hemodynamic monitoring and ECG interpretation
A nurse is caring for a client who has a cardiopulmonary arrest. The nurse anticipates the emergency response team will administer which of the following medications if the client's restored rhythm is symptomatic bradycardia?
A. Atropine
A nurse is caring for a client who develops a ventricular fibrillation rhythm. The client is unresponsive, pulseless, and apneic. Which of the following actions is the nurse's priority?
A. Defibrillation
When performing an initial pulmonary artery occlusion pressure (PAOP/PCWP), what are the best nursing actions (Select all that apply)?
A. 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 E. Inflate the balloon for no more than 8 to 10 seconds while noting the waveform change
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. Monitor the patient's cardiac rhythm B. Inflate the balloon during the procedure when indicated by the physician C. Allay the patient's anxiety D. Ensure that a sterile field is maintained during the insertion procedure
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. Obtain the right atrial pressure measurement during end exhalation D. Compare measured pressures with other physiological parameters, such as urine output E. Zero reference transducer system at the level of the phlebostatic axis
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 of 1.2L/min/m3 (Normal range is 2.8-4.2 L/min/m2)
Which of the following are important nursing considerations for a patient with a right radial arterial line (Select all that apply)?
A. checking the circulation to the right hand every 2 hours D. Monitoring the waveform on the monitor for dampening E. Maintaining a pressurized flush solution to the arterial line set-up
A nurse in an urgent care center is assessing a client who reports a sudden onset of irregular palpitations, fatigue, and dizziness. The nurse finds a rapid and irregular heart rate with a significant pulse deficit. Which of the following dysrhythmias should the nurse expect to find on the ECG?
B. Atrial Fibrillation
During hemodynamic monitoring, the nurse observes that the patient has a decreased cardiac output (CO) with unchanged pulmonary artery wedge pressure (PAWP), heart rate (HR) or systemic vascular resistance (SVR). The nurse concludes that the patient has a decrease in what?
B. Contractility
Which of the following situations may result in a low cardiac output and index (Select all that apply)?
B. Hypovolemia C. Myocardial infarction D. Shock F. third degree heart block
A nurse in a cardiac care unit is caring for a client with acute right-sided heart failure. Which of the following findings should the nurse expect?
B. elevated central venous pressure (CVP)
A nurse in the ICU is caring for a client who has heart failure and is receiving a dobutamine drip. The nurse should identify that which of the following findings indicates that the medication is effective?
B. increased urine output
A nurse is admitting a client who has acute heart failure following myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider requires clarification?
C. 0.9% normal saline IV at 50 mL/hr
A nurse is caring for a client who has valvular heart disease and is at risk for developing left-sided heart failure. Which of the following manifestations should alert the nurse the client is developing this condition?
C. Breathlessness
The patient has experienced an increased preload, which supports an increase in cardiac output (CO). What nursing action contributes to an increased preload?
C. Increase fluid administration
The nurse is caring for a group of patients monitored with a variety of invasive hemodynamic devices. Which patient should the nurse evaluate first?
C. a patient with a pulmonary artery occlusive pressurre of 25 mmHg and an oxygen saturation of 89% on 3 L of oxygen via nasal cannula
What factor will cause a decrease in cardiac output (CO)?
C. decreased HR
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?
D. "The catheter will allow the physician to better manage fluid therapy"
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?
D. Apply pressure to the insertion site for 5 minutes
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?
D. Diminished breath sounds over left lung field
While caring for a patient with a small bowel obstruction, the nurse assesses a pulmonary artery occlusive pressure (PAOP/PCWP) of 1 mm Hg (normal is 4-12 mmHg) and a urine output of 15 mL/hour. The nurse anticipates which therapeutic intervention?
D. 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?
D. Numbness and tingling in the left hand
Before taking hemodynamic measurements, how must the nurse reference the monitoring equipment?
D. position the stopcock nearest the transducer level with the phlebosatic axis
A nurse is evaluating the central venous pressure (CVP) of a client who has sustained multiple traumas. Which of the following interpretations of a low CVP pressure should the nurse make?
Hypovolemia
Resistance to the flow of blood ejected from the ventricle is termed:
afterload
