. d. Level and zero reference the air-fluid interface of the transducer with the patient supine in the side-lying position and record hemodynamic values.

c. Level and zero reference the air-fluid interface of the transducer with the patient's head of bed elevated to 30 degrees and record hemodynamic values.

Following insertion of a central venous catheter, the nurse obtains a stat chest x-ray film to verify proper catheter placement. The radiologist reports to the nurse: "The tip of the catheter is located in the superior vena cava." What is the best interpretation of these results by the nurse? a. The catheter is not positioned correctly and should be removed. b. The catheter position increases the risk of ventricular dysrhythmias. c. The distal tip of the catheter is in the appropriate position. d. The physician should be called to advance the catheter into the pulmonary artery.

c. The distal tip of the catheter is in the appropriate position.

The charge nurse has a Vigileo pulse contour cardiac output monitoring system available for use in the surgical intensive care unit. For which patient is use of this device most appropriate? a. A patient with a history of aortic insufficiency admitted with a postoperative myocardial infarction b. A mechanically ventilated patient with cardiogenic shock being treated with an intraaortic balloon pump c. A patient with a history of atrial fibrillation having frequent episodes of paroxysmal supraventricular tachycardia d. A mechanically ventilated patient admitted following repair of an acute bowel obstruction

d. A mechanically ventilated patient admitted following repair of an acute bowel obstruction

The nurse is caring for a patient with a pulmonary artery catheter. Assessment findings include a blood pressure of 85/40 mm Hg, heart rate of 125 beats/min, respiratory rate 35 breaths/min, and arterial oxygen saturation (SpO2) of 90% on a 50% venturi mask. Hemodynamic values include a cardiac output (CO) of 1.0 L/min, central venous pressure (CVP) of 1 mm Hg, and a pulmonary artery occlusion pressure (PAOP) of 3 mm Hg. The nurse questions which of the following physician's order? a. Titrate supplemental oxygen to achieve a SpO2 > 94%. b. Infuse 500 mL 0.9% normal saline over 1 hour. c. Obtain arterial blood gas and serum electrolytes. d. Administer furosemide (Lasix) 20 mg intravenously.

d. Administer furosemide (Lasix) 20 mg intravenously.

The nurse is caring for a patient with an admitting diagnosis of congestive failure. While attempting to obtain a pulmonary artery occlusion pressure in the supine position, the patient becomes anxious and tachypneic. What is the best action by the nurse? a. Limit the patient's supine position to no more than 10 seconds. b. Administer anxiety medications while recording the pressure. c. Encourage the patient to take slow deep breaths while supine. d. Elevate the head of the bed 45 degrees while recording pressures.

d. Elevate the head of the bed 45 degrees while recording pressures.

During insertion of a pulmonary artery catheter, the physician asks the nurse to assist by inflating the balloon with 1.5 mL of air. As the physician advances the catheter, the nurse notices premature ventricular contractions on the monitor. What is the best action by the nurse? a. Deflate the balloon while slowly withdrawing the catheter. b. Instruct the patient to cough and deep-breathe forcefully. c. Inflate the catheter balloon with an additional 1 mL of air. d. Ensure lidocaine hydrochloride (IV) is immediately available.

d. Ensure lidocaine hydrochloride (IV) is immediately available.

The nurse is preparing to obtain a pulmonary artery occlusion pressure (PAOP) reading for a patient who is mechanically ventilated. Ensuring that the air-fluid interface is at the level of the phlebostatic axis, what is the best nursing action? a. Place the patient in the supine position and record the PAOP immediately after exhalation. b. Place the patient in the supine position and document the average PAOP obtained after three measurements. c. Place the patient with the head of bed elevated 30 degrees and document the average PAOP pressure obtained. d. Place the patient with the head of bed elevated 30 degrees and record the PAOP just before the increase in pressures during inhalation.

d. Place the patient with the head of bed elevated 30 degrees and record the PAOP just before the increase in pressures during inhalation.

While caring for a patient with a pulmonary artery catheter, the nurse notes the pulmonary artery occlusion pressure (PAOP) to be significantly higher than previously recorded values. The nurse assesses respirations to be unlabored at 16 breaths/min, oxygen saturation of 98% on 3 L of oxygen via nasal cannula, and lungs clear to auscultation bilaterally. What is the priority nursing action? a. Increase supplemental oxygen and notify respiratory therapy. b. Notify the physician immediately of the assessment findings. c. Obtain a stat chest x-ray film to verify proper catheter placement. d. Zero reference and level the catheter at the phlebostatic axis.

d. Zero reference and level the catheter at the phlebostatic axis.

