EAQs Hemodynamics
A patient with a heart rate of 68 beats/minute has a stroke volume (SV) of 100 mL/beat. What is this patient's cardiac output (CO)? 1 6.8 L/min 2 2.4 L/min 3 9.2 L/min 4 10.3 L/min
1 Cardiac output (CO) is calculated by multiplying stroke volume (SV) by the heart rate (HR). For this patient, the nurse should multiply 100 mL/beat x 68 beats/minute = 6800 mL/minute or 6.8 L/minute. A normal cardiac output is between 4 and 8 L/min.
The nurse is concerned about a patient's stroke volume. What determining factors should the nurse consider when determining stroke volume? 1 Preload, afterload, and contractility 2 Cardiac output, heart rate, and body surface area 3 Afterload, cardiac output, and mean arterial pressure 4 Cardiac index, mean arterial pressure, and blood pressure
1 Preload, afterload, and contractility determine stroke volume (SV). Cardiac output and heart rate are used to determine stroke volume; however, body surface area is used to determine cardiac index. Mean arterial pressure is used to determine afterload, not stroke volume. Cardiac index is a more precise measurement of the efficiency of the heart's pumping action; it is not used to determine stroke volume.
A patient is scheduled to have an insertion of a pulmonary artery catheter for hemodynamic monitoring. What conditions should the nurse recognize are contraindicated for insertion of the catheter? Select all that apply. 1 Coagulopathy 2 Cardiogenic shock 3 Fulminant myocarditis 4 Endocardial pacemaker 5 Mechanical tricuspid valve
1, 4, 5 Pulmonary artery catheterization helps to monitor and manage the care of patients who are at high risk for hemodynamic compromise. Pulmonary artery catheterization may cause trauma in the blood vessels and worsen symptoms of coagulopathy. Pulmonary artery catheterization increases the risk of trauma in patients with mechanical tricuspid valves and endocardial pacemakers; therefore, it is contraindicated in the patient with coagulopathy, mechanical tricuspid valve, and transvenous pacemaker. Pulmonary artery catheterization is performed in patients with cardiogenic shock and fulminant myocarditis to detect the risk of heart failure.
What data are used to calculate stroke volume (SV) for a patient with arterial pressure-based cardiac output (APCO) monitoring? 1 Height, BMR, age, gender 2 Gender, age, height, weight 3 BMI, BMR, blood pressure, heart rate 4 Age, gender, blood pressure, heart rate
2 Arterial pressure-based cardiac output (APCO) monitoring uses the arterial waveform characteristics along with patient demographic data including gender, age, height, and weight to calculate stroke volume (SV). Basal metabolic rate (BMR), body mass index (BMI), blood pressure, and heart rate are not used to calculate stroke volume with this measuring device. Heart rate is used to calculate continuous cardiac output (COO) and continuous cardiac index (CCI).
A patient with severe left ventricular failure is considering artificial heart transplantation. What should the nurse inform the patient is a long-term treatment associated with this device? 1 Beta-blockers 2 Anticoagulation 3 Antibiotic therapy 4 Immunosuppressive agents
2 Patients require lifelong anticoagulation with an artificial heart. Beta-blockers are not indicated for this device. Antibiotic therapy is not indicated for this device. Patients do not require immunosuppression with this device.
A patient is recovering from the implantation of a ventricular assist device (VAD). What should the nurse anticipate being prescribed for this patient's activity status? 1 Complete bedrest 2 Progressive ambulation 3 Moving out of bed to a chair twice a day 4 Bedrest with bathroom privileges
2 The patient with a ventricular assist device (VAD) may be mobile and require an activity plan such as progressive ambulation. Complete bedrest is not required. The patient will be permitted to do more than move from the bed to a chair twice a day. Activity will be greater than bed rest with bathroom privileges.
A patient with an implanted ventricular assist device (VAD) is being prepared for discharge. To ensure the patient's safety, what should the nurse make sure is completed prior to the patient leaving the hospital? 1 Home care referral 2 Diet and activity teaching 3 Battery charger in the home 4 Oxygen condenser delivered
3 In some cases, patients with ventricular assist devices (VADs) may go home. Preparation for discharge is complex and requires in-depth teaching about the device and the need to have a battery charger in the home. A home care referral can be made after the patient is discharged. Diet and activity teaching should occur before the patient is discharged; however, this is not directly related to the safety and functioning of the device. There is no information to suggest that the patient needs or will be prescribed oxygen therapy at home.
A patient's blood pressure is 172/94 mm Hg. What would the nurse calculate as being this patient's mean arterial pressure (MAP)? 1 80 2 100 3 120 4 160
3 MAP is calculated by adding the systolic blood pressure to two times the diastolic blood pressure and dividing by three. For this patient that calculation would be 172 + 2(94)/3 = 120 mm Hg. Normal MAP is between 70 and 105 mm Hg.
The nurse is attempting to determine a patient's left ventricular afterload. Which hemodynamic value should the nurse use? 1 Central venous pressure 2 Pulmonary arterial pressure 3 Systemic vascular resistance 4 Peripheral vascular resistance
3 Systemic vascular resistance is an index of left ventricular afterload. Central venous pressure is an index of preload. Pulmonary arterial pressure and peripheral vascular resistance are indices of right ventricular afterload.
What is the function of a transducer? 1 Helps locate the phlebostatic axis 2 Transmits electronic signal as a pressure wave 3 Converts pressure waves into an electronic signal 4 Changes zero reference point to atmospheric pressure
3 The transducer functions to take pressure waves from catheters and converts them into an electronic signal that is displayed on the monitor from which readings are collected. It does not help locate the phlebostatic axis; this landmark is used to level the transducer to the atria. The transducer does not transmit electronic signals as pressure waves; this is the opposite of how a transducer functions. The transducer does not change zero reference point to atmospheric pressure. Zero reference point is a landmark.
A patient is experiencing cardiogenic shock after an acute myocardial infarction. Why would an intraaortic balloon pump (IABP) be beneficial for this patient? 1 Improves coronary artery vessel perfusion 2 Reduces pressure in the pulmonary artery 3 Enhances effectiveness of cardiac medications 4 Provides time for an emergency angiogram to be performed
4 Indications for intraaortic balloon pump (IABP) therapy include acute myocardial infarction and cardiogenic shock. The use of the pump with this health problem allows time for emergent angiography. The pump is not used to reduce pressure in the pulmonary artery, improve coronary artery vessel perfusion, or to enhance the effectiveness of cardiac medications.
The nurse is caring for a patient receiving intraaortic balloon pump (IABP) therapy. On which part of the electrocardiogram should the nurse expect the balloon to be inflated? 1 P wave 2 Q wave 3 R wave 4 T wave
4 The electrocardiogram (ECG) is the trigger for the pump to start inflation on the T wave. Deflation occurs on the upstroke of the R wave (of the QRS) complex. The P and Q waves are not triggers for the pump to either inflate or deflate.
A patient has the following device. Which port should be used to measure pulmonary artery pressure?
The distal lumen port (catheter tip), labeled A in the image, is within the pulmonary artery. This port is used to monitor pulmonary artery (PA) pressures. Choice B is the port used for infusions. Choice C is the port used for injecting medications. Choice D is the port used to inflate the balloon.
The nurse is observing waveforms during the insertion of a pulmonary artery catheter. Which waveform indicates that the catheter is in the patient's right ventricle?
There are characteristic waveforms seen on the monitor as the catheter is moved through the heart to the pulmonary artery. Choice 2 is the waveform seen when the catheter is in the right ventricle. Choice 1 is the waveform seen when the catheter is in the pulmonary artery. Choice 3 is the waveform seen when the catheter is in the pulmonary artery and wedged. Choice 4 is the waveform seen when the catheter is in the right atrium.