Advanced MedSurg EAQ 1
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 admitted to ICU and is to be intubated using an endotracheal tube (ET). What might the patient's condition be to indicate the need for intubation? Select all that apply. 1 The patient has a risk of aspiration. 2 The patient has respiratory distress. 3 The patient has a high risk of stroke. 4 The patient has a fracture of the humerus. 5 The patient has an upper airway obstruction.
1, 2, 5 Intubation is done in cases where the person cannot breathe and ventilate normally. Indications for ET intubation include high risk of aspiration, respiratory distress, and upper airway obstruction. Being a high-risk patient for stroke is not an indication for intubation unless there is respiratory distress. Intubation may be required in bilateral femur fracture as there is massive bleeding. Humerus fracture does not involve considerable bleeding, therefore, in these cases; ET insertion is usually not required.
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).
The nurse is monitoring a patient in ICU. Which ScvO2/SvO2 reading should the nurse report to the primary health care provider? 1 68% 2 54% 3 72% 4 78%
2 Normal central venous oxygen saturation or ScvO2/SvO2 is 60% to 80%. It denotes normal oxygen supply and metabolic demand. Any reading out of the normal range can cause danger to the patient. More than 80% denotes increased oxygen supply and decreased oxygen demand. Less than 60% denotes decreased oxygen supply and increased demand. STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.
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.
What are the three determinants of stroke volume? 1 Heart rate, preload, and afterload 2 Preload, afterload, and contractility 3 Heart rate, preload, and contractility 4 Blood pressure, afterload, and contractility
2 Preload, afterload, and contractility are three determinants of stroke volume. Preload is the amount of blood in the ventricle at the end of diastole. Afterload describes the forces opposing ventricular ejection, including systemic arterial pressure, the resistance of the aortic valve, and mass and density of blood to be moved. Contractility is the strength of the heart's contraction. Heart rate influences cardiac output but not stroke volume directly. Blood pressure is too broad of a term when referring to what influences stroke volume.
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'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.