Before determining a patient's cardiac output, the nurse reviews normal values and realizes the value for cardiac output is: 1. 6-9 L/min 2. 4-8 L/min 3. 8-10 L/min 4. 2-4 L/min

Correct Answer: 2

In order to correctly calculate cardiac output, the nurse should: 1. Only take two measurements and then average the two readings. 2. Take one measurement to prevent fluid volume overload. 3. Obtain five measurements and record the highest reading. 4. Take three to five measurements and take the average of the three readings that are within 10% of one another.

Correct Answer: 4 Rationale 1: There could be inconsistency on both temperature and technique. Rationale 2: This could cause an inaccurate measurement. Rationale 3: There could be inconsistency on both temperature and technique. Rationale 4: There could be inconsistency on both temperature and technique. The average of the three closest measurements is standard to reflect accuracy.

The nurse suspects that a patient is experiencing cardiogenic shock. Which parameter indicates that the nurse's suspicion is correct? 1. Cardiac output of 8.9 L/min 2. Pulmonary artery wedge pressure (PAWP) of 8 mm Hg 3. Central venous pressure (CVP) of 5 mm Hg 4. Cardiac index (CI) of 1.8 L/min/m2

Correct Answer: 4 Rationale 1: This cardiac output is elevated and is not consistent with cardiogenic shock. Rationale 2: The PAWP will be elevated in cardiogenic shock. Rationale 3: This is a normal central venous pressure reading. Rationale 4: The cardiac index (CI) is a measure of cardiac output and tissue perfusion in relation to the patient's body surface area. This reading would be consistent with cardiogenic shock.

The nurse is preparing for insertion of a pulmonary artery catheter (PAC). During insertion of the catheter, what are the priority nursing actions? (Select all that apply.) a. Allay the patient's anxiety by providing information about the procedure. b. Ensure that a sterile field is maintained during the insertion procedure. c. Inflate the balloon during the procedure when indicated by the physician. d. Monitor the patient's cardiac rhythm throughout the entire procedure. e. Obtain informed consent by informing the patient of procedural risks.

a. Allay the patient's anxiety by providing information about the procedure. b. Ensure that a sterile field is maintained during the insertion procedure. c. Inflate the balloon during the procedure when indicated by the physician. d. Monitor the patient's cardiac rhythm throughout the entire procedure.

The nurse is caring for a 70-kg patient in septic shock with a pulmonary artery catheter. Which hemodynamic value indicates an appropriate response to therapy aimed at enhancing oxygen delivery to the organs and tissues? a. Arterial lactate level of 1.0 mEq/L b. Cardiac output of 2.5 L/min c. Mixed venous (SvO2 ) of 40% d. Cardiac index of 1.5 L/min/m2

a. Arterial lactate level of 1.0 mEq/L

A patient is admitted to the hospital with multiple trauma and extensive blood loss. The nurse assesses vital signs to be BP 80/50 mm Hg, heart rate 135 beats/min, respirations 36 breaths/min, cardiac output (CO) of 2 L/min, systemic vascular resistance of 3000 dynes/sec/cm-5, and a hematocrit of 20%. The nurse anticipates administration of which the following therapies or medications? a. Blood transfusion b. Furosemide (Lasix) c. Dobutamine (Dobutrex) infusion d. Dopamine hydrochloride (Dopamine) infusion

a. Blood transfusion

The physician writes an order to discontinue a patient's left radial arterial line. When discontinuing the patient's invasive line, what is the priority nursing action? a. Apply an air occlusion dressing to insertion site. b. Apply pressure to the insertion site for 5 minutes. c. Elevate the affected limb on pillows for 24 hours. d. Keep the patient's wrist in a neutral position.

b. Apply pressure to the insertion site for 5 minutes.

The nurse is caring for a patient with an arterial monitoring system. The nurse assesses the patient's noninvasive cuff blood pressure to be 70/40 mm Hg. The arterial blood pressure measurement via an intraarterial catheter in the same arm is assessed by the nurse to be 108/70 mm Hg. What is the best action by the nurse? a. Activate the rapid response system. b. Place the patient in Trendelenburg position. c. Assess the cuff for proper arm size. d. Administer 0.9% normal saline bolus.

c. Assess the cuff for proper arm size.