Essentials of Critical Care Nursing Hemodynamics Monitoring – Flashcards
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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.
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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.
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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)
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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.
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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.
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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.
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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
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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.
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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
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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.
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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."
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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.
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Correct Answer: 1 Rationale 1: This time frame is necessary to ensure accuracy because the injectate will be pumped out during one cardiac cycle.
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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
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Correct Answer: 2
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A patient is experiencing reduced afterload. The nurse realizes that causes of reduced afterload include: Select all that apply. 1. Sepsis 2. Mitral stenosis 3. Reduced circulating blood volume 4. Vasodilator medications 5. Myocarditis
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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.
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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.
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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.
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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
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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.
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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
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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.
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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
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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.
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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? Select all that apply. 1. Pericardial tamponade 2. Constrictive pericarditis 3. Hypovolemia 4. Neurogenic shock 5. Mitral stenosis
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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.
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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
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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.
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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? 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
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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.
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The health care provider is planning to insert a pulmonary artery catheter into a patient. The nurse realizes this monitoring device is used to: 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
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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.
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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? 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
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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.